The National Adult Tobacco Survey: What is it and How Can I Use it? Martha Engstrom, MS Peter Mariolis, PhD Centers for Disease Control and Prevention Office on Smoking and Health

Evaluation Netconference January 21, 2010

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Purpose  To obtain representative data on Key Outcome Indicators at state & national levels for monitoring and evaluating progress toward the goals of the National Tobacco Control Program (NTCP) • Preventing Initiation of Tobacco Use Among Young People • Eliminating Nonsmokers’ Exposure to Secondhand Smoke • Promoting Quitting Among Adults and Young People • Identifying and Eliminating Tobacco-Related Disparities

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Scope and Content  Measures Key Outcome Indicators that can be appropriately measured using a telephone survey of adults  Questions can be obtained from CDC-OSH’s Questionnaire Inventory on Tobacco (QIT) – www.cdc.gov/tobacco/qit

 Questionnaire will be available and shared with with states very soon

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Topics  General Health  Tobacco Use  Cessation  Smoke-free and Tobacco-free Policies  Demographic Items  Existing Chronic Conditions and Diseases  Opinions and Attitudes related to Tobacco

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Sample Design  Random-digit dialing (RDD) telephone survey  Landline and cell phone frames  State sample supplements

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Sample Design  Landline frame – Stratification by state or sub-state region – Federal target: About 95,000 completes (≈1900/state) – State supplement target: About 12,000 completes

 Cell phone frame – Screening for cell-phone-only users – Stratification by state – Federal target: > 3,000 completes – State supplement target: About 1,000 completes 6

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Data Collection  Following ATS/BRFSS protocols  Field period for federal data collection: – October 2009 through February 2010

 Field period for entire data collection effort: – October 2009 through March 2010

 Survey organization is ICF Macro

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How can you use KOI along with NATS data to monitor & evaluate TCPs? 1. Select an NTCP goal area 2. Select outcomes for your program 3. Select indicators of progress toward your selected outcomes 4. Evaluate your progress toward achieving your selected outcomes 8

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How can you use KOI along with NATS data to monitor & evaluate TCPs? (cont.) 4. Evaluate your progress toward achieving your selected outcomes – Focus your evaluation design by translating indicators into program objectives – Select a data source for each indicator • National Adult Tobacco Survey will provide point-in-time data for 2009-2010 for your state on key outcome indicators that can be appropriately measured using a telephone survey of adults – Monitor selected indicators • Consider conducting an OSH-supported state adult tobacco survey or other state survey to obtain data on key outcome indicators in future years 9

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Preventing Initiation of Tobacco Use Among Young People Inputs

Activities 1

State health department and partners

Community mobilization

CounterMarketing

SchoolBased prevention

Policy and regulatory action

Targeted to populations with tobaccorelated disparities

Outcomes

Outputs Completed activities to reduce and counteract protobacco messages

Short-term 6

Increased knowledge of, improved antitobacco attitudes toward, and increased support for policies to reduce youth initiation

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Completed activities to disseminate anti-tobacco and pro-health messages

3 Completed activities to increase tobaccofree policies and use of anti-tobacco curricula in schools

4 Completed activities to increase restrictions on tobacco sales to minors and to enforce those restrictions

5 Completed activities to increase cigarette excise tax

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Increased anti-tobacco policies and programs in schools

Increased restriction and enforcement of restrictions on tobacco sales to minors

Reduced tobacco industry influences

Long-term

Intermediate 13

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Reduced susceptibility to experimentation with tobacco products

Reduced initiation of tobacco use by young people

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Reduced tobacco-use prevalence among young people

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Decreased access to tobacco products

Reduced tobaccorelated morbidity and mortality

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Decreased tobacco-related disparities

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Increased price of tobacco products

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Preventing Initiation of Tobacco Use Among Young People  Indicator: Level of support for increasing excise tax on tobacco products [1.6.5]  Indicator: Prevalence of tobacco use among young people [1.14.1]

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Eliminating Nonsmokers’ Exposure to Secondhand Smoke

Inputs State health department and partners

Activities

Short-term

CounterMarketing

1 Completed activities

Community mobilization

to disseminate information about secondhand smoke and tobacco-free policies 2

Policy and regulatory action

Outcomes

Outputs

Completed activities to create and enforce tobacco-free policies

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Increased knowledge of, improved attitudes toward, and increased support for the creation and active enforcement of tobacco-free policies

4 Targeted to populations with tobaccorelated disparities

Intermediate

Creation of tobacco-free policies

5 Enforcement of tobacco-free public policies

Long-term 7

Reduced exposure to secondhand smoke

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Reduced tobacco consumption

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Reduced tobacco-related morbidity and mortality

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Compliance with tobacco-free policies

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Decreased tobacco-related disparities

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Eliminating Nonsmokers’ Exposure to Secondhand Smoke  Indicator: Level of support for creating tobaccofree policies in public places and workplaces [2.3.7]  Indicator: Perceived compliance with tobaccofree policies in workplaces [2.6.1]  Indicator: Proportion of nonsmokers reporting overall exposure to SHS [2.7.5]

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Promoting Quitting Among Adults and Young People Inputs

Activities 1

State health department and partners

Countermarketing

Community mobilization

Outcomes

Outputs Completed activities to disseminate information about cessation

Short-term 7 Establishment or increased use of cessation services

2 Cessation quitline is operational

Increased number of quit attempts and quit attempts using proven cessation methods

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Targeted to populations with tobaccorelated disparities

3 Completed activities to work with health care systems to institutionalize PHS-recommended cessation interventions

4 Completed activities to support cessation programs in communities, workplaces, and schools

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Increased cessation among adults and young people

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8 Policy and regulatory action

Long-term

Intermediate

Increased awareness, knowledge, intention to quit, and support for policies that support cessation

9 Increase in the number of health care providers and health care systems following Public Health Service (PHS) guidelines

12 Increased price of tobacco products 15

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Reduced tobacco-use prevalence and consumption

Reduced tobacco-related morbidity and mortality

Decreased tobacco-related disparities

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Completed activities to increase insurance coverage for cessation interventions

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Increased insurance coverage for cessation services

6 Completed activities to increase tobacco excise tax

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Promoting Quitting Among Adults and Young People  Indicator: Proportion of adult smokers who have made a quit attempt using proven cessation methods [3.11.3]  Indicator: Proportion of the population reporting exposure to secondhand smoke at home or in vehicles [2.7.3]  Indicator: Proportion of smokers who have sustained abstinence from tobacco use [3.13.1]

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What States will Receive:  Weighted SAS dataset for your state – State-added questions will be one long text string

 Codebook for federal questions  Possibly additional tables  Timeline for providing to states: Summer

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Weighting  Probability of selection  Possible explicit non-response adjustment (landline sample only)  Post-stratification to state (or possibly regional) populations by: – age, gender, and possibly race/ethnicity

 Non-response bias analysis

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Future Directions  OSH plans to publish MMWR’s and/or MMWR Surveillance Summary with NATS data  OSH plans to fully utilize NATS data in our tobacco-related evaluation, surveillance and research publications as appropriate  OSH plans to develop and share a public-use dataset

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National Adult Tobacco Survey: What is it and How Can I Use it? Centers for Disease Control and Prevention Office on Smoking and Health

[email protected] [email protected] www.cdc.gov/tobacco

The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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