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Introduction
to
Program
Evaluation
for
Comprehensive
Tobacco
Control
Programs
Executive Summary
This document is a "how to" guide for planning and implementing evaluation activities. The
manual reflects the priorities of the Centers for Disease Control and Prevention (CDC), Office on Smoking
and Health (OSH), for program monitoring and evaluation. The purpose of this manual is to assist state
tobacco control program managers and staff in the planning, design, implementation, and use of practical
and increasingly comprehensive evaluations of tobacco control efforts. The strategy presented in this
manual will aid those responsible for evaluation activities to demonstrate accountability to diverse
stakeholders. In this case, accountability includes assessing and documenting the effectiveness of
programs, measuring program outcomes, documenting implementation and cost effectiveness, and
increasing the impact of programs.
Why evaluate programs to prevent and control tobacco use?
Tobacco use is the leading preventable cause of death and disease in the United States, contributing
to more than 430,000 deaths annually.1 Tobacco control programs are designed ultimately to
help reduce disease, disability, and death related to tobacco use. To determine the effectiveness of these
programs, one must document and measure both their implementation and their effect. Program evaluation
is a tool used to assess the implementation and outcomes of a program, to increase a program's efficiency
and impact over time, and to demonstrate accountability.
Program implementation
The task of evaluation encourages us to examine the operations of a program, including which activities
take place, who conducts the activities, and who is reached as a result. In addition, evaluation will show how
well the program adheres to implementation protocols. Through program evaluation we can determine
whether activities are implemented as planned and identify program strengths, weaknesses, and areas for
improvement. For example, a smoking cessation program may be very effective for those who complete it,
but it may not be attended by many people. Evaluation activities may determine that the location of the
program or prospective participants' lack of transportation is an attendance barrier. As a result, program
managers can try to increase attendance by moving the class location or meeting times, or by providing
free public transportation.
Program effectiveness
The CDC has identified four goals that tobacco control programs should work within to reduce
tobacco-related morbidity and mortality:
- Preventing the initiation of tobacco use among young people.
- Promoting quitting among young people and adults.
- Eliminating nonsmokers' exposure to environmental tobacco smoke (ETS).
- Identifying and eliminating the disparities related to tobacco use and its effects among different population groups.
Comprehensive tobacco control programs use multiple strategies to address these goals. Typically,
strategies are grouped into three program components: community mobilization, policy and regulatory
action, and the strategic use of media. Program evaluation includes documenting the effectiveness of these
strategies in meeting program goals.
Program accountability
Program evaluation is a tool with which to demonstrate accountability to program stakeholders
(including state and local officials, policymakers, and community leaders) by showing them that a program
really does contribute to reduced tobacco use and less exposure to ETS. Evaluation findings can thus be
used to show that money is being spent appropriately and effectively and that further funding, increased
support, and policy change might lead to even more improved health outcomes. Evaluation helps ensure
that only effective approaches are maintained and that resources are not wasted on ineffective programs.
This manual is based on the CDC's Framework for Program Evaluation in Public Health
Practice3 and is aligned with the Healthy People 2010 4 objectives for
the nation, Best Practices for Comprehensive Tobacco Control Programs,2 and other
relevant guidelines. This manual is an adaptation of the CDC evaluation framework and is specific to
tobacco control and prevention. It is organized into the following six steps:
- Engage stakeholders.
- Describe the program.
- Focus the evaluation and design.
- Gather credible evidence.
- Justify conclusions.
- Ensure use of evaluation findings, and share lessons learned.
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