title: An evaluation of the California community intervention.
abstract: 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.
authors.affiliation: 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
authors.forename: Mary V
authors.initials: MV
authors.lastname: Modayil
authors.forename: David W
authors.initials: DW
authors.lastname: Cowling
authors.forename: Hao
authors.initials: H
authors.lastname: Tang
authors.forename: April
authors.initials: A
authors.lastname: Roeseler
mesh_terms: 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
chemical_list: D014028:Tobacco Smoke Pollution
references.citation: Public Health Rep. 1996 Jul-Aug;111(4):353-8
references.pmid: 8711104
references.citation: Tob Control. 2002 Jun;11(2):140-5
references.pmid: 12035008
references.citation: Am J Public Health. 2008 Feb;98(2):268-9
references.pmid: 18172141
references.citation: Cancer Causes Control. 2004 Sep;15(7):689-95
references.pmid: 15280627
references.citation: Eval Rev. 1999 Jun;23(3):259-80
references.pmid: 10538783
references.citation: Am J Health Behav. 2006 Jan-Feb;30(1):15-26
references.pmid: 16430317
references.citation: Nicotine Tob Res. 2007 Dec;9(12):1287-96
references.pmid: 18058347
references.citation: PLoS Med. 2008 Aug 26;5(8):e178
references.pmid: 18752344
references.citation: Cancer. 1998 Dec 15;83(12 Suppl Robert):2755-9
references.pmid: 9874392
references.citation: Am J Public Health. 1998 Jun;88(6):918-23
references.pmid: 9618620
references.citation: Am J Public Health. 2002 Jun;92(6):975-83
references.pmid: 12036792
references.citation: N Engl J Med. 2000 Dec 14;343(24):1772-7
references.pmid: 11114317
references.citation: Am J Public Health. 2000 Jan;90(1):25-33
references.pmid: 10630133
references.citation: Am J Public Health. 2000 Mar;90(3):372-9
references.pmid: 10705854