Program

Infrastructure

in Tobacco Prevention and Control
Acknowledgements

This guide was produced for the Centers for Disease Control and Prevention by the Center for Public 

Health Systems Science (CPHSS) at the Brown School at Washington University in St. Louis. 

Primary contributors:

Stephanie Andersen, Laura Brossart, Sarah Moreland-Russell, Anne Shea, Paige Riegel, Heidi Walsh, Laura Edison, 

Laura Bach, Caitlin Ashby, Rachel Barth, Isaiah Zoschke, Erin Foster

Input was provided by:

Brian Armour, Monica Eischen, Karen Girard, Roy Hart, Sally Herndon, Rene Lavinghouze, Brian King, Chris 

Kissler, Judy Martin, Danny McGoldrick, Jane Moore, Tiffany Netters, Meg Riordan, Karla Sneegas, Deidre Sully, 

Michael Tynan, Renee Wright

Input for the case studies was provided by:

Karen Girard, Oregon State Tobacco Prevention and Education Program

Chris Tholkes, Minnesota Office of Statewide Health Improvement Initiatives 
Table of Contents

Guide to the Reader .................................................................................................................1

Making the Case .......................................................................................................................2

Brief History .............................................................................................................................3

How to .....................................................................................................................................4

What is Program Infrastructure in Tobacco Prevention and Control? ..............................4

Developing Program Infrastructure ..............................................................................6

Responsive Plans and Planning ..........................................................................6

Multilevel Leadership .......................................................................................13

Networked Partnerships ...................................................................................17

Managed Resources .........................................................................................21

Engaged Data ...................................................................................................26

Providing Support ..................................................................................................................31

Case Studies ...........................................................................................................................32

Case for Investment ...............................................................................................................36

Resources ...............................................................................................................................38

References .............................................................................................................................41
Program Infrastructure 

Purpose

The Centers for Disease Control and Prevention’s 

(CDC) Office on Smoking and Health and the Center 

for Public Health Systems Science at Washington 

University in St. Louis are developing a set of user 

guides funded by the Centers for Disease Control 

and Prevention (contract 200-2015-87568) for the 

Best Practices for Comprehensive Tobacco Control 

Programs—2014 (Best Practices 2014).

1

The purpose of the user guides is to help tobacco 

control staff and partners implement evidencebased best practices by translating research into 

practical guidance. The guides focus on strategies 

(e.g., programs and interventions) that have shown 

strong or promising evidence of effectiveness. 

Recommendations in this guide are suggestions for 

programs working to achieve strong infrastructure. 

Programs can follow these recommendations 

according to their needs, goals, and capacity.

Content

This user guide focuses on the critical role of program 

infrastructure in achieving and sustaining tobacco 

prevention and control goals. According to Best Practices 

2014, “program infrastructure is the foundation that 

supports program capacity, implementation, and 

sustainability.”1

 In 2011, CDC developed the Component 

Model of Infrastructure (CMI), an evidence-based model 

that defines infrastructure in practical and actionable 

terms.1,2

 The CMI includes five core components of 

program infrastructure: Responsive Plans and Planning, 

Multilevel Leadership, Networked Partnerships, Managed 

Resources, and Engaged Data. As programs are 

increasingly challenged to secure funding and support, 

building a strong infrastructure becomes even more 

important to sustain programs and achieve goals.2,3

 This 

guide gives program staff and partners information on 

how to begin developing strong program infrastructure.

Links to More Information

Each instance of italicized, bolded blue text in the guide 

indicates a link to an additional resource or a page 

within the guide itself with more information. Website 

addresses for all of the blue resources noted throughout 

the guide are also included in the Resources section.

l 1

GUIDE TO THE READER

Organization

8 Making the Case: A brief overview of why it is 

important for tobacco control programs to develop 

a strong program infrastructure

8 Brief History: How program infrastructure has 

become recognized as a critical foundation for 

tobacco prevention and control efforts

8 How to: Strategies to develop and strengthen 

program infrastructure

8 Providing Support: How tobacco control 

programs can support efforts to develop program 

infrastructure

8 Case Studies: Real-world examples of how 

program infrastructure supports the work of 

tobacco control programs

8 Case for Investment: Information that can 

be used to inform efforts to develop program 

infrastructure

8 Resources: Publications, toolkits, and websites to 

help in infrastructure planning efforts

Best Practices for Comprehensive 

Tobacco Control Programs–20141

The Infrastructure, Administration, and 

Management section in Best Practices 2014

offers recommendations and guidance on 

managing an effective tobacco prevention 

and control program. The section describes 

why it is important for programs to invest 

in strong tobacco control infrastructure, 

explains the Component Model of 

Infrastructure, gives examples of how states 

have put the components into practice, 

and includes budget recommendations for 

developing and maintaining infrastructure.
Program Infrastructure l 2

MAKING THE CASE

Making the Case for Program Infrastructure 

Program infrastructure is the foundation that supports tobacco control program capacity, implementation, and 

sustainability.1

 Investing in a stable foundation is critical for building a strong program, which is vital to achieve 

public health goals. As funding and overall support fluctuate, having a strong infrastructure becomes increasingly 

important to sustain program support and achieve program goals. Learn more about the core components of a 

strong program infrastructure on page 4.

How the Core Components of Infrastructure Support Program Goals

8 Responsive Plans and Planning

Tobacco control program plans help staff and partners develop effective strategies and make wise investments 

of resources.4

 Plans that are revised when new information becomes available or changes in the program’s 

environment occur help programs adapt existing activities and launch new strategies. 

8 Multilevel Leadership

Leadership at multiple levels can extend a program’s reach and leverage resources for tobacco control efforts.2

Leaders within the program contribute expertise and make day-to-day decisions about the program. Leaders of 

other chronic disease programs and partner organizations can help programs work toward common goals.

8 Networked Partnerships

Partnerships bring crucial skills and resources to tobacco control efforts, extending the reach and successes of 

programs.5

 Partnerships help build motivation, achieve goals, reduce risk, and win allies.6

8 Managed Resources

Obtaining, diversifying, and managing resources helps programs implement effective tobacco control strategies, 

even as overall support fluctuates. Developing skilled staff and partners helps avoid knowledge gaps and adapt 

to changing program environments.

8 Engaged Data

Collecting and analyzing data helps staff and partners understand how programs work, improve program 

quality, and make decisions about future activities.1,2

 Data can also help demonstrate effectiveness and 

communicate the importance of comprehensive tobacco control programs to the public.7,8
Program Infrastructure l 3

BRIEF HISTORY

Brief History 

Traditionally, the term infrastructure describes the 

structures that support a society (e.g., roads, bridges, 

and railroads) and help distribute goods and services.9

The term can also describe the many components that 

support an organization’s growth and achievement 

of goals. Infrastructure is the basic underlying 

framework of policies, financial and human resources, 

organizational structures, and communications 

channels that help programs develop and grow.10

The importance of program infrastructure can be easily 

overlooked. Emphasis is often placed on outputs or 

goals instead of building a strong foundation to reach 

those goals.3 Budget constraints have led programs 

to be required to show results and cost-effective 

spending. Because many programs must track dayto-day activities, assess program results, and plan for 

sustainability, developing a strong infrastructure is now 

more important than ever. 

The National Cancer Institute and American Cancer 

Society’s American Stop Smoking Intervention 

Study for Cancer Prevention (ASSIST) was the first 

major federal investment in state tobacco control 

infrastructure. Running from 1991-1999, ASSIST 

combined evidence-based policy strategies and capacity 

building.11 To build capacity, state tobacco control 

programs established coalitions, offered training and 

technical assistance, and shared resources among 

coalition members.12 ASSIST showed that states that 

developed stronger program infrastructure to support 

the implementation of evidence-based strategies had 

lower cigarette consumption.11

The importance of infrastructure for public health 

programs has also been recognized by organizations 

like the Institute of Medicine and the U.S. Department 

of Health and Human Services.13,14 According to 

Healthy People 2020, “Infrastructure is the foundation 

for planning, delivering, and evaluating public 

health.”14 Developing a strong infrastructure helps 

sustain programs in an environment of increasingly 

tight budgets, out-of-date information systems, and 

inadequate staff capacity.13,15

Even the tobacco industry has recognized the 

importance of infrastructure in preventing tobacco 

use initiation and promoting cessation.4

 An internal 

tobacco industry document dating from the early 

1990s described the creation of an anti-smoking 

infrastructure in California as the biggest threat to 

industry interests in the state.16 In response to growing 

recognition of the importance of strong program 

infrastructure, the CDC began encouraging states to 

develop assessment plans and improve infrastructure 

by focusing on building workforce skills, information 

and data systems, and organizational capacity.17

In 2011, the CDC Office on Smoking and Health 

developed the Component Model of Infrastructure 

(CMI) using evaluation data from 18 state tobacco 

control programs.2 Collected over three phases, the 

evaluation explored program infrastructure, capacity, 

progress toward outcomes, and sustainability. 

Development of the model also incorporated a 

literature review of diverse public health program 

infrastructure articles (e.g., asthma, diabetes, oral 

health, physical activity, HIV/AIDS, and mental health) 

and theories such as organizational development, 

sociology, and economics.2,3 The model was refined 

with input from over 400 public health practitioners. 

The CMI includes five core components that make up 

program infrastructure: Responsive Plans and Planning, 

Multilevel Leadership, Networked Partnerships, Managed 

Resources, and Engaged Data. In 2014, the CMI was 

included in the recommendations for comprehensive 

tobacco control programs in Best Practices 2014.

1

“Infrastructure is the foundation 

for planning, delivering, and 

evaluating public health.”

– Healthy People 202014
Program Infrastructure l 4

HOW TO

What is Program 

Infrastructure in Tobacco 

Prevention and Control?

Program infrastructure is the foundation of all tobacco 

control programs.1,2

 Developing a strong infrastructure 

can help achieve public health goals, support program 

capacity and implementation, and sustain programs.1,18

In the Component Model of Infrastructure (CMI), 

program infrastructure has five components:2

• Responsive Plans and Planning

• Multilevel Leadership

• Networked Partnerships

• Managed Resources

• Engaged Data

Figure 1 below illustrates these five core components and 

how they relate to program outcomes and sustainability. 

Figure 1. Component Model of Infrastructure 

Source: Lavinghouze, Snyder, & Rieker2

It also includes other supportive components that

influence program infrastructure, such as Strategic

Understanding, Operations, and Contextual Influences.

2

Understanding how these components affect program

infrastructure is important to develop a strong

foundation for tobacco control programs.

Core Components

Responsive Plans and Planning

Responsive Plans and Planning is the process of creating 

plans that guide the program’s actions and goals. 

Programs often develop multiple plans, including a 

strategic plan, annual work plan, communications 

plan, evaluation plan, and sustainability plan. These 

plans are responsive because they are revised as new 

scientific evidence becomes available or shifts occur 

in the tobacco prevention and control landscape 

(e.g., emerging products).1,2 Responsive Plans can help

develop effective strategies, inform hiring decisions, 

and make wise investments of resources.4
Program Infrastructure l 5

HOW TO

Multilevel Leadership

Multilevel Leadership is the development of leadership 

at all levels that affect a program.2

 Leaders may come 

from within the program (e.g., program staff) and 

outside the program (e.g., from other departments, the 

community, and partner organizations).2 These leaders 

create a vision for the program, inspire staff, and drive 

program success.2,19

Networked Partnerships

Networked Partnerships are diverse, strategic 

relationships made up of partners from different 

levels, organizations, and content areas.2 For instance, 

tobacco control program staff often partner with local, 

state, and regional programs; other chronic disease 

programs; state and national organizations; and federal 

partners, including CDC, to work toward program 

goals. Networked Partnerships work best when they 

are connected to each other and to the program.2

These partnerships help programs build motivation, 

reduce risk, and win allies.6

 By including community 

representatives and populations most affected by 

tobacco use, partnerships will have the diverse 

perspectives that are critical to achieve health equity. 

Managed Resources

Managed Resources are the funding and staff resources 

that are critical to carry out a program. Securing 

multiple funding sources and staff with diverse skills 

helps programs implement effective strategies even 

as budgets and staff levels change. Managing these 

resources effectively includes continuously training 

staff, providing technical assistance to partners, and 

ensuring funding stability, so that losing one funding 

source or staff person does not stop the program from 

making progress toward goals.2

Engaged Data

Engaged Data is data that is used by staff, partners, 

decision makers, and local programs to promote action, 

such as planning and improving tobacco control efforts.1

Programs can use surveillance and evaluation data to 

guide program direction, understand how a program 

works, and make decisions about future activities.1

Sharing data with partners and decision makers can 

build support for programs by demonstrating their 

effectiveness and return on investment.20

Supportive Components

A program’s infrastructure is also affected by outside 

supports and influences. Strategic Understanding is 

the term used to describe the ideas, guidelines, and 

thinking that support the development of program 

infrastructure.2 For example, decision makers and the 

public may not feel that program infrastructure is a 

public health issue. Educating these groups about the 

importance of infrastructure for effective programs 

helps make the case for crucial infrastructure resources. 

Operations includes all of the day-to-day work 

structures used to carry out the program, such as 

clearly defined staff roles and systems to communicate 

with staff and partners.2

 It also includes the structure 

of the agency that houses the program. A strong 

operations structure can help programs coordinate 

activities and manage resources.2

Contextual Influences are the broad cultural, political, 

economic, and social priorities of the environment 

in which the program works.2 For example, the way a 

community views tobacco use and its level of support 

for tobacco control efforts are important influences 

on a program’s success. While these factors are often 

unpredictable and difficult to measure, it is important 

for staff to think about and prepare for how these 

influences may affect their programs.2

Capacity

Capacity is the program’s ability to implement tobacco 

control strategies.1,2 Developing program infrastructure 

builds capacity to take advantage of opportunities and 

defend against threats to achieving program goals.1

 For 

example, it is important for programs to be able to act 

quickly when funding opportunities appear. 

Continued Support

Continued Support is used to describe the resources 

that sustain a fully-functioning program infrastructure. 

It can take many forms and may include financial 

support, technical support, or support from decision 

makers, the media, or the public. Continued support 

is critical to sustain program infrastructure so the 

program can continue to achieve its goals.2
Program Infrastructure l 6

HOW TO

Developing Program 

Infrastructure 

To build a strong foundation for tobacco control 

programs, it is important to develop all five 

infrastructure components.1 Developing the 

components is not a step-by-step process. Building 

infrastructure in one area supports and reinforces the 

development of other areas. Programs that focus on 

developing all of the components are better prepared 

to take advantage of opportunities and defend against 

threats to achieving their goals.1 Table 1 below 

describes ways programs can strengthen each of the 

core components of program infrastructure, which are 

described in more detail throughout this guide. 

Responsive Plans and Planning

Responsive Plans and Planning is the process of creating 

plans that guide the program’s actions and goals.2

 Plans 

lay out the program’s mission, vision, goals, objectives, 

and strategies.21 Staff and partners work together 

to develop plans, creating shared responsibility for 

program activities. Programs often develop multiple 

Responsive Plans, including a strategic plan, annual 

work plan, communications plan, evaluation plan, and 

sustainability plan.

Responsive Plans also evolve over time.2

 They are revised 

to respond to new information and changes in the 

program’s environment and tobacco control landscape, 

such as changes in scientific evidence, health department 

priorities, funding levels, or public support.1,2

Table 1. Example Program Activities for Each Core Infrastructure Component

Core Component Program Activities

Responsive Plans and Planning

Create plans that guide the program’s actions 

and goals.

• Gather and analyze data before planning.

• Develop multiple plans (e.g., strategic plan, communications plan, 

evaluation plan, and sustainability plan).

• Communicate plans to stakeholders and the public.

• Review plans regularly and revise them if needed.

Multilevel Leadership

Develop leadership at all levels that affect the 

program.

• Identify ways leaders can contribute.

• Develop new leaders.

• Adjust leaders’ responsibilities as the environment changes.

Networked Partnerships 

Work with partners from different levels, 

organizations, and content areas.

• Develop purposeful partnerships.

• Partner with diverse stakeholders.

• Engage partners to achieve goals.

• Evaluate partnerships.

Managed Resources

Strengthen funding and staff resources.

• Ensure funding stability.

• Direct funds to strategies with the greatest impact.

• Share positions and resources.

• Communicate program successes.

• Develop staff competencies.

• Train staff and partners.

Engaged Data

Use data to plan and improve program efforts.

• Engage stakeholders in using data.

• Understand the program and choose questions before collecting data.

• Gather credible data.

• Develop conclusions.

• Share results and ensure use.
Program Infrastructure l 7

HOW TO

Developing Responsive Plans takes time and 

resources, but can help program staff select effective 

strategies, make good hiring decisions, and make wise 

investments of resources.4

 Programs with less planning 

experience may want to consider an outside consultant 

to help make the process a success.22

The Importance of Responsive Plans and 

Planning in Program Infrastructure

Responsive Plans are important tools for developing a 

strong program infrastructure. When programs plan 

ahead for how they will support existing activities 

and keep experienced staff if funding changes, they 

make the most of their financial and staff resources 

(or Managed Resources). Developing Responsive Plans

can also help programs identify the resources that are 

critical for gathering Engaged Data, such as staff and 

funding for data collection.

The planning process puts the components of 

infrastructure into action. Planners use Engaged Data to 

decide whether past strategies have been successful or 

whether the program should pursue new ideas. Involving 

Networked Partnerships in planning creates buy-in, 

enthusiasm, and momentum for tobacco control efforts.2

Partners also gain a better understanding of their roles 

and responsibilities to carry out the program.2

 Planners 

can include organizations that have a stake in program 

results and those most affected by tobacco use, such 

as the LGBT community or members of certain racial 

and ethnic groups.23 Asking these partners to define 

their goals for the 

program strengthens 

Responsive Planning

and increases their 

support for the 

program.23

It is also important 

to include Multilevel 

Leaders in planning. 

The knowledge, 

creativity, and talents 

of leaders inside 

and outside the 

program strengthens 

Responsive Plans.

24

Leadership support 

can also encourage 

staff to take planning seriously and make sure that the 

program will have enough resources to carry out the 

plan.25 Once plans are developed, leaders guide how 

plans are carried out, share progress with partners, and 

make sure the program is working toward its goals.

Developing Responsive Plans and Planning

Understanding the Different Plans

When programs begin planning, they often focus on 

creating a strategic plan. Though the strategic plan is 

an important long-term tool that can help staff decide 

the direction of their program, it is not the only plan 

important to program infrastructure. Other program 

plans often draw goals from the strategic plan, but also 

include important goals of their own.2

 Programs often 

develop multiple plans, including:

• Strategic Plan

• Annual Work Plan

• Communications Plan

• Evaluation Plan

• Sustainability Plan

Plans do not have to be developed separately. Developing 

the plans is a continuous, integrated process.
Strategic Plan

The strategic plan sets goals and objectives that 

supports the program’s mission and respond to its 

environment (e.g., available funding and community 

demographics). In tobacco control programs, the 

strategic plan is often called the comprehensive state 

tobacco control plan.1 It describes the problem of 

tobacco use in the state, strategies for addressing the 

problem, the program’s goals and objectives, baseline 

data and benchmarks for progress, and key partners 

who will carry out the plan.26 The strongest plans 

combine state and community partners’ programs, 

goals, and strategies into a single plan and include goals 

and strategies to reduce tobacco-related disparities.27,28

Learn about integrating tobacco control and other 

chronic disease strategic plans on page 10. 

Although the strategic plan lays out a long-term vision 

for the program, it typically covers a specific period of 

time, usually 3 to 5 years.4,22 It is a dynamic document 

that is revised as the program’s priorities, resources, 

or environment change. During the planning process, 

partners and leaders decide which activities can be 

carried out with the program’s current resources 

and which activities could be accomplished if more 

resources become available. Learn more about the 

elements of a strategic plan on page 9.

Program Infrastructure l 8

HOW TO

Annual Work Plan

The annual work plan lists objectives, priority 

populations, activities, start and end dates, and the 

people responsible for carrying out each activity.29 It is 

used by staff to carry out the strategies that the program 

will use to achieve objectives.30 An annual work plan 

is important because organizational and community 

priorities will likely change over the period covered by 

the strategic plan.30

The annual is aligned with the long-term goals, 

objectives, strategies, and timeline that have been 

developed as part of the strategic plan and describes 

the strategies that will be used each year to move the 

program toward its long-term goals.31 Some program 

goals will be new. To meet these goals, the annual work 

plan will likely include strategies for obtaining new 

resources.31 For more information, see CDC’s Work 

Plan Template.

32

Communications Plan

The communications plan guides how health 

communications strategies (e.g., paid and earned media 

strategies) will be carried out to help achieve program 

goals.33 This plan complements the comprehensive state 

tobacco control plan and can help staff choose effective 

strategies, set priorities, assign responsibilities, create a 

timeline, and assess progress toward communications 

goals.33 The communications plan is most useful if it 

answers these important questions:34

• Why do you want to communicate? 

• Who do you want to communicate with? 

• What do you want to communicate? 

• How do you want to communicate it? 

• What channels will you use for communication?

The communications plan describes the messages, 

products, and intended audiences for the program’s 

communications campaigns.33 It also details how 

the program will leverage national campaigns and 

new evidence, build local communications capacity, 

and use health communications strategies to reduce 

tobacco-related disparities. The communications 

plan also likely includes detailed annual work plans. 

The purposes, audiences, messages, and channels for 

communications may change over time, so it is best if 

the communications plan is revised regularly.34

Evaluation Plan

The evaluation plan is “a written document that 

describes how you will monitor and evaluate your 

program, as well as how you intend to use evaluation 

results for program improvement and decision 

making.”35 The plan describes what, how, and when 

data will be collected.26,35 It is an important tool to 

create a shared understanding among partners and 

decision makers of how the evaluation will be used 

to improve the program and achieve outcomes.35 For 

instance, evaluation results can help develop future 

objectives and strategies that may be included in the 

strategic plan.31,35 The evaluation plan covers all parts 

of the program and typically spans multiple years.1

When writing the evaluation plan, it is critical to 

include those who have an interest in the program’s 

outcomes, such as community partners, grantees, 
A CLOSER LOOK: Elements of a Strategic Plan

Strategic plans are used by all kinds of 

organizations, within and outside of tobacco 

control. The format of the strategic plan can vary, 

but typically includes several common elements. 

Planners can include the following sections:

8 Letter of Introduction

The strategic plan can begin with a public 

letter from the director or leader of the program.22

8 Executive Summary

This one- to two-page summary describes the planning process and the strategies that the program 

will use to reach its goals.31 It also describes how the plan will be implemented, communicated, 

and evaluated.31

8 Mission, Vision, and Guiding Values

This section describes the program’s purpose, the principles and beliefs that guide its work, and its 

vision for the future.22 

8 Data Sources

This section lists sources for internal data (i.e., data about the program and how it works) and 

external data (i.e., data about people served by the program).31 Planners analyze this data to develop 

the rest of the strategic plan.31

8 SWOT Analysis

This section includes a summary of the findings from a SWOT (i.e., Strengths, Weaknesses, 

Opportunities, Threats) analysis.36 Information from the SWOT analysis helps planners brainstorm 

questions about the program and develop objectives. Learn more about SWOT analysis on page 11.

8 Goals and Objectives

This section includes program goals, objectives, and key outcome indicators to measure progress.37,38

Some programs display this information in a logic model.39 Learn more about logic models in the 

CDC workbook, Developing an Effective Evaluation Plan.

35

8 Program Strategies

This section describes the approaches that the program will take to achieve its goals.31 It also gives a 

rationale and timeline for carrying out each strategy.31

8 Plan for Review

This section includes a schedule to review the plan at least annually and use the results to revise the 

program’s activities and goals.27

8 Appendices

This section includes any supporting documents from the planning process, including a list of all the 

people who helped create the plan, dates and times of planning meetings, and the full SWOT analysis.22

Program Infrastructure l 9

HOW TO
Program Infrastructure l 10

HOW TO

elected officials, and community members.35 For more 

information, see the CDC workbook, Developing an 

Effective Evaluation Plan.

35

Sustainability Plan

The sustainability plan maps out how the program 

will maintain or increase funding and sustain tobacco 

control achievements.27 The sustainability plan includes 

the program’s sustainability goals. These goals are 

specific, measurable changes to increase the program’s 

capacity for sustainability in areas like support for the 

program, funding stability, partnerships, organizational 

capacity, program adaptation, program evaluation, 

communications, and strategic planning.40,41,42 The plan 

also includes action steps to reach each sustainability 

goal and the staff, partners, resources, and time 

needed to do so.41,43 Partners are essential to create 

the infrastructure to sustain programs, and their 

involvement and input during the development of the 

sustainability plan is crucial.2

Integrating Tobacco Control and Chronic Disease Strategic Plans

Strategic plans can integrate chronic disease prevention and tobacco control goals in areas where they 

overlap.27 Tobacco use combined with other risk factors such as an inactive lifestyle, poor diet, heart 

disease, high blood pressure, or diabetes poses a greater risk and poorer prognosis for many chronic 

diseases than the sum of each individual risk.1 Coordinating chronic disease and tobacco control efforts 

can reduce tobacco-related disease, reach more people by pairing tobacco control with other public 

health activities, and reduce the combined effect of tobacco use and chronic disease risk factors.1

Chronic disease staff can help develop tobacco control plans to make sure objectives align and identify 

ways to strategically collaborate on program and policy development.45 Jointly developed plans show that 

program cooperation is necessary and normal.45 They can incorporate both tobacco control and chronic 

disease priorities, pool funding for common objectives, and coordinate critical resources.46 It is also 

important for programs and chronic disease partners to periodically assess integration progress.45

Steps for Responsive Planning

Many different approaches can be used to develop 

program plans. The National Association of County 

& City Health Officials resource, Mobilizing for 

Action through Planning and Partnerships (MAPP) 

Framework, is one example.44 The best approach for a 

program depends on its unique goals and complexity. 

Programs can use the following steps as a general guide 

to develop each of the plans listed on page 7:

22,31

• Prepare: Lay the foundation for planning.

• Assess: Gather and analyze data.

• Create: Develop the plan.

• Share: Communicate the plan.

• Implement: Put the plan into action.

• Review: Revise the plan.

These steps do not have to be completed in order. To 

be truly responsive, it is critical that plans are revised 

regularly and programs revisit steps as new issues arise.2

PREPARE: Lay the Foundation for Planning

In this step, program staff and stakeholders decide on 

the purpose of the plan, develop a timeline to complete 

the plan, and determine the staffing and other resources 

needed for planning.31 Planning may be completed over 

a few intensive days or take several months, depending 

on the amount of data to be reviewed and how much 

discussion is needed.22

Program staff also decide which stakeholders to involve 

in planning.22 The planning process is collaborative and 

incorporates input from many sources, such as staff, 

partners, community members, and grantees. Programs 

that involve diverse partners from the start of planning 
Program Infrastructure l 11

HOW TO

can secure more resources and achieve greater results.4

It is important for partners to know how much time 

they will be expected to commit to planning.31 Partners 

may be involved in every planning discussion or only 

weigh in on topics that fit their interests.31

A committee or workgroup can help oversee the 

planning process and make decisions.22,31 The 

committee may be a small or large group (e.g., 5 to 12 

members), depending on the size of the program.22 It 

is helpful to appoint a chairperson who is committed 

to and understands the organization. Staff with 

less planning experience may want to choose an 

outside consultant to lead the planning process. A 

skilled chairperson has strong communication and 

organizational skills, the ability to lead a committee, 

and no actual or perceived conflicts of interest.47 Many 

organizations have limited time for planning. The 

committee can draft a clear timeline and task list to 

make sure planning is completed. 

ASSESS: Gather and Analyze Data

During this step, the planning committee collects and 

analyzes data to develop the objectives and goals of 

the plan. Data may come from internal or external 

sources.31 For example, staff may gather internal 

data about the program (e.g., existing program 

infrastructure) and external data about the population 

served by the program (e.g., tobacco use data).

The committee reviews and summarizes this 

information in a report shared with everyone involved 

in the planning process. The planning committee 

may also complete a SWOT analysis (see Figure 2 

on the right) to assess the program’s strengths and 

weaknesses.31 By gathering this information in advance 

and involving diverse stakeholders in the process, 

planners are better equipped to set realistic goals and 

objectives. The planning committee often decides at 

this stage that past strategies were not effective and that 

by redirecting efforts, the program’s activities could be 

much more successful.48

Figure 2. Elements of SWOT Analysis

Source: Adapted from Centers for Disease Control and Prevention36 and the 

Minnesota Department of Health49

CREATE: Develop the Plan

In this step, the planning committee writes the plan.31

Many programs hold a stakeholders meeting to kick 

off the planning process and start developing the plan 

in as much detail as possible. This inclusive meeting is 

especially important to create a plan that will effectively 

address health equity and include more than just what 

the program can manage itself. Using data and analysis 

from the last step, stakeholders outline new goals, 

objectives, key outcome indicators, and strategies. Goals 

are the broad, long-term changes that the plan helps the 

program achieve.22 Objectives are realistic, measurable 

steps taken to achieve goals.50 To develop objectives, the 

committee can apply the SMART (Specific, Measurable, 

Achievable, Relevant, Time Bound) approach.51 Strong, 

clear objectives fulfill all SMART components (see an 

example of a SMART objective on page 12). The 

committee also selects indicators to measure progress 

toward goals. CDC’s Office on Smoking and Health has 

several workbooks to help programs select goals and 

key outcome indicators, including:

• Preventing Initiation of Tobacco Use: Outcome 

Indicators for Comprehensive Tobacco Control 

Programs—201437

• Promoting Quitting Among Adults and Young 

People: Outcome Indicators for Comprehensive 

Tobacco Control Programs—201538
Example of a SMART Objective

Specific: 

“Decrease the number of pharmacies in the 

tri-state area selling tobacco products...”

Measurable and Achievable:

“by 10%, from 80% to 70%...”

Relevant:

“to decrease both retailer density and youth 

exposure to tobacco advertising...”

Timebound: 

“by June 1, 2016.”

Program Infrastructure l 12

Strategies are the approaches used by the program to 

achieve its goals and objectives.31 Effective strategies 

take advantage of program strengths.31 For example, a 

strategy to decrease the number of pharmacies that sell 

tobacco products could draw on existing Networked 

Partnerships with community groups or city officials. 

Program activities put the strategies into action. 

Developing a written timeline helps the program keep 

staff accountable and activities on track. Effective 

timelines are clear, current, 

and include dates for activities 

and data collection. 

SHARE: Communicate the Plan

In this step, the plan is 

shared with partners and 

stakeholders.31 It is important 

that information shared 

about the plan is useful and 

easy to understand.31 Staff 

can tailor communications 

by taking into account 

the priorities of different 

stakeholders and the 

information that will be most 

useful to each group. Details 

about the plan can be shared in reports, executive

summaries, or fact sheets. It is best to share plans as

soon as possible after they are created.31

Sharing the plan holds the program and partners 

accountable for completing the plan’s strategies and 

activities.22 This step can be revisited whenever new or 

updated results of the program are available. Sharing 

progress shows stakeholders that the time and resources 

used to develop the plan were worthwhile.22

IMPLEMENT: Put the Plan into Action

In this step, the plan’s strategies are put into action.31

The annual work plan guides implementation and 

is shared with everyone involved. The planning 

chairperson can also make sure that staff and partners 

have the resources to complete their activities.31 If gaps 

in knowledge or skills exist, professional development 

or training may be helpful.31 At meetings, time can also 

be set aside for program staff to report on the status of 

tasks and celebrate achievements. 

REVIEW: Revise the Plan

Plans sometimes cover a long timeframe and may 

need to be revised based on changes to the program’s 

environment.22 Staff can monitor the implementation 

of each plan and revise them regularly (e.g., every 

six months). Programs can use evaluation results to 

identify outcomes that are not being achieved and 

activities that are ineffective. 

HOW TO
Program Infrastructure l 13

HOW TO

Multilevel Leadership

Multilevel Leadership is the development of leadership 

for efforts at all levels that affect a tobacco control 

program.2 Tobacco control efforts benefit from leaders 

within the program, such as program staff, and outside 

the program, such as members of the community 

or staff from partner organizations.2 Figure 3 below 

shows examples of leadership at multiple levels of a 

tobacco control program. Depending on the tobacco 

control strategy the program is pursuing, the program 

may want to include leaders from other organizations 

outside of tobacco control, such as health systems 

personnel or staff from other government agencies 

like the department of revenue, the state mental health 

agency, or state law enforcement.

Figure 3. Multilevel Leaders Who Contribute to Tobacco Control Efforts

Source: Adapted from Avolio & Bass53

To achieve tobacco control goals, it is important that 

programs actively engage leaders at every level.2,52

Multilevel leaders create a vision for the program, 

inspire staff, and drive program success.2,19 They create 

a work environment that is empowering, efficient, and 

task-oriented. Successful leaders are open to innovation 

and risk taking and see developing new leaders as 

important to sustain the program.2

The program manager is often considered a key leader. 

However, developing leadership among other program 

staff can deepen their commitment to program goals 

and ensure that transitions are smooth when staff 

changes occur.2

It is also important to develop leaders from outside 

the program. Leaders may work for other programs 

with related goals (e.g., chronic disease prevention 
Program Infrastructure l 14

HOW TO

programs), hold higher positions of authority in the 

health department or organization where the program 

is located, or work in partner organizations.2

 They 

may also be members of the community served by 

the program, decision makers, or other stakeholders. 

Involving partners as leaders gives them a stake in the 

program’s success while giving the program a broader 

perspective. External leaders also inspire motivation 

and build momentum, which in turn helps internal 

program leaders.

The Importance of Multilevel Leadership in 

Program Infrastructure

Multilevel leaders guide the development and 

maintenance of the core components of infrastructure.2

Leaders use Engaged Data to guide Responsive Planning

and Managed Resources, helping the program plan for 

funding and staff needs and respond to changes like 

staff turnover. Involving staff in creating Responsive 

Plans and using Engaged Data creates ownership and 

develops staff as leaders. 

Developing leaders outside the program also 

strengthens program infrastructure. External leaders 

contribute to Networked Partnerships and Managed 

Resources by building a broad base of support for the 

program and adding new ideas, skills, and resources 

to help achieve program goals. Leaders from outside 

the program also strengthen Responsive Planning.

3

Involving diverse leaders in planning can bring in new 

perspectives and help planners recognize changes in the 

program’s environment. 

Developing Multilevel Leadership

How a program approaches leadership is often deeply 

rooted in the organization’s culture. Although changes 

to how a program structures leadership take time 

and dedication, staff can begin developing Multilevel 

Leadership by focusing on:

• Responsibilities of effective leaders

• Leadership roles important for an effective 

tobacco control movement

• Strategies for developing new leaders

• Responsive leadership in stable and unstable 

environments

Responsibilities of Effective Leaders

Leaders make important contributions to program 

success. Effective leaders develop the program’s vision 

and create a road map to get there.54 They are also 

skilled communicators who maintain open and effective 

communication with other leaders, team members, and 

communities to inspire others, establish the program’s 

credibility, and build relationships.54,55

Effective leaders are also responsible for strengthening 

the program’s infrastructure. For example, leaders can 

secure resources and funding by sharing the program’s 

vision with external partners and community members. 

Sharing goals and achievements can also increase 

program visibility, accountability, and sustainability. It 

is unlikely that one leader can fulfill all of the leadership 

responsibilities important for a successful program. 

Developing leaders with diverse skills and perspectives 

means that responsibilities can be shared among several 

leaders, making the program more relevant and effective.

Responsibilities of Leaders

Effective leaders contribute to program 

infrastructure by:

• Guiding Responsive Planning1

• Creating an effective communications 

system internally, across chronic 

disease programs, and with partners1

• Recruiting, developing, and managing 

staff and other resources efficiently1

• Inspiring staff commitment to 

program goals through personal 

commitment to these goals56

• Making sure staff have the skills to 

implement the program1,57

Using Engaged Data to educate the public 

and decision makers on the importance of 

comprehensive tobacco control programs1
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HOW TO

Leadership Roles 

Successful tobacco control efforts bring leaders with 

different leadership styles and skill sets to the table.62

Leadership style is the way in which a leader achieves 

his goals, for example how he sets out to complete a task, 

mobilize support, or deal with a problem.63 Many types 

of leaders are important for tobacco control efforts:62

• Visionaries: Leaders who aim high, take risks, and 

challenge what is possible

• Strategists: Leaders who determine what is 

realistically achievable, anticipate obstacles, and 

develop a plan to achieve goals

• Statespersons: Leaders who bring credibility 

to and raise awareness of the importance of 

tobacco control efforts

• Experts: Leaders who make sure strategies are 

based on credible scientific evidence

• Strategic communicators: Leaders who translate 

complex information to build support among 

the program’s stakeholders and the public

• Movement builders: Leaders who focus 

on building external support, resolving 

organizational conflict, and encouraging people 

to share their opinions

• Outside sparkplugs: Leaders outside the program 

who start movements and keep them energized

• Inside advocates: Leaders who are skilled 

negotiators and understand the policy process 

No single leader can fulfill all of these roles.54

Programs benefit from leaders that can fill each of 

these leadership roles at different times. Recognizing 

these skills in current leaders and recruiting multilevel 

leaders to fill gaps can make sure the program is 

prepared for multiple leadership needs. 
Program Infrastructure l 16

HOW TO

Strategies for Developing New Leaders

It is important that leaders devote some of their time 

to developing new leaders. Preparing new leaders and 

preserving knowledge during leadership transitions 

is a proactive way to support program infrastructure 

and sustainability.58,59 Planning for leadership changes 

ensures that the program will continue to make 

progress toward its goals without interruption when 

leaders leave their positions.58 Advance preparation for 

how changes in leadership will occur is particularly 

important if a leader leaves unexpectedly. 

Though there can be risks in inviting inexperienced staff 

to take on more responsibility, for instance encouraging 

an inexperienced person to lead a meeting or event, 

developing new leaders is a long-term investment in 

the program.60 Some people may not view themselves 

as leaders, and it may be helpful to point out the other 

informal leadership roles they already hold (e.g., 

coaching or motivating others to complete tasks).60

Delegating smaller tasks to future leaders can help boost 

the confidence of those who are “leaders in training.” 

Cultivating external leaders is also important to 

develop leadership for tobacco control efforts. They 

inspire staff and bring new ideas, expertise, and 

resources. To develop external leaders, program staff 

can focus on finding and nurturing champions.2

These champions may be existing partners who are 

ready to take on a larger role or new connections with 

similar interests. Educating community members and 

decision makers about the impact of comprehensive 

tobacco control programs can encourage new 

champions to get involved. 

Champions are critical to build support for new 

tobacco control initiatives. For instance, the Utah and 

Oregon tobacco control programs identified champions 

to help establish tobacco-free policies in substance 

abuse and mental health treatment centers.61 The 

champions included treatment center directors, local 

health department staff, nonprofit organization staff, 

and treatment center clients.61 These knowledgeable 

and respected individuals were able to correct 

misunderstandings about treatment issues, which helped 

gain credibility and support from center directors.61

Responsive Leadership in Stable and Unstable 

Environments

Some programs work in stable, predictable 

environments. Predictable environments are orderly, 

structured, and have secure funding and administrative 

support. Other program leaders may be challenged 

by uncertain political, administrative, and economic 

times. As the stability of the environment changes, the 

responsibilities of leaders will change.64,65

In stable environments, leaders guide the work of 

program staff, communicate expectations, and motivate 

the team to reach its goals.65 Leaders can also keep 

partnerships strong and communicate program successes 

to stakeholders. In a stable environment, stagnation 

within a program can easily go unnoticed. It is helpful if 

leaders watch for signs the program has stopped gaining 

momentum and progressing toward goals. 

Programs often work in unstable environments with 

uncertain, changing conditions.52 To meet these 

challenges, a leader’s first responsibility is to use 

Engaged Data to identify instability and adapt the 

program as needed. Leaders can support the program 

by encouraging team creativity and being flexible 

enough to adapt to changes.52 It is important that they 

reassess resources often and reach out to partners to 

create new ways that the program and partners can 

support each other. In unstable environments, it is 

important for leaders at all levels to communicate 

with each other often. Multilevel Leadership gathers 

information from multiple sources so that programs 

can be aware of changes to the environment as soon as 

they occur.
Networked Partnerships

Networked Partnerships are diverse, 

strategic relationships made up 

of partners from different levels, 

organizations, and content areas.2

 For 

instance, tobacco control program staff 

often partner with local, state, regional, 

and national organizations; programs 

in other states; and chronic disease 

programs to work toward program 

goals. Partners may work toward a 

common goal or mission, but each 

partner may fulfill different roles.2

Networked Partnerships work best 

when they are connected to each other 

and to the program.2

Networked Partnerships help build motivation, achieve 

goals, reduce risk, and win allies.6

 Partnerships 

strengthen programs by:

• Educating the public about the importance of 

tobacco prevention and control

• Increasing awareness of changes in the 

community

• Reducing duplication of efforts and resources

• Increasing access to community information 

and decision making

• Developing cultural competency

• Increasing accountability

• Offering new financial support

The Importance of Networked Partnerships in 

Program Infrastructure

Networked Partnerships contribute to program 

infrastructure by providing critical resources to plan, 

implement, sustain, and expand programs.6

 For example, 

partners may have skills beyond those of program 

staff. They may be able to offer training and technical 

assistance to staff and other partners. They can also 

contribute to Managed Resources by providing financial 

support and sharing knowledge with the program. 

Networked partners add to Multilevel Leadership and 

contribute to and carry out Responsive Plans. Partners also 

Program Infrastructure l 17

HOW TO

help use Engaged Data to achieve program goals. Partners 

work with program staff to decide what data to collect, 

review data, and put recommendations into action.

Creating Networked Partnerships

To incorporate Networked Partnerships into their 

programs, staff can focus on four main goals:

• Developing purposeful, strategic partnerships 

with key partners, rather than a large number of 

partners2

• Partnering with diverse groups, including partners 

who do not usually work in tobacco control

• Working with partners to achieve goals

• Evaluating partnerships for strengths, outcomes, 

and areas for improvement

Developing Partnerships: Quality over Quantity

Having the right partnerships helps achieve tobacco 

control goals; having the wrong partnerships can divert 

time and energy and set back a program’s goals. Before 

developing Networked Partnerships, it is important to 

decide what kinds of partnerships will result in a more 

effective program. High quality partnerships include:6,66

• Open and frequent communication

• Sensitivity to each partner’s priorities, goals, and 

culture

• Mutual trust and respect

• Shared stake in the process and outcome
• Ability to manage potential conflict and work 

with others

• Willingness to cross disciplinary or 

organizational boundaries

• Shared mission and passion

Building relationships with commitment and trust 

takes time.2

 Inadequate funding, limited organizational 

capacity, unequal sharing of responsibilities, and 

conflicting interests can challenge partnerships.66

Conflicts caused by miscommunication, differing 

missions, and disagreements over ownership or 

funding arrangements can also damage partnerships. 

Networked Partnerships can work to avoid challenges by 

developing clear expectations and responsibilities. 

Dealing with Conflict

Working with diverse partners 

can present special challenges for 

Networked Partnerships. Following these 

recommendations helps prevent conflicts 

from limiting a partnership’s ability to 

achieve tobacco control goals:70

• Balance representation of 

stakeholders to encourage respect for 

different opinions.

• Set ground rules for meeting behavior, 

attendance, and decision making.

• Look for shared interests when people 

will not change stated positions.

• Keep differences of opinion from 

becoming personal attacks.

• Agree on and use objective criteria to 

make decisions.

• When serious conflicts occur, focus 

on areas where some agreement exists 

instead of on tough sticking points.

Partnering with Diverse Stakeholders

Networked Partnerships include non-traditional 

partners who do not typically work on tobacco control 

issues. Joining forces with people from different 

backgrounds adds credibility and new perspectives 

to tobacco control efforts.66 These partners 

could include community organizations, youth 

organizations, local businesses, members of the media, 

housing authorities, neighborhood associations, or 

organizations working on other issues that share 

common goals (e.g., chronic disease prevention). 

It is also important to include representatives from 

populations most affected by tobacco use and the 

organizations that serve them.1 Reaching out beyond 

the “usual suspects”66 to include non-traditional 

partners in tobacco control efforts adds these benefits:

• New skills and knowledge to help programs 

achieve their goals

• A greater understanding of the community and 

the problem

• Valuable connections for those already working 

in tobacco control

• Wider promotion of tobacco control efforts

In a small state, partners may be called upon often by 

many parts of the public health system. Programs must 

understand partner time constraints and choose their 

partners strategically. Giving partners as much notice as 

possible can help them make room in their schedule for 

program activities.67

Many examples of unique partnerships exist in public 

health. For example, New York City developed a broad 

coalition for its efforts to reduce access to cheap tobacco 

and reduce youth access to tobacco products at the 

point of sale.68 The coalition included organizations 

traditionally involved in tobacco control and new 

partners. For example, other city departments were part 

of the coalition, such as the Department of Finance, 

which enforces cigarette tax laws. The partnership was 

based on the idea that illegal cheap tobacco “wasn’t 

just a finance issue but...a health issue.”68 The city also 

partnered with local businesses, connecting with retailers 

through other partners whose membership included 

business owners. This resulted in a partnership with a 

tobacco retailer in the Bronx who testified in support of 

point-of-sale policies at a public hearing. 

In some cases, Networked Partnerships are formed 

between organizations with different rules, interests, 

or levels of power.69 For example, over 1,000 voluntary, 

Program Infrastructure l 18

HOW TO
Program Infrastructure l 19

HOW TO

professional, and community organizations partnered 

with Canada’s 10 provincial health departments to 

develop a national strategy to prevent cardiovascular 

disease.69 The collaboration formed a coalition called 

Health Canada, which coordinated the country’s 

resources to act together on problems too complex 

for one organization to tackle alone.71 Although the 

coalition was formed to prevent cardiovascular disease, 

it increased capacity for general health promotion and 

disease prevention.69

With the direction and support of the state office, 

local programs can be a fundamental part of program 

infrastructure and vital partners in achieving 

goals. Local programs have diverse relationships 

and resources that can be useful to state programs, 

including connections with community leaders who 

give insight into the community.72 In turn, states can 

help local programs by providing access to data, expert 

guidance, partnership development, funding, and 

technical assistance and training on best practices.1

Working with Partners to Achieve Goals

The purpose of a Networked Partnership is to achieve 

a common goal. The particular goal can vary as much 

as the partners themselves. Some partnerships work 

to carry out evidence-based strategies like smoke-free 

workplaces, while others focus on building program 

capacity through training and technical assistance.

To help achieve program goals, diverse partners and 

community members can take on responsibilities that 

draw on their strengths and match project needs.73 For 

example, those with strong ties to the community can 

serve as local experts and give insight into community 

priorities during planning.74,75 Partners may also be 

able to donate needed skills free of charge, such as 

communications expertise or grant writing.75 Others 

may be able to bring attention to an issue by lending 

their name or organizing public events to support the 

program’s efforts.75

Recognizing how partners’ contributions support 

tobacco control efforts and documenting progress 

toward goals can help keep partners engaged.66

Routinely checking in with partners is important to 

address concerns and expand the ways they contribute 

to the program. See an example of Networked 

Partnerships from New York City on page 20.

Evaluating Partnerships

Formal reports of successful Networked Partnerships

are uncommon.76 In many evaluations of public 

health programs, little attention is paid to the qualities 

of successful partnerships and the challenges that 

partners face.77 Evaluating partnerships for strengths, 

outcomes, and areas for improvement is just as 

important as evaluating tobacco control strategies. 

Sharing the purposes and benefits of evaluating 

partnerships with partners can help build buy-in and 

ensure the findings are used.35 Partnership evaluation 

can help programs by:73,78

• Identifying partnership strengths and areas for 

improvement

• Determining if partnership goals have been met

• Increasing public awareness of the partnership

• Helping the partnership be accountable to 

stakeholders

• Helping achieve tobacco control goals

Information about partnerships are often collected 

through short surveys. The partnership may also 

decide to gather more in-depth information through 

interviews with partners.73 The CDC’s National Heart 

Disease & Stroke Prevention Program resource, 

Fundamentals of Evaluating Partnerships, includes 

sample partnership evaluation questions and 

assessment tools.73 

The California Healthy Cities and Communities 

program evaluates partnerships as part of its program 

to help communities carry out health initiatives.79

Evaluators assessed how well partnerships secured 

resources, expanded programs, and influenced 

organizational policies.79 The evaluators interviewed 

coalition and community leaders, held focus groups 

with coalition members, and reviewed documents.80

The results suggested that multi-sector partnerships 

can strengthen the infrastructure of communities to 

promote health.81
A CLOSER LOOK: NYC Smoke-Free Develops Networked Partnerships

NYC Smoke-Free, (formerly the NYC Coalition 

for a Smoke-Free City), a program of Public 

Health Solutions, works to protect the health of 

New Yorkers through tobacco control policy and 

education.82 They have locations in four boroughs 

across New York City (the Bronx, Brooklyn, 

Manhattan, and Queens) and support their efforts 

through Networked Partnerships with over 130 

community partners.82 NYC Smoke-Free focuses 

on community engagement among populations 

experiencing tobacco-related disparities to build support for initiatives to:83

• Reduce access to tobacco products and limit tobacco industry marketing to youth

• Expand smoke-free environments through voluntary adoption of smoke-free housing and 

outdoor air policies

• Reduce pro-tobacco imagery in youth-rated movies and on the Internet

Developing strong Networked Partnerships has been critical to NYC Smoke-Free’s success in reducing 

tobacco use. To address the increasing demand for smoke-free housing, NYC Smoke-Free works with 

tenants, landlords, and property owners to create thousands of smoke-free housing units. NYC SmokeFree shares resources, makes referrals to partner organizations, and offers technical assistance. They also 

meet regularly with community boards to educate and inform communities on the negative health effects 

of tobacco use and the benefits of smoke-free housing.84,85 As a result, community boards have passed 

resolutions encouraging smoke-free housing and smoking disclosure policies in multi-unit housing.84

To encourage connections among partners, NYC Smoke-Free has hosted smoke-free housing summits 

where partners interact with each other and share information. Partners discussed strategies to increase 

smoke-free housing in their own communities, such as involving tenants, partnering with health 

initiatives, and encouraging smoke-free new construction.86 To keep partners connected throughout the 

year, NYC Smoke-Free hosts meetings for all partners and communicates updates through e-newsletters, 

blog posts, Twitter, and Facebook. 

Innovative partnerships have also helped NYC Smoke-Free tackle its toughest challenges. Despite 

an overall drop in smoking prevalence in New York City, smoking has remained high among certain 

populations, including the Asian American and LGBT communities.87,88 To reduce these disparities, NYC 

Smoke-Free partnered with influential community organizations. For example, NYC Smoke-Free worked 

with the Chinese-American Planning Council to design a culturally relevant ad for Chinese language 

newspapers to help parents understand the dangers of secondhand smoke exposure at home.87

NYC Smoke-Free’s strategic use of Networked Partnerships to share ideas and resources, implement 

programs, and increase public awareness of smoke-free strategies has helped New York City lower 

smoking prevalence, safeguard youth from tobacco industry marketing, and protect New Yorkers from 

the harmful effects of secondhand smoke exposure where they live, work, and play. For more information 

on NYC Smoke-Free, visit www.NYCSmokeFree.org.

Program Infrastructure l 20

HOW TO
Program Infrastructure l 21

HOW TO

Managed Resources

Managed Resources are the funding and staff 

resources used to implement a program. It is essential 

that programs have enough funding and skilled 

staff to oversee programs and conduct technical 

assistance and training.1 The process for managing 

these resources is often referred to as the program’s 

operations strategy; it serves as a guide for how a 

program’s resources will be used to achieve intended 

outcomes.89 This strategy is developed with the 

support of leadership and plans for the resources 

needed to not only meet funding requirements, but 

also achieve program goals and vision.2

Securing multiple funding sources and staff with 

diverse skills can help programs use effective tobacco 

control strategies, even as budgets and staff levels 

change. Diversifying and managing funding is 

important so that the loss of a single funding source 

will not have a large impact on the program’s work.2

Programs that focus on funding sources that fit best 

with their goals, instead of pursuing every funding 

opportunity, can build more stable revenue sources and 

engage new partners and funders.2

Successful programs also view staff as their most 

important asset. Staff with diverse technical, 

programmatic, and administrative skills are crucial to 

achieve program goals.1

 Their work is supported by 

local programs and grantees who are skilled in carrying 

out tobacco control strategies. Developing staff skills 

encourages staff ownership of the program.3

The Importance of Managed Resources in 

Program Infrastructure

Developing strong Managed Resources supports the 

other components of infrastructure. Continuously 

training staff, partners, and local programs helps 

develop skilled Multilevel Leadership and Networked 

Partnerships. These leaders and partners increase the 

capacity of programs by contributing much-needed 

resources and knowledge.

Managed Resources are also an important part of the 

Responsive Planning process. Planners use information 

about staff skills and funding to develop plans. Responsive 

Plans in turn help staff decide how to use resources. 

Adequate resources and skilled staff are also important 

to collect and analyze Engaged Data. Data can then be 

used to allocate resources and justify continued staff 

and financial support. 

Strengthening Managed Resources 

Strong Managed Resources begin with a firm 

understanding of the program’s environment. It is 

important that program staff understand the state and 

regional funding climate and the health department’s 

capacity to support tobacco control efforts. Knowing 

what funding and staffing strategies have been tried in 

the past can also help make wise Managed Resources

decisions. This knowledge is most useful when it is 

shared among program staff, so that it is not lost if 

someone leaves. Using this information, staff can 

work to develop and strengthen Managed Resources by 

focusing on these important goals:

• Ensuring funding stability

• Directing resources to strategies with the 

greatest impact

• Sharing positions and resources

• Communicating program successes

• Developing staff competencies

• Training staff and partners

Ensuring Funding Stability

Creating an adequate and consistent financial base for 

the program is important for Managed Resources.

90

Stable funding strongly influences a program’s 

sustainability, or the ability the maintain the program 

and its achievements over time.40 Because the 

availability of state, federal, and foundation funding 

changes from year to year, it is important for program 

managers and supporters to be aware of funding threats 

and adapt to changes. Programs that have maintained 

stable funding during difficult times have shared the 

following characteristics:91

• Experienced leadership

• Understanding of the internal processes to make 

budget decisions

• Strong ties across departments and levels of the 

organization
Program Infrastructure l 22

HOW TO

• Coordinated efforts

• Strategic use of Engaged Data

• Effective messages

• Active communication about program successes

• Visible and influential champions

Careful planning and strong financial management 

can lessen the effect of funding losses. Working 

with leadership to develop a funding plan, diversify 

funding sources, and train staff in financial 

management skills like grant writing are important 

steps to sustain the program when one funding 

source.92 See below for information on Best Practices 

2014 funding recommendations.

A CLOSER LOOK: Understanding Best Practices Funding Recommendations1

Best Practices 2014 recommends that states make annual investments to fund and sustain comprehensive 

tobacco control programs. A reasonable target is between $7.41 and $10.53 for each member of the 

state’s population, depending on the state’s demographics, smoking prevalence, and existing health 

infrastructure. These levels of investment are lower than past recommendations because of new 

opportunities created by the Affordable Care Act and other factors, including new scientific evidence, 

state experiences, and the changing tobacco control landscape.

What Do States Fund?

The CDC recommends that states create, fund, and sustain tobacco control programs that include five main 

elements: state and community interventions, mass-reach health communication interventions, cessation 

interventions, surveillance and evaluation, and infrastructure, administration, and management. Best 

Practices 2014 includes state-by-state recommendations for funding each of these elements. 

Who Do States Fund?

To support local infrastructure and implement programs, states often fund local health departments, 

boards of health, or health-related nonprofit organizations representing counties or metropolitan areas. 

Funds can also be awarded to tribal health departments or tribal-serving organizations and other 

community organizations that serve specific populations. Best Practices 2014 includes minimum and 

recommended funding levels which reflect the annual investment that each state can make to fully fund 

and sustain a comprehensive tobacco control program. The minimum funding level represents the lowest 

annual investment to implement a comprehensive tobacco control program. The recommended funding 

level represents the annual level of investment to ensure a fully funded and sustained comprehensive 

tobacco control program, with enough resources to effectively reduce tobacco use.

Programs with a single funding source are more 

vulnerable to funding cuts.2,3,90 Strategically adding 

funding sources that fit with program goals can build 

more stable revenues for the program and engage 

new partners and funders.92,93 Responding to funding 

opportunities takes time and resources, so it is important 

that program staff carefully consider which funding 

sources to pursue, instead of pursuing every opportunity.2

It is also important that program staff not wait until the 

last year of funding to think about where new funding 

will come from.92 Once a program is past the start-up 

phase for a new funding award, staff can develop a 

plan for securing ongoing support.92 Learn more about 

developing a sustainability plan on page 10. Keeping 

an updated list of current and potential funders and 

considering non-traditional funding sources can 
Program Infrastructure l 23

HOW TO

be useful strategies.92 Developing a timeline and 

deciding who will manage the funding plan encourages 

ownership of the plan by making it the responsibility of 

both program leadership and staff.92

Directing Resources to Strategies with the Greatest 

Impact

To lessen the effect of funding cuts on program goals, 

staff can direct limited resources to strategies with the 

widest reach and strongest evidence of effectiveness. 

For example, tobacco control policies that focus on 

population-level changes have the potential to reach 

more people, shifting social norms about tobacco use 

and reducing initiation, tobacco use, and secondhand 

smoke exposure.94,95 A flexible operations strategy allows 

the program to redirect resources toward these strategies.

Sharing Positions and Resources

Creative funding and staff arrangements serve many 

uses in public health. Programs with common goals 

may want to share a specialized staff person, such as an 

epidemiologist or policy expert. Programs may also use 

these arrangements to sustain activities when funding 

levels change, though it is important not to wait to 

share resources until budgets are threatened. This could 

mean sharing Managed Resources across projects or 

departments, such as grant writing, communications 

materials, and administrative support.96 Redefining 

positions and sharing resources often makes the 

difference for programs that are able to sustain a high 

level of services after losing funding.97

Communicating Program Successes

Communicating about the importance and successes 

of a program can be one effective strategy to strengthen 

Managed Resources. Gathering data about activities 

and strategically sharing the results are powerful ways 

to highlight the achievements of a program (see the 

Engaged Data section on page 26 for more details). 

One way to communicate accomplishments is by 

writing a success story. Success stories describe the 

program’s progress, achievements, and lessons learned 

and can take many formats.98 Learn more about 

developing success stories on page 30.

Developing Staff Competencies

Having the right people with the right skills is critical 

to effectively carry out tobacco control programs.1

Programs can focus on developing staff competencies 

(i.e., skills that people need to do a job well) to 

build staff capacity in key areas.99 Developing staff 

competencies helps avoid knowledge gaps and creates 

a workforce that is skilled enough to adapt to changing 

program environments. Competencies help managers 

set realistic expectations for staff, identify areas for 

improvement, and recognize successes. Reviewing 

competencies can also help during performance 

evaluations and hiring.100,101 Program managers can 

assess staff competencies to justify requests for more 

resources and develop program plans.100

The Council on Linkages Between Academia and 

Public Health Practice developed competencies for 

public health programs to assess staff knowledge, skills, 

and training needs.99 The competencies are organized 

into eight important skill areas, called domains. Table 

2 on page 25 describes entry-level staff competencies 

in each domain. Competencies for program managers 

and leadership are also available at the web page, Core 

Competencies Tools.

101 There, program leaders can 

review all the competencies, along with self-assessment 

tools, sample job descriptions, and guidance on 

incorporating the competencies into staff training.

Training Staff and Partners

Hiring and keeping skilled staff is a priority for 

public health programs. State and local programs 

can face recruitment and retention problems that 

are made worse by hiring requirements, hiring 

freezes, and budget crises.102 Predetermined budgets 

can interfere with career ladders and competitive 

salary structures that recognize skills and motivate 

staff performance.102,103 These problems can lead to 

inadequate staffing levels and staff who are not prepared 

for their jobs, which can weaken all components of 

program infrastructure and keep programs from 

achieving goals. 

Continuous training processes help programs overcome 

these challenges by ensuring that staff have the right 

skills for tobacco control efforts. Continuous training is 

a four-step process: orientation, onboarding, training, 
Program Infrastructure l 24

HOW TO

and professional development.104

Orientation helps new staff 

understand the basic structure 

and philosophy of the 

organization, see what their daily 

routine will be like, and learn 

about who the program serves.104

Onboarding can be a 6 to 12 

month process of learning about 

tobacco control, understanding 

how the program works, and 

adapting to the program’s 

culture. Training helps staff build 

the skills and knowledge needed 

for their position and typically 

covers:104

• The skills and 

information needed 

to do the job, such as 

knowledge of tobacco 

control strategies and funder reporting 

requirements

• The processes and tools used by the program;

• New developments, policies, and regulations in 

tobacco control

• Other skills that staff need to do their jobs, such 

as interpersonal skills or cultural sensitivity

Professional development is an ongoing process for 

all staff that helps them build new skills above and 

beyond past training.104 Opportunities for staff might 

include participating in informal interest groups with 

other staff on specific topics, taking university courses, 

attending conferences or workshops, or completing 

topic-based institutes.104

It is helpful to develop a systematic process to carry out 

each phase of training that includes checklists and tools 

that are followed with each staff person. This ensures 

that training will actually take place amid the many 

other responsibilities of busy program staff. 

Staff join programs with different backgrounds and 

skills.104 Training can be tailored to the needs of 

each staff person by first assessing what skills the 

person already has and what he needs to develop. 

Assessment tools like the Public Health Foundation 

resource, Competency Assessments for Public Health 

Professionals, can help assess staff skills.105 CDC 

resources can also help meet training needs. The State 

and Community Resources section of the CDC Office 

and Smoking and Health’s website includes resources 

for program development, surveillance and evaluation, 

and Best Practices 2014 guidance.106 The CDC Learning 

Connection portal includes links to tobacco control 

resources and CDC TRAIN, an online learning system 

that offers courses on topics like strategic planning and 

financial management.107,108 Most CDC Train courses 

are available free of charge. 

Programs can also use individual development plans 

to ensure that ongoing training builds on existing 

staff skills. The National Association and County 

& City Health Officials resource, Your Individual 

Development Plan, is one template that can be used to 

create staff development plans.109

Skilled local grantees and partners help achieve 

program goals and sustain impacts.1 Program staff 

can offer training and technical assistance to partners 

by assessing the needs of local programs and building 

these skills first. Programs can offer foundational 

trainings and partner with expert consultants when 

more specialized technical assistance is needed. It is 

also important for grantees to set training goals and 

required competencies for their own staff.
Program Infrastructure l 25

HOW TO

Table 2. Tobacco Control Domains and Competencies

Domain Competency

Communication 

Program staff communicate clearly and effectively 

with partners and the public to build support for 

tobacco prevention and control.

• Communicate clearly and respectfully with diverse groups.

• Use multiple strategies to communicate with professionals and 

the public (e.g., reports, presentations, e-mail, and letters).

• Develop effective messages to speak with funding organizations.

Community Engagement

Program staff work closely with community partners 

and the public to improve health.

• Partner with community members and organizations to reduce 

tobacco use (e.g., share data and connect people to resources).

• Inform the public about policies, programs, and resources that 

improve community health.

Cultural Competency 

Program staff gather input from diverse stakeholders 

and consider the needs of specific populations when 

developing, implementing, and evaluating programs.

• Include diverse perspectives in the development, 

implementation, and evaluation of policies and programs.

• Describe the effects of policies and programs on different 

populations in a community.

Data Analysis

Program staff gather, analyze, interpret, and share 

data to develop, implement, and evaluate evidencebased strategies.

• Use quantitative and qualitative data to assess the health of a 

community.

• Apply ethical principles in collecting, analyzing, using, and 

sharing data.

• Understand how community assessments use information about 

tobacco use.

Financial Planning and Management

Program staff develop the administrative and 

financial skills necessary to carry out and sustain 

activities.

• Help develop program budgets.

• Gather information for funding proposals and service contracts.

• Motivate colleagues to achieve program goals (e.g., work in 

teams, encourage others to share ideas).

Leadership and Systems Thinking

Program staff contribute to a shared vision for the 

program and develop their own skills.

• Understand how tobacco control is part of a larger inter-related 

system of organizations that influence health at local, national, 

and global levels.

• Recognize professional development needs (e.g., mentoring, 

training, peer advising) and take part in opportunities.

Policy Development and Program Planning

Program staff help develop the program’s goals and 

strategies.

• Help develop and implement program goals, objectives, and 

strategic plans.

• Gather information and data to develop strategies.

Tobacco Control Evidence

Program staff stay up to date on scientific evidence, 

use evidence to improve programs, and share findings 

from their work.

• Learn about and apply scientific evidence.

• Contribute to the evidence base (e.g., write articles).

• Recognize limitations of evidence (e.g., validity, reliability, 

sample size, bias, generalizability).

Source: Adapted from The Council on Linkages Between Academia and Public Health Practice99
Program Infrastructure l 26

HOW TO

Engaged Data

Engaged Data is data that is used by staff, partners, 

decision makers, and local programs to act.1

 Tobacco 

control programs may be required to collect and report 

data to funders, decision makers, or the public. These 

efforts take staff time and resources. Programs can 

get the best return on this investment by also using 

data to plan and improve their efforts. Programs can 

use surveillance data to monitor attitudes, behaviors, 

and health outcomes over time and guide program 

direction.1,110 Evaluation data about program activities 

and results can help understand how the program works, 

improve the program, and plan future activities.1 Sharing 

data with partners and decision makers can increase 

program visibility, transparency, and credibility.

The Importance of Engaged Data in Program 

Infrastructure

Engaged Data provides critical information about 

the program to support the other four infrastructure 

components. For example, programs use data during 

Responsive Planning to assess program strengths and 

weaknesses, track progress toward goals, and identify 

areas for improvement.8,111 It is very difficult for 

programs to respond to problems, gaps in service, or 

changes in the environment without timely, correct data. 

Multilevel Leadership also uses data to drive program 

success. Leaders share data with the public and decision 

makers to make the case for continued program support 

of the program.111 Internally, leaders use data to make 

decisions about how to manage program resources. 

Leaders also inspire staff commitment and can use data 

to show staff that their work makes a difference.56

Engaged Data is also an important tool for creating 

Networked Partnerships. Involving partners in selecting 

and reviewing data makes sure their questions 

about the program are answered and increases their 

commitment to the program. Sharing data with the 

public can encourage people to get involved in tobacco 

control efforts in their community.20

Sound decisions about Managed Resources are 

grounded in data. Program staff review data to allocate 

resources to new strategies and decide if activities will 

be revised or eliminated.

Using Engaged Data

Program staff can use data to track progress toward 

goals, learn from mistakes, make changes, and create 

effective programs.111 Program staff with less experience 

collecting and analyzing data may also want to 

partner with an outside expert, such as a university or 

evaluation firm. Learn more about developing staff data 

skills on page 28.

Surveillance and evaluation are two reasons programs 

often collect data, but any data gathered by the 

program can become Engaged Data when it is used 

to promote action.2

 Data can come from sources such 

as the Behavioral Risk Factor Surveillance System 

(BRFSS), local surveys, or internal program records. 

Data can also be carefully collected if none exists. 

More guidance on collecting data is available on 

the CDC Office on Smoking and Health’s web page, 

Surveillance and Evaluation.

112

Six Steps of Engaged Data 

Programs can follow these six steps to effectively use 

Engaged Data:

8,35

• Step 1: Engage stakeholders. 

• Step 2: Describe the program.

• Step 3: Choose questions to answer.

• Step 4: Gather credible data.

• Step 5: Develop conclusions.

• Step 6: Share results and ensure use.

Stakeholders can be involved in each step. They 

can help select key questions, test data collection 

tools, collect and analyze data, and decide on 

recommendations.35 Keeping stakeholders engaged 

increases their ownership of evaluation results.35

Although the process only has six steps, Engaged 

Data is an ongoing process that is continuously used 

by programs. When staff and stakeholders reach the 

last step, they can use the results to inform the next 

Engaged Data process. More guidance on completing 

the six steps of Engaged Data is also available in the 

CDC workbook, Developing an Effective Evaluation 

Plan.

35 The workbook describes each step and includes 

worksheets for completing the steps to develop the 

program’s evaluation plan.
Program Infrastructure l 27

HOW TO

Step 1: Engage Stakeholders

Involving stakeholders in using data increases the 

chances that recommendations will be accepted and 

put into action. Stakeholders who help review data 

are more likely to share results with others, support 

recommendations, and act on findings.111 Without 

stakeholder support, data might be criticized, resisted, 

or ignored.111

Stakeholders involved in using data might include 

people served by the program (e.g., community 

members or taxpayers), people involved in program 

operations (e.g., program staff or partners), or people 

who make decisions about the program (e.g., funders 

and elected officials).111 The first list of stakeholders 

created by program staff may be long. Programs can 

focus on including stakeholders who:

• Are responsible for day-to-day program 

activities111

• Are involved in Responsive Planning

• Can authorize changes to the program 

recommended by the Engaged Data process111

• Will fund or authorize the continuation or 

expansion of the program111

• Can increase the credibility of the results111

Stakeholders are more likely to support 

recommendations if they are involved from the 

beginning.35 Incorporating input from diverse 

stakeholders early on also helps ensure that data 

answers stakeholders’ most important questions and 

that evaluation results are used.35,111 Program staff can 

also share the list of stakeholders and how they were 

involved to increase buy-in from people who did not 

participate.35 Knowing that someone they find credible 

was involved encourages others to the use the results.

Step 2: Describe the Program

It is important that staff and stakeholders agree on 

how to achieve program goals before they use data to 

make decisions about the program.35 Knowing what 

the program does (and does not do) helps stakeholders 

develop realistic expectations for what questions 

can and cannot be answered by the data.35 When 

stakeholders know what to expect, they can plan for 

how they will use the results. 

Working with stakeholders to develop the program 

description and the logic model creates a shared 

understanding of the program. The program 

description explains the need for the program, the 

program’s activities, its capacity to improve public 

health, and the program’s environment.35 The logic 

model is a diagram showing all parts of the program 

and how they relate to intended outcomes.31 Learn 

more about how to develop logic models in the CDC 

workbook, Introduction to Program Evaluation for 

Public Health Programs: A Self-Study Guide.

111 The 

logic model and program description may have already 

been developed for strategic planning. If the program 

already has these documents, staff can review them 

with stakeholders before collecting data. 

Questions to Ask Stakeholders

To assess their interests, programs can ask 

each stakeholder:111

• Who do you represent and what about 

the program is important to you? 

• What would you like the program to 

achieve? 

• How much progress do you expect the 

program to have made at this time? 

• What do you think are the critical 

questions at this time? 

• How will you use the results? 

• What resources (e.g., time, funds, or 

knowledge) could you contribute? 

Step 3: Choose Questions to Answer

Programs have limited resources to collect and analyze 

data. They should focus on the most important 

questions about the program, rather than trying to 

answer every question that stakeholders may ask. This 

focused approach leads to results that can be used to 

make decisions about the program. Program staff can 

ask, “What information will be used by the program 

and stakeholders (including funders) to improve the 

program and make decisions?”35
A CLOSER LOOK: Developing Engaged Data Skills

For inexperienced staff and partners, collecting and analyzing data may seem overwhelming. Tobacco 

control staff use specialized skills to turn data into action. Offering trainings on the following topics can 

help develop Engaged Data skills:114

• Creating sound evaluation plans

• Developing and using data collection instruments

• Training data collection teams

• Using culturally competent methods

• Analyzing and interpreting data

• Reporting evaluation results

Programs can use the evaluation workbooks on the CDC’s Surveillance and Evaluation web page 

to develop Engaged Data skills. Webinars, newsletters, and a regional peer-to-peer network are also 

available. Technical assistance such as site visits, webinars, and “how-to” guides can also ensure that local 

program staff also have the skills to use data. Technical assistance is most effective when it is tailored to 

the needs and budgets of local programs and partners. 

Program Infrastructure l 28

HOW TO

Evaluations typically include two kinds of questions: 

process questions that examine how the program is 

carried out and outcome questions that examine what 

has happened because of the program. Decisions about 

what questions to include should be guided by how the 

results will be used.

Project activities and resources change from year to 

year. Staff and stakeholders may want to add questions 

for new activities or adjust questions for strategies that 

have been delayed, scaled down, or ended.35 Updating 

questions helps prevent programs from making 

recommendations that do not reflect current strategies.

Step 4: Gather Credible Data

It is important that staff and stakeholders view the data 

gathered as believable, trustworthy, and relevant to their 

questions about the program.113 If stakeholders do not 

trust the data source or data collection method, they 

may reject it when making changes to the program, 

especially if the results are negative. To collect data that 

stakeholders can trust and rely on, program staff can:

• Ask stakeholders to help select methods, data 

sources, and key outcome indicators35

• Check methods and sources to make sure 

relevant data is collected for each question35

• Use multiple data sources and methods113

• Make sure data is collected on tobacco use and 

exposure among specific population groups1

• Consult with tobacco control experts and review 

CDC evaluation resources

Step 5: Develop Conclusions

An important part of Engaged Data is taking the time 

to figure out what the data means and translate it into 

useful information.35,113 Programs with tight budgets 

and short deadlines may be tempted to skip this step, 

but it is important to devote adequate time to data 

analysis and interpretation. 

Stakeholders can help review the data to develop 

useful conclusions. They may have new insights into 

what the data mean, especially if they help implement 

the program.35 Stakeholders may also be more 

willing to accept and act on recommendations if they 

helped reach the conclusions.35 Staff can meet with 

stakeholders to discuss findings and present options 

instead of predetermined conclusions.113
Checklist to Get Results 

Used111,115

• Discuss with stakeholders how they 

will use positive and negative results.

• Revisit intended uses of the data 

when preparing recommendations.

• Avoid jargon.

• Tailor report content, format, and 

style for each audience.

• Communicate findings in several 

ways, such as reports, presentations, 

success stories, or social media posts.

• Create interim reports for key 

audiences.

• Use results during annual and longterm Responsive Planning.

• Think about how to reduce the 

chance that information will be 

misinterpreted.

• Schedule follow-up meetings to 

discuss results.

• Identify training and technical 

assistance needed to act on 

recommendations.

Program Infrastructure l 29

HOW TO

Stakeholders may reach different or even conflicting 

conclusions when reviewing the data.111 Program staff 

can use the following questions to guide discussion and 

reach consensus:111

• Why was the data gathered? Do the results 

answer all the questions?

• Are the results similar to expected results? 

• Do the results address the priorities of the 

program and stakeholders? 

• How do the results compare with those of 

similar programs? 

• How does the social and political environment 

of the program affect the results?

• Do the results support tobacco control goals?

Step 6: Share Results and Ensure Use

Evaluation recommendations are most useful when they 

are shared with the people who make decisions about 

the program. Programs can plan for how results and 

lessons learned will be communicated with others. This 

information can be included in the communications plan 

developed as part of Responsive Planning.

To decide what information to share, staff can think about 

how stakeholders plan to use the results. For example, 

will stakeholders use the results to build support for 

the program or to make changes to program activities? 

Stakeholders may also prefer different levels of detail. 

Effective evaluation reports include:115

• An executive summary 

• A list of stakeholders and how they were engaged

• A description of the program

• A description of the focus of the evaluation and 

its limitations

• The criteria used to draw conclusions

• Recommendations for action

• For each recommendation, a description of the 

pros, cons, and resources

• Technical information in appendices

Decision makers may not have time to read full reports 

and may prefer web-based or visual formats. Local 

grantees may want the detail of a full report. Some 

stakeholders may also prefer more frequent updates 

than others. Interim reports can be especially useful 

when programs are new or work in rapidly changing 

environments. Learn more about developing evaluation 

reports in the CDC workbook, Developing an Effective 

Evaluation Report.

115 Success stories can also be 

used along with evaluation reports to share data in 

a compelling and accessible way. Learn more about 

developing success stories on page 30. 

Audiences access information in different ways. Online 

reports or presentations may not be appropriate 

for stakeholders with limited Internet access. Some 

stakeholders may have limited English-speaking 

abilities or lower literacy levels. Others may have 

little knowledge of tobacco control. It is best to avoid 

technical terms and jargon in all communications.
Program Infrastructure l 30

HOW TO

Even well-thought-out communications plans may 

not be enough to get programs, partners, and decision 

makers to act on recommendations. Programs 

can increase the likelihood that results are used by 

following up with stakeholders to help them carry out 

recommendations.3,111 Program staff can review results 

during internal staff meetings, hold regular meetings 

with stakeholders to brainstorm ways to put results 

into action, and track efforts of staff and stakeholders 

to make changes.35 These efforts take time and 

commitment, but are important to remind stakeholders 

what was learned, prevent misuse of results, and keep 

recommendations from being forgotten or ignored 

during complex or political decisions.111

A CLOSER LOOK: Using the Success Story

An effective, flexible way to frame results is to use a “success 

story.” Success stories can help explain program data in a 

compelling, easily understandable format. An “upstream” 

success story follows a project in its early stages. A 

“midstream” success story follows a program that is up and 

running and shows progress. A “downstream” success story 

shows program impact.116 Highlighting a success story can 

educate decision makers, celebrate achievements, and show 

progress toward long-term goals.116 A success story can take 

several forms. The story’s purpose and the intended audience 

will help programs decide which format to use:116,98

• An “elevator story,” an attention-grabbing short story 

that describes the program and can be easily recited

• A “paragraph spotlight,” a paragraph explaining the 

program that can be used in newspapers and other 

media

• A “one-pager,” a polished document with pictures 

and contact information that can be easily handed to 

decision makers or funders

• A “two-page success story,” a detailed story that presents a more complete picture of a program 

and can be used for best practice submissions or to highlight a specific program

• A “full brief,” a more formal combination of the above formats, as well as data visualizations that 

showcase program achievements

• A “published article,” an article that synthesizes the program’s work and experiences, used when 

the public recognizes the public health issue and supports the program’s efforts

Effective success stories are recent, relatable, realistic, jargon-free, tailored to the audience, and tied to 

other issues important to the community (e.g., child health or public safety). The workbook, Impact and 

Value: Telling Your Program’s Story,

116 and the web page, Tips for Writing an Effective Success Story,117

can help programs create success stories. The website, NCCDPHP Success Stories, includes step-by-step 

instructions for developing content and designing success story layouts.118

Austin: Tobacco-Free On-The-Go and At Work by: Dr. Philip Huang, M.D. M. P.H 

SUMMARY 

After identifying tobacco use and secondhand smoke as an issue for both its 

employees and patrons, Capital Metropolitan Transportation Authority (Capital 

Metro) implemented a comprehensive Tobacco-Free Workplace Wellness 

Initiative. This effort established tobacco-free properties and promoted tobacco 

cessation and support to its workforce and the local community. Now, all of 

Capital Metro worksites, bus stops, rail platforms, transfer centers, and “park & 

rides” are tobacco-free, affecting over 280,000 riders and 1,100 employees each 

year. 

CHALLENGE 

Through the June 2010 Customer 

Survey, Capital Metro learned that 

56% of its workforce was in favor of 

the Tobacco-Free Workplace 

Wellness Initiative, and 66% of its 

riders supported such an initiative. 

These results posed the challenge of 

how to best create a plan to make 

Capital Metro 100% tobacco-free over 

the coming months. The greatest 

perceived internal challenge was 

organizational buy-in from the 

development of voluntary agency 

policies to full employee support. Some 

concerns included the safety of buses 

left unattended during breaks, litter to 

neighboring properties, enforcement, 

and the perception of a disproportionate 

burden on employees and riders who 

frequently. In addition, many area bus 

stops were technically on city-owned 

property, which did not give Capital 

Metro the full authority to make them 

tobacco-free. 

YOUR INVOLVEMENT IS KEY 

It is clear that with patience, 

robust information and 

awareness efforts, and a clear 

implementation plan, any 

organization can go tobaccofree. Capital Metro was 

successful in its efforts to be a 

100% tobacco-free organization 

and encourages other 

organizations to become 

tobacco-free as well. 

"We believe that addressing an 

issue such as this will attract 

more riders in a cleaner, 

healthier, safer system."

- Mike Nyren, Risk Manager at 

Capital Metro 
Program Infrastructure l 31

PROVIDING SUPPORT

How Can Tobacco Control Programs Support 

Program Infrastructure?

Program staff can take the following actions to support the development of a strong program infrastructure:

Responsive Plans and Planning

8 Encourage diverse staff, partners, community members, and grantees to take part in the planning process.

8 Think about what data will be needed to develop plans and gather information before starting planning.

8 Regularly assess implementation of plans and revise activities as needed.

Multilevel Leadership

8 Identify organizations or people in the community that could become leaders and make sure they understand 

the value of tobacco prevention and cessation. 

8 Look for staff that can be developed into future leaders.

Networked Partnerships

8 Continue to develop and strengthen internal partnerships with public health directors or other agency 

administrators.

8 Create opportunities to connect people inside and outside the program (e.g., networking events and partner 

meetings) to strengthen the entire network of tobacco control champions. 

Managed Resources

8 Develop a plan to secure resources for the program, including identifying champions, alternative funding 

sources, and opportunities to share resources and staff with other programs.

8 Establish competencies for staff to guide the development of staff skills and knowledge. 

8 Assess the technical assistance needs of local grantees and partners and offer trainings on these topics.

Engaged Data 

8 Tailor how results are shared, choosing information, format, and language that is relevant to the audience.

8 Meet with stakeholders to discuss how results can be put into action and follow-up with technical assistance to 

make changes.
Program Infrastructure l 32

CASE STUDIES

“ We learned you can weather 

even big swings in your budget if 

you have that basic framework to 

build on. ”

– Karen Girard

Oregon Case Study

Oregon maintains basic infrastructure during complete budget cut and uses Engaged Data to build 

support to restore funding

Oregon’s efforts result in sharp decreases in statewide tobacco use 

In the late 1990s, Oregon’s tobacco control program 

was among the most successful in the country. In 1996, 

voters approved a 30¢ increase in the cigarette tax and 

set aside 10% of the revenue to fund tobacco prevention 

and education, leading to the creation of the Oregon 

State Tobacco Prevention and Education Program 

(TPEP).119,120 Two years later, TPEP’s efforts were paying 

off; smoking prevalence in Oregon had declined by 

11%.121 The state started funding tobacco cessation 

coverage for Medicaid recipients in 1998, passed the 

first private employer smoke-free workplace law in 

2001, and raised the cigarette tax by another 60¢ in 

2002.120 Smokers in Oregon started to cut back on their 

use, and smoking prevalence decreased by 40% from 

1996 to 2003.119

Program infrastructure devastated by loss of funding

In response to a state budget crisis in March 2003, the 

Oregon state legislature completely defunded TPEP. 

Just as the program had become recognized as a model 

tobacco control program, it was shut down. Many 

programs, including the Quit Line, were dismantled. 

The state’s paid media campaign ended as billboards 

and other counteradvertising were removed.121

Defunding also nearly dissolved TPEP’s infrastructure 

that had sustained efforts across the state. Though 

a fraction of its funding was replaced in 2004, the 

damage to TPEP’s infrastructure had been done. TPEP’s 

Networked Partnerships and Managed Resources were 

most affected.121 TPEP was forced to end contracts 

with all 34 local health departments, representing 

36 counties. Staff members who had been working 

for TPEP were forced to find new jobs. Partnerships 

developed over time and investments in staff training 

and technical assistance were lost.121

TPEP uses Engaged Data and Multilevel Leadership to build 

support to reinstate funding

Following the 2003 funding cut, TPEP was forced to 

operate with less than 40% of its former budget, limited 

annual funding from the CDC, and basic program 

infrastructure.121 TPEP made the strategic decision to 

focus on continuing surveillance and evaluation. Using 

Engaged Data gathered from these efforts, Oregon was 

able to show the legislature and public that the loss of 

funds was having a profound effect on cigarette sales 

rates (see Figure 4 on page 33). Because TPEP’s 

efforts were scaled back, the decline in cigarette pack 

sales had slowed and eventually began to rise in 2005.121

Multilevel Leadership helped gain the support necessary 

to reinstate TPEP’s funding. Staff from the Oregon 

Department of Human Services educated decision 

makers and the public on the need for comprehensive 

tobacco control programs. In 2007, they presented 
Program Infrastructure l 33

CASE STUDIES

budget recommendations to the legislature, predicting 

that cigarette sales and tobacco use would continue 

to increase if TPEP kept operating without enough 

funding.121 By this time, Oregon’s fiscal situation had 

improved, and former Governor Ted Kulongoski 

responded to the recommendations, pledging his 

support for TPEP and tobacco prevention.121 In 

2007, the legislature and Governor supported fully 

restoring funding to 1990s levels, and Oregon again 

began making progress in reducing tobacco use and 

secondhand smoke exposure. 

The legislature also passed the Indoor Clean Air Act 

in 2007. The law went into effect in 2009 and protects 

most Oregonians from secondhand smoke exposure 

at work and prohibits smoking within 10 feet of 

public buildings.121 Tobacco product sales started to 

decrease again, and as of 2015 adult cigarette smoking 

prevalence was below the national average.122,123

Karen Girard, Health Promotion & Chronic Disease 

Prevention Section Manager, credited the program 

refunding to Engaged Data, saying, “Data gathering 

is an ongoing need to help plan and then evaluate. It 

is very important to have the evidence to back up the 

work that is being done.”

Managed Resources support program sustainability 

TPEP is now well-integrated into Oregon’s Public 

Health Division. Staff and resources are shared across 

all chronic disease programs, so that if the money goes 

away again in the future, the infrastructure will not. 

Girard explained, “Unstable funding is devastating to a 

program. After some of the funding was reinstated, we 

spent the next two years rebuilding the infrastructure 

that had been torn down from not having funding for 

just a few months. We learned you can weather even big 

swings in your budget if you have that basic framework 

to build on.”

Figure 4. Oregon Cigarette Sales Trends and Funding of TPEP

Source: Oregon Health Authority122
Program Infrastructure l 34

CASE STUDIES

“The partnerships that we built 

with non-traditional partners 

were unusual suspects. They 

grabbed people’s attention. ”

– Chris Tholkes

Minnesota Case Study

Minnesota focuses on strengthening tobacco control program infrastructure as funding fluctuates

Statewide Health Improvement Program (SHIP) sees fluctuating 

levels of support

Created in 2009, Minnesota’s SHIP works to reduce 

obesity and tobacco use by offering grants and technical 

assistance to local public health departments and tribes 

throughout the state.124 While Minnesota’s legislature 

first funded SHIP at $47 million, a state budget deficit 

in 2011 led to a 70% funding cut. As a result, some 

grantees lost all funding and many were forced to lay 

off their entire SHIP staff.124

Networked Partnerships help sustain program infrastructure after 

defunding

After losing funding, SHIP turned to its Networked 

Partnerships to make the case for reinstating funding. 

Health advocates brought together business leaders, 

decision makers, and community groups to town hall 

meetings across Minnesota to show support for SHIP. 

As Chris Tholkes, former manager of Minnesota’s 

Alcohol and Tobacco Prevention and Control Program 

(TPCP) explains, “The partnerships that we built 

through workplace wellness strategies and other 

strategies with non-traditional partners were unusual 

suspects. They grabbed people’s attention.”

TPCP also used a unique partnership-based funding 

structure to sustain program infrastructure and 

activities after SHIP funding was cut. Minnesota’s 

tobacco control efforts are funded by three main 

sources: Blue Cross and Blue Shield of Minnesota (a 

health insurance provider), ClearWay Minnesota (an 

independent nonprofit foundation), and the Minnesota 

Department of Health. Additional yearly CDC funding 

supports staffing. This diversified funding structure 

allowed T PCP to respond to a volatile funding 

environment and manage resources so that they could 

continue program activities. As a result, the program 

continued to achieve tobacco control successes, 

including a tobacco tax increase and progress on 

innovative point-of-sale policies. 

Responsive Plans and Planning help SHIP regain position as a 

tobacco control leader 

In 2012, Tholkes worked with CDC’s Office on 

Smoking and Health to revise the program’s strategic 

plan to better respond to changes in funding. During 

the planning process, the committee acknowledged that 

the program had lost its status as the state’s primary 

resource for evidence-based knowledge. To regain 

the program’s position as a tobacco control leader, 
Program Infrastructure l 35

CASE STUDIES

“The group that convened 

identified tobacco as the topic 

that touches the most areas of 

the department...they wanted 

that to be the focus of the quality 

improvement work. ”

– Chris Tholkes

the committee presented at national and regional 

conferences, developed a communications plan, and 

emphasized evaluation objectives in the new plan’s 

goals. The new plan also focused on educating state 

officials on tobacco control initiatives and featured 

a “menu” of strategies for grantees,124 including 

increasing tobacco prices and expanding local point-ofsale work. The plan also included evaluation tools that 

could be used to assess each of the strategies. Tholkes 

sees the Minnesota program once again serving as a 

leader in tobacco control and as a resource for data and 

education on tobacco-related issues for Minnesota.

TPCP adapts Managed Resources to respond to funding instability

After experiencing drastic funding changes over the 

course of five years, Tholkes and colleagues realized 

the importance of being proactive instead of reactive to 

funding changes. In response, the program focused on 

strengthening Managed Resources to help sustain the 

program when funding fluctuates. 

State tobacco funding in Minnesota does not cover 

administrative costs, including staffing. To protect 

staff from future budget cuts, the program (with the 

support of state leadership) revisited the statute that 

prohibits administrative expenses and began sharing 

staff with other divisions of the Health Department. 

Sharing staff allowed TPCP to hire part-time staff to 

support Engaged Data efforts. Staff used data to develop 

public health messages to support tobacco control 

strategies. These messages were an important factor in 

recent program wins, including increasing Minnesota’s 

tobacco tax by $1.60 in 2013. 

TPCP strengthens Networked Partnerships 

Because of its connection to many other community 

issues (e.g., chronic disease prevention, environmental 

concerns, and state revenue), Tholkes sees the program 

acting as a “hub” within the public health department 

that can guide the work of Networked Partnerships

across many departments. In 2013, the Minnesota 

Health Department received a Quality Improvement 

Grant. According to Tholkes, “The group that convened 

identified tobacco as the topic that touches the most 

areas in the department, and they wanted that to be the 

focus of the quality improvement work.” The Minnesota 

TPCP used the grant opportunity to improve how 

tobacco control works and communicates information 

with other health department programs. 

SHIP funding fluctuations encourage Responsive Planning for 

state tobacco control efforts 

In 2013, SHIP funding increased from $15 million 

to $35 million.124 Communities that were defunded 

reapplied for SHIP grants, and 38 communities and 

10 tribal nations were awarded SHIP funding.125 The 

program also began awarding planning grants to 

ensure that grantees had time to rebuild capacity before 

implementation.125 These experiences have also led to 

Responsive Planning for other tobacco control initiatives 

in the state. ClearWay Minnesota runs the state 

quitline, but these services will end in 2023. “It seems 

far into the future, but we’re already thinking about 

who will take on the quitline and what that transition 

might look like.”
Program Infrastructure l 36

CASE FOR INVESTMENT

Why Invest in Program Infrastructure?

Fully-functioning program infrastructure is essential to develop and implement successful tobacco prevention 

and control programs.1

 Program infrastructure is the foundation that supports the organizational capacity to 

carry out tobacco control strategies and achieve program goals.1 Investing in a strong program infrastructure also 

helps sustain programs during times of fluctuating support.1,2,3

 This case for investment provides information that 

programs can use to educate decision makers and leadership on why program infrastructure should be funded and 

the important role it plays in a comprehensive tobacco control program.

History and Adoption

Since 2000, the CDC has encouraged states to improve 

public health infrastructure by assessing staff skills, 

information and data systems, and organizational 

capacity.17 Healthy People 2020 also included the 

development of public health infrastructure among its 

goals.14 The initiative described infrastructure as “key 

to all other topic areas in Healthy People 2020. It allows 

for and supports key goals of Healthy People, including 

the improvement of health, creation of environments 

that promote good health, and promotion of healthy 

development and behaviors.”14

In 2009, building on past work, the CDC conducted 

a literature review on public health infrastructure 

and theories from other disciplines such as sociology, 

organizational development, and economics.2,3

 In 2011, 

the CDC developed an infrastructure model based on 

data from 18 state tobacco control programs.2 Tobacco 

control programs and partners can use the model’s five 

core components (i.e., Responsive Plans and Planning, 

Multilevel Leadership, Networked Partnerships, Managed 

Resources, and Engaged Data) to measure success 

and increase the sustainability of programs. This 

“practical, actionable, and evaluable” model was added 

to the expanded Infrastructure, Administration, and 

Management category in Best Practices 2014.

1,2

Scientific Evidence

Several national public health organizations 

recommend infrastructure development as key to 

achieving public health goals. The 2002 Institute of 

Medicine report, The Future of the Public’s Health in 

the 21st Century; the 2007 National Cancer Institute 

monograph, Greater Than the Sum: Systems Thinking 

in Tobacco Control; and Healthy People 2020 all 

include infrastructure development as important 

objectives.13,14,126

Evidence shows that greater investments in tobacco 

control programs lead to greater declines in tobacco 

use.1,127,128 In states that have made larger investments 

in comprehensive tobacco control programs, smoking 

prevalence and cigarette sales have decreased 

faster than national rates.129 Major cuts to program 

infrastructure have also had drastic effects. Decreases 

in staffing and funding have increased cigarette use, 

youth willingness to try smoking, and youth smoking 

prevalence.130,131,132,133 Developing and maintaining fullyfunctioning infrastructure supports program capacity 

to reach tobacco control goals.1,2
Program Infrastructure l 37

CASE FOR INVESTMENT

Cost 

Tobacco use and secondhand smoke exposure is the 

leading cause of preventable disease and death in the 

U.S.128 Cigarette smoking resulted in approximately 

$175.9 billion in direct health care costs in 2013 and 

approximately $150.7 billion in annual productivity 

losses.128 Comprehensive tobacco control programs 

reduce both the health and financial burdens of 

tobacco use.127 A solid infrastructure is the supporting 

foundation that gives states the capacity to effectively 

implement tobacco control programs.1

Creating and maintaining a strong program 

infrastructure is a continuous process. Fully developing 

each component is important to carry out effective 

strategies. Developing all components takes resources 

and time. The cost of building a strong infrastructure 

depends on the infrastructure the program already has 

in place and the program’s scope of work. Best Practices 

2014 recommends that at least 5% of a state’s CDCrecommended budget go toward administration and 

management of infrastructure activities, even if actual 

program funding is below this level.1

When programs have a complete infrastructure in 

place, they can take advantage of opportunities and 

defend against threats to achieving program goals.1

The core infrastructure components of Responsive 

Plans and Planning, Multilevel Leadership, Networked 

Partnerships, Managed Resources, and Engaged Data

interact with each other to create a synergy that builds 

capacity to implement evidence-based strategies and 

achieve public health outcomes.2

Sustainability

Sustainability is not just about funding; it is also about 

being able to maintain program activities and their 

benefits over time.40,41,42 Investing in tobacco control 

program infrastructure can have a lasting effect on 

tobacco use and secondhand smoke exposure.

Each of the five core infrastructure components help 

sustain the effects of tobacco control programs.2

Responsive Planning helps programs create a longterm plan for success that maps out how the program 

will maintain or increase funding and sustain its 

achievements. Developing strong Multilevel Leadership

and Networked Partnerships secures resources and 

creates champions that are critical to achieve goals 

and keep programs going when funding is cut. 

Careful attention to Managed Resources can lessen 

the effect of funding losses and help ensure program 

sustainability. Programs can also use Engaged Data to 

justify continued support for programs and to improve 

their effectiveness. When programs are successful, it 

helps make the case for continued support of tobacco 

prevention and control strategies.134
Program Infrastructure l 38

RESOURCES

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Model of Infrastructure: a practical approach to 

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Lavinghouze R, Price A, Smith K. The program success 

story: a valuable tool for program evaluation. Health 

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Program Infrastructure l 39

RESOURCES

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Disease Control and Prevention, National Center for 

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Disease Control and Prevention, National Center for 

Chronic Disease Prevention and Health Promotion, 

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Centers for Disease Control and Prevention. Using 

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Program Infrastructure l 40

RESOURCES

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National Association of County & City Health Officials, 

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Program Infrastructure l 41

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This document was produced for the Centers for Disease Control and Prevention by the 

Center for Public Health Systems Science (CPHSS) at the Brown School at Washington 

University in St. Louis.

Suggested citation:

Centers for Disease Control and Prevention. Best Practices User Guide: Program Infrastructure in 

Tobacco Prevention and Control. Atlanta: U.S. Department of Health and Human Services, Centers 

for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health, 2017.

Ordering information:

To download or order copies of this report, go to www.cdc.gov/tobacco or to order single copies, 

call toll-free 1-800-CDC-INFO or 1-800-232-4636.

More information:

For more information about tobacco control and prevention, visit CDC’s Smoking & Tobacco Use 

website at www.cdc.gov/tobacco.