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Click on the links below to read more about each project.
- Hospital E-cigarette Study
- North Carolina Food and Drug Administration (FDA) Compliance Check Inspections Program
- Center for Regulatory Research on Tobacco Communication (CRRTC) Eye Tracking Project
- Enhancing Source Credibility in Tobacco Regulatory Communications
- Evaluations of the Connecticut Tobacco Use Control Programs in the State of Connecticut
- National African American Tobacco Prevention Network (NAATPN) Evaluation
- Health and Wellness Trust Fund Tobacco Initiatives Evaluations
- Breathe Easy, Live Well Pilot Program Evaluation
- Tobacco-Free Colleges Initiative Evaluation
- QuitlineNC Evaluations
The Joint Commission on Accreditation of Healthcare Organizations banned indoor smoking in U.S. hospitals in 1992, helping to support the availability of cessation services, improve quit attempts among hospital employees, and de-normalize smoking. The rapid increase of electronic cigarette (e-cigarette use) has the potential to reverse these gains made in establishing hospitals as tobacco-free environments. Development of e-cigarette policies on hospital campuses is imperative to maintaining the social norms that the field of tobacco control have built in the past decades, though research examining how healthcare environments have created regulations that address the use of e-cigarettes on campus is lacking.
To explore this issue, TPEP surveyed all hospitals in North Carolina to address the following areas: 1) Current policies and use of tobacco products and e-cigarettes at the hospital; 2) Implementation of e-cigarette policies, including barriers and motivators to policy development and enforcement and communication of the policy; and 3) Attitudes and perceptions regarding e-cigarette use and polices.
Findings will provide key insight to hospitals and other healthcare organizations looking to implement e-cigarette policies, both in the United States and globally.
TPEP is currently contracted with the NC DHHS to implement the Food and Drug Administration’s tobacco retailer compliance check inspections program in the state of North Carolina. This two-part project involves FDA commissioned officers conducting inspections of tobacco retailers in all parts of the state. 2,000 stores will be randomly selected for inspection to verify compliance with Advertising and Labeling provisions of the Family Smoking Prevention and Tobacco Control Act. An additional 2,000 stores will be inspected by sending teens ages 16-17 (under the supervision of a law enforcement officer and adult FDA commissioned officer) to attempt to purchase regulated tobacco products. This will verify that retailers are in compliance with federal minimum age requirements for sale of those products. More about the FDA’s compliance and enforcement program can be found here.
- Aim 1: Characterize the impact of FDA source prominence of The Real Cost campaign print and video ads on source awareness, credibility, recall, fixations and dwell time. A between-subjects experimental design with eye-tracking and questionnaires will determine whether a larger FDA source (i.e., logo and text) of Real Cost ads increase fixations, dwell time on source, source recall and perceptions of FDA credibility.
- Aim 2: Use FDA Real Cost ads to experimentally examine impact of media channel, print vs. video advertisements, on adolescent risk perceptions, attitudes, beliefs, and intention to initiate tobacco use. A within-subjects experimental design with eye-tracking and questionnaires will determine if anti-smoking video ads increase health risk perceptions, ad effectiveness, and behavioral intentions more than print ads.
- Significance. This study will assist formative work conducted by FDA to: 1) provide information on effectiveness of content of anti-smoking messages, 2) examine how source of ads impact perceived trustworthiness of messages, 3) provide evidence on ideal channels for delivering anti-smoking messages to adolescents, and 4) address gaps in the literature about whether the medium of message content makes a difference in ad effectiveness. Public health and marketing research is plagued by inconsistent findings on the advertising genres for anti-smoking ads that positively influence adolescents. Stronger research is needed on how ad content bolsters anti-smoking beliefs and intentions and how message sources maximize communication effectiveness. Our study will be guided by the Elaboration Likelihood and Communication/Persuasion Conceptual Models.
- Innovation. The interdisciplinary researcher team will address the following innovations: 1) Use of eye tracking on tobacco control communications to optimize message characteristics, channel and source credibility, 2) Directly examine FDA regulatory research by experiments to determine the most effective communication channels to convey risks of tobacco products to adolescents and factors that may influence perceptions of credibility.
- Study Team. Our interdisciplinary study team has extensive experience in public health communications research and communications research specific to tobacco control and message optimization research utilizing eye tracking.
Under the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act), the Food and Drug Administration (FDA) has regulatory authority over the manufacture, marketing, and distribution of tobacco products. The FDA seeks to foster new communications research on tobacco regulation. TPEP will assist the FDA in evaluating the effectiveness of communication on tobacco product risk through a three-part research and evaluation process:
- Aim 1 will characterize perceptions of the FDA regulatory authority, credibility, and tobacco control communication campaigns among adolescents, young adults and adults, and among vulnerable populations (Black and gay, lesbian, and bisexual (GLB)). We will conduct seven focus groups with North Carolina (NC) adolescent, young adult and adult tobacco and non-tobacco users, and Black and GLB tobacco users to assess existing perceptions of the FDA. A national, cross-sectional survey will be conducted in years 2 and 4 to collect data from 3800 young adult and adult tobacco users and non-users, and 800 adolescents. The survey will collect data to: 1) monitor changes in public perceptions of the FDA, and 2) determine which source sponsors are deemed most credible to increase source credibility.
- Aim 2 will use FDA regulatory communication messages to examine determinants of source credibility to create optimally framed messages and test them among current smokers. We will conduct 10 focus groups with young adult, adult, Black and GLB smokers to design communication messages with high source credibility. We will reduce multiple combinations of source credibility determinants to two optimal message frames. Using a within-subjects experimental design eye-tracking technology, we will interview 300 NC young adult, adult, Black and GLB smokers to determine if optimally framed messages improve message effectiveness compared to sub-optimally framed messages.
- Aim 3 will conduct a randomized control trial of 352 young adult and adult smokers to test the hypothesis that optimally framed FDA cigarette constituent messages increase intentions to quit more than sub-optimally framed messages. We hypothesize that FDA messages with optimal source credibility will lead to stronger behavioral intentions compared to messages with sub-optimal source credibility.
TPEP has contracted with the state of Connecticut for “Evaluations of the Connecticut Tobacco Use Control Programs” by the Connecticut Department of Public Health. As Connecticut’s independent evaluators, TPEP will conduct evaluations of Connecticut’s Community Cessation Programs,Connecticut Quitline, and media campaign.TPEP will work with project personnel to conduct needs assessments, develop logic models, and create program indicators. TPEP designs tailored evaluations to fit program budget costs while maximizing return on investment, a crucial and often underappreciated facet of successful evaluation.
The National African American Tobacco Prevention Network (NAATPN) is a private non-profit, 501(c)(3) organization whose mission is to “facilitate the development and implementation of comprehensive and community competent public health programs to benefit communities and people of African descent.” NAATPN is engaging in a five-year, Centers for Disease Control and Prevention (CDC)-funded project entitled Utilizing the NAATPN Network to Reduce Tobacco-related and Cancer Health Disparities. This project aims to address existing gaps in tobacco control and cancer prevention and work towards reducing disparities among the African American community. Using the principles of a utilization-focused evaluation, Tobacco Prevention and Evaluation Program is conducting a process and outcome evaluation to assess NAATPN’s impact on reducing tobacco-related and cancer health disparities among African American communities. The evaluation is guided by the annual work plan as well as the logic model. The following are links to evaluation reports developed for NAATPN.
To read the full text of the NAATPN evaluation reports, please click here.
- Teen Tobacco Use Prevention and Cessation Initiative (Teen Initiative) and the Tobacco.Reality.Unfiltered. (TRU) media campaign
- Tobacco-Free Colleges Initiative (Colleges Initiative)
- North Carolina Tobacco Quitline (QuitlineNC) and the “Call it Quits” media campaign
Breathe Easy, Live Well Pilot Program Evaluation
Tobacco use among individuals with mental illness remains a major health inequality. To address this, the N.C. Health and Wellness Trust Fund funded the Southern Regional Area Health Education Center (SR-AHEC) to pilot a wellness and tobacco cessation curriculum originally developed by the University of Medicine and Dentistry of New Jersey at nine clubhouses (voluntary, participatory day centers for individuals with severe and persistent mental illness) across the state. The $505,000 Breathe Easy, Live Well program is being implemented from 2008 to 2011. The Tobacco Prevention and Evaluation Program assisted in the development of the program’s logic model and evaluation plan and independently conducts interviews with clubhouse staff and surveys of participating clubhouse members to evaluate the implementation of this pilot project.
Click here to view BELW archived reports.
The Teen Initiative, funded by the NC Department of Health and Human Services, includes over 50 organizations working to educate young people about the dangers of tobacco use. The main goals of the Teen Initiative are to:
1) Prevent youth initiation of tobacco use;
2) Eliminate youth exposure to secondhand smoke;
3) Provide tobacco cessation among youth; and
4) Reduce health disparities among youth attributable to tobacco use.
TPEP conducts outcomes and programmatic evaluations for all components of the Teen Initiative with the exception of resources dedicated to the enforcement of tobacco sales prohibited to minors. The purpose of the evaluation is to demonstrate the effectiveness of the initiative at reaching its desired outcomes, and to make recommendations for program improvement. The evaluation team is responsible for analyzing monthly progress data from grantees, as well as analyzing and disseminating results. Evaluation information is published in Annual, Semi-Annual, Quarterly, and Special Reports.
Quarterly Reports: Every three months, data from NC Health and Wellness Trust Fund (HWTF) Teen Initiative Community/School and Priority Population grantees are compiled and analyzed. The Quarterly Reports provide an overall picture of grantee progress during the three month period in relation to the four goals of the Teen Initiative: reducing youth initiation of tobacco use, reducing youth exposure to secondhand smoke, increasing youth access to cessation services, and reducing health disparities among youth attributable to tobacco use.
Semi-Annual Survey Reports: Twice each year, NC Health and Wellness Trust Fund (HWTF) grantees for the Teen Initiative complete a Semi-Annual Survey. This survey assesses program progress and utilization of technical assistance and resource providers. Grantees also provide narratives describing major accomplishments.
Annual Reports: TPEP’s Annual Report for the NC Health and Wellness Trust Fund (HWTF) Teen Initiative provides a summary of activities conducted by HWTF grantees (Community/Schools and Priority Populations) during the year and evaluation results for the statewide HWTF TRU Media Campaign. This report is a comprehensive review of process and outcome indicators, along with recommendations for improving future program activities.
Technical Assistance Report: NC Health and Wellness Trust Fund (HWTF) contracts with a variety of providers to offer technical assistance (TA), training, and resources to Teen Initiative grantees. An evaluation of these services took place during the spring of 2005. The report summarizes the results of telephone interviews with TA providers and grantee coordinators, as well as data from a Semi-Annual Survey Report completed at the end of June 2005. It includes recommendations for increasing the effectiveness of TA for grantees and also improving their utilization of TA resources. Click here to view the Technical Assistance report.
Logic Models: Logic models provide a visual representation of a program’s activities and outcomes. The following logic models relate to three of the Teen Initiative’s four goal areas (Initiation, Secondhand Smoke, and Cessation) and local coalition infrastructure development.
Click here to view archived Teen Tobacco Use Prevention and Cessation reports.
The Tobacco-Free Colleges Initiative works to prevent and reduce tobacco use among North Carolina young adults through the promotion of tobacco-free policies and cessation services on college campuses across the state.
TPEP conducts the outcomes evaluation for the Colleges Initiative. The purpose of the evaluation is to demonstrate the effectiveness of the initiative at reaching its desired outcomes, and to make recommendations for program improvement. The evaluation team is responsible for collecting baseline and monthly progress data from grantees using a web-based tracking system, as well as analyzing and disseminating results through the NC Tobacco-Free Colleges Initiative.
Evaluation data have been used to report on the Initiative’s successes nationally at the American Public Health Association, National Conference on Tobacco or Health, NC Public Health Association, and in Tobacco Control
Click here to view archived reports.
In 2004 a tobacco use prevention television media campaign for youth called
Tobacco.Reality.Unfiltered. (TRU) was initiated to complement their community-based tobacco prevention and cessation programs. An on-going evaluation of the campaign is one of TPEP’s current projects. There are two key components to the evaluation: 1) Focus group testing prior to the launch of each flight of ads, and 2) A telephone survey to assess the awareness of the ads among NC youth.
Focus Group Testing
TPEP has conducted several focus group studies to evaluate how NC youth see and interpret the TRU ads and to gain insight into how the ads may be improved for future campaign flights. The scope of these studies range from a comprehensive 14-group study of 140 youth of varying demographic characteristics across the state to a three-group study of local youth to provide specific feedback to the TRU media vendor.
TPEP designed a telephone survey to evaluate the reach and receptivity of the TRU ads, as well as to measure tobacco-related attitudes and behaviors of NC youth. TPEP contracted with the UNC Survey Research Unit to conduct the interviews. As of Spring 2009, five waves of data collection have been completed.
In the spring of 2005, TPEP conducted a special study to gather information to assist the HWTF in launching the first statewide television campaign to promote 100% Tobacco Free School (TFS) policies in the country. Specifically, TPEP reviewed the literature on media and 100% TFS policies, developed a conceptual model for the campaign, and discussed the proposed campaign with TFS experts and community stakeholders. Based on the information from the literature review, conceptual model, and interviews, TPEP compiled a report to assist the NC Health and Wellness Trust Fund (HWTF) and its contracted media vendor in reviewing best practices surrounding the adoption and enforcement of TFS policy in NC, and providing recommendations for use in the development of an effective and politically feasible media campaign to promote TFS policy.
In the fall of 2003, the HWTF contracted with TPEP to compile a report on evidence-based practices for youth-focused tobacco prevention media campaigns, in preparation for the development and launch of the TRU campaign in spring of 2004. This report contains the results of a comprehensive literature review and of interviews with state and national experts and local stakeholders, providing recommendations for use in the development of the TRU media campaign.
Click here to view all archived TRU reports.
The NC Tobacco Quitline is a proactive, telephone-based, tobacco cessation service that provides support and information to all North Carolinians. The NC Department of Health and Human Services funds Quitline services. TPEP conducts an independent outcomes evaluation for the NC Tobacco Quitline. The purpose of this evaluation is to demonstrate the effectiveness of the Quitline at providing tobacco cessation services to and increasing successful quit attempts among Quitline callers. The evaluation team is responsible for analyzing Quitline data, and providing recommendations.
Click here to view archived Quitline reports.
West Virginia Covenant House contracted with TPEP to provide an independent survey of smoking in West Virginia’s lesbian, gay, and bisexual community. TPEP staff are designing the survey, training volunteer surveyors, and implementing the survey in bars and the state’s Pride festival using hand-held survey units through a partnership with the N.C. Institute for Public Health’s Spatial Health Assessment Research Program.
Read the Final Report of the 2010 WV LGB Tobacco Survey
The North Carolina General Assembly passed Session Law 2009-16 in April 2009. This legislation required the State Health Plan for Teachers and State Employees (SHP) to develop and implement a Comprehensive Wellness Initiative (CWI) focusing specifically on tobacco cessation and weight management. The NC Health and Wellness Trust Fund (HWTF), which leads a substantial portion of the State’s tobacco prevention and cessation efforts, partnered with the SHP to fund process evaluations of the tobacco cessation component of the CWI. These process evaluations are designed to help the SHP understand and improve the implementation of their future programs. The evaluations included: a) focus groups and interviews with diverse SHP members enrolled in the 70/30 Plan who also use tobacco products, and b) a web-based satisfaction survey of SHP members who utilized QuitlineNC, a free telephone cessation coaching service. This report summarizes the quantitative data from the web-based survey evaluating SHP members who utilized QuitlineNC.
The evaluations also included: a) focus groups and interviews with diverse SHP members enrolled in the 70/30 Plan who also use tobacco products, and b) a web-based satisfaction survey of SHP members who utilized QuitlineNC, a free telephone cessation coaching service. This report summarizes the qualitative data from the focus groups and individual interviews. Outcome evaluations of how the CWI tobacco cessation component may have led to increased cessation among SHP tobacco users are the subject of separate research.
North Carolina (NC) youth smoking rates in 2011 were at a historic low, likely based in large part on comprehensive youth prevention programs established in NC from 2003-2011. This program founded by the NC Health and Wellness Trust Fund, was eliminated June 2011. The NC Department of Health and Human Services’ Tobacco Prevention and Control Branch (TPCB) continued the tobacco prevention and control programs for an additional year, with $830,000 for youth tobacco prevention, down from an estimated $9 million in 2010-2011.1 With this funding, the TPCB gave a grant to the NC Association of Local Health Directors (LHD) to work in collaboration with ten regional tobacco use prevention and youth empowerment programs in regional health department coalitions.
The University of North Carolina at Chapel Hill (UNC) Tobacco Prevention and Evaluation Program (TPEP) conducted a statewide evaluation of these ten programs and one-year funding. The aim of this evaluation was to examine program successes and challenges, and to make recommendations for future improvements in state tobacco use prevention and cessation efforts.
TPEP conducted a series of three interviews to assess program outcomes: in person interviews with 18 Youth Tobacco Prevention and ASSIST Program Coordinators (i.e., American Stop Smoking Intervention Study coordinators who are funded by the Center for Disease Control and Prevention and work for the TPCB) and other funded personnel in the 10 geographic regions; 6 survivors of tobacco-related illness who worked with these Program Coordinators; and11 follow up telephone interviews with Program Coordinators after the conclusion of funding. Interviews were coded, and an exploratory qualitative analysis approach was used, based on the principles of applied thematic analysis.2
TRU Sustainability Policymaker Interviews Final Report 2012
Despite fiscal uncertainties at the state level, North Carolina’s tobacco prevention and cessation programs were prioritized by the Department of Public Health and continued in fiscal year 2011-2012, maintaining their strong track record of successes. While these programs have continued to reduce the health and financial costs of tobacco use to the state, future funding is uncertain. To promote sustainability of these critical public health programs, communication must be strengthened between program evaluators and key stakeholders, including policymakers in North Carolina with the ability to support continued funding for tobacco prevention and cessation programs throughout the state.
To understand the motivations, priorities, and concerns of policymakers in North Carolina, interviews were conducted with Democratic and Republican former state legislators (including both former Senators and Representatives), and current lobbyists working for health-related organizations. Participants were asked open-ended questions about their prior knowledge of and attitudes towards tobacco prevention and cessation programs, as well as their views about state responsibility to fund such programs. Participants were also asked for their reactions to two policy briefs, one focused on how tobacco prevention and cessation programs save lives and the other focused on how these programs save dollars.