misrgo evaluationinfo.davidfetterman.com/2ndqtrreport2018-2019.pdf · 2nd quarter report 2018-2019...

MISRGOEVALUATION

2nd Quarter Report 2018-2019 – February 18, 2019

Fetterman & Associates • (650) 269-5689 • [email protected]

HIGHLIGHTThis2ndQuarterevaluationreporthighlightsMISRGOandMISRGOgranteeprogressmid-year.Itincludes:goals,milestones,andbaselines,comparingmilestoneswithactualperformance.PREPAREDBY:Dr.Fetterman&Ms.DelaneyPreparedforMISRGO,AdvisoryBoard,ArkansasDepartmentofHealth,Grantees&LegislativeOffices

1

Introduction MISRGO’s has been leading the challenge of addressing minority tobacco use in Arkansas for over a decade. The purpose of this report is present the status of MISRGO and grantee performance in mid-year. Problem “Tobacco use is the single most preventable cause of disease, disability, and death in the United States” (Center for Disease Control and Prevention, 2017). “Smoking kills more people than alcohol, AIDS, car crashes, illegal drugs, murders, and suicides combined. ”1 The annual health care costs in Arkansas directly caused by smoking is $1.21 billion, according to the Campaign for Tobacco Free Kids (2018). The tobacco industry spends over $116 million marketing tobacco in Arkansas (CDC, 2018). Arkansas’ Master Tobacco Settlement revenue is being used in part to address this serious health issue. (See also Arkansas Department of Health (2009).) However, “as of fiscal year 2016, Arkansas allocated 35% of the CDC-recommended funding for tobacco control ($12.8 million of $36.7 million).”i

Public Health Response to Tobacco Use in Arkansas (second hand smoke) Secondhand smoke causes stroke, lung cancer, and coronary heart disease in adults. Arkansas passed the Arkansas Clean Indoor Act in 2006. It was designed to “protect workers in Arkansas from secondhand smoke in the workplace and to protect the citizens of Arkansas from secondhand smoke in public places” (Senate Bill 29). Although, “Arkansas does not have a comprehensive smoke-free law to protect people from secondhand smoke in all indoor areas of workplaces, restaurants, and bars…building on the Clean Indoor Act, the state has implemented state laws that prohibits smoking in cars with children” (Act 13 - 2006, Act 811 - 2011).

1 See Campaign for Tobacco Free Kids (2017).

2

In addition, the state provides research, data, and scientific consultation to communities, multiunit housing operators, hospitals, businesses, and colleges and universities that want to protect residents from secondhand smoke. Arkansas has established over 126 tobacco-free policies protecting more than 669,421 residents in parks, colleges, and businesses. Arkansas college campuses in Arkansas have been smoke-free since 2009, including electronic cigarettes since 2015. (CDC, 2018). MISRGO & Grantees The University of Arkansas at Pine Bluff’s Minority Initiative Sub-Recipient Grant Office (MISRGO) has received a portion of the Arkansas’ Master Tobacco Settlement funds through the Arkansas Department of Health to focus on tobacco use in minority communities. MISRGO’s mission is specifically to prevent and reduce tobacco use in minority communities. MISRGO has awarded more than 50 Arkansas organizations with funding for tobacco prevention and cessation programs. MISRGO currently sponsors and provides technical assistance for 10 grantees across the State of Arkansas. (See Appendix A for a glossary of grantee names.) MISRGO grantees have broad-based support across the State for their tobacco prevention and cessation work. (See MISRGO Empowerment Evaluation: June 2011 Annual Report, Fetterman, Tremain, and Delaney, 2011.) MISRGOgranteesalsohaveastrongtrackrecordofsuccessbasedonpastperformance.Forexample,inthelast7years,themajorityofMISRGOgranteesmetorexceededtheirannualperformancegoals.(SeeMISRGOEmpowermentEvaluationAnnualReport,2017-2018,FettermanandDelaney;MISRGOEmpowermentEvaluationAnnualReport,2016-2017,FettermanandDelaney;MISRGOEmpowermentEvaluationAnnualReport,2015-2016,FettermanandDelaney;MISRGOEmpowermentEvaluationAnnualReport,2014-2015,FettermanandDelaney;MISRGOEvaluationAnnualReport2013-2014Fetterman,Delaney,andTremain,July11,2014;2012-2013Fetterman,Delaney,Tremain,July18,2013a;and2011-12Fetterman,Tremain,andDelaney,July12,2012). MISRGO Performance Measures MISRGO goals and activities are aligned with CDC intervention areas, including:

• Area1:EliminateExposuretoSecondhandSmoke• Area2:PreventingInitiationAmongYouthandYoungAdults• Area3:PromotingQuittingAmongYouthandAdults• Area4:AddressingDisparities

Their goals and activities are measurable and monitored on a quarterly basis, to allow for mid-course corrections as needed.

3

Quarterly Progress During the first quarter, MISRGO and the grantees established their goals, milestones, and baselines. Goals are the planned outcomes or results at the end of the year, e.g. number of smoke-free parks. Milestones are intermediate objectives or approximations of outcomes. Baselines represent, for example, the number of smoke-free environments that existed before the grantee activity or intervention. During the second quarter, the focus of this report, MISRGO and their grantees report on their mid-year progress toward annual goals. This provides MISRGO and grantees with an opportunity to reflect on their performance. Based on these data, MISRGO and their grantees continue as planned, make mid-course changes, and/or request assistance as needed. The third quarter focuses on any gaps between milestones and annual goals. MISRGO staff and the evaluation team discuss strategies and tradeoffs with the aim of helping use evaluation data to improve performance and accomplish their goals. Grantees also consult with colleagues to help close the gap. They share techniques with each other, MISRGO staff provide additional recommendations, and Fetterman & Associates notify grantees about gaps and make specific recommendations to help them accomplish their goals. The fourth quarter is the annual comparison of their goals with their actual performance throughout the year. MISRGO Goal Areas include:

• DecreasingInitiationofTobaccoAmongYouthandYoungAdults(CDCarea2)

• DecreaseExposuretoSecondHandSmoke(CDCarea1)• DecreaseTobaccoUseAmongAdults&Youth(CDCarea3)• SurveillanceandEvaluation(CDCarea1,2,3,and4)

The status of their work, organized by goal area is presented below: Decreasing Initiation of Tobacco Among Youth and Young Adults MISRGO’s goal concerning decreasing initiation of tobacco among youth and young adults (CDC area 2) is to increase the number of faith-based institutions from 15 to 19 involved in tobacco control advocacy. MISRGO has established quarterly milestones to accompany their goals. The following chart depicts their 1st (1), 2nd (2), 3rd (3), and 4th (4) quarter milestones. This evaluation dashboard is designed to help them monitor their own performance and simultaneously allow external bodies, including Fetterman & Associates, to monitor their progress and offer assistance as needed. MISRGO devoted their 1st and 2nd quarters to planning and implementation and anticipate progress in their 3rd quarter.

4

MISRGO is also engaged in key activities designed to contribute to their CDC aligned interventions. The activities are categorized as follows: Community Interventions, Community Engagement, Educating Key Decision-makers, and Mass-Reach Health Communications. The details associated with each category are provided below:

Community Interventions Assessed faith-based institutions re: No Menthol Sunday Collaborated with local faith based to implement No Menthol

Provide mini-grants to support churches to implement No Menthol

Evaluate implementation (post intervention data)

Community Engagement Solicit feedback from partners re: No Menthol Sunday Hold mini-local media events re: No Menthol Sunday

Educating Key Decision-Makers Engage faith-leaders re: menthol, point of sale ordinances

Assist faith-leaders in assessing No Menthol info and implementation

Disseminate a paper on effects of menthol tobacco

Mass-Reach Health Communications Conduct a social media campaign re: No Menthol Sunday

Secure traditional and non-traditional media for policy change Share information at Ark Dept of Health Quarterly Meeting

Hold press conference No World Tobacco Day This list of key activities represents MISRGO’s road map to accomplishing its larger goals and objectives. They have assessed faith-based institutions regarding No Menthol Sunday. In addition, they are moving rapidly toward awarding mini-grants to support churches to help them implement agreed upon tobacco prevention projects. The timeline

1

2

3

4

4 4 4 4

0

1

2

3

4

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

Decrease Initiation of Tobacco UseYouth & Young Adults

Actual Milestone Goal

5

has been adjusted as a result of larger fiscal issues in the State. The remaining activities are planned for the next two quarters.

Decrease Exposure to Second Hand Smoke MISRGO’S overarching goal, concerning decreasing exposure to second hand smoke (CDC area 1), involves providing technical assistance to 10 CBOs. The following chart depicts their 1st (0), 2nd (5), 3rd (10), and 4th (13) quarter milestones. This evaluation dashboard is designed to help them monitor their own performance and simultaneously allow external bodies to monitor their progress and offer assistance as needed. The steps taken to-date are promising and will contribute to their desired outcomes. Their goals and milestones are presented below. MISRGO will document their progress throughout the year by populating this chart with their actual performance.

MISRGO is also engaged in key activities designed to contribute to their CDC aligned interventions. The activities are categorized as follows: Community Interventions, Community Engagement, Educating Key Decision-makers, and Mass-Reach Health Communications. The details associated with each category are provided below:

YES0

1

2

Community In

terve

nt ion

s

Assesse

d faith

-based i

nstitu

tions…

Collabora

ted w

ith lo

cal fa

ith base

d…

Provide m

ini-gran

ts to

supp

ort…

Evaluate

imple

mentatio

n (post

…

Community En

gagement

Solici

t feedb

ack fro

m partners r

e:…

Hold m

ini-local

media

events r

e: No…

Educat

ing Key

Decisio

n-Make

rs

Enga

ge fai

th-lead

ers re

: menth

ol,…

Assist

faith-le

aders i

n assessi

ng No…

Dissem

inate a p

aper o

n effects

of…

Mass-Reac

h Health

Communicatio

ns

Conduct

a socia

l med

ia cam

paign

…

Secure tra

ditional a

nd non-…

Share

inform

ation a

t Ark

Dept o

f…

Hold press

conference

No World

…

MISRGO Decrease Initiation

YES NO

0

5

10

13

13 13 13 13

-1

1

3

5

7

9

11

13


Decrease Exposure to Second Hand Smoke


6

Community Intervention Develop a presentation tobacco free policy - housing Develop a model for local sub-grantees for local policy

Community Engagement Facilitate presentation on tobacco free multi-unit housing Engage housing developers at Chamber of Commerce

Educating Key Decision-Makers Inform property owner association tobacco free housing policy Assist in distributing MRC data - impact on health

Mass-Reach Health Communication Advertise presentations using traditional and non-traditional advertising

This list of key activities represents MISRGO’s path to accomplish its larger goals and objectives. They are making progress in each of these areas. However, the majority of their efforts are planned for the next two quarters.

Decrease Tobacco Use Among Adults & Youth MISRGO’S overarching goal, concerning decreasing tobacco use among adults & youth (CDC area 3), involves working with 5 stakeholders to develop statewide plans to reduce disparities. The following chart depicts their 1st (0), 2nd (1), 3rd (3), and 4th (5) quarter milestones. This evaluation dashboard is designed to help them monitor their own performance and simultaneously allow external bodies to monitor their progress and offer assistance as needed. MISRGO remains in the planning and initial implementation stages, concerning these activities during the 1st and 2nd quarters. The steps taken to-date are

YES0

1

2

Comm

unity In

terv

ention

Develop

a pre

senta

tion…

Develop

a m

odel fo

r loca

l…

Comm

unity En

gage

ment

Facil

iate

pre

sent

ation o

n…

Enga

ge h

ousing d

evelo

pers…

Educa

ting K

ey D

ecisi

on-…

Info

rm p

roperty

owner

…

Assist

in di

strib

uting M

RC…

Mas

s-Rea

ch H

ealth

…

Advert

ise pr

esen

tatio

ns…

Decrease Exposure to Second Hand Smoke

YES NO

7

promising and will contribute to their desired outcomes in the 3rd and 4th quarters. Their goal and milestones are presented below. MISRGO will document their progress throughout the year by populating this chart with their actual performance.

MISRGO is also engaged in key activities designed to contribute to their CDC aligned interventions. The activities are categorized as follows: Community Interventions, Community Engagement, Educating Key Decision-Makers, and Mass-Reach Health Communications. The details associated with each category are provided below:

Community Intervention Identify stakeholders Outline plans to address disparities Solicit feedback from stakeholders and incorporate feedback into final plan

Community Engagement Collaborate with local stakeholders on priority areas of implementation plan Identify key individuals that will assist with implementation plan

Educating Key Decision-Makers Share plan with stakeholders Share plan and solicit feedback from Advisory Committee

Mass-Reach Health Communications Disseminate plan to prevention and identify individual to assist One-day Conference (educate 150 tobacco control coalition members)

Community Interventions

0

1

3

5

5 5 5 5

0

1

2

3

4

5


Decrease Tobacco Use Among Adults & Youth


8

Explore feasibility of joint one-day conference MRC and ASP Design, implement, and evaluate conference

Community Engagement Include stakeholders in planning conference Invite grassroots advocates and partners to conference - best practices Engage partners who attend conference - identify research opportunities Expand promotion of conference outside sub-grantees

Educating Key Decision-Makers Educate and inform decision makers about conference (minority com) Foster collaborative research - across institution Identify 3 new partners to increase reach of tobacco control in minority community

Mass-Reach Health Communications Collaborate with media consultants to advertise conference

This list of key activities represents MISRGO’s path to accomplish its larger goals and objectives. They have made progress during the first and second quarters. The listed activities are designed to be implemented over the next two quarters.

0

1

2

Community int

erventi

on

explore fe

asibil

ity of

joint o

ne…

design

, implem, an

d eval…

Community en

gagem

ent

include sta

keholde

rs in p

lan…

invite g

rassro

ots advo

cates…

enga

ge pa

rtners

expan

d promotion

of…

Educat

ing Key

Decisio

n Make

rs

educat

e and in

form deci

sion…

foster co

llabo

rative r

eseach

identify

3 new part

ners to…

highigh

t histo

rical s

ignific

ance…

Mass Rea

ch Hea

lth

collab

orate

with m

edia…

Decrease Tobacco Use Among Adults & Youth

YES NO

9

Surveillance and Evaluation MISRGO’S overarching goal, concerning Surveillance and Evaluation (CDC area1, 2, 3, and 4), involves funding 10 sub-grantees. The following chart depicts their 1st (10), 2nd

(10), 3rd (10), and 4th (10) quarter milestones. In essence, by funding the 10 grantees they accomplished their annual goal in the 1st quarter.

MISRGO is also engaged in key activities designed to contribute to their CDC aligned interventions. The activities are categorized as follows: Community Interventions, Community Engagement, Educating Key Decision-Makers, and Mass-Reach Health Communications. The details associated with each category are provided below:

Community Intervention Review and disseminate request for proposals Fund 11 sub-grantees ($58K-$65K) Provide technical assistance (qtrly workshops) Monitor monthly, qtrly, annual Hire external evaluator (annual report) Community Engagement

-10

10

30

50

70

90

110

130

150


One Day Conference


10 10 10 1010 10 10 1010 10 10 10

0123456789

10


Surveillance & Evaluation


10

RFP workshop Provide continuous monitoring of sub-grantees Conduct community assessment (gaps) Engage stakeholders (outcome eval plan)

Educating Key Decision Makers Inform Advisory Board about MISRGO successes Report monthly to TPCP on work plan activities Disseminate findings and evaluation reports to Advisory Board Utilize findings to educate and improve perform Mass-Reach Health Communications Collaborate with media consultant - promote sub Submit write up to ADH for TPCP Times Newsletter Submit success stories to TPP for reports

This list of key activities represents MISRGO’s road map to accomplish its larger goals and objectives. They have made progress in the following areas during the first and second quarter: 1) fund 11 sub-grantees ($58K-$65K); 2) provide technical assistance (qtr workshops); 3) monitor monthly, quarterly; 4) hire external evaluator; 5) provide continuous monitoring of sub-grantees; 6) engage stakeholders (outcome eval plan); 7) inform Advisory Board about MISRGO successes; 8) report monthly to TPCP on work plan activities; 9) inform Advisor Board about MISRGO successes; 10) disseminate findings and evaluation reports to Advisory Board; and 11) utilize findings to educate and improve perform. MISRGO has made less progress in the areas of: 1) conduct community assessment (gaps); 2) collaborate with media consultant - promote sub; 3) submit write up to ADH for TPCP Times Newsletter; and 4) submit success stories to TPP for reports. The remaining activities are planned for the next two quarters.

11

See Appendix B for a log of the frequency of activities designed to accomplish MISRGO/MISRGO grantee goals.

0

1

2

Community In

terve

nt ion

Fund 1

3 sub-g

rantee

s ($58K-$

65K)

(11…

Review and

disseminate

reque

st for…

Provide te

chnica

l assis

tance

(qrt works

hops)

Monito

r monthly,

qtrly, a

nnual

Hire exte

rnal eval

uator (a

nnual repo

rt)

Community En

gagement

RFP W

orkshop

Provide co

ntinuou

s monit

oring o

f sub

-…

Conduct

community

asses

sment

(gaps)

Enga

ge sta

kehold

ers (outc

ome eval pl

an)

Educat

ing Key

Decisio

n Make

rs

Inform Advis

or Board

about M

ISRGO…

Report m

onthly t

o TPC

P on work

plan…

Dissem

inate fin

dings an

d eval

reports

to…

Utilize

findin

gs to ed

ucate and

improve

…

Mass-Reac

h Health

Communicatio

ns

Collabora

te with

med

ia consulta

nt -…

Submit w

ri te u

p to ADH fo

r TPC

P Times…

Submit s

uccess

storie

s to TP

P for re

ports

MISRGO Surveillance & Evaluation

YES NO

12

MISRGO Grantee Intervention Areas MISRGO grantees also adhere to the Centers for Disease Control and Prevention’s (CDC) approved and recommended intervention areas. They include:

Area 1: Eliminate Exposure to Secondhand Smoke Area 2: Preventing Initiation Among Youth and Young Adults Area 3: Promoting Quitting Among Youth and Adults Area 4: Addressing Disparities

As discussed earlier, grantee progress and activities are reported on both a quarterly and annual basis, according to these CDC intervention areas. 2nd Quarter Findings 100% of MISRGO grantees established their goals, milestones, and baselines for the year. Between 20% and 70%2 of the grantees have met or exceeded their quarterly milestones.

2 This figure excludes grantees meeting milestones set at 0%, which were used for planning purposes.

50%

70%

50%

20%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Eliminating Exposure Preventing Initiation Promoting Quiting AddressingDisparities

% Grantees Meeting or Exceeding Milestone

Intervention Area % Met/Exceeded Milestones

1. Eliminating 50% 2. Preventing 75% 3. Promoting 50% 4. Addressing 20%

13

CDC Area 1: Eliminate Exposure to Secondhand Smoke 100% of the grantees developed and use their 1st and 2nd Quarter evaluation dashboards. 50% have met or exceeded their quarterly milestones concerning Area 1: Eliminate Exposure to Secondhand Smoke. Granteeactivitiesfocusedon:

• Encourage voluntary smoke-free perimeter policies • Increase number of businesses with voluntary tobacco-free policies • Help establish smoke-free park policies • Encourage tobacco-free policies, including vape products • Implement anti-smoking media campaigns (via radio, social media and television) • Promote smoke-free home and car campaign • Educate about the impact of marketing strategies • Educate about the benefits of smoke free environments in the car (ACT 811) and

in the home • Conduct operation storefront/STARTS surveys • Organize tobacco free workshops/coalition meetings • Educating faith-based organizations about the usefulness of adopting a tobacco-

free policy CDC Area 2: Preventing Initiation Among Youth and Young Adults 100% of the grantees developed and use their 1st and 2nd Quarter evaluation dashboards. 70% have met or exceeded their quarterly milestones concerning Area 2: Preventing Initiation Among Youth and Young Adults. Grantee activities focused on:

• Encourage increase tax on tobacco products • Increase number of voluntary smoke/tobacco free policies • Conduct National Tobacco Control Observation Events • Conduct Operation Store Front/STARS surveys

45% 45%

64% 64%50%

70%

50%

20%

0%

20%

40%

60%

80%

100%

Eliminating Exposure Preventing Initiation Promoting Quiting AddressingDisparities

% Comparison of 1st and 2nd QuaartersGrantees Meeting or Exceeding Milestones

1st Qtr 2nd Qtr

14

• Use media, include radio campaigns, social media (such as Facebook) and promotions, to inform youth about dangers of smoking

• Educate minority youth about the effects of smoking (African American and Hispanic youth)

• Help to implement point of purchase policy • Decrease tobacco chewing • Educate youth about benefits of increasing legal age (concerning purchase) • Educate tobacco retailers on the benefits of being responsible retailers • Encourage youth to pledge to be tobacco free • Train youth to be tobacco prevention advocates, strategies include use of media

outreach and youth rallies • Use media to educate about prevention strategies • Participate in youth related events such as Red Ribbon Week, Kick Butts Day, and

school health fairs to educate on the dangers of tobacco and nicotine

CDC Area 3: Promoting Quitting Among Youth and Adults 100% of the grantees developed and use their 1st and 2nd Quarter evaluation dashboards. 50% have met or exceeded their quarterly milestones concerning Area 3: Promoting Quitting. Grantee activities focused on:

• Encourage use of Arkansas Quit-line Fax Referral System • Encourage youth to pledge to quit • Work with churches, schools and peers to help friends quit smoking • Use media to promote pro-health messages (social media and websites) • Increase social support concerning eliminating tobacco use • Partner with community organizations to host or take part in events,

presentations, and/or activities to help people quit smoking • Helpincreasethenumberofparticipantsincessationprograms• Educate through radio/social media and print about the dangers of tobacco

products • Educate people about cessation services • Present information (tobacco facts) concerning the effects of tobacco • Encourage people to participate in the established cessation programs • Educate about the dangers of tobacco through evidence-based strategies • Educate about cessation services using surveys, education activities, and media

outreach • Engage local grassroots advocates and health professionals to educate

community residents on the health benefits of tobacco-free homes • Conduct outreach such as, workshops, trainings, lunch & learns, prevention

banquets, and barbershop wellness events to inform on the perils of secondhand and third-hand smoke exposure

15

• Encourage adults to adopt a tobacco-free home policy • Educate, mobilize, and equip youth to design/develop and implement tobacco

control activities

CDC Area 4: Addressing Disparities 100% of the grantees developed and use their 1st and 2nd Quarter evaluation dashboards. 20% have met or exceeded their quarterly milestones concerning Area 4: Addressing Disparities. Granteeactivitiesfocusedon:

• Provide information about dangers of tobacco use and secondhand smoke and the importance of tobacco laws

• Encourage minority community members to call and enroll with the Arkansas Tobacco Quitline

• Help increase the number of voluntary smoke-free home policies • Encourage people to make smoke-free home pledges • Help to increase knowledge about tobacco policies and regulations regarding

youth • Conduct media campaigns to increase awareness of tobacco dangers and tobacco

industry advertising tactics using radio, social media, billboards, and flyers (disproportionately targeting minorities)

• Educate about the hazards of secondhand smoke through a radio, print, and social media campaign (focusing on African American males)

• Educate tobacco retailers about the laws associated with selling tobacco to underage minority youth

• Encourage smoke-free policy or point of purchase policy to reduce advertising to youth and disparity groups

• Encourage health care providers to talk with minority patients about the dangers of tobacco, encourage their patients to quit, and refer them to the Quitline.

• Participate in community events with a large African-American presence to promote quitting and introduce available cessation services, including the Fax Referral System

• Conduct STARS surveys at tobacco retail establishments to determine how minorities are being targeted in order to tailor counter marketing to minorities

• Contact minority owned daycare centers, and places of worship in targeted zip codes that do not have a tobacco free perimeter policy in place

• Contact faith-based leaders and discuss the benefits of tobacco-free holy grounds • Enlist additional facilities that promote tobacco prevention strategies • Increase media communication concerning tobacco prevention • Increase tobacco-free home/car pledges

Grantees maintain an evaluation dashboard, consisting of baseline, goal, milestone, and actual performance data, presented later. It helps them monitor their own performance

16

and facilitates technical assistance efforts. The MISRGO Grantee Activity Log provides an additional insight into the list of grantee activities across sites and intervention areas (Appendix B). Technical Assistance MISRGO receives evaluation technical assistance throughout the year, including assistance monitoring and evaluating their progress. For example, during the 1st quarter, Fetterman & Associates drafted the MISRGO evaluation dashboard. Fetterman & Associates also provided grantees with guidance concerning the development of their evaluation dashboards. During the 1st and 2nd quarters, Fetterman & Associates helped grantees prepare their dashboards, ensuring figures were cumulative, evidence supported figures, numbers rather than percentages were used, etc. In addition, Fetterman & Associates helped grantees as they thought about mid-course corrections and changes. They also disseminated useful information about smoking statistics, resources, and upcoming concerns. Workshops. Previous technical assistance workshops focused on: 1) facilitating dialogue to problem solve; 2) sharing tobacco prevention resources; 3) highlighting challenges, such as E-cigarettes; and 4) refreshers concerning the development of evaluation dashboards. (See also Fetterman, 2015 for details concerning approaches to establishing financial stability and sustainability.)

Dialogue. During empowerment evaluation workshops, grantees openly discuss obstacles and generously share advice and best practices, based on their own experience.

17

These opportunities promote networking and sharing information, build programmatic and evaluation capacity, and solve common problems. Tobacco Prevention Resources. The evaluation resources shared with the grantees included: Campaign for Tobacco-Free Kids; County Health Ranking; County Health Calculator; Arkansas Department of Health; CDC State Tobacco Activities, Tracking, and Evaluation System; as well as the MISRGO Evaluation blog.

In addition, a chapter about 10 years of MISRGO tobacco prevention evaluation was distributed and discussed. The title is “Empowerment Evaluation and Evaluation Capacity building in a 10-Year Tobacco Prevention Initiative. It was published in: Fetterman, D.M., Kaftarian, S. and Wandersman, A. (2015) Empowerment Evaluation: Knowledge and Tools for Self-assessment, Evaluation Capacity Building, and Accountability. Thousand Oaks, CA: Sage.

18

Grantees are provided with additional tobacco prevention tools and updates to facilitate their programmatic and evaluative efforts. (See Appendix C for an example of a periodic technical assistance communication, including E-cigarette usage.) Evaluation Dashboards. Grantees participated in both face-to-face training and webinars in previous years focusing on the use of evaluation dashboards, specifically to monitor their own progress throughout the year. The exercise highlighted the value of establishing goals, milestones, and baselines. Once established, only the actual performance measures were needed throughout the year – comparing actual performance with milestones and goals to determine if adequate progress has been made.

Evaluation team members also use these evaluation dashboards to enhance accountability, signaling precisely when assistance is required to increase the probability of MISRGO and their grantees accomplishing their end-of-year goals. The evaluation dashboards are designed to build capacity and produce outcomes. They are in accordance with an empowerment evaluation approach. (Fetterman and Wandersman, 2005; Fetterman, Kaftarian, and Wandersman, 2015; Fetterman & Ravitz, 2017; and Fetterman, 2013 and Fetterman, Rodríguez-Campos, Zukoski, and Contributors, 2018, p. 85.) Tobacco Related Information and Challenges Shared: E-cigarette Example. One type of update provided by Fetterman & Associates during the year is E-cigarette trends. For example, Fetterman & Associates posted relevant CDC findings. They have found that: “E-cigarette use tripled among middle and high school students in just one year” (CDC, 2015). The FDA and World Health Organization have called for stricter regulation of E-cigarettes. The E-cigarette has been discussed at previous workshops to better prepare grantees for the next wave of tobacco prevention work. Recently, science updates concerning the use of heated devices (heats solid tobacco instead of e-liquid), as well as vaping have been shared with grantees. [E-cigarettes have been identified as the basis for stalls in the decline of youth smoking statistics.] [See Appendix C.]

19

Dissemination Fetterman & Associates keep MISRGO and grantees informed of preliminary results, technical assistance opportunities, and updates on tobacco prevention news initiatives, and trends nationally and internationally. The MISRGO tobacco prevention blog is one of the outlets for this information.

In addition, Fetterman & Associates present MISRGO evaluation findings at various professional association meetings, including American Public Health Association and American Evaluation Association. Additional details concerning evaluation technical assistance are provided on the MISRGO tobacco prevention evaluation blog at: http://tobaccoprevention.blogspot.com Conclusion MISRGO adheres to CDC recommended intervention areas, specifically:

• DecreasingInitiationofTobaccoAmongYouthandYoungAdults(CDCarea2)

• DecreaseExposuretoSecondHandSmoke(CDCarea1)• DecreaseTobaccoUseAmongAdults&Youth(CDCarea3)• SurveillanceandEvaluation(CDCarea1,2,3,and4)

MISRGO is engaged in key activities designed to contribute to their CDC aligned interventions. The activities are categorized as follows: Community Interventions, Community Engagement, Educating Key Decision-makers, and Mass-Reach Health Communications. This report presents their progress in each area. Monitoring & Assessing Performance. The evaluation dashboard described in this report help MISRGO and grantees monitor and assess their own performance. They include their goals, quarterly milestones, and baselines. In addition, MISRGO and their grantees have compared their anticipated quarterly milestones with their actual performance.

20

They are being used to confirm effective performance and alert MISRGO, Fetterman & Associates, and other grantees concerning the need for course corrections throughout the year. In Sum. The findings in this report can be highlighted in the following manner: First, MISRGO and 100% of their grantees have constructed and use their evaluation dashboards. Second, MISRGO’s most significant accomplishment in the 1st quarter was funding the 10 grantees. This enabled them to activate and implement their plans, representing a significant part of MISRGO’s intervention efforts. Grantees. Between 20% and 70% of the grantees have met or exceeded their quarterly milestones (as measured and documented by these evaluation dashboards). This compares with a range of 45% to 64% last quarter. This measurement represents a window into their progress. It also provides them with an opportunity to reflect on their performance and make mid-course changes as needed. The evaluation findings reported in this 2nd quarter evaluation report provide evidence of MISRGO and grantee dedication and commitment, concerning tobacco prevention. They represent the evaluation foundation that will guide them throughout the year and help them accomplish their goals.

References

ArkansasDepartmentofHealth(2009).TobaccoPreventionandCessationProgramARKANSASSTRATEGICPLANTOPREVENTANDREDUCETOBACCOUSE2009–2014.LittleRock,Arkansas:ArkansasDepartmentofHealth,p.3.http://www.healthy.arkansas.gov/programsServices/tobaccoprevent/Documents/TPCPStrategicPlan.pdfCampaignforTobaccoFreeKids(2017).TheTollofTobaccoinArkansas.DeathsinArkansasfromSmoking.https://www.tobaccofreekids.org/problem/toll-us/arkansasCampaignforTobaccoFreeKids(2017).AnnualhealthcarecostsinArkansasdirectlycausedbysmoking.http://www.tobaccofreekids.org/facts_issues/toll_us/arkansasCentersforDiseaseControlandPrevention(2018).ExtinguishingtheTobaccoEpidemic.PublicHealthResponsetoTobaccoUseinArkansas.OfficeonSmokingandHealth,NationalCenterforChronicDiseasePreventionandHealthPromotion.https://www.cdc.gov/tobacco/about/osh/state-fact-sheets/arkansas/

21

CentersforDiseaseControlandPrevention(2017).Helpingpeoplequittobacco.Centers for Disease Control and Prevention, Office of the Associate Director for Policy. https://www.cdc.gov/policy/hst/hi5/tobaccointerventions/index.html CentersforDiseaseControlandPrevention(2015).E-cigaretteusetriplesamongmiddleandhighschoolstudentsinjustoneyearhttp://www.cdc.gov/media/releases/2015/p0416-e-cigarette-use.htmlCentersforDiseaseControlandPreventionNationalCenterforChronicDiseasePreventionandHealthPromotion(2014).TobaccoUse.TargetingtheNation’sLeadingKiller-AtAGlance2011.Atlanta,Georgia:CentersforDiseaseControlandPrevention.http://www.cdc.gov/chronicdisease/resources/publications/aag/osh.htm.Seealso:http://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2011/Tobacco_AAG_2011_508.pdfCentersforDiseaseControlandPrevention.PreventionStatusReport,2013.http://www.cdc.gov/psr/tobacco/2013/ar-tobacco.pdf Fetterman, D.M. (2013). Empowerment Evaluation in the Digital Villages: Hewlett-Packard’s $15 Million Race Toward Social Justice. Stanford: Stanford University Press. Fetterman, D.M. and Delaney, L. (2018). MISRGO Empowerment Evaluation Annual Report 2017-2018. San Jose: Fetterman & Associates. Fetterman, D.M. and Delaney, L. (2017). MISRGO Empowerment Evaluation Annual Report 2016-2017. San Jose: Fetterman & Associates. Fetterman, D.M. and Delaney, L. (2016). MISRGO Empowerment Evaluation Annual Report 2015-2016. San Jose: Fetterman & Associates. Fetterman, D.M. (2015). MISRGO: Sustainability Report (Empowerment Evaluation Workshop). San Jose: Fetterman & Associates. Fetterman, D.M. and Delaney, L. (2015). MISRGO Empowerment Evaluation Annual Report 2014-2015. San Jose: Fetterman & Associates. Fetterman, D.M., Delaney, L., Triana-Tremain, B., and Evans-Lee, M. (2014). Empowerment Evaluation and Capacity Building in a 10-Year Tobacco Prevention Initiative. In Fetterman, D.M., Kaftarian, S., and Wandersman, A. (eds). Empowerment Evaluation: Knowledge and Tools for Self-assessment, Evaluation Capacity Building, and Accountability. Thousand Oaks, CA: Sage. Fetterman, D.M., Delaney, L., and Tremain, B. MISRGO Evaluation Annual Report 2013-2014. San Jose: Fetterman & Associates (July 11, 2014).

22

Fetterman, D., Delaney, L., Tremain, B. (2013a). MISRGO Evaluation Annual Report 2012-2013. San Jose: Fetterman & Associates (July 18, 2013). Fetterman, D.M., Delaney, L., and Tremain, B. (2013b). MISRGO Evaluation 2nd Quarter Progress Report 2013. San Jose: Fetterman & Associates. Fetterman, D.M., Delaney, L., and Tremain, B. (2013c). MISRGO Evaluation 3rd Quarter Progress Report 2013. San Jose: Fetterman & Associates. Fetterman, D.M., Kaftarian, S., and Wandersman, A. (2015). Empowerment Evaluation: Knowledge and Tools for Self-assessment, Evaluation Capacity Building, and Accountability. Thousand Oaks, CA: Sage. Fetterman, D.M. and Ravitz, J. (2017). A Google Enhanced Empowerment Evaluation Approach in a Graduate School Program. In Fetterman, D.M., Rodriguez-Campos, and Zukoski, A. (eds.). Collaborative, Participatory, and Empowerment Evaluation: Stakeholder Involvement Approaches. New York: Guilford Press. Fetterman, D.M., Rodríguez-Campos, L., Zukoski, A.P., and Contributors (2018). Collaborative, Participatory, and Empowerment: Stakeholder Involvement Approaches. New York: Guilford Press. Fetterman, D.M., Tremain, B., and Delaney, L. (2012). MISRGO Evaluation Annual Report 2011-2-12. July 12, 2012. San Jose: Fetterman & Associates. Fetterman, D.M., Tremain, B., and Delaney, L. (2011). MISRGO Empowerment Evaluation: June 2011 Annual Report. San Jose: Fetterman & Associates. Fetterman, D.M. and Wandersman, A. (2005). Empowerment Evaluation Principles in Practice. New York: Guilford Publication.

23

Appendix A

Glossary of Grantee Names

Arkansas Human Development

Brandon House – Arts over Tobacco

Calhoun Heights Community Outreach Inc.

Coalition for a Tobacco Free Arkansas

Family & Youth Enrichment Network, Inc.

Future Builders, Inc.

Legacy Initiatives

Madison County Health Coalition

St. Francis House NWA, Inc.

Women’s Council on African American Affairs

24

Appendix B

25

Appendix C

Sample of Technical Assistance Emails

Below are a few articles sent to MISRGO and grantees, concerning cigarette policy:

MISRGO Evaluation: Tobacco Prevention & Cessation News Related Heating Device and Vaping Focus

February 15, 2019

NEWS Fetterman & Associates periodically provides MISRGO and MISRGO grantees with science updates concerning tobacco use and prevention. A few highlights about tobacco heating devices and vaping are provided below: New Heated Device and Vaping – All Toxic to Human Lung Cells

Date: February 11, 2019 Source: European Lung Foundation URL: https://www.sciencedaily.com/releases/2019/02/190211083119.htm Summary: A new study that directly compares new heated tobacco devices with vaping and traditional cigarettes shows that all three are toxic to human lung cells. The study published in ERJ Open Research suggests that the new device, which heats solid tobacco instead of an e-liquid, is no less toxic to the cells than ordinary cigarette smoke. Researchers say the study adds to evidence that these newer electronic nicotine delivery devices may not be a safer substitute for cigarette smoking. The study was led by Dr. Pawan Sharma, a researcher at the University of Technology Sydney and the Woolcock Institute of Medical Research, Sydney, Australia.

26

e-Cigarettes Responsible for Stalls in Decline of Youth Smoking Statistics

Medical Press Date: February 11, 2019 Source: Medical Xpress 2011 - 2019 powered by Science X Network URL: https://medicalxpress.com/news/2019-02-youth-decline-stalls-vaping-blame.html Summary: e-cigarettes in part responsible for stall in decline of youth smoking statistics In this Tuesday, Dec. 10, 2002 file photo, a high school junior holds a cigarette as another high school student takes a drag in Lawrence, Kan. The smoking rate among U.S. high school and middle school students has been flat for three years now, after a fairly steady decline for nearly two decades, according to new numbers released Monday, Feb. 11, 2019. (Thad Allender/The Lawrence Journal-World via AP) Cigarette smoking rates have stopped falling among U.S. kids, and health officials believe youth vaping is responsible.

For decades, the percentage of high school and middle school students who smoked cigarettes had been declining fairly steadily. For the past three years, it has flattened, according to new numbers released Monday.

There may be several reasons, but a recent boom in vaping is the most likely explanation, said Brian King of the Centers for Disease Control and Prevention.

"We were making progress, and now you have the introduction of a product that is heavily popular among youth that has completely erased that progress," King said.

What do we really know about vaping? Date: February 12, 2019 Source: Medical Express URL: https://medicalxpress.com/news/2019-02-e-cigarettes-vaping.html Summary: e-Cigarettes – less harmful isn’t not harmful

27

E-cigarettes get teenagers hooked on nicotine. Or they aid cigarette smokers seeking to quit. Or they may be harmful in other ways. Those competing messages make the devices a tricky subject for health communicators, says Cabral Bigman, a professor of communication at Illinois whose research focuses on health communication issues around vaping. She spoke with News Bureau social sciences editor Craig Chamberlain. What does the research say regarding public attitudes or beliefs around e-cigarettes? And how do those jibe with what we know? Some people see the risks from vaping as similar to, or even greater than, smoking. However, it is more common for people to think that vaping or exposure to secondhand vapor is less harmful. Current research suggests that vaping is less harmful overall than smoking. But less harmful doesn't necessarily mean no harm. The truth is that there isn't yet a good sense of the long-term effects of vaping or exposure to secondhand vapor or aerosol. The science is still evolving. Some experts see e-cigarettes as a promising harm-reduction strategy for smokers. There is emerging evidence that under certain circumstances e-cigarettes may help with quitting smoking. One example is a U.K. study published in January in The New England Journal of Medicine, which found that counseling combined with the use of e-cigarettes was more effective than other nicotine-replacement methods combined with counseling. However, it is worth noting that the U.S. Food and Drug Administration has not specifically approved e-cigarettes for quitting smoking; there are alternative nicotine-replacement strategies that have a more established track record. In the U.K. study, most of the people who quit smoking with e-cigarettes were still vaping when researchers followed up with them a year later. That wasn't the case for the other methods. So there may be risks and benefits to using e-cigarettes for this purpose.

28

POLICY: PRICE INCREASE AND RAISING SMOKING AGE

20% more Smokers quit after $1 Price Increase (New York Times) https://www.nytimes.com/2017/08/23/well/live/20-percent-more-smokers-quit-after-1-price-increase.html?rref=collection%2Ftimestopic%2FSmoking%20and%20Tobacco&action=click&contentCollection=timestopics&region=stream&module=stream_unit&version=latest&contentPlacement=6&pgtype=collection Maine Raises Smoking Age to 21 After Lawmakers Override Veto https://www.nytimes.com/2017/08/02/us/maine-law-tobacco-age.html?rref=collection%2Ftimestopic%2FSmoking%20and%20Tobacco&action=click&contentCollection=timestopics&region=stream&module=stream_unit&version=latest&contentPlacement=9&pgtype=collection

E-CIGARETTES Backgrounder on WHO report on regulation of e-cigarettes and similar products http://www.who.int/nmh/events/2014/backgrounder-e-cigarettes/en/ E-cigaretteusetriplesamongmiddleandhighschoolstudentsinjustoneyearhttp://www.cdc.gov/media/releases/2015/p0416-e-cigarette-use.html

Electroniccigarettes(e-cigarettes)orelectronicnicotinedeliverysystems http://www.who.int/tobacco/communications/statements/eletronic_cigarettes/en/ Health risks of e-cigarettes emerge https://www.sciencenews.org/article/health-risks-e-cigarettes-emerge Difference between tobacco and nicotine, pipe smoking and cigarette smoking, use of menthol cigarettes, and so on http://www.smokehelp.org/html/safe_tobacco.html

29

iSeeCDCsite:http://www.cdc.gov/psr/tobacco/2013/ar-tobacco.pdfandCampaignforTobaccoFreeKids:http://www.tobaccofreekids.org/microsites/statereport2016/arkansas.html