Meeting performance management outcomes: Learning from the success of the Synar program

In 1996, the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Prevention (CSAP) introduced the outcomes-based Synar program to prohibit the sale of tobacco to minors. The program requires that States (i.e., all States, District of Columbia, and Territories) (1) have in effect laws prohibiting youth tobacco sales; (2) enforce laws to reduce youth access to tobacco; and (3) conduct annual random, unannounced inspections of tobacco outlets to ensure retailers' compliance with the laws. SAMHSA/CSAP set a 20% target retailer violation rate (RVR) that States must achieve to meet the Synar compliance requirements of the Substance Abuse Prevention and Treatment Block Grant. CSAP, with support from JBS International, Inc., provides statistical and programmatic assistance to States to evaluate, strengthen, and sustain their Synar programs. Each year, States calculate their RVR and assess their compliance; CSAP and JBS review each State's survey sampling design to validate the survey methodology and ensure its fidelity. CSAP and JBS conduct reviews in the States to monitor implementation of each State's Synar program and provide technical assistance to strengthen and sustain State Synar infrastructure and outcomes. This process ensures that States are able to make annual adjustments to meet their outcomes. For more than 10 years, States faced many challenges in implementing their Synar programs but have exceeded their outcomes. When the RVR baseline was established in 1996, the national RVR was reported as 40.1%. In 2006, the national RVR was reported at 10.9%, an almost 30% reduction in merchant noncompliance.