Background: Smokefree legislation is just one of a number of tobacco control policies introduced in the UK in the last decade in an attempt to curb the harm caused by smoking. Whilst such legislation is known to have reduced non-smokers' exposure to environmental tobacco smoke, less is known about whether the introduction of a smoking ban encourages existing smokers to attempt to quit and to seek support to do so from appropriate sources such as their general practitioner. High quality data are needed to evaluate the effectiveness of legislation in prompting smokers to change their smoking behaviour, and data collected routinely in primary care may provide such an opportunity. However, there is little contemporary evidence about the quality of the smoking data recorded in primary care, nor how best to analyse these data, which must be addressed before the resource can be used to evaluate the effectiveness of tobacco control policies. Methods: Initially, a systematic review was undertaken to assess the impact of national comprehensive smokefree legislation on population smoking prevalence, cigarette consumption and quitting behaviour. Then, the quality of smoking status and cessation intervention recording in The Health Improvement Network (THIN) database, a large database of UK primary care records, was investigated using indirect standardisation to compare rates of recording with external data sources. Having identified Autoregressive Integrated Moving Average (ARIMA) interrupted time series analysis as an appropriate method to assess the impact of smokefree legislation on measures of smoking-related clinical activity recorded in THIN data, several sensitivity analyses were untaken to assess the impact of decisions that must be taken during the data analysis process. In the light of this knowledge, ARIMA models were used to investigate changes in the rate of recording of patients' smoking status, delivery of cessation advice, referral of smokers to specialist cessation services and prescribing of smoking cessation medications in the months leading up to, and after, the introduction of smokefree legislation. Results: The findings of the systematic review provide some evidence that in populations where well-enforced, comprehensive smokefree policies have been implemented quitting activity increased in the run up to, and/or following, the introduction of the legislation. Assessment of the quality of the smoking information recorded in THIN showed that the data have improved in recent years, such that the recorded prevalence of smoking is now similar to that reported in national surveys. Some uncertainty does, however, remain about the quality of recording of the delivery of cessation advice or referral of smokers to cessation services. ARIMA modelling highlighted a 6.2% increase in Nicotine Replacement Therapy (NRT) prescribing in the six months before smokefree legislation was introduced in England, and a 13.2% increase in bupropion prescribing in the three months pre-ban. A 5.5% decline in NRT prescribing and a 13.7% decline in bupropion prescribing were seen in the nine months post-legislation, declines which were offset to an extent, but not completely, by prescribing of varenicline which was first available on prescription in December 2006. Similar, though non-statistically significant, patterns were seen in Scotland, Wales and Northern Ireland, where the smaller number of practices in THIN in these countries reduced the power to detect small changes in prescribing. In England, the patterns of change in prescribing did not differ with patient sex, age group, medical history or social class. Conclusions: The improved quality of the smoking data recorded in the THIN dataset suggests that primary care data may be a valuable resource with which to evaluate the effectiveness of tobacco control policies such as smokefree legislation. The significant increases in prescribing of NRT and bupropion in the run-up to the introduction of smokefree legislation in the UK suggest that smokers looking to quit may seek support to do so from primary care, though the decline in rates of prescribing post-legislation suggests that this positive change may not be sustained. This may represent a missed opportunity to maximise the impact of smoking bans by ensuring that smokers are aware of, and indeed access, cessation support available through primary care both before and after legislation is enacted, and should be noted by policy makers planning the introduction of smokefree legislation elsewhere. Ensuring that smokers are aware of, and indeed access, the effective support that is available through primary care to help them quit may be one way to maximise the positive impacts of smokefree legislation and reduce the health and economic burdens of continued tobacco use.

The health and economic costs of tobacco use in military and veteran populations are high. In 2007, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) requested that the Institute of Medicine (IOM) make recommendations on how to reduce tobacco initiation and encourage cessation in both military and veteran populations. In its 2009 report, Combating Tobacco in Military and Veteran Populations, the authoring committee concludes that to prevent tobacco initiation and encourage cessation, both DoD and VA should implement comprehensive tobacco-control programs.

If the United States were to meet the Healthy People 2010 goal of reducing smoking prevalence to 12% among adults and 16% among young people aged 14 through 17 years, more than 7 million premature deaths after 2010 could be prevented. Studies show that investing in state tobacco control programs and implementing effective tobacco control policies significantly reduces cigarette consumption and improves health outcomes. To continue funding state programs, however, legislators, policy makers, and other funders of state programs want to see evidence that the program is effective and that resources are being used wisely. To produce such evidence, state tobacco control programs must evaluate their programs. Good evaluation is the key to persuading policy makers that your program is producing results that will lead to improved health for the community. If good evaluation is key to proving that your program is effective, then selecting the right indicators to measure is key to a good evaluation. That's where this book will help. This publication is a companion to the 2001 publication Introduction to Program Evaluation for Comprehensive Tobacco Control Programs, which is based on the Centers for Disease Control and Prevention's (CDC's) Framework for Program Evaluation. In Introduction to Program Evaluation for Comprehensive Tobacco Control Programs, we discuss in detail the six steps of a good evaluation as they apply to tobacco prevention and control programs: 1. Engage stakeholders. 2. Describe the program. 3. Focus the evaluation. 4. Gather credible evidence. 5. Justify your conclusions. 6. Ensure evaluation findings are used and share lessons learned. This new publication provides information on selecting indicators and linking them to outcomes. In Introduction to Program Evaluation for Comprehensive Tobacco Control Programs, we described how to select indicators to measure program outcomes. We also gave examples of indicators and suggested sources of data on those indicators. This publication goes further. Here we discuss in detail 120 evidence-based key indicators that have been scientifically linked to program outcomes. We also document the evidence that shows the value of using these indicators to measure the progress of a state tobacco control program. To help you make informed choices about which indicators are most suitable for your program, we engaged a panel of experts in the field of tobacco control to rate each indicator on various criteria, including overall quality, resources needed, strength of evaluation evidence, utility, accepted practice, and face validity to policy makers. The ratings will help the reader decide, for example, which indicators can be measured within budget or which indicators are likely to carry the most weight with policy makers. In essence, this publication is a consumer's guide to tobacco control indicators for program managers and evaluators. In this publication we provide examples of data sources and survey questions that evaluators can use to gather data from their programs' target populations. We were particularly careful about our choice of example data sources and survey questions. Most come from commonly used state and national surveys and surveillance systems, and using them will allow managers and evaluators to compare their findings with data from other states and over time.

The "Handbook" covers how the effects of a tobacco control policy are determined, the core constructs for understanding how and why a given policy works, the potential moderator variables to consider when evaluating a given policy and the data sources that might be useful for evaluation. The "Handbook" includes logic models outlining relevant constructs for evaluating the effectiveness of policies on tobacco taxation, smoke-free environments, tobacco product regulations, limits on tobacco marketing communications, product labeling, anti-tobacco public communication campaigns and tobacco use cessation interventions.

The report "Monitoring tobacco use and prevention policies" tracks the status of the tobacco epidemic and interventions to combat it. The report finds that more countries have implemented tobacco control policies, ranging from graphic pack warnings and advertising bans to no smoking areas. About 4.7 billion people - 63% of the world's population - are covered by at least one comprehensive tobacco control measure, which has quadrupled since 2007 when only 1 billion people and 15% of the world's population were covered.

This thesis conducts an intelligent model based analysis to evaluate the effectiveness of tobacco control policies. By using the International Tobacco Control Four Country Survey data, the impact of tobacco control policies on smokers' quitting behaviour is examined in four developed countries: Australia, Canada, the United Kingdom and the United States. A set of intelligent models are developed for predicting smokers' quitting behaviour. The performance of these intelligent models is evaluated in order to select the best intelligent model for analyses. An attribute-based analysis is further conducted to investigate the underlying patterns and identify the factors that have the greatest impact on smokers' plans to quit and their attempts to quit. Four policy drivers identified from the existing motivational attributes include: personal concerns, cigarette price, environmental restrictions and health system encouragement. They can be used to represent tobacco control policies. Outliers in the data are removed to improve the performance of the intelligent models. Results show that the derived policy drivers can fully represent the original attributes based on the performance of intelligent models using these two groups of input attributes. To evaluate the relative degrees of impact of tobacco control policies, hypothetical policy impacted populations are created to examine the variations of the quit attempt rate of smokers. Comparative studies are conducted for offering insightful analyses of impact degrees of tobacco control policies on different groups of smokers across the four countries. Results show that smokers' health concerns and professional advice for quitting are two important factors to encourage quitting behaviour. Smoke-free policies may have a certain impact on increasing the quit attempt rate. In comparison with other tobacco control policies, the effectiveness of increasing cigarette price to reduce tobacco use is weak. Overall, this research establishes a methodological framework for modelling the complex planning process of tobacco control policies. In particular the framework can be used to measure the impact of specific tobacco control policies on smokers' quitting behaviour across the four countries.

The nation has made tremendous progress in reducing tobacco use during the past 40 years. Despite extensive knowledge about successful interventions, however, approximately one-quarter of American adults still smoke. Tobacco-related illnesses and death place a huge burden on our society. Ending the Tobacco Problem generates a blueprint for the nation in the struggle to reduce tobacco use. The report reviews effective prevention and treatment interventions and considers a set of new tobacco control policies for adoption by federal and state governments. Carefully constructed with two distinct parts, the book first provides background information on the history and nature of tobacco use, developing the context for the policy blueprint proposed in the second half of the report. The report documents the extraordinary growth of tobacco use during the first half of the 20th century as well as its subsequent reversal in the mid-1960s (in the wake of findings from the Surgeon General). It also reviews the addictive properties of nicotine, delving into the factors that make it so difficult for people to quit and examines recent trends in tobacco use. In addition, an overview of the development of governmental and nongovernmental tobacco control efforts is provided. After reviewing the ethical grounding of tobacco control, the second half of the book sets forth to present a blueprint for ending the tobacco problem. The book offers broad-reaching recommendations targeting federal, state, local, nonprofit and for-profit entities. This book also identifies the benefits to society when fully implementing effective tobacco control interventions and policies.