C H A P T E R 5�

Future Directions�

In this publication, we discuss key outcome indicators to evaluate comprehensive state tobacco control programs. Outcome indicators are important for program 

planning, monitoring, and evaluation. In addition, increasing demands for timelier 

program performance measures and the need to synthesize existing evidence for 

evaluation of tobacco control programs contributed to the need for this publication.

The Centers for Disease Control and Prevention’s (CDC’s) future plans include 

(1) developing process indicators for evaluating comprehensive tobacco control 

programs, (2) developing process and outcome indicators for evaluating activities 

that address tobacco-related disparities (National Tobacco Control Program [NTCP] 

goal area 4), and (3) conducting research and building scientific evidence for indicators and theories related to tobacco control.

Process Indicators

Process indicators are used to measure success in program planning and implementation. Indicators in this area help to answer questions about the planning, 

infrastructure, and implementation of a program’s activities and the extent to 

which these activities are reaching the target population. Process indicators are 

also used to understand why outcomes were or were not achieved as planned. 

For example, program managers can learn whether implementation of a program 

component could be improved or whether a new strategy is needed to overcome 

an unexpected obstacle (e.g., political opposition). 

In the NTCP logic models, the emphasis is on environmental, behavioral, and health 

outcomes; it is assumed that the capacity and infrastructure needed for goal-specific 

activities are, for the most part, in place. However, for fully informed program planning and evaluation, the program’s capacity, infrastructure, and processes must also 

be assessed. To do so, well-defined indicators of these aspects of the program are 

needed. Although considerable work has been completed on defining indicators 

that can be used by program planners and evaluators for measuring program 

capacity, working with CDC partners to define these indicators in a meaningful 

and systematic way is necessary. 

Indicators for NTCP Goal Area 4: Eliminating Tobacco-related Disparities

Unlike activities to prevent initiation of tobacco use by young people, eliminate 

nonsmokers’ exposure to secondhand smoke, and promote quitting among adults 

and young people, activities to identify and eliminate tobacco-related disparities 

lack a definitive evidence base for implementing a program and identifying target 

outcomes. Sufficient public health knowledge and experience exists, however, to 

provide a well-founded framework for approaching tasks associated with improving 

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C H A P T E R 5 Future Directions

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the public health infrastructure and related capacities so that tobacco control 

programs can address tobacco-related disparities among specific populations. 

Building on successful capacity-building and infrastructure activities during the 

past 10 years, CDC began the Disparities Pilot Training Project, an initiative to 

improve the state and territorial public health capacity and infrastructure needed 

to address tobacco-related disparities. To assist health departments and their 

partners with planning and implementing strategic activities to identify and 

eliminate tobacco-related disparities, CDC prepared a draft logic model that is 

based on state practices, published scientific findings, and input from external 

partners (see draft logic model, page 271). Instead of focusing on traditional health 

outcomes, this logic model focuses on the minimum capacity needed by state and 

territorial health departments to pursue strategic activities that would identify 

and eliminate tobacco-related disparities. 

In cooperation with its partners, CDC will continue the task of developing an 

approach to identifying, evaluating, and eliminating tobacco-related disparities. 

The draft logic model is a window to the work that is being done now and that 

needs to continue. 

Research Opportunities

We encourage researchers outside CDC who read this publication to identify research 

opportunities. For example, where the strength of the evidence for using certain indicators is low, expanding that evidence base would be beneficial. Researchers might 

also consider developing new evaluation designs that could (1) further refine theories 

related to tobacco control or (2) identify other outcome indicators, especially indicators for program components that need additional research or scientific evidence 

to support them. In addition, researchers might work on developing methods for 

measuring indicators for which no well-established methods are currently available. 

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

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C H A P T E R 5 Future Directions

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Goal Area 4Identifying and Eliminating Tobacco-Related Disparities

Inputs Activities Outputs Outcomes

1 Health 2 Convene a 5 Planning

�

workgroup

� departments diverse and

and diverse inclusive group formed

�

national, state, of stakeholders

�

tribal, and 

� 6 community Data sources

partners assessed 3 LOCATE

Access relevant

Short-term Intermediate Long-term

collection system

Community

norms supportive

of tobacco use

Dissemination

interventions

Institutionalization and

leveraging of

Ownership and

substantive

participation

in tobacco use

COMMUNITY

COMPETENT

developed

FUNDING and

RESOURCES

Stable funding

COMMUNITY

DEVELOPMENT

social capital

developed for specific

populations

DIVERSITY and

INCLUSIVITY

and practice in place

12

13

16

17

18

19

Ongoing

identification of

20

10

DATA SYSTEMS

A more sensitive data

created

prevention and

control efforts

and diffusion of

resources

prevention and 

control

INTERVENTIONS

Appropriate and 

effective interventions

stream identified

Capacity, 

Representative and 

infrastructure, and

equitable partnerships

11

14

15 tobacco-related

PLAN TO

ADDRESS

DISPARITIES

Policy and data sources to 7 environmental identify tobacco- Capacity, change related disparities infrastructure, 

and social

capital assessed

Health 4 LEARN

equity Identify gaps 8 Tobacco-

�

and assess

�

in available data

related

�

opportunities for disparities

� Social justice expanded data identified

�

collection

�

9 Qualitative

and

quantitative

data needs

identified

disparities

collection system

Community

norms supportive

of tobacco use

Dissemination

interventions

Institutionalization and

leveraging of

Ownership and

substantive

participation

in tobacco use

COMMUNITY

COMPETENT

developed

FUNDING and

RESOURCES

Stable funding

COMMUNITY

DEVELOPMENT

social capital

developed for specific

populations

DIVERSITY and

INCLUSIVITY

and practice in place

12

13

16

17

18

19

Ongoing

identification of

20

10

DATA SYSTEMS

A more sensitive data

created

prevention and 

control efforts

and diffusion of

resources

prevention and 

control

INTERVENTIONS

Appropriate and 

effective interventions

stream identified

Capacity, 

Representative and 

infrastructure, and

equitable partnerships

11

14

15 tobacco-related

PLAN TO

ADDRESS

DISPARITIES

1 2

3

4