Planning the Impact of Your Tobacco Program

Using A Needs Assessment

Reviewing results of current Arizona Tobacco Use Needs Assessment (Strich, Sloane, & Muramoto, 2000) conducted for your service area is essential in planning tobacco interventions appropriate for your community. It will guide your tobacco program planning in identifying target populations in need, estimating the demand for tobacco services, and designing effective outreach strategies.

Impact

In public health theory, the concept of population impact is frequently used in determining what interventions are the best for which types of people at what cost and efficacy.  Population impact can also be used in  planning, implementing, and evaluating effective recruitment strategies (Velicer & Prochaska, 1999; Ruggiero & deGroot, 1998; Prochaska & Velicer, 1997; Abrams, Orleans, Niaura, Prochaska, & Velicer, 1996). The following equation displays a simple method for planning the impact of your tobacco control program:

IMPACT = Efficacy (E)  X  Reach (R)

Efficacy (E) = Percentage of clients quit at a given point in time (such as 3-mo., 6-mo., or 12-mo.). This may be obtained from your evaluation department or from the literature in the field of tobacco treatment programs. Estimates of the efficacy (quit rate) of tobacco programs with at least 5-months follow-up, range from:15% to 20% with behavioral therapy only; 18% to 31% with behavioral therapy and nicotine replacement therapy or bupropion (Fiore, Michael C. et al., 2000).

Reach (R) = This can be obtained by multiplying the (1) population in need, times (2) the stage-specific tobacco users targeted, times (3)  the percent of people using an assisted method of cessation.

Population in Need = Estimated number of tobacco users (prevalence).  This figure can be calculated (total population x prevalence) or obtained from the published literature.

Stage-Specific Tobacco Users Targeted = The Readiness to Change Model alludes to (a) 20 percent of tobacco users are in the ready to quit stage; (b) 40 percent are in the thinking about quitting stage; and (c) 40 percent are in the not ready to quit stage (Prochaska, Redding, & Evers, 1997).

Target Population Percentage (percent using an assisted method) = The literature identifies 15% of tobacco users used an assisted method of cessation; therefore, your intensive intervention program could expect to serve 15% or less of the targeted population in need.

 

Program “A” Case Example

IMPACT = Efficacy (E)  X  Reach (R)

Step 1: Efficacy (E)

Estimates of the efficacy (quit rate) of tobacco programs with at least 5-months follow-up, range from:15% to 20% with behavioral therapy only; 18% to 31% with behavioral therapy and nicotine replacement therapy or bupropion (Fiore, Michael C. et al., 2000).  For the purpose of this example, lets use 18% as the quit rate for people in Program “A” at 6-months. 
 

Step 2: Reach (R)

Use this three-step process to determine the possible reach of your program (population in need  X  stage-specific tobacco users  X  percent using an assisted method)

A.  Population in Need (total population X tobacco use prevalence)

Using the Arizona Tobacco Use Needs Assessment (Strich, Sloane, & Muramoto, 2000), of the 60,916 white, 18-24 year old adults residing in Pima County, 23.9% are estimated to be tobacco users. Your population in need for white, 18-24 year old adults is (60916 x .239) 14,559 tobacco users.  This figure can either be calculated, or obtained directly from the Arizona Tobacco Use Needs Assessment.

B.   Stage-Specific Tobacco Users Targeted (population in need x stage-specific percentage)

Setting your expected recruitment population goal should be done in collaboration with your ADHS-TEPP Local Project.  Since expecting to recruit 100% of your population in need is not realistic, using a stage-matched approach is more accurate. For the estimated 14,559 white, 18-24 year old adult tobacco users living in Pima County, the readiness to change stage-specific breakdown is:

This breakdown provides you with an opportunity to set a realistic goal for your population in need. You can expect to recruit up to 2,912 tobacco users for your intensive programs. Additionally, about 5,824 tobacco users thinking about quitting may participate in other stage-matched interventions, as well as join intensive programs. The remaining 5,824 tobacco users not ready to quit may be reached through minimal and brief interventions.

C. Target Population Percentage (stage-specific tobacco users targeted X percent using an assisted method)

Determining the percent of the population to be served will be dependent on your ADHS-TEPP Local Project contract deliverables. For the purposes of this example, the literature has determined that you can expect 15% of the ready-to-quit tobacco users to participate in your intensive program (2, 912 x 15%); therefore, about 437 tobacco users would represent your expected recruitment population.
 

Step 3: Impact

To determine the impact of your program on a ready-to-quit population at 6-months:

Based on the above calculations, 79 people in your community who are served by your program would be abstinent from tobacco 6 months after completing your program.

To determine the impact of your service on a ready to quit and thinking about quitting population:

Based on the above calculations, 236 people in your community who are served by your program would be abstinent from tobacco 6 months after completing your program.


Improving the impact of your program

Two extreme situations could hypothetically result in zero impact: (a) a very effective, expensive program (100% Efficacy) that fails to attract any clients (0% Reach) or (b) a self-help brochure delivered to every person who uses tobacco at no charge (100% Reach) that does not work at all (0% Efficacy).

You play an integral part in producing a positive impact in your community.  The recruitment rate can be influenced by using and developing effective recruitment and retention strategies.

The impact of your program in reducing tobacco use in your community can therefore be
improved by:

• Planning recruitment from both the ready to quit population ands the thinking about quitting population
• Increasing the recruitment rate
• Increasing the efficacy of your program