In Maine, one-fifth of the adult population smokes cigarettes (1) causing an estimated 2,235 premature deaths each year. (2) For every person who dies from tobacco use, 20 others suffer from tobacco-related illnesses (3) These health issues cost the state of Maine more than $534 million in smoking-attributable productivity losses and $550 million in health care expenditures. (2)
The Institute of Medicine's Ending the Tobacco Problem: A Blueprint for the Nation outlines recommendations to support comprehensive state tobacco control programs, including mass media campaigns. (4) Mass media campaigns can reduce smoking prevalence when combined with other effective community-based interventions such as smoking bans and restrictions, higher prices for tobacco products, smoking cessation interventions, and telephone quitlines. (5)
The Centers for Disease Control and Prevention (CDC) recommends that health communication interventions, also described as tobacco counter-marketing campaigns, should be considered for ad dressing the agency's goals for comprehensive tobacco control programs, including: (1) preventing initiation among youth and young adults, (2) promoting quitting among youth and adults, (3) eliminating exposure to secondhand smoke, and (4) identifying and eliminating tobacco-related disparities among specific populations. (6) These campaigns can also influence public support for tobacco control funding and contribute to a supportive climate for school, community, state and national policies to prevent tobacco use. (7)
Maine was one of eight states to meet the CDC's minimum funding recommendation and the only state to have met the minimum funding recommendation every year since the release of the first Best Practices for Comprehensive Tobacco Control Programs in 1999. (6) Since then, Maine is one of three states to have experienced 45%-60% reductions in youth smoking rates with sustained comprehensive statewide programs. (6) In 2005, the state was the first to receive"straight A's" on the American Lung Association's State Tobacco Control Report Card.
Arizona, California, Florida, Massachusetts, Minnesota, New York City and Oregon have documented the effectiveness of statewide tobacco counter-marketing campaigns? To explore the best practices in health communication efforts for tobacco control further, the Maine Center for Public Health on behalf of the Partnership for a Tobacco-Free Maine sought to integrate media evaluation with future campaigns. Using the conceptual framework from the CDC's Introduction to Program Evaluation for Comprehensive Tobacco Control Programs and integrating the CDC's Designing and Implementing an Effective Tobacco-Counter-Marketing Campaign, the Maine Center for Public Health interviewed key informants in the state about their health communication programs, and key informants outside the state with experience in media evaluation. (8,9,10) These key informants identified stakeholders who could help design Maine's tobacco counter-marketing campaign evaluation.
Figure 1, CDC's Framework
for Program Evaluation (8)
1. Engage Stakeholders
2. Describe the Program
3. Focus the Evaluation Design
4. Gather Credible Evidence
5, Justify Conclusions
6. Ensure Use and Share Lessons
This article shares the strategies that were generated during key informant interviews and meetings with stakeholders to guide future efforts in tobacco counter-marketing campaigns in Maine. This information may be helpful to other state programs that plan to evaluate their health communication programs.
In the spring of 2008, the Maine Center for Public Health's evaluation team began to develop a new media evaluation plan (Figures 1 and 2) (9,10) The first step in the CDC's Framework for Program Evaluation is to engage stakeholders? The CDC has identified three main groups of stakeholders necessary for evaluation: program staff (e. …