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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.
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.