Table of contents for Evaluation of the Arkansas tobacco settlement program : progress from program inception to 2004 / Donna O. Farley ... [et al.].

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Table of Contents
Preface	iii
Table of Contents	v
Table of Figures	ix
Table of Tables	xi
Summary	xv
Summary of Performance Through Fiscal Year 2004	xvi
Program Effects on Outcomes	xviii
Common Themes and Issues	xx
Are the Goals in the Act the Correct Goals?	xxv
Recommendations Regarding Program Funding	xxvi
Discussion	xxviii
Acknowledgements	xxix
Chapter 1. Introduction	1
The Master Settlement Agreement	1
Evaluation Approach	3
Chapter 2. History and Policy Context	7
The CHART Process in Arkansas	7
The Arkansas Tobacco Settlement Proceeds Act	8
Appropriations for the Funded Programs	12
The Tobacco Settlement Commission	14
Legislative Audit of the Tobacco Settlement Program	18
Chapter 3. Tobacco Prevention and Cessation Program	21
Expectations Specified in the Initiated Act	21
Program Direction and Operation	21
Performance on Process Indicators Through 2003	26
Analysis of Spending Trends	33
Evaluation of the Program	38
Findings and Recommendations	43
Chapter 4. Arkansas College of Public Health	49
Expectations Specified in the Initiated Act	49
Program Direction and Operation	49
Performance on Process Indicators Through 2003	52
Analysis of Spending Trends	57
Evaluation of the Program	59
Findings and Recommendations	60
Chapter 5. Delta Area Health Education Center	63
Expectations Specified in the Initiated Act	63
Program Direction and Operation	63
Performance on Process Indicators Through 2003	66
Analysis of Spending Trends	69
Evaluation of the Program	72
Findings and Recommendations	74
Chapter 6. Arkansas Aging Initiative	79
Expectations Specified in the Initiated Act	79
Program Direction and Operation	79
Performance on Process Indicators Through 2003	84
Analysis of Spending Trends	88
Evaluation of the Program	92
Findings and Recommendations	93
Chapter 7. Minority Health Initiative	95
Expectations Specified in the Initiated Act	95
Program Direction and Operation	95
Performance on Process Indicators Through 2003	99
Analysis of Spending Trends	104
Evaluation of the Program	106
Findings and Recommendations	110
Chapter 8. Arkansas Biosciences Institute	113
Expectations Specified in the Initiated Act	113
Program Direction and Operation	113
Performance on Process Indicators Through 2003	115
Analysis of Spending Trends	120
Evaluation of the Program	123
Findings and Recommendations	124
Chapter 9. Medicaid Expansion Programs	127
Expectations Specified in the Initiated Act	127
Program Direction and Operation	127
Performance on Process Indicators Through 2003	129
Analysis of Spending Trends	132
Evaluation of the Program	136
Findings and Recommendations	138
Chapter 10. Evaluation of Smoking-Related Outcomes	139
Highlights of Findings on smoking Outcomes	140
Statewide Trends in Smoking Behaviors	142
Discussion of Outcome Analyses by Gallup	154
Comparison to Experiences of Other States	157
Geographic Analyses for ADH Program Outcomes	157
Analysis of Outcomes in the Delta Region	164
Short-Term Health Outcomes	166
Summary	167
Chapter 11. Evaluation of Non-Smoking Outcomes	169
Highlights of Findings on Program Outcomes	170
Analysis of Outcomes for the Delta AHEC	171
Medicaid Outcomes Analysis	172
Arkansas Aging Initiative	178
Summary	180
Chapter 12. Synthesis and Recommendations	181
Summary of Performance Through Fiscal Year 2004	181
Common Themes and Issues	183
Are the Goals in the Act the Correct Goals?	190
Recommendations Regarding Program Funding	197
Continued Evaluation Activities	200
Discussion	201
Appendix A. RAND Evaluation of the Arkansas Tobacco Settlement Program 
Evaluation Methods	203
Appendix B. Initiated Act 1 of 2000 The Tobacco Settlement Proceeds Act	219
Appendix C. Arkansas Department of Health Monitoring the Implementation of the 
CDC's Guidelines for School Health Programs to Prevent Tobacco Use and 
Addictiona	243
Appendix D. DOH Formation and Planning	247
Appendix E. Council on Education for Public Health (CEPH) Review	249
Appendix F. Measures & Markers Report: Start-December 31, 2003 College of 
Public Health	255
Appendix G. Quarterly Expenditures by Center on Aging	267
Appendix H. Measures & Markers Report: Start- December 31, 2003 Arkansas 
Biosciences Institute	271
References	275
Table of Figures
Figure 1.1 Logic Model for Evaluation of the Arkansas Tobacco Settlement Program	4
Figure 2.1 Flow of Master Settlement Funds Received by Arkansas, As Defined in the Tobacco 
Settlement Proceeds Act of 2000	10
Figure 2.2 Distribution of Annual Tobacco Settlement Appropriations Across Funded Programs
	13
Figure 2.3 Quarterly Spending by the Arkansas Tobacco Settlement Commission	17
Figure 3.1 ADH Tobacco Settlement Fund Spending, by Quarter of Fiscal Years	37
Figure 3.2 Percentage of Tobacco Cessation and Prevention Funds Spent on Non-Prevention 
and Cessation Activities	37
Figure 4.1 Trends in Enrollment Distributions by Region	53
Figure 4.2 Student Distribution by Race/Ethnicity	54
Figure 4.3 Service Activity Trends	56
Figure 4.4 COPH Tobacco Settlement Fund Spending, by Quarter of Fiscal Years	58
Figure 4.5 Percentage of Spending from Tobacco Settlement Funds and Other Funds by Fiscal 
Year	59
Figure 5.1 Encounter Rates for Selected Delta AHEC Programs	68
Figure 5.2 Delta AHEC Tobacco Settlement Fund Spending, by Quarter of Fiscal Years	72
Figure 5.3 Percentage of Delta AHEC Budget from Tobacco Settlement Funds, by Fiscal Year
	72
Figure 6.1 Quarterly Expenditures by Aging Initiative	92
Figure 7.1 AMHC Tobacco Settlement Fund Spending, by Quarter of Fiscal Years	106
Figure 8.1 ABI and Extramural Funding for ABI Faculty Research	119
Figure 9.1 Medicaid Expansion Program Spending, Sum of Tobacco Settlement Funds and 
Federal Matching Funds, by Program Office, by Quarter of Fiscal Years	135
Figure 9.2 Spending by the Medicaid Expansion Program, Sum of Tobacco Settlement Funds 
and Federal Matching Funds, by Program, by Quarter	136
Figure 10.1 Conceptual Model of Behavioral Responses for Smoking Cessation	143
Figure 10.2 Percentage of Adults in Arkansas who Smoke, 1996 through 2003	145
Figure 10.3 Percentage of Adults Age 18 and Over in Arkansas who Smoke, Adjusted for 
Changes in Survey Sample Demographic Characteristics	145
Figure 10.4 Number of Packs of Cigarettes Sold per Arkansan, Age Fifteen and Older	147
Figure 10.5 Percentage of Pregnant Women in Arkansas who Smoke, 1995 through 2003	148
Figure 10.6 Adjusted Pregnant Women Smoking Prevalence in Arkansas, Adjusted for 
Demographic Changes, 1995 through 2003	149
Figure 10.7 Youth Smoking Rate, Unadjusted and Adjusted for Demographic Changes, 1995 
through 2003	152
Figure 10.8 Adjusted Prevalence of Smokers for Young Adults in Arkansas, adjusted for 
demographic changes, Age 18 to 25 years, 1996 through 2003	152
Figure 10.9 Adjusted Prevalence of Smokers for Pregnant Teens in Arkansas, adjusted for 
demographic changes, Ages 11 through 18, 1995 through 2003	153
Figure 10.10 Compliance Rates for Not Selling Tobacco Products to Minors, FFY 1997 through 
FFY 2004	154
Figure 10.11 Spending per capita for the ADH Tobacco Prevention and Education Program 
Community Grants, School Grants, and Sponsorship Awards, January 2001 / June 2004
	160
Figure 10.12 Smoking Trends among Pregnant Women by Tobacco Prevention and Cessation 
County Funding Levels	162
Figure 10.13 Tobacco Control Board Inspections per 1,000 residents by AHEC Region, April, 
2002 through March, 2004	163
Figure 10.14 Trends in the Percentage of Pregnant Women who Smoke, AFMC Counties and 
Non-AFMC Counties	164
Figure 10.15 Percentage of Adults who Smoke, Arkansas Delta Region, Adjusted for 
Demographic Changes, 1996 through 2003	165
Figure 10.16 Short-Term Health Indicators, Baseline Trends and Early Deviations	167
Figure 11.1 Teen Pregnancy Trends for the Delta Region and the Rest of the State, Ages 15-19, 
1995 through 2003	172
Figure 11.2 Use of Adequate Prenatal Care Visits, for Counties with High and Low Percentages 
of People Eligible for Expanded Medicaid Benefits, Age, Sex and Race Adjusted, 1995 
through 2003.	173
Figure 11.3 Percentage of Elderly With At Least One Avoidable Hospitalization for 
Preventable and Acute conditions, by Counties with High and Low Poverty Rates	177
Figure 11.4 Fraction of Elderly with at Least One Avoidable Hospitalization for Preventable 
and Acute Conditions, Comparison of Counties	179
Figure 11.5 Fraction of Elderly with at Least One Avoidable Hospitalization for Preventable 
and Acute Conditions, Four Counties with COAs	180
Figure 12.1 Health Problems of Older Adults	192
Figure 12.2 Priority Health Needs of Older Adults	192
Figure 12.3 Population Density for Arkansas Counties, Census 2000	193
Figure 12.4 Number of Physicians Serving Arkansas Counties	194
Table of Tables
Table 2.1 Appropriations for the Programs Supported by the Tobacco Settlement Funds	13
Table 2.2 Appropriations for the Tobacco Settlement Commission	16
Table 2.3 Actual Spending by the Arkansas Tobacco Settlement Commission, Fiscal Year 2003 
and First Half of 2004	16
Table 2.4 Community Grants Awarded by the ATSC in 2003	18
Table 3.1 Community Changes for Tobacco Prevention	27
Table 3.2 Implementation of the CDC-Recommended Approaches for Tobacco Prevention 
Education by ADH Educational Cooperatives, As Of December 2003	29
Table 3.3 Compliance Checks of Stores by the Arkansas Tobacco Control Board	30
Table 3.4 Enrollments and Quit Rates for ADH Tobacco Cessation Programs	31
Table 3.5 Media and Community Events for Tobacco Prevention and Cessation	32
Table 3.6 Media Advertisement Costs Paid by the ADH and from Donated Funds	32
Table 3.7 Percentage of Survey Respondents Who Reported They Recalled the SOS Media 
Campaign	33
Table 3.8 Tobacco Settlement Funds Appropriated (and Received) for the ADH Tobacco 
Prevention and Cessation Program, by Fiscal Year	35
Table 3.9 Tobacco Settlement Funds Spent by ADH by Fiscal Year	36
Table 3.10 Tobacco Settlement Funds Spent on Tobacco Prevention Programs Compared to 
CDC Guidelines*	38
Table 4.1 Distribution of Students by Region of Origin	53
Table 4.2 Distribution of COPH Students by Race/Ethnicity	54
Table 4.3 Grants Submitted by COPH Faculty	55
Table 4.4 Grant Amounts Funded for COPH Faculty	55
Table 4.5 Papers Published by COPH Faculty	55
Table 4.6 Ongoing Research Projects by COPH Faculty	56
Table 4.7 Service Activities by COPH Faculty to State	56
Table 4.8 Tobacco Settlement Funds Appropriated to the College of Public Health, by Fiscal 
Year	57
Table 4.9 Tobacco Settlement Funds Received and Spent by the COPH, by fiscal Year	58
Table 5.1 Additional Delta AHEC Funding from Grants and Donations	66
Table 5.2 Session Encounter Rates for Delta AHEC Programs	67
Table 5.3 Delta AHEC Training Encounters for Health Care Students and Personnel and 
Number of Students Supported by the AHEC	68
Table 5.4 Primary Care Providers Recruited by the Delta AHEC	69
Table 5.5 Tobacco Settlement Funds Appropriated to the Delta AHEC, by Fiscal Year	70
Table 5.6 Tobacco Settlement Funds Spent by the Delta AHEC, by fiscal Year	70
Table 6.1 Encounters at AAI Classes for Community Members	85
Table 6.2 Encounters at Geriatric Education Center for Health Care Professionals	85
Table 6.3 Encounters at AAI Education for Health and Social Service Students	86
Table 6.4 Post-Graduate Encounters at Geriatric Education Center for Regional Faculty	87
Table 6.5 Educational Encounters for Paraprofessionals and Paraprofessional Students	87
Table 6.6 Tobacco Settlement Funds Appropriated to Arkansas Aging Initiative, by Fiscal Year
	88
Table 6.7 Tobacco Settlement Funds Received and Spent by Each Center on Aging in the 
Arkansas Aging Institute, by Fiscal Year	90
Table 6.8 Tobacco Settlement Funds Received and Spent by Arkansas Aging Initiative by 
Allocation Category and Fiscal Year *	91
Table 7.1 Self-Reported Changes in Daily Dietary Consumption Among Eating and Moving 
Program Participants	98
Table 7.2 Media Communication Events for the Minority Health Initiative	100
Table 7.3 Number of Health Screening Opportunities by AMHC Involvement	101
Table 7.4 Estimated Number of Minorities Screened and Rates of Minority Arkansans 
Screened, by Type of Screening++	102
Table 7.5 Estimated Number of Minorities Screened and Rates of Minority Arkansans Screened 
by Type of Screening at AMHC Sponsored Events++	102
Table 7.6 Registration Rates for Hypertension and Eating-and-Moving Programs	103
Table 7.7 Tobacco Settlement Funds Appropriated to the Minority Health Commission by 
Fiscal Year	105
Table 7.8 Tobacco Settlement Funds Spent by the Minority Health Commission by Fiscal Year
	105
Table 8.1 Number of Projects and Funding Amounts for ABI-Supported Research, by 
Institution and Category of Research	116
Table 8.2 Collaborative Research Projects by ABI Institutions	117
Table 8.3 Portions of ABI and Extramural Funding Being Used for Collaborative Research 
Projects	118
Table 8.4 Amounts of Funding Awarded for ABI Faculty Research	119
Table 8.5 Service and Promotional Activity Encounters by ABI Research	120
Table 8.6 Tobacco Settlement Funds Appropriated to Arkansas Biosciences Institute 
Institutions, by Fiscal Year	121
Table 8.7 Tobacco Settlement Funds Received and Spent by Arkansas Biosciences Institute by 
Fiscal Year	122
Table 8.8 Quarterly Expenditures on Research Projects by ABI Institution	123
Table 9.1 Use of Expanded Pregnancy Medicaid Benefits by Eligible Women	130
Table 9.2 Medicaid Recipients Using Expanded Inpatient Benefits	131
Table 9.3 Eligible Elderly Persons Using Expanded Medicaid Coverage	131
Table 9.4 Appropriations for the Medicaid Expansion Program, Sum of Tobacco Settlement 
Funds and Federal Matching Funds, by Fiscal Year	133
Table 9.5 Spending by the Medicaid Expansion Program, Sum of Tobacco Settlement Funds and 
Federal Matching Funds, by Fiscal Year	134
Table 10.1 Elapsed Times Until Effects of Smoking Control Programs Are Found, Comparison 
of Arkansas to Four Other States	157
Table 10.2 Arkansas Counties by AHEC Region	158
Table 11.1 Percentage of Medicaid and Non-Medicaid Patients with Few Hospital Days by 
Cumulative Days, 1998 through 2003	175
Table 11.2 Cumulative Hospital Days for Patients with Many Days, All patients with 19 or 
more hospital days in the indicated year.	176
Table 11.3 Avoidable Hospitalization Conditions	177
Table 12.1 Summary of Program Status on the Initiation and Short-Term Performance 
Indicators Listed in the Initiated Act	182
Table 12.2 Arkansas Health Issues Addressed by the Tobacco Settlement Programs	196

Library of Congress Subject Headings for this publication:

Public health -- Arkansas.
Health promotion -- Arkansas.
Tobacco industry.
Remedies (Law).
Smoking -- prevention & control -- Arkansas.
Health Policy -- Arkansas.
Health Promotion -- methods -- Arkansas.
Program Evaluation -- Arkansas.
Tobacco Industry -- legislation & jurisprudence -- Arkansas.
Tobacco Use Disorder -- prevention & control -- Arkansas.
Technical Report. mesh.