An evaluation of the California community intervention.
OBJECTIVE
We conducted this study to determine key community-level factors associated with higher tobacco control programme performance.


METHODS
A combination of surveys, administrative and fiscal data were collected to measure local county-level health department performance over a 7-year period. Longitudinal analyses were performed using generalised estimating equations to examine whether counties that exerted higher effort were successful in creating more tobacco retail licensing (TRL) and secondhand smoke policies. Several social, political and contextual factors were examined as confounders.


RESULTS
Local county health departments (CHDs) that demonstrated high effort on their work plans increased the proportion of residents covered by TRL policies (7.2%; 95% CI -1.7 to 16.1%) compared to CHDs with lower levels of effort. Having legislators who voted in favour of tobacco control bills was found to significantly increase the passage of local TRL policies. CHDs demonstrating higher efforts also increased the proportion of residents covered by secondhand smoke policies (9.2%; 95% CI -3.5 to 21.9%).


CONCLUSIONS
There was strong evidence that higher county-level efforts predicted an increasing number of local tobacco control policies. Evaluations using integrated designs are recommended as effective strategies to provide a more accurate assessment of how well community-level interventions catalyse community-wide change.
Modayil
Mary V
MV
California Department of Public Health, California Tobacco Control Program, MS 7206, P.O. Box 997377, Sacramento, CA 95899-7377, USA. mary.modayil@cdph.ca.gov
Cowling
David W
DW
Tang
Hao
H
Roeseler
April
A
D002140:California; D003132:Commerce / Q000331:legislation & jurisprudence*; D003625:Data Collection; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006293:Health Promotion; D006801:Humans; D009111:Local Government; D015397:Program Evaluation; D011634:Public Health / Q000379:methods*; D011635:Public Health Administration; D012111:Residence Characteristics; D012907:Smoking / Q000331:legislation & jurisprudence; D000074606:Smoking Prevention; D014028:Tobacco Smoke Pollution / Q000331:legislation & jurisprudence*; D014029:Tobacco Use Disorder / Q000517:prevention & control
D014028:Tobacco Smoke Pollution
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