More than 26,000 people die each year as a result of tobacco use in Texas. To lessen the health burden of tobacco, innovative and intensive interventions are urgently needed. The tobacco suit settlement in Texas has led to an allocation of approximately $10 million/yr. for state-level tobacco control. To match per-capita expenditures that have appeared to influence behavior in other major state initiatives, the funds will be concentrated in media, community and policy activities for a single region, involving approximately one-fifth of the state population and forming a "natural" quasi-experimental design. The University of Texas School of Public Health, the Baylor College of Medicine and the Texas Department of Health (TDH) will evaluate these regional activities and investigate their processes and effects in the three major cultural groups in Texas (Anglo-, Hispanic- and African-American). Data sources will include annual telephone surveys of adults (approx. 10,000 year/with 2,200 smokers), biannual surveys of secondary school students (n=15,000/2 years), surveys of physicians, other providers, schools, other organizations and key individuals, media content tracking and other qualitative and quantitative studies to document and evaluate the implementation of media, community and policy activities. In the quasi-experimental regional studies, trends in adult and youth prevalence and related factors will be compared in statewide and regional groups. Tobacco use cessation effects in the intensive regions will be evaluated through comparative panel studies. In an experimental study limited to randomly selected panel participants, some smokers and their families will receive mail-telephone contacts from peer outreach workers to increase exposure and response to media and community activities. The research designs employed in these studies will allow us to answer questions about the effects of different intensive regional interventions on tobacco use prevalence and smoking cessation and the processes and qualitative factors that are associated with the success or failure of different interventions in different ethnic and SES groups. To enhance the quality of intensive regional activities supported by the settlement funds, technical assistance will be provided through training workshops for TDH and its partners and contractors, focusing on effective multi-cultural action and the use of innovative media, community and policy interventions to address specific theoretical variables related to cessation and prevention. A publicity and peer modeling campaign will be conducted to promote individual behavior change and organizational program and policy innovation. This regional project within Texas is designed to gather evidence of effects of anti-smoking expenditures and to provide capacity development to justify later funding of similarly intensive tobacco control activities for the entire state.
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