ProgramProgram

Highlights, Highlights,

Evaluation Evaluation

& Surveillance & Surveillance

2002-20042002-2004

Highlights from 2002-2004Highlights from 2002-2004

Awarded grants to 25 agencies across Awarded grants to 25 agencies across Cuyahoga CountyCuyahoga County

Target areas included Cleveland (East Target areas included Cleveland (East and West), Lakewood, Warrensville and West), Lakewood, Warrensville Heights, Garfield Heights, Euclid, Heights, Garfield Heights, Euclid, Cleveland Heights/University HeightsCleveland Heights/University Heights

Highlights 2002-2004Highlights 2002-2004

Reached 2,414 fourth grade students Reached 2,414 fourth grade students with Word of Mouth Program (27 with Word of Mouth Program (27 schools)schools)

Reached 1,666 sixth grade students Reached 1,666 sixth grade students with the Life Skills Program (14 schools)with the Life Skills Program (14 schools)

Enrolled 356 adults in the Freedom Enrolled 356 adults in the Freedom from Smoking Program in 12 sites from Smoking Program in 12 sites across Cuyahoga Countyacross Cuyahoga County

Highlights 2002-2004Highlights 2002-2004 Conducted two vendor compliance Conducted two vendor compliance

check programs reaching 474 sitescheck programs reaching 474 sites Established 16 SHOUT teamsEstablished 16 SHOUT teams Launched a second media campaignLaunched a second media campaign

School-Based PreventionSchool-Based Prevention

44thth & 5 & 5thth graders: Word of Mouth graders: Word of Mouth66thth graders: Life Skills Training graders: Life Skills Training

Program Evaluation Program Evaluation MethodologyMethodology

Pre- and post-test design. Post-test is Pre- and post-test design. Post-test is within one month following the within one month following the program (short-term).program (short-term).

Pencil/paper questionnairePencil/paper questionnaire Standardized questionsStandardized questions Changes over time examined.Changes over time examined. No control group in Year 2 evaluation No control group in Year 2 evaluation

(added in Year 3).(added in Year 3).

Word of MouthWord of Mouth (4(4thth/5/5thth

grade)grade)

20% have been offered a cigarette in the past.

8% have tried at least a puff or two of a cigarette.

21% think that more than half of kids their age smoke.

53% live with someone who smokes.

8% do not think that smoking is harmful to their health.

Students who live with a smoker are more than 3 times more likely to have tried smoking than those who do not live with a smoker (12% vs. 3%).

Students who live with a smoker are also 3 times more likely to say they’ll probably smoke in the future (9% vs. 3%).

Program Impact: Word of Program Impact: Word of MouthMouth

• Most of students begin the program with anti-tobacco beliefs.

• However, among the small number of students who don’t the program does impact their beliefs.

• Before the program started only 8% of students felt cigarettes were not harmful. However, 73% of these students changed their opinion after the program (compared to only 4% changing from harmful to not harmful).

• Before the program started, only 6% of students said they would be smoking five years from now. However, over half (51%) of these students changed their mind after the program, as compared to only 3% who developed new intentions to smoke.

Life Skills Training Life Skills Training (6(6thth graders)graders)

34% have been offered a cigarette or little cigar (41% males; 27% females). 18% have tried one or both of them.

12% of 11 yr olds; 21% of 12 yr olds and 37% of 13+ yr olds have tried smoking.

Among those who have tried, 11% report that they now smoke everyday.

81% say that at least one parent has told them not to smoke in the past 12 months.

30% report that at least one of their 4 closest friends have tried smoking.

Program Impact: Life SkillsProgram Impact: Life Skills

• Most of these students also begin the program with anti-tobacco beliefs.

• Program does appear to have a short-term impact.

• For example, only 10% of students felt it was safe to smoke for a few years as long as you quit after that. However, 74% of these students changed their opinion after the program (compared to only 7% changing from unsafe to safe).

• Before the program started, only 6% of students said they intended smoke in the next year. However, 34% of these students changed their mind after the program, as compared to only 5% who developed new intentions to smoke.

Smoking Smoking CessationCessation

Freedom From Freedom From SmokingSmoking

Nearly half (49%) of adults in Cuyahoga County who currently smoke have tried to quit at least once in the past year.

- Source: 2003 Cuyahoga County BRFSS.

47% of Cuyahoga County high school smokers say that they have tried to quit in the past 12 months.

-Source: 2003 Partnership Youth Tobacco Survey

Adult Smoking CessationAdult Smoking Cessation

12%

24%

7%

25%

32%

Age when FSS participants

started smoking regularly

Under 10 yrs

10-15 yrs

16-17 yrs

18-21 yrs

Over 21 yrsUse of Cessation AidsAmong the 356 participants,

% who had previously tried the

following cessation aids:

Nicotine patch 48%Nicotine gum 31%Pills (Zyban,Wellbutrin)26%Inhaler/nasal (Nicotrol) 7%Lozenge (Commit) 9%Counseling (face-to-face)

5%Tobacco Quitline 6%

Freedom from SmokingFreedom from Smoking Of the 356 enrolled in the FES Of the 356 enrolled in the FES

program, over half completed at program, over half completed at least 5 sessions and 43% completed least 5 sessions and 43% completed a final survey on the 8a final survey on the 8thth session. session.

Of these participants, 84% reported Of these participants, 84% reported quitting during the program and 74% quitting during the program and 74% were still abstinent on the last were still abstinent on the last session (8 weeks).session (8 weeks).

Current evaluation includes 30, 60, Current evaluation includes 30, 60, and 90 day follow ups.and 90 day follow ups.

Adult Tobacco Adult Tobacco SurveillanceSurveillance

2003 Cuyahoga County 2003 Cuyahoga County

Risk Behavior SurveyRisk Behavior Survey

Random Digit, Telephone-Based SurveyRandom Digit, Telephone-Based Survey

1,516 Cuyahoga County residents1,516 Cuyahoga County residents

Aged 18 and Older, Aug-Oct, 2003Aged 18 and Older, Aug-Oct, 2003

Data collected by ORC Macro and managed by the CASE Center for Health Promotion Research Dept. of Epidemiology and Biostatistics CASE School of Medicine

Adult Tobacco Use in Cuyahoga Adult Tobacco Use in Cuyahoga County: County:

2003 Cuyahoga County BRFSS2003 Cuyahoga County BRFSS

Current Tobacco Users

Adult Cigarette Use: Adult Cigarette Use: County, State & National County, State & National

ComparisonsComparisonsAdult Cigarette Use: County, State and National

Comparisons

Cigarette Smoking History a Cuyahoga County, 2003

Ohio, 2003b

National, 2003b

Never Smokers 48.5 50.7 53.0Past Smoker 24.9 23.9 24.6Current Cigarette User

26.7 25.4 22.1

aCurrent cigarette smoking is defined in the BRFSS as persons aged 18-98 years who report having smoked >100 cigarettes during their lifetime and who currently smoke every day or some days. Past smokers report smoking >100 cigarettes but not currently. Never smokers report smoking <100 cigarettes in their lifetime. bState and national comparison data are derived from the 2003 Behavioral Risk Factor Surveillance Survey. The BRFSS is a state-based system and therefore does not provide a national estimate. Thus, thus as suggested by the CDC, the median prevalence rate across the 50 states is used for the national estimate (CDC, 2004).

Other Tobacco Products: Other Tobacco Products: County, State & National County, State & National

ComparisonsComparisonsOther Tobacco Product Use Among Adults:

County, State and National Comparisons

Other Tobacco Products

Cuyahoga County,

2003

Ohio, 2002a

National, 2002a

Pipe Use 0.8 0.8 0.8

Cigar Useb 5.2 7.2 5.7

Cigar & Little Cigar

(e.g. Black & Milds) Use

7.1 n/a n/a

Smokeless Tobacco Use

1.6 2.8 3.6

a Data on other tobacco products, such as cigars, pipes and smokeless tobacco, are only collected in the even years (i.e., 2000, 2002) in the Ohio BRFSS. Thus, 2003 county-level estimates can only be compared to estimates from the 2002 Ohio BRFSS. b The BRFSS does not ask specifically about the use of little cigars (e.g., Black and Milds). Due to the suspected high use in Cuyahoga County, these products were specifically assessed in the Cuyahoga County BRFSS. Thus, cigar use prevalence is provided both with and without little cigar use for comparative purposes.

Key for Prevalence Rates

Prevalence of Total Tobacco Use Prevalence of Total Tobacco Use Among Adults, Cuyahoga County, Among Adults, Cuyahoga County,

20032003

Highest: 41%

Lowest: 22%

Key for Prevalence Rates

Prevalence of Cigarette Use Prevalence of Cigarette Use Among Adults, Cuyahoga Among Adults, Cuyahoga

County, 2003County, 2003

Highest: 42%

Comparison:

Ohio: 25.4%

National: 22.1%

Lowest: 16%

Key for Prevalence Rates

Prevalence of Cigars and Little Cigar Prevalence of Cigars and Little Cigar Use Among Adults, Cuyahoga Use Among Adults, Cuyahoga

County, 2003County, 2003

Highest: 18%

Lowest: 5%

Comparison (cigars only):

Ohio: 7.2%

National: 5.7%

Adolescent SurveillanceAdolescent Surveillance

Partnership Youth Tobacco Partnership Youth Tobacco SurveySurvey

(PYTS)(PYTS)

Grade 9-12Grade 9-12

Demographics of Adolescent Demographics of Adolescent SampleSample

Grade LevelGrade Level 30% 930% 9thth grade grade 28% 1028% 10thth grade grade 22% 1122% 11thth grade grade 19% 1219% 12thth grade grade

SESSES 25% Low 25% Low

(neither parent attended college)(neither parent attended college) 54% Med 54% Med

(at least 1 parent attended some (at least 1 parent attended some college)college)

21% High21% High (at least 1 parent has graduate (at least 1 parent has graduate

education)education)

GenderGender 48% Female48% Female 52% Male52% Male

RaceRace 56% White56% White 26% African-American26% African-American 7% Hispanic7% Hispanic 3% Asian3% Asian 2% Multiracial2% Multiracial 1% American Indian1% American Indian 1% Pacific Islander1% Pacific Islander

Data provided by the Center for Adolescent Health, CASE www.adolhealth.org

28.4 25.2 30.5 30.524.9 25.0

34.327.2

20.127.1 31.0

36.0

0

10

20

30

40

50

60

70

80

90

100

1

Per

cen

tag

e

Cuy. Cnty. female male Wht AA Hisp low SES high SES 9th 10th 11th 12th

Prevalence of Students Who Prevalence of Students Who Are Currently Using TobaccoAre Currently Using Tobacco

Data provided by the Center for Adolescent Health, CASE www.adolhealth.org

Current Tobacco Use, by Current Tobacco Use, by ProductProduct

19.96.8

17.814.7

1.52.1

9.35.4

20.817.8

1.5 5.4 15.95.5

18.818.4

4.67.5

0

10

20

30

40

50

Cigarettes Chew/Snuff Cigars/Black & Milds Blunts Bidis Kreteks

White African-American Hispanic

%

Data provided by the Center for Adolescent Health, CASE www.adolhealth.org

Although only 16% of adolescents Although only 16% of adolescents currently smoke cigarettes, an currently smoke cigarettes, an additional 47% appear to be additional 47% appear to be

susceptible to smoking in the future.susceptible to smoking in the future.

Data provided by the Center for Adolescent Health, CASE www.adolhealth.org

Parental Attitudes May Impact Parental Attitudes May Impact Student Tobacco UseStudent Tobacco Use

91.5

49

70.4

20.8

0

20

40

60

80

100

Pe

rce

nta

ge

(%

)

Perceive parents believe cigarette use is "Not Wrong"

Perceive parents believe cigarette use is "Very Wrong"

% who have tried tobacco % who currently use tobacco

Data provided by the Center for Adolescent Health, CASE www.adolhealth.org

State and National State and National ComparisonsComparisons

No tobacco related behaviors were No tobacco related behaviors were reported at significantly higher rates reported at significantly higher rates in Cuyahoga County than in the state in Cuyahoga County than in the state or nation. or nation.

Data provided by the Center for Adolescent Health, CASE www.adolhealth.org

State and National State and National ComparisonsComparisons

Current Bidi Use Current Bidi Use Lifetime Cigarette Lifetime Cigarette Use Use

Early Onset of Early Onset of Cigarette Use Cigarette Use

Regular Cigarette UseRegular Cigarette Use Current Bidi UseCurrent Bidi Use

Better than Ohio

Better than US

Data provided by the Center for Adolescent Health, CASE www.adolhealth.org

Year ThreeYear Three

Expand the delivery of youth prevention Expand the delivery of youth prevention and adult smoking cessation programs.and adult smoking cessation programs.

Launch a pilot youth smoking cessation Launch a pilot youth smoking cessation program.program.

Enhance program evaluation design Enhance program evaluation design with the addition of control groups.with the addition of control groups.

Continue adult and youth surveillance.Continue adult and youth surveillance.