ASSIST

Evaluating the American Stop Smoking Intervention Study (ASSIST): A Blueprint for Understanding State-Level Tobacco Control

Dr. Frances Stillman is the senior scientific editor of Monograph 17, Evaluating ASSIST: A Blueprint for Understanding State-Level Tobacco Control. Monograph 17 addresses the evaluation framework of the American Stop Smoking Evaluation Study (ASSIST), the details of the ASSIST evaluation, and the results of this effort.

Successes and challenges of the ASSIST evaluation
The American Stop Smoking Intervention Study for Cancer Prevention (ASSIST) was one of the most ambitious, publicly-funded tobacco use prevention and control efforts in history. As a measure of its success, ASSIST interventions were adopted in numerous settings beyond the ASSIST states and tailored to unique state or local conditions.

The inherent complexity of ASSIST presented significant challenges to its evaluators. Unlike standard evaluations that document program processes, implementations and outcomes, the ASSIST evaluation relied on the construction of logic models, use of a network of stakeholders for model validation and development of a prototype knowledge base. A conceptual model showing the relationships between ASSIST interventions, “upstream” changes attributable to ASSIST, and subsequent reductions in tobacco use prevalence guided the evaluation.

Components of the ASSIST evaluation
The ASSIST evaluation required new measures, new national data collection efforts and new methodologies, including:

• the Strength of Tobacco Control (SoTC) index, a measure of a state’s resources for tobacco use prevention and control, including capacity and infrastructure to deliver tobacco control efforts, as well as policy, media and program services toward achieving ASSIST goals
• the Initial Outcome Index (IOI), an aggregate measure requiring new measures of state and local clean, indoor air legislation and state dependence on tobacco growing and manufacturing
• a measure of newspaper coverage of ASSIST policy priority areas
• a measure of tobacco industry efforts to interfere with ASSIST
• state contextual factors affecting tobacco use prevention and control
• development and implementation of the Tobacco Use Supplement to the Current Population Survey
• hierarchical methods to aggregate survey items into single index measures

Conclusions
Many global health problems result from complex interactions between individual behavior, economics, politics, socio-cultural factors and national and international corporate interests. Evaluating multifaceted interventions that can effectively address these problems requires an approach that incorporates these components in context. The framework described in this monograph will be useful in evaluating future tobacco use prevention and control efforts in the United States and around the world. It also serves as a comprehensive resource for those who evaluate other population-based behavioral health or social interventions that, like ASSIST, cannot be evaluated using randomized controlled trial models.

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Visit http://cancer.gov/publications
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Related Publications

Trochim WM, Stillman FA, Clark PI, Schmitt CL. Development of a model of the tobacco industry's interference with tobacco control programmes.Tob Control. 2003 Jun;12(2):140-7. See article

Stillman FA, Hartman AM, Graubard BI, Gilpin EA, Murray DM, Gibson JT. Evaluation of the American Stop Smoking Intervention Study (ASSIST): A report of outcomes.J Natl Cancer Inst. 2003 Nov 19;95(22):1681-91. See article
 
Davis WW, Graubard BI, Hartman AM, Stillman FA. Descriptive methods for evaluation of state-based intervention programs. Eval Rev. 2003 Oct;27(5):506-34. See article

Stillman FA, Cronin KA, Evans WD, Ulasevich A. Can media advocacy influence newspaper coverage of tobacc measuring the effectiveness of the American Stop Smoking Intervention Study's (ASSIST) media advocacy strategies.Tob Control. 2001 Jun;10(2):137-44. See article

Gilpin EA, Stillman FA, Hartman AM, Gibson JT, Pierce JP. Index for US state tobacco control initial outcomes.Am J Epidemiol. 2000 Oct 15;152(8):727-38. See article