Evaluation of a statewide educational campaign to build support for a tobacco tax increase in Missouri

Context: To reduce the morbidity/mortality associated with tobacco use, a health foundation in one Mid-western state implemented a 3-pronged strategy for tobacco prevention & cessation: (1) launch an educational campaign to build support for increasing the tobacco tax, (2) support workplace clean air policies & cessation services, and (3) support prevention programs for school-aged youth. Unlike strategies 2 & 3 that are ongoing, strategy 1 was limited to the election cycle that ended in November 2006. Objective: To conduct a process & outcome evaluation of the educational campaign described above. Methods: A comprehensive logic model (inputs, activities, outputs, outcomes) guided the general evaluation approach, development and adoption of the 15 evaluation questions, and specific methods. Approaches used included development of a monitoring system to track coalition building and education/outreach activities; review of campaign materials; media content analysis; a statewide telephone survey using a probability sample at 3 strategic time points; polling data from the accompanying political campaign; and interviews/focus groups of primary stakeholders. Results & Conclusion: Results reported include adequacy of the structure and resources for the campaign; effectiveness of communication among stakeholders; adaptability of the campaign to politics, tobacco industry, etc.; the reach and coverage of the campaign's messages; media response; public awareness and acceptance of campaign messages; and effect of the campaign on public attitudes about support for increased tobacco taxes. While the tobacco tax ballot initiative in this state failed in November 2006, this comprehensive evaluation provides many important lessons learned for current and future efforts.