Putting Evidence

into Practice

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 at the Brown School at Washington University in St. Louis. 

Primary contributors:

Stephanie Andersen, Laura Brossart, Rebecca Ballard, Amy Endrizal, Rachel Hackett, Douglas Luke, Angella 

Namwase

Input was provided by:

Lindsay Bishop, Ross Brownson, Natasha Buchanan Lunsford, Kevin Collins, Elizabeth Courtney-Long, Erika 

Fulmer, Karen Gutierrez, Nikki Hawkins, Michelle Johns, Brian King, Michon Mabry, Rebecca Murphy, Byron 

Powell, Robert M. Rodes, Robin Scala, Katelyn Sives, Karla S. Sneegas, Tamatha Thomas-Haase, Michael Tynan, 

Renee Wright

Input for the case studies was provided by:

Jackie Kaslow, CA Quits

Dr. Elisa Tong, CA Quits

April Roeseler, California Tobacco Control Program

Amanda Mortensen, Tobacco Free Nebraska

Other contributions:

Photograph on page 9 courtesy of Implementation Science

Photograph on page 21 courtesy of ClearWay Minnesota

Photograph on page 22 courtesy of the North Carolina Department of Health and Human Services

Photograph on page 28 courtesy of District of Columbia Smokefree Housing

Photograph on page 41 courtesy of Santa Clara County Public Health

Photograph on page 38 courtesy of American Academy of Family Physicians

Photograph on page 43 courtesy of Emory Prevention Research Center

Photograph on page 45 courtesy of Association for Nonsmokers – Minnesota
Table of Contents

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

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

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

How To .........................................................................................................4

Understanding Evidence-Based Interventions .................................................4

Getting Started .................................................................................... 10

Disseminating Evidence-Based Interventions ................................................ 20

Implementing Evidence-Based Interventions .................................................33

Reaching Priority Populations through D&I ....................................................42

Evaluating D&I Strategies .........................................................................47

Sustaining Evidence-Based Interventions ..................................................... 49

Providing Support ...........................................................................................51

Case Studies ..................................................................................................52

Case for Investment ........................................................................................ 56

Resources .................................................................................................... 58

References ................................................................................................... 68
Putting Evidence into Practice l 1

GUIDE TO THE READER

Purpose

The Center for Public Health Systems Science at 

Washington University in St. Louis is developing 

a set of user guides funded by the Centers for 

Disease Control and Prevention (CDC), contract 

75D30120C09195, for the Best Practices for 

Comprehensive Tobacco Control Programs—2014

(Best Practices 2014), an evidence-based tool to help 

states develop and sustain comprehensive tobacco 

control programs.1

The purpose of the user guides is to help commercial 

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 

are designed to help programs put into practice 

scientific evidence about reducing commercial tobacco 

use. Programs can follow these recommendations 

according to their needs, goals, and capacity. 

Content

This user guide focuses on how commercial tobacco 

control programs can increase the use of evidence-based 

interventions. Evidence-based interventions broadly include 

programs, practices, processes, policies, and guidelines.2

According to Best Practices 2014, “full implementation 

of comprehensive tobacco control policies and 

evidence-based interventions at CDC-recommended 

funding levels would result in a substantial reduction in 

tobacco-related morbidity and mortality and billions of 

dollars in savings from averted medical costs and lost 

productivity in the United States.”1

 This guide describes 

how program staff and partners can use dissemination 

and implementation strategies from the field of 

Implementation Science, which is the study of how to 

carry out evidence-based interventions.

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 with more information. Website 

addresses for all of the blue resources noted throughout 

the guide are also included in the Resources section.

Organization

8 Making the Case: A brief overview of why 

increasing the use of evidence-based interventions 

is essential to commercial tobacco control efforts

8 Brief History: How evidence-based interventions 

have become a major focus of public health

8 How to: Strategies to disseminate and implement 

evidence-based interventions

8 Providing Support: How commercial 

tobacco control programs can support efforts 

to disseminate and implement evidence-based 

interventions

8 Case Studies: Examples of successful efforts to 

put evidence into practice

8 Case for Investment: Information to raise 

awareness about the importance of evidence-based 

commercial tobacco control

8 Resources: Publications, toolkits, and websites to 

help in planning efforts\

Best Practices for Comprehensive 

Tobacco Control Programs–20141

Best Practices 2014 is an evidence-based 

guide to help states plan, establish, and 

evaluate comprehensive tobacco prevention 

and control programs. The report offers 

recommendations and evidence for five 

essential components of effective programs:

• State and community interventions 

• Mass-reach health communication 

interventions

• Cessation interventions

• Surveillance and evaluation 

• Infrastructure, administration, and 

management
MAKING THE CASE

Making the Case for Putting Evidence into Practice

After more than fifty years of research, we know what works to reduce commercial tobacco use.3 Yet more than 

480,000 people die from smoking-related causes each year and tobacco use remains the leading cause of preventable 

disease and death in the U.S.3 Effective commercial tobacco control interventions are unequally distributed across 

communities, states, and the country.4

 As a result, evidence-based interventions are not reaching the people who 

need them most.4 Together, researchers and programs can tackle this problem by combining scientific evidence 

about what works with real-world experiences and widely sharing that information at state and local levels. 

Strategies that focus on communicating and implementing evidence are an important part of commercial tobacco 

control programs because they:

8 Increase the impact of commercial tobacco control

Interventions tested in controlled research settings 

often fail to produce the same results in the real 

world.5 Commercial tobacco control programs 

can support communities in wisely adapting 

interventions to fit their needs while retaining the 

core components that are critical to reduce tobacco 

use. When fully and consistently implemented, 

evidence-based interventions have enormous 

potential to improve public health.6-10

8 Ensure commercial tobacco control efforts act on 

the most up-to-date scientific information

Commercial tobacco control is continually 

evolving. New products are emerging on the 

market, patterns of tobacco use are changing, and 

states face new challenges to protect commercial 

tobacco control achievements.4 Programs need 

access to the most current research evidence to 

address these challenges. 

8 Reduce the use of interventions that are not 

evidence-based

When programs continue to use ineffective 

interventions or fail to implement new ones that 

are effective, they risk slowing progress in reducing 

commercial tobacco use. Ending ineffective 

interventions also makes the best use of limited 

public health resources.11

8 Raise awareness about the continued importance 

of commercial tobacco control

Declines in cigarette smoking prevalence have 

created a perception among some people that other 

health issues are more important than reducing 

tobacco use.4 Disseminating information about the 

remaining gaps in commercial tobacco control and 

how we can work to end the tobacco epidemic can 

energize and empower communities to continue to 

address tobacco. 

8 Address tobacco-related disparities

Discovering and delivering new science to 

communities are both important to increase 

the impact of commercial tobacco control.3

Dissemination and implementation strategies bring 

evidence-based interventions to populations that 

need them most by involving community members 

in decision making and overcoming barriers to 

implementation.12

8 Increase return on investment

CDC invested nearly $70 million in state 

commercial tobacco control program funding 

in 2020.13 Using evidence-based interventions 

increases the likelihood that this investment will 

result in the highest possible benefit to the public. 

Well-implemented interventions also have the 

potential to greatly reduce the staggering economic 

toll of cigarette smoking, which costs more than 

$300 billion a year in direct healthcare costs and 

lost productivity.3,14

Putting Evidence into Practice l 2
BRIEF HISTORY

Emphasis on Evidence 

Researchers have been studying how new practices 

spread across communities since the early 1900s. As 

federal research funding grew in the 1960s and 1970s, so 

did interest in ensuring findings were put into practice 

(see Figure 1 below).15 New information about the lack 

of scientific evidence supporting the use of medical 

treatments also led researchers to apply these concepts 

to health.16 In 1984, Congress approved funding for 

Prevention Research Centers to identify, disseminate, 

and implement effective public health interventions that 

can be applied across diverse communities. The program 

now includes 26 academic research centers across the 

country working on a range of public health problems.17

The 1990s marked a new era of research on using 

evidence to improve health care and public health, 

leading to a surge in federal programs, systematic 

reviews, and guidelines recommending evidence-based 

interventions.

15 In 1996, the U.S. Department of Health 

and Human Services created the Community Preventive 

Services Task Force to develop recommendations for 

communities on which public health interventions 

are most effective. The resulting Community Guide

now includes an online database of evidence-based 

recommendations for over 20 public health issues, 

including commercial tobacco use.18 More federal 

programs followed to develop evidence-based guidelines 

for mental health and substance use interventions, HIV 

prevention, and cancer control.19-21

Even with this increased attention on using evidence, 

major reports continued to warn of a “quality chasm” 

in health care and stress the importance of evidencebased decision making.22,23 These calls to action 

spurred more interest in studying how to increase use 

of scientific knowledge. The field of Implementation 

Science began to expand rapidly: the number of 

Implementation Science research articles increased 

from under 100 in 1990 to over 100,000 by 2012.24

Implementation Science methods have been especially 

important in commercial tobacco control, where 

interventions have traditionally been tested first at 

community and state levels. Resources like the National 

Cancer Institute Tobacco Control Monographs, launched 

in 1991; CDC’s first Best Practices for Comprehensive 

Tobacco Control Programs (1999); and the World Health 

Organization’s Framework Convention on Tobacco 

Control (2003) and MPOWER framework (2008) led the 

push to implement effective interventions.25-28 Since then, 

CDC has published two more editions of Best Practices

and eight Best Practices User Guides to provide evidencebased guidance for states and communities.1,29-36 These 

efforts have led to successes in reducing commercial 

tobacco use, including the rapid adoption of state 

quitlines and smokefree environments.4,37 Gaps 

remain, especially in extending smokefree protections 

to at-risk populations.4 New initiatives, such as the 

Advancing Science & Practice in the Retail Environment 

(ASPiRE) project, focus on using dissemination and 

implementation strategies to increase evidence use.38

Figure 1. History of Putting Tobacco Control Evidence into Practice

Putting Evidence into Practice l 3
HOW TO

Understanding 

Evidence-Based 

Interventions

Over the last 50 years, scientists have carefully 

evaluated the risks of commercial tobacco use and the 

effectiveness of different interventions.3 This work has 

built a solid foundation of evidence-based interventions: 

programs, practices, processes, policies, and guidelines 

that have been tested using rigorous scientific methods 

and peer-reviewed research and are proven to reduce or 

prevent commercial tobacco use.2,39 They may be new 

interventions or changes to existing interventions.

Awareness of the importance of using evidence-based 

interventions has grown in recent years. Researchers are 

increasingly reviewing the evidence, new initiatives are 

promoting evidence-based health care, and funders are 

requiring scientists to share their research findings.40 So 

it is easy to assume that evidence-based interventions 

will naturally be put into practice.

The Research-to-Practice Gap

In reality, there is a gap between what researchers 

know and what practitioners do. In fact, public health 

departments have reported that just over half of 

programs and policies were evidence-based.41 Similar 

percentages have been reported of the use of evidencebased interventions in medical care.42

Even when evidence-based interventions are used, they 

may be poorly implemented and not consistent with 

the original intervention. These challenges can cause 

a “voltage drop” that makes it difficult to achieve the 

same results outside the research setting.43

Implementation gaps exist in the use of evidence-based 

commercial tobacco control interventions.4

 Despite 

the fact that using evidence-based cessation treatments 

more than triples the likelihood of quitting, less than 3 

in 5 people who smoke received advice to quit from a 

health professional in 2015 (shown in Figure 2).44 Gaps 

also remain in insurance coverage for evidence-based 

cessation treatment and funding for state quitlines.4

Why Use Evidence-Based 

Interventions?45

Using evidence-based interventions increases 

the likelihood of achieving commercial 

tobacco control goals. Putting evidence-based 

interventions into action also helps:

• Justify investment in commercial 

tobacco control

• Build the program’s credibility with 

partners and the community

• Provide a framework for planning

• Secure future resources

• Learn from others who developed 

or used the intervention if problems 

occur

Strong evidence also shows that comprehensive 

smokefree laws reduce tobacco use and secondhand 

smoke exposure at the state or local level.7

 Yet nearly 

40% of the U.S. population lives in a place without a 

comprehensive smokefree law, leaving millions at risk 

of tobacco-related disease and death (shown in Figure 

3 on page 5).46 Even in places with smokefree 

protections, exemptions leave people at risk of exposure 

to secondhand smoke in small businesses, hotels, and 

family-based daycares.3

Figure 2. Advice to Quit from a Health 

Professional, 2015

Source: Babb S, Malarcher A, Schauer G, Asman K, Jamal A44

Putting Evidence into Practice l 4
Figure 3. United States Comprehensive Smokefree Air Laws, April 1, 2021

Source: American Nonsmokers’ Rights Foundation47,48

Disparities in commercial tobacco use and cessation 

remain challenges, despite clear evidence on how to help 

people quit for good.49 Table 1 on page 6 describes 

implementation gaps in commercial tobacco control 

and the information that programs can share with 

practitioners and decision makers to close the gaps.

Barriers to Putting Evidence into 

Practice

Both researchers and practitioners face barriers 

when disseminating and implementing evidence. 

Traditionally, researchers generate new findings and 

publish them using channels designed for fellow 

researchers. Health care providers, health departments, 

and tobacco control staff then put them into action 

without communicating with the researchers.50 As a 

result, the priorities of researchers have sometimes 

guided the development of evidence, instead of 

the needs and interests of practitioners and the 

communities they work with.

HOW TO

Putting Evidence into Practice l 5
Table 1. Best Practices 2014 Components and Implementation Gaps

Program Component Implementation Gaps Key Messages

State and Community 

Interventions

• Gaps in smokefree law adoption; 

exemptions for certain settings 

• Lack of smokefree law coverage of 

other commercial tobacco products

• Wide variation in commercial 

tobacco tax rates

• Limited adoption of innovative retail 

interventions

• Effectiveness of adopting smokefree 

laws

• Effectiveness of increasing the price of 

commercial tobacco products

• Effectiveness of retail interventions

• Implementation guidance for states and 

communities

Cessation Interventions • Disparities in access to commercial 

tobacco cessation treatment, quitting 

success

• Low levels of provider assistance to 

quit commercial tobacco

• Gaps in insurance coverage of 

evidence-based cessation treatments

• Effectiveness of evidence-based 

cessation treatments

• Implementation guidance for healthcare 

providers

• Cost-effectiveness information for 

health insurers

Mass-Reach Health 

Communication Interventions

• Decreased funding for media 

campaigns

• New and expanding ways that people 

get information

• Effectiveness of commercial tobacco 

control media campaigns

• Implementation guidance for limited 

media budgets

Surveillance and Evaluation • Limited sources of local data

• Limited information on emerging 

commercial tobacco products

• Importance of surveillance information 

to assess commercial tobacco use 

patterns and effectiveness of different 

interventions

Infrastructure, Administration, 

and Management

• Decreased funding for state 

commercial tobacco control 

programs

• Cost-effectiveness of comprehensive 

tobacco control programs

• Return on investment for commercial 

tobacco control interventions

Source: Adapted from Farrelly et al.4

Researcher Barriers

Researchers tend to value the discovery of information, 

while practitioners value practical ways to use this 

information. Because they are focused on creating 

new knowledge, nearly half of researchers (47%) do 

not have a person or team in their unit dedicated to 

dissemination.51 Most devote less than 10% of their 

time to disseminating their findings.51

When researchers do share their findings, they may 

not always be a good fit for practice. Scientific evidence 

is published using complex technical language and in 

journals that can be hard for practitioners to access 

because of time or resource constraints.52

Because interventions are often tested in controlled 

settings, findings may fail to take into account 

community needs, program resources, and feasibility. 

As a result, recommended interventions are often 

too costly or complex to implement.50 Findings 

often include little information on how to integrate 

them into existing practice or adapt them to the 

practitioner’s environment.50 Publishing evidence also 

takes time; by the time findings reach practitioners 

they may be out of date.50

Putting Evidence into Practice l 6

HOW TO
Practitioner Barriers

Public health practitioners often do 

not have access to sources of research 

evidence, time to read new findings, 

or the training to assess the strength 

of evidence and how well it fits with 

their setting.53 For example, a study 

of The Community Guide, an online 

collection of evidence-based public 

health interventions, found that only 

30% of local health department staff 

had heard of the Guide.54 Awareness 

was much higher among state program 

staff (90%), but use of the guidelines 

to make program changes was still low 

(35%).54

Even when practitioners are equipped 

to use evidence, other barriers can prevent practitioners 

from acting on new information.53 Potential barriers to 

using evidence may include:

• Funding barriers: Inadequate or unstable funding, 

lack of funding for training or technical 

assistance55

• Organizational barriers: Lack of leadership support, 

an organizational culture that does not prioritize 

evidence-based interventions, or lack of facilities 

or equipment56

• Professional barriers: Practitioners who face 

competing priorities for their time, feel that 

continuing existing interventions is easier, or 

fear the unfamiliar56

• External barriers: Political, community, or other 

pressures outside the organization56

Closing the Gap between Research 

and Practice

Dissemination and implementation (D&I) strategies 

can help close the gap between research and practice by 

turning what we know into what we do. In commercial 

tobacco control, D&I strategies help achieve goals 

by sharing information about what works to reduce 

commercial tobacco use and putting new or improved 

interventions into practice.56

Evidence Skills for 

Practitioners57

The following skills can help practitioners 

put evidence-based interventions into 

practice:

• Finding evidence

• Assessing the strength of evidence, 

how well it fits with their population 

or setting, and their organization’s 

capacity to implement evidence 

• Communicating about evidence to 

stakeholders 

• Adapting evidence to their population 

or setting

• Implementing evidence with quality

• Sustaining use of evidence-based 

interventions 

Putting Evidence into Practice l 7

HOW TO

Figure 4 on page 8 illustrates how dissemination and 

implementation help move evidence-based interventions 

through the pipeline of scientific discovery to public 

health impact.4

 Dissemination strategies “push” 

information about the evidence-based intervention to 
the people responsible for 

implementing interventions, such 

as local health department staff, 

health care providers, or employers. 

Implementation strategies can 

“push” evidence out. They can also 

and promote the “pull” of evidence 

by these practitioners by building 

capacity to find and use evidence.58

Dissemination spreads 

evidence-based interventions

to the intended audience 

through planned, systematic 

communications efforts.2

The goal of dissemination is 

to increase awareness and 

understanding of evidence-based 

interventions to support their 

widespread adoption.59

Programs are likely already doing some dissemination, 

such as when they post evidence-based guidance on a 

website where practitioners, decision makers, and the 

public can access it. This is called passive dissemination

because it relies on users to seek out the information.60

Passive dissemination alone is unlikely to increase use of 

evidence-based interventions.

2

Successful dissemination requires the use of active

approaches to tailor messages for specific audiences and 

try to reach them through planned strategies, such as 

delivering hands-on technical assistance, developing 

user guides, or conducting mass media campaigns.9,61

Figure 4. Scientific Discovery to Public Health Impact Pipeline

Source: Farrelly et al.4

Implementation is the process of putting evidence-based 

interventions into routine use in specific settings, such 

as a health clinic, school, or community.2 Because 

the people who decide to adopt an intervention

(e.g., organization leadership) are often not the 

same people who carry it out (e.g., program staff, 

healthcare providers, or community members) 

implementation strategies are critical to make sure that 

the implementers actually change their behavior and 

use the intervention.

2

 Programs are likely to use many 

implementation strategies to put a single evidencebased intervention into use. 

HOW TO

Putting Evidence into Practice l 8
D&I strategies often focus on changing healthcare 

practices, such as integrating commercial tobacco 

use treatment into every patient visit. But D&I efforts 

are also important to improve implementation of 

population-level interventions, such as implementing 

comprehensive smokefree laws, raising the price 

of commercial tobacco products, and reducing the 

influence of the tobacco industry in retail stores.62

Sustainment is the ability to continue an evidence-based 

intervention and its benefits over time.31 D&I strategies 

help support sustainability by spreading awareness 

of the intervention and its benefits. They also help 

overcome barriers that might make the intervention

difficult to maintain, such as staff turnover and changing 

community needs. Over time, it may be better to end 

an intervention than to sustain it, especially as more 

effective or efficient interventions become available.

De-implementation is the process of ending interventions

that have become ineffective, harmful, or unnecessary.62

De-implementation strategies may be necessary for a 

smooth process.63

Sustaining effective interventions and deimplementing ineffective ones increases the potential 

to improve the public’s health. As stakeholders see the 

effects of these interventions in their communities, 

they provide important feedback to researchers, which 

helps improve future D&I efforts.

What is Implementation Science? 

Implementation Science is the study of the factors that lead 

to effective implementation of evidence-based interventions

to improve population health.64 Implementation scientists 

study organizational readiness, external and internal 

conditions that affect implementation, and strategies to put 

evidence into practice.2 They seek to understand what does 

and does not work to implement interventions in the real 

world.64 Implementation Science research can help support 

commercial tobacco control efforts by:

• Providing more and better information about what 

works to reduce commercial tobacco use56

• Testing strategies to put commercial tobacco control 

interventions into practice56

• Reducing the use of interventions that are not 

evidence-based64

• Reducing program costs64

• Examining ways to reduce tobacco-related disparities64

The free online journals Implementation Science, Implementation Science Communications, and

Implementation Research and Practice publish the latest research on implementing evidence-based 

interventions in healthcare, organizational, and policy settings. The annual Conference on the Science of 

Dissemination and Implementation in Health presents new Implementation Science research, discusses 

challenges facing the field, and sets upcoming research priorities. Every other year, the Society for 

Implementation Research Collaboration hosts a conference open to researchers and practitioners to share 

knowledge and network.

Putting Evidence into Practice l 9

HOW TO
Getting Started

It is tempting to want to jump right into making 

changes after learning of a new effective intervention.65

Taking the time to carefully plan for changes can 

help ensure success. Programs can get started putting 

evidence into practice by taking the following actions:

• Planning for dissemination and implementation

• Assessing the evidence

• Understanding external context

• Assessing organizational readiness for change

• Forming a D&I team

• Engaging stakeholders

Planning for Dissemination and 

Implementation

Building D&I activities into a state commercial tobacco 

control plan helps programs clarify D&I goals, measure 

how well an intervention was carried out, and find 

and overcome potential challenges to putting evidence 

into practice. Like other commercial tobacco control 

strategies, D&I efforts have their own goals, activities, 

budget and timelines.

Setting D&I Goals

Setting goals is important to make sure that D&I efforts 

have their intended impact. Programs may choose 

to start with defining just one or two goals for D&I 

activities. For example, dissemination goals might seek to 

raise awareness, educate stakeholders, or get input from 

community members. Implementation goals might seek 

to test, adapt, or scale up interventions.

Goals are easier to meet when they are realistic and 

measurable. Using the SMART approach (Specific, 

Measurable, Achievable, Relevant, Time Bound) sets 

realistic expectations, identifies necessary activities, and 

defines success.66 For example, a program might set a 

goal to raise awareness of the importance of smokefree 

homes among community members by increasing 

website traffic to smokefree homes information by 150% 

within one year. Learn more about creating SMART 

goals and objectives in the CDC’s Evaluation Guide: 

Writing SMART Objectives.

Planning D&I Activities

Table 2 on page 11 describes potential activities 

to disseminate and implement evidence-based 

interventions. Each section is described in more detail 

throughout this user guide. Programs may not complete 

all the activities and may complete them in any order. 

For example, programs might include dissemination 

activities before and after an evidence-based intervention 

is implemented. They might first disseminate a toolkit 

to increase use of the intervention and then disseminate 

success stories after implementation.

Creating a Budget and Timeline

Budgeting for the added cost of D&I activities is 

critical to decide if they can be carried out with existing 

resources or require more support. Dissemination 

costs might include website hosting, or translation of 

materials into other languages. Implementation costs 

might include travel for in-person training or technical 

assistance. Being as precise as possible when creating 

the budget is important to have realistic expectations 

for D&I work.67 See a complete list of potential D&I 

costs and ways to save money in Te D-Cubed Guide: 

Planning for Effective Dissemination.

Creating a timeline helps make sure that D&I activities 

are realistic given other program activities. Useful 

timelines cover planning, implementing, sustaining, and 

evaluating D&I activities as well as the expected end date 

for D&I efforts. They also assign responsibilities.

Reviewing and Revising D&I Activities

Regularly updating D&I activities is important to 

account for external changes, such as changing budget 

priorities or new commercial tobacco control laws. 

Planning who will review and how often can help 

reviewers set aside time for this important task even as 

they get busy with other D&I activities.

Putting Evidence into Practice l 10

HOW TO
Table 2. What to Include in the D&I Plan

D&I Activity What to Include in the D&I Plan Planning Resources

Assessing 

Evidence

• Describe the evidence-based intervention that will be 

disseminated or implemented

• Describe the quality of evidence, including effectiveness, 

feasibility, and adaptability to other settings

• National Collaborating Centre 

for Methods and Tools’ Appraise 

Tools

Understanding 

External Context

• Describe the environment where the intervention will be 

disseminated and implemented, including the cultural, 

economic, and political climate

• Community Tool Box’s 

Developing a Plan for Assessing 

Local Needs and Resources

Building 

Organizational 

Readiness

• Describe staff and organizational capacity to do D&I 

activities

• Identify program resources that can be dedicated to D&I 

activities

• National Institutes of Health’s 

Organizational Readiness 

for Implementing Change 

Assessment

Forming a D&I 

Team

• Identify program staff with skills that can support D&I 

activities

• Define D&I team roles and responsibilities

• Patient-Centered Outcomes 

Research Institute’s 

Dissemination and 

Implementation Framework

Engaging 

Stakeholders

• Identify key stakeholders for D&I efforts 

• Describe stakeholders’ goals and roles in D&I

• Patient-Centered Outcomes 

Research Institute’s 

Dissemination and 

Implementation Toolkit

Disseminating 

Evidence-based 

Interventions

• Identify people who would likely use and benefit from 

information about the evidence-based intervention 

• Describe what message will be communicated to the 

audience and how they will be framed 

• Identify what products will be created to communicate 

the message and explain how they will be shared 

• The Australian Teaching and 

Learning Council’s The D-Cube

Guide: Planning for Effective 

Dissemination

Implementing 

Evidence-based 

Interventions

• Describe education that will be provided, such as training, 

TA, or health communications

• Describe core components of the intervention and which 

parts can be adapted

• Describe how the intervention will be pilot tested or 

scaled up

• Describe how changes will be monitored and feedback 

provided during implementation

• AI Hub’s Training Plan Template

• CPCRN’s Putting Public Health 

Evidence in Action workshop

• ExpandNet website

Evaluating D&I • Describe how data will be collected 

• Define evaluation measures for D&I activities, including 

progress toward D&I goals and unintended outcomes

• Describe how results will be shared

• RE-AIM’s Evaluation of RE-AIM 

Dimensions

Sustaining 

Evidence-based 

Interventions

• Describe how the program will build capacity to continue 

D&I activities, such as training staff 

• Define criteria for determining whether to end an 

intervention

• Center for Public Health Systems 

Science’s Program Sustainability 

Assessment Tool

Putting Evidence into Practice l 11

HOW TO
Assessing Evidence

Evidence is the supporting information that helps 

people make decisions about an intervention.56

Evidence-based interventions usually rely on 

published research studies for support. But, evidence 

also includes local experiences, expert consensus, 

national or international guidelines, and facts about a 

population or community. Evidence helps show what 

interventions work, for whom, and whether they are 

cost effective.68

Gathering Evidence

Collecting different types of evidence can help 

program staff make an educated decision. Evidence 

can come from formal or informal sources, depending 

on the type of evidence and the program’s needs. 

Research evidence comes from peer-reviewed studies that 

define and test research questions. Research evidence 

can help decide how much study has been done on an 

intervention, whether the intervention did what it was 

designed to do, and whether implementation guidance 

is available.69 Because it often appears in peer-reviewed 

journals, this type of evidence appeals to healthcare 

administrators and providers who rely on and trust data 

from experimental studies.70 Government reports and 

guidelines often synthesize and organize the strongest 

available research evidence, making them another good 

source of research evidence. 

Experiential evidence includes the practical experiences 

of people who have used the intervention. This kind 

of evidence, which can include stories and anecdotes, 

can show what approaches worked or did not work 

in a particular setting and why an evidence-based 

intervention might appeal to certain groups.69

Contextual evidence refers to information about the 

community that can help programs decide whether an 

intervention fits well and would be possible in a new 

setting. It may include information about the setting, 

population characteristics, and community resources 

that may affect dissemination and implementation.69

Examples include information about the community’s 

history, culture, and infrastructure. Table 3 on page 13

lists where to find different types of evidence.

Assessing the quality of evidence is important because 

the best available evidence is not necessarily the best 

possible evidence. Useful evidence: 

• Shows that an evidence-based intervention led 

to its intended results71

• Accurately describes the study methods71

• Includes implementation guidance64

• Identifies study limitations71

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Table 3. Sources of Evidence

Type of Evidence Sources Examples

Research Evidence • Systematic review databases

• Journal databases of peer-reviewed studies

• Government reports 

• Technical assistance resource centers

• Internet sites of foundations, private funders, 

government agencies, and state or national 

professional and advocacy organizations

• Registries of effective interventions

• Academic libraries

• The Community Gui

• Cochrane Library

• PubMed

• National Academies of Sciences, 

Engineering, and Medicine

• National Institutes of Health Tobacco 

Control Monographs

• Surgeon General’s Reports

• Best Practices User Guides

• Public Health Law Center

• World Health Organization MPOWER

Experiential Evidence • Case studies

• Success stories

• Community example webinars or presentations

• Community word of mouth

• Stories from colleagues

• Personal communications with researchers and 

intervention developers

• National Tobacco Control Programs 

in Action

• Tobacco Control Network Resources

Contextual Evidence • Community assessments

• Local government data

• Surveys of community members

• Focus groups and interviews with community 

members

• Community Health Needs Assessments

• Health Impact Assessments

• Comes from a trustworthy source, free from 

financial and professional conflicts of interest, 

including involvement with the commercial

tobacco industry71

A good resource to begin with is a registry of evidencebased interventions, such as The Community Guide

shown in Table 4 on page 14. If the research base is 

weak, experiential and contextual evidence may add 

useful information. Reviewing evidence from a variety 

of sources allows programs to see how different kinds of 

evidence agree and disagree, and how they are related.56

Using Evidence to Make Decisions

It is important for both program staff and stakeholders 

to learn about different types of evidence. When 

health department staff get access to and training on 

finding evidence, they are better able to understand 

evidence and more likely to implement evidencebased interventions.72 Staff can use the National 

Collaborating Centre for Methods and Tools’ Appraise 

Tools to assess the quality of evidence.

Stakeholders may weigh evidence differently than staff 

when making decisions. Programs can ask stakeholders:

• What types of evidence they find most useful73

• What concerns they have about the strength of 

the evidence73

• What else they need to know to use the evidence73

• Whether the intervention is compelling enough 

to act now73

• What barriers might exist to using the 

intervention73

• What stakeholders know about commercial 

tobacco use and what misconceptions they 

may have74

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Table 4. Community Guide Recommendations

The Community Guide is an online registry of evidence-based interventions. Created by 

the Community Prevention Task Force, The Community Guide rates and recommends 

public health interventions that are effective at prevention. It includes recommendations 

for over 20 public health topics, including tobacco control. Learn more at Th

Community Guide website.

Category & Description Commercial Tobacco Control Interventions

Recommended 

There is strong or sufficient evidence 

that the intervention is effective based 

on the number of studies, how well 

the studies were carried out, and the 

strength of the results.

• Internet-based cessation interventions (2019)

• Comprehensive tobacco control programs (2014)

• Mass-reach health communication interventions (2013)

• Increasing the unit price of tobacco products (2012)

• Quitline interventions (2012)

• Reducing out-of-pocket costs for cessation (2012)

• Smokefree policies (2012)

• Mobile phone–based cessation interventions (2011) 

• Incentives and competitions to increase smoking cessation 

among workers, with additional interventions (2005)

• Community mobilization to restrict youth access to tobacco 

products, with additional interventions (2001)

Insufficient Evidence 

There is not enough evidence to 

decide whether the intervention is 

effective. This does not mean the 

intervention does not work. Programs 

that use interventions with insufficient 

evidence are encouraged to evaluate 

their efforts.

• Incentives and competitions to increase smoking cessation 

among workers, when used alone (2005)

• Community education about youth access to tobacco (2001)

• Laws directed at minors’ purchase, possession, or use of tobacco 

products (2001)

• Retailer sales laws and enforcement, when used alone (2001)

• Retailer education about restricting youth access, when used 

alone (2001) 

• Community education to reduce exposure in the home (2000)

• Mass media cessation contests (2000)

Recommended Against 

There is strong or sufficient evidence 

that the intervention is harmful or not 

effective.

Source: The Community Guide (as of May, 2021)75

Understanding External Context

Even if an intervention works well in one setting, it 

may not work well in others.76 Outside factors that may 

affect successful dissemination and implementation are 

called external context. External context can include:77

• Professional influences: Norms, rules, policies, or 

standards guiding the organizations in which 

people work (e.g., a health system’s commercial 

tobacco cessation treatment protocol)

• Political support: Level of support or opposition 

from public officials or special interest groups 

• Social climate: Community beliefs, values, and 

customs (e.g., anti-smoking norms)

• Local infrastructure: Physical or technical resources 

(e.g., availability of cessation services)

Putting Evidence into Practice l 14

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• Legal climate: National, state, or local commercial 

tobacco control laws

• Relational climate: Relationships with key 

organizations, networks, and stakeholders

• Population: Characteristics of those affected by the 

intervention, including their culture, preferences, 

barriers, and motivations to participate

• Funding and economic climate: Funding 

availability and health of the national, regional, 

or local economy

Taking the time to gather information about the 

external context is important to select evidencebased interventions and plan D&I activities that meet 

community needs. Assessing external context can 

also help identify resources and anticipate possible 

challenges, such as competing stakeholder and funder 

priorities, community resistance, or poor fit with 

existing practices.40

Routinely monitoring external context may reveal 

opportunities for efficiencies, such as planning a 

cessation media campaign at the same time as a new 

smokefree law.

Responding quickly to unexpected changes can 

help create a more supportive external context. For 

example, when a series of smoking-related apartment 

fires attracted media attention, practitioners used the 

opportunity to educate landlords 

on the importance of smokefree 

housing.78

Identifying External Factors

The first step in assessing 

external context is to identify 

which external factors are likely 

to affect implementation.69 For 

example, the implementation of 

a tobacco-free university campus 

may be affected by student 

attitudes and behaviors toward 

commercial tobacco use, where 

students buy tobacco products, 

school leadership support, and 

the physical campus landscape. 

Available cessation services and 

resources for educational materials and enforcement 

are also important factors.79

Free online tools, such as the National Collaborating 

Centre for Methods and Tools’ online learning module, 

Applicability and Transferability of Evidence, can help 

identify and assess context. The tool uses 21 questions 

to assess whether an evidence-based intervention can 

work in a specific setting based on social and political 

acceptability, available resources, organizational 

alignment, and population characteristics. Programs 

can invite stakeholders to discuss and rate the relevance 

of each question to figure out the most important 

external factors.

Collecting Contextual Information

Gathering different types of data about external 

context gives a richer, more comprehensive view of the 

environment. Community assessments are a good place 

to start because they combine existing data sources and 

community input to gather information on local needs 

and resources.80 Community assessments also engage 

the community early on in D&I activities. Learn more 

about community assessments in Community Tool 

Box’s Assessing Community Needs and Resources and 

the Association for Community Health Improvement’s 

Community Health Assessment Toolkit.

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HOW TO
Community Health Needs Assessments (CHNAs) are 

a special type of community assessment which ranks 

community health priorities. The Patient Protection 

and Affordable Care Act requires all nonprofit hospitals 

to complete CHNAs every three years. Programs 

can use CHNAs to understand the community’s 

other health issues and make the case for prioritizing 

commercial tobacco use. See the American Lung 

Association’s Hospital Community Benefits and 

Tobacco Cessation Toolkit to learn more about hospital 

CHNAs and how to take part in them. 

Online databases (such as census data, school records, 

hospital data, law enforcement data, and the County 

Health Rankings) are also good sources of additional 

information. The CDC’s State Tobacco Activities 

Tracking and Evaluation (STATE) System includes 

past and current state-level health data, maps, and fact 

sheets. The CDC also hosts the PLACES project, which 

provides local-level data on chronic disease risk and 

outcomes. Users can compare places, view interactive 

maps, and download data.

Programs may also have already collected contextual 

information for other activities, such as completing 

retail store assessments or public opinion surveys. This 

information can provide valuable insight into how the 

community views and uses tobacco products. For a free 

store assessment tool, see the Standardized Tobacco 

Assessment for Retail Settings (STARS) tool.

Social network analysis is a tool that can 

help programs understand the relationships 

between stakeholders that are important 

to increase the use of an evidence-based 

intervention. For step-by-step guidance on 

using social network analysis with any level 

of expertise, see Module 1 of Health Equity 

Works’ Healthy Schools Toolkit.

Increasing Organizational 

Readiness for Change

Evidence-based interventions are more 

likely to be successfully implemented when 

the organization making the changes (e.g., 

the state program, healthcare system, or 

workplace) is ready for change.81

Readiness has three key parts:81

• Motivation: how willing staff are to change

• General Capacity: how well the organization works

• Intervention-specific Capacity: how capable the 

organization is to implement the change

An organization with high readiness for change is 

often referred to as a “learning organization.”82 These 

organizations are continuously finding new knowledge 

and using it to improve their current practices. Shared 

decision making, clear strategic goals, and the presence 

of an internal champion also help support change.83

Although large organizations tend to have more 

resources and can more easily explore and implement 

evidence-based interventions, organizations of any size 

can become learning organizations.84

Building readiness often requires altering 

organizational infrastructure and culture to increase 

ability and motivation to change.83 This may include 

altering: 

• Staff perceptions of the need for the evidencebased intervention and its benefits85

• Leadership commitment86

• Staff D&I skills, such as evidence assessment, 

communications, and evaluation86

• Financial and human resources85

Putting Evidence into Practice l 16

HOW TO
• Physical infrastructure, such as the equipment, 

technology, and physical space needed to 

implement the intervention85

• Partnerships from different sectors, such as local 

coalitions, businesses, and government87

Assessing Organizational Readiness

Around half of all unsuccessful implementation efforts 

result from organizations overestimating their readiness 

to begin.88 Organizational readiness assessments can 

help practitioners understand their organization’s 

strengths and weaknesses. 

Formal assessment methods like surveys and 

focus groups may be more time consuming and 

expensive to conduct but can provide more in-depth 

information. Informal methods include comment 

cards, brainstorming sessions, and observations. See the 

National Institutes of Health's Organizational Readiness 

for Implementing Change Assessment for an example.

Building Readiness among Leaders and Staff

Cultivating leadership and staff support for evidencebased interventions fosters a climate of readiness. To get 

leaders on board, staff can educate them on the benefits 

of using a new evidence-based intervention and how 

it fits with the organization’s values. Leadership can 

support the use of evidence-based interventions by: 

• Accessing information about evidence-based 

interventions and sharing it widely89

• Securing necessary resources and staffing before 

beginning D&I activities68

• Including staff in decision making89

• Training staff in skills needed to use the 

intervention90

• Regularly communicating with staff about 

changes68

When individuals are ready to make a change, they are 

more likely to invest time and effort into the process.2

Staff who are ready for change are also more persistent 

when facing challenges that arise.2

Some staff may be resistant to implementing new 

evidence-based interventions. D&I activities to put 

new interventions into practice are often added to 

staff ’s other responsibilities, which may cause concern 

about increased workload.91 When asked to change 

their current practice, they may feel as if their previous 

work is being devalued. Taking the time to listen to 

concerns and educate them on the benefits of the new 

intervention and how it might impact their workload 

can help reduce resistance to change.83

Forming a D&I Team

Dedicated teams are important for successful D&I 

efforts.92 Team members commit their time, skills, and 

resources to bring evidence into practice. Having a 

team, instead of relying on one or two people, prevents 

individual turnover from slowing progress.93 It is 

important for each member of the team to fulfill at least 

one role, though many tasks require more than one 

team member.

Selecting Team Members

Effective teams are multi-disciplinary. Together, team 

members have complementary experience and the 

D&I Team Roles94

D&I teams typically include enough 

members to fill the following roles: 

• Leadership: Set goals, secure D&I 

resources, increase staff buy-in and 

organizational readiness 

• Organization and Coordination: Develop 

the budget and timeline, host team 

meetings

• Dissemination: Select evidence to 

disseminate, create messages and 

products

• Implementation: Communicate with 

local programs and communities, 

provide training and technical 

assistance to implementers

• Evaluation: Select evaluation measures, 

collect data, share findings with team

Putting Evidence into Practice l 17

HOW TO
necessary knowledge, skills, abilities, and time to conduct 

successful D&I.93 Program staff who can serve on the 

team include those with experience in health promotion, 

evaluation and statistics, or program management. 

People with communications expertise who can 

translate evidence into messages are also beneficial team 

members. Programs without specialists in these areas 

may want to bring on external partners to fill these roles. 

In general, qualified team members:

• Clearly communicate with stakeholders95

• Know how to find resources and generate 

support96

• Understand the evidence95

• Have knowledge of the community and 

credibility with program partners96

The team works best when it includes members 

who can commit adequate time to their role and are 

available for a longer-term commitment, since D&I 

is an ongoing process.68 The size and makeup of the 

D&I team depends on the needs and resources of the 

program. The implementation process alone ideally 

includes at least 3 to 5 people.93 For example, teams 

focused on increasing cessation interventions in health 

systems may include tobacco treatment specialists, 

patient data analysts, and medical directors. Teams 

focused on preventing youth commercial tobacco use 

may include health and school psychologists, school 

administrators, parents, and pediatricians. 

A unique type of D&I team is the Practice-Based 

Research Network. These networks are designed to 

bring together researchers and practitioners from 

diverse fields to leverage different skills to achieve 

a common goal.97 They are commonly found in 

healthcare settings.

Engaging Stakeholders

Stakeholders include many different people with an 

interest in the intervention, including those who may:56

• Use a new evidence-based intervention (e.g., 

healthcare providers)

• Be affected by its use (e.g., people who use 

commercial tobacco)

• Care about the results (e.g., community leaders 

or funders) 

Because stakeholders understand their local 

community, their input is especially important to 

make sure that the evidence-based intervention fits 

with community needs, interests, and resources. 

Stakeholders may oppose or support D&I efforts to 

increase use of the intervention.56 Those who oppose it 

still provide an important perspective.

Stakeholders can be involved in all D&I activities. 

They can assess whether interventions, dissemination 

products, and implementation strategies will be 

acceptable to the local community. Learning about 

stakeholders’ concerns prevents roadblocks later in the 

process.73 Stakeholders can also help choose evaluation 

questions and brainstorm ways to sustain D&I 

efforts. Stakeholder involvement can vary from active 

involvement to an advising role, depending on their 

availability and skill sets.98

Identifying Stakeholders

Stakeholders who are already involved with the state 

program can be helpful in carrying out D&I efforts. 

Guiding Questions to Identify 

Stakeholders99

• What need does the intervention 

address and for whom?

• Who will use the intervention? 

• Who would carry out the 

intervention?

• Who has influence and resources that 

can support D&I activities? 

• Who will support use of the 

intervention? Who will oppose it?

• What can each of these individuals 

contribute to the process? 

• Are diverse populations represented 

among the stakeholders?

• Who was not involved in the past but 

should have been? 

Putting Evidence into Practice l 18

HOW TO
Programs may also want to 

consider new stakeholders with 

experience using, disseminating, 

or implementing a specific 

intervention. 

Finding out who has taken 

part in similar initiatives or 

are working toward similar 

goals, such as those interested 

in health systems change or 

creating environments free of 

commercial tobacco, is a good 

place to start. Program staff can 

also ask existing stakeholders 

for recommendations from 

their social and professional 

networks. Ideal stakeholders 

are enthusiastic, trusted by the 

community, and have resources 

and skills to support D&I activities.2,94

Involving too many stakeholders can lead to unrealistic 

expectations and make it difficult to make decisions.99

Including too few stakeholders, however, may leave out 

valuable perspectives and resources.99 The following 

questions can help decide if additional stakeholders 

would be helpful for D&I efforts:100

• Is more support needed to increase use of the 

evidence-based intervention?

• Are those who will benefit from the intervention 

participating?

• Is there representation from many different 

community groups? 

Planning for Stakeholder Engagement

Well-planned efforts to engage stakeholders foster trust 

and successful partnerships. Too little communication 

or direction can lead to frustration. Defining when and 

how stakeholders will be involved before reaching out 

creates strong relationships by managing expectations.

Early stakeholder engagement is essential for 

successful D&I. Thinking about stakeholder 

availability and how they like to communicate 

helps engage them in meetings and other activities. 

Reaching different stakeholders may require different 

communications channels. For example, program staff 

may attend meetings of stakeholder organizations 

to share updates and encourage participation. Other 

stakeholders may depend more heavily on email and 

electronic communication. Meeting regularly with 

stakeholders creates opportunities to share success 

stories, offer encouragement, and discuss challenges. 

Learn more about working together effectively 

in the CDC resource, Best Practices User Guide: 

Partnerships in Tobacco Prevention and Control. 

When involving stakeholders, there is potential 

for conflicting opinions and power imbalances.101

Different communication styles, competing 

interests, and assumptions about roles can all lead 

to conflict.101-103 For example, stakeholders may 

have different commitments to fulfill the same goal, 

such as working with specific community groups 

or developing specific community practices. These 

responsibilities may cause conflict when stakeholders 

push to achieve them above others because they are 

required to fulfill them due to their funding or other 

requirements. Learn more about potential challenges 

to stakeholder engagement and ways to overcome 

them in the Australian Government Department of 

Health's Stakeholder Engagement Framework.

Putting Evidence into Practice l 19

HOW TO
Disseminating 

Evidence-Based 

Interventions

Dissemination uses planned strategies to widely share 

information about evidence-based interventions with 

the people who will put it into practice.2 Dissemination 

may occur at several different points in the D&I process. 

Early on, program managers may host a training with 

healthcare providers to increase use of an evidence-based 

intervention. Later, they may publish success stories or 

post about outcomes on social media to raise awareness 

among community members. The activities will look 

different depending on the audience and goals, but the 

process typically follows four steps: 

• Identifying the audience 

• Developing messages

• Creating products

• Selecting dissemination strategies

Identifying the Audience

Audiences are the people who want or need 

information about an evidence-based intervention.104

The stakeholders identified on page 18 are all potential 

dissemination audiences. For example, the audience 

may be the local agency leading implementation or 

community organizations providing resources and 

support. Funders, decision makers, and community 

members that will be affected by the intervention can 

also be important audiences. 

Segmenting the Audience

Audiences are most useful when they are defined as 

specifically as possible.32 Breaking the audience down 

into smaller groups based on similar characteristics, 

or segmenting, narrows the scope of information that 

needs to be collected and allows for more tailored 

dissemination.2

 Audiences can be segmented by size 

and type of organization, location, or population 

served. Ideal segments are relevant to dissemination 

goals, have clear dissemination channels, and do not 

overlap with each other.105 For example, programs may 

focus on reaching landlords with smokefree multiunit housing information and tribal health clinics 

with interventions to integrate commercial tobacco 

treatment into routine care.

Audiences can also be classified into two categories: 

primary and secondary. The primary audience is 

the people who have the authority or role to make 

changes based on the evidence.67 The secondary 

audience includes people who can influence the 

primary audience’s decisions or who are affected by the 

intervention.67 For example, when implementing a new 

smokefree housing law, landlords would be a primary 

audience. Renters and the chamber of commerce could 

be secondary audiences. 

Learning about the Audience

Information about the audience’s beliefs and values helps 

design effective messages and products. Understanding 

how the audience likes to receive information may 

help control costs by concentrating resources on fewer 

communications channels. 

Audience research can help programs answer the 

following questions:2

• What does the audience want to accomplish? 

• How would information about an evidencebased intervention be helpful?

• How would the audience use the information?

• Does the intervention fit with the audience’s 

current practices?

• What concerns might the audience have about 

the intervention?

To answer many of the questions about how the 

audience will use an intervention, programs may need 

to talk to audience members directly. Helpful methods 

include focus groups, interviews, and surveys. These 

can give insight into the audience’s priorities, attitudes, 

lifestyles, perceptions of commercial tobacco control, 

and skills needed to implement the intervention. 

Forming partnerships with community groups and 

trusted sources to collect this information, such as a 

local university or faith-based organization, can save 

money and time.32

Putting Evidence into Practice l 20

HOW TO
A CLOSER LOOK: Disseminating Evidence-Based Interventions to Tribal 

Communities

It is important that messages to tribal communities respect traditional ways of communicating and 

recognize past exploitation by non-Native researchers.106 Incorporating tribal traditions such as 

storytelling and including tribal phrases alongside statistics can help evidence-based information 

resonate with tribal members.107 Programs can take the following steps to disseminate evidence-based 

interventions in tribal communities:

• Center Native voices

Tribes vary in geographic location, governmental structure, language, culture, and tobacco use. 

Programs can focus on engaging their tribal partners and learning about community needs to tailor 

and disseminate messages.30 Offering opportunities for community members to ask questions and 

talk about the evidence helps increase support and understanding of messages.108

• Respect ceremonial tobacco

Many tribes use traditional tobacco, which may include the tobacco plant Nicotiana as well as 

mixtures of other native plants, for sacred or medicinal purposes.109 It is important that messages 

focus on the use of commercial tobacco and respect ceremonial tobacco use. Learn more about 

traditional tobacco use on the National Native Network’s website, Keep It Sacred. 

• Know tribal communications channels

Reservations are often located in rural areas, which can make dissemination efforts challenging.110

Recommended strategies for outreach to tribal communities include community newsletters, 

websites, and social media, particularly Facebook and Twitter.111

• Build trust

Because of past exploitation, tribal communities may distrust non-Native services.107 Community 

review of all products and tribal ownership of any data collected honors tribal sovereignty and 

can help build trust between the tribe and state program.112 Partnering with messengers from the 

community, such as tribal pharmacists or elders, and disseminating information in trusted spaces, 

like community centers or clinics, give messages more credibility.107,111

Digital banner ad from Keep Tobacco Sacred's quit-smoking campaign Source: ClearWay Minnesota

Putting Evidence into Practice l 21

HOW TO
For some audiences, demographic and health 

behavior information can also be found in 

databases such as the Behavioral Risk Factor 

Surveillance System or the U.S. Census 

Bureau. Community assessments conducted 

by state and local health departments 

may also provide this information. These 

sources may require assistance in finding 

specific information. Information about 

media preferences, such as TV or radio 

usage, may be available for a fee from 

marketing firms. Paying the fee to access this 

information is often more cost-effective than 

programs collecting the data themselves.113

Learn more about audience research in 

CDC's Best Practices User Guide: Health 

Communications in Tobacco Prevention and 

Control. 

Developing Dissemination 

Messages

Dissemination messages typically explain how 

the intervention works, why it is important or 

useful, what results can be expected, and what actions 

the practitioner can take.114

Messages may be shared in many kinds of dissemination 

products, such as toolkits, fact sheets, or social media 

posts. Focusing on three to five key messages keeps 

products brief and to the point.67 Using a clear message 

structure, framing messages to match audience interests, 

and using familiar language helps audiences understand 

and accept information. 

Structuring Messages

Memorable messages use a clear structure with three 

key parts:32

• An introduction with the most important information

Clear, concise messages state the most 

important information first: the problem, the 

solution, and what the evidence means for 

practitioners. Audiences have limited time to 

spend interpreting research results. 

• Credible supporting statements that evoke shared values

Credible supporting statements back up claims of 

evidence effectiveness and match audience values, 

Ad sharing new evidence about the dangers of secondhand smoke Source: North Carolina 

Department of Health and Human Services

prompting the reader to reflect on their beliefs 

or actions and encourage behavior change.115

Stories can create an emotional connection to the 

evidence, which may increase adoption.83

• A conclusion with a call to action

A call to action encourages the audience to use 

the intervention. It is strongest when it presents 

steps the audience can take now. 

Making Messages Relevant

Framing messages to match what the audience cares 

about can affect how they perceive the message and 

drive them to act.116 Effective messages match the 

audience’s knowledge, skill level, and interests.60,67

Putting the evidence into the local context makes it 

more relevant to the audience.117 Local implementers 

may want information about feasibility and how to 

overcome potential challenges. Including materials 

and tools developed by local practitioners is especially 

helpful for this audience.62 Decision makers may care 

about other information, such as costs and how widely 

the intervention can be used. Telling a story of a single 

Putting Evidence into Practice l 22

HOW TO
person who could benefit from the intervention can also 

help decision makers empathize with the individual and 

garner their support.118 Community members are likely 

to care most about the evidence’s impact on the people in 

the community and their quality of life.119

It is also important to avoid messages that:

• Blame individuals for commercial tobacco use120

• Include images of commercial tobacco use121

• Repeat the tobacco industry’s messages121

Programs can also consider how other public health 

issues (e.g., substance use) and populations (e.g., persons 

with disabilities) are portrayed in commercial tobacco 

control messages. Figure 5 on page 23 describes eight 

questions to guide message framing. See Table 6 on page 

32 for messages for specific audience groups. 

Writing Clear Messages

Easy-to-understand messages increase the likelihood that 

the audience will understand and act on the message.122

Guidelines for writing readable messages include:

• Use familiar, everyday words with one or two 

syllables123

• Include definitions for technical and 

mathematical terms, such as “risk” or “range”123

• Limit abbreviations123

• Write in the active voice in present tense124

• Keep sentences short, 20 words or less124

• Keep paragraphs short, about three to eight 

sentences124

• Highlight key points125

Figure 5. Questions to Guide Message Framing

Source: Adapted from du Toit126

Putting Evidence into Practice l 23

HOW TO
Testing messages with audiences can guide 

development and make sure they are clearly 

communicating the intended information. 

Creating Dissemination Products

Dissemination messages are shared with audiences 

in many formats such as toolkits, journal articles, 

and reports. These products are designed to raise 

awareness of an intervention among the intended 

audience, enhance understanding, and encourage 

action. Practitioners have limited time and resources 

to find and review evidence, so effective dissemination 

products make it easy for them to access and use 

information.

Table 5 on page 26 describes the products that 

programs typically use to share information about 

evidence-based interventions. Many can be disseminated 

in both print and online formats. Online materials allow 

users to navigate to content they are most interested in, 

personalizing their experience.127

Selecting Product Type

Choosing the right type of product helps practitioners 

see and act on the information. For instance, because 

decision makers receive large amounts of information, 

products that summarize evidence into shorter 

messages with graphics are often most effective with 

this group.128 Local grantees and partners who will be 

making the changes may prefer more detailed how-to 

information in a guide or toolkit.

The right product may also vary based on the goals 

of D&I activities. Online announcements, news 

stories, and social media posts are good for raising 

awareness. Webinars and online trainings can support 

implementation by allowing peers to share lessons 

learned and ask questions.

A 2019 survey found that state program staff and 

partners preferred fact sheets and infographics to learn 

about new commercial tobacco control information, as 

depicted in Figure 6.

129 Policy briefs, one-page research 

briefs, and online toolkits were also popular. Reports 

and journal articles were least popular. Learn how to 

create an effective fact sheet in Figure 7 on page 25.

Designing User-Friendly Products

Dissemination products work best when they are easy for 

the audience to use. User-friendly products are evidencebased, actionable, modular, understandable, accessible.130

EVIDENCE-INFORMED SOURCE 

Dissemination products about evidence-based 

interventions synthesize scientific findings into 

understandable information for a wide audience. 

They share the best available research evidence 

alongside practical experiences, addressing gaps in 

implementation guidance. They may be reviewed by 

topic experts or users before being shared.

ACTIONABLE INFORMATION Effective dissemination products make it easy for 

the audience to plan and implement evidence-based 

interventions. Step-by-step guidance helps users imagine 

themselves taking action, increasing the likelihood 

they will implement recommendations.122 Linking to 

additional resources and giving users the flexibility to 

choose from multiple strategies can also help facilitate 

action.131 Including a clear call to action in a message is 

important to motivate the audience to act. 

Figure 6. How Tobacco Control Practitioners 

Like to Receive Information

Source: Andersen et al.129

Putting Evidence into Practice l 24

HOW TO
Figure 7. Anatomy of a Fact Sheet

Putting Evidence into Practice l 25

HOW TO
Table 5. Dissemination Products

Product Features Types Example Products

Audio & Video 

Tools

• Complement other 

products

• Can be free and 

downloadable for 

audiences

• Podcasts

• Videos

• Tobacco Free Florida’s 

“The Reasons” vide

series

• The NACCHO Podcas

Series

Case Studies • Describe real-world 

efforts to put evidence 

into practice

• Focus on people, places, 

and organizations that 

have had success with the 

new intervention

• In-depth case 

studies

• Short success 

stories

• CDC’s National 

Tobacco Control 

Programs in Action

Fact Sheets • Provide concise (1- or 

2-page) summary of data

• Emphasize key points with 

bullets, tables, headings

• Fact sheets

• Stand-alone 

infographics

• Virginia’s Adult 

Tobacco Survey 

Snapshot

Issue Briefs • Provide concise summary 

of an issue, along with 

interventions to address it

• Often contain visuals like 

photographs, graphs, and 

tables

• Policy briefs

• Topic summaries

• Minnesota’s Tobacco 

Use and Asthma brief

• Indiana’s Youth 

Exposure to 

Secondhand Smoke

brief

News & 

Announcements

• Reach broad audience 

• Quickly share timely 

information about research 

findings, events, or other 

newsworthy items

• Press releases

• Press conferences

• Website news 

stories

• Media toolkit

• California Department 

of Public Health News 

and Press Releases

Paid Media 

Products

• Reach specific audiences 

at certain times to educate 

audiences about new 

evidence

• Direct audience to do 

something or learn more 

with a call to action

• TV and radio ads

• Posters

• Digital ads

• Billboard, and 

transit ads

• New York State’s 

Talk to Your Patients 

Campaign

Presentations • Educate and build support 

among stakeholders 

• Allow practitioners to ask 

questions and interact

• Presentations 

at community 

meetings

• Webinars and 

online trainings

• South Dakota’s Tobacco 

Prevention and Control 

Program Webinars

Putting Evidence into Practice l 26

HOW TO
Table 5. Dissemination Products (cont.)

Product Features Types Example Products

Reports • 

• 

Give in-depth evidence 

underlying an intervention

Share outcomes with 

stakeholders

• 

• 

• 

Evaluation 

reports

Progress reports

Community 

assessments 

• 

• 

Mississippi’s Office 

of Tobacco Control 

Executive Report 2018

Oregon’s Tobacco 

21 Law: Impact 

Evaluation

Research 

Summaries

• 

• 

Summarize key findings 

about an evidence-based 

intervention 

Contain focused, succinct 

messages with citations to 

underlying research

• 

• 

Short brief on a 

research article

Brief summary of 

current evidence 

on a topic

• 

• 

Center for Public 

Health Systems 

Science’s Research 

Brief

CDC Evidence Brief: 

Tobacco Industry 

Sponsored Programs 

in Schools

Scientific 

Articles

• 

• 

Written by subject expert 

and reviewed by peers

Describe findings from 

a specific study or set of 

studies

• 

• 

Journal articles

Systematic 

reviews

• Cowling et al., 

Assessing the 

relationship between 

ad volume and 

awareness of a tobacco 

education media 

campaign

Social Media 

Posts

• 

• 

Accessible on convenient 

platforms for audience

Allow users to disseminate 

information by sharing, 

liking, or commenting

• 

• 

• 

• 

Tweets

Facebook posts

Instagram posts

YouTube videos

• Utah’s Way to Quit 

Facebook page

Guides & Toolkits • 

• 

Contain tools, guidance, 

and other resources for 

implementing an evidencebased intervention

Include links to more 

resources

• 

• 

• 

User guides

Training manuals

Online toolkits

• 

• 

Surgeon General’s 

Report Consumer 

Guide

California’s Provider 

Toolkit: Special 

Services for Special 

People 

Interactive Tools • 

• 

Give step-by-step 

instructions

Allow users to choose 

data and explore specific 

information 

• 

• 

• 

Data dashboards

Interactive maps

Flow charts

• Florida’s interactive 

tobacco maps

Web Pages • 

• 

• 

Can be updated quickly

Allows users to interact 

with information

Includes links to more 

resources

• 

• 

Program website

Topic-based web 

pages

• California Tobacco 

Control Program’s 

website

Putting Evidence into Practice l 27

HOW TO
MODULAR STRUCTURE 

Modular products organize and break down content 

into sections. Breaking down longer documents into 

sections and using elements such as headings, a table 

of contents, and bullet points captures users' attention 

and helps them follow and process text more easily.132

Using these organizing tools makes it easier for users 

to quickly locate and share the information they need, 

especially when multiple products follow the same 

structure.62 

UNDERSTANDABLE DELIVERY 

Understandable products combine plain language text 

and graphics to convey meaning.26,125 Text is written 

simply, using short sentences and everyday words 

and grammar. Products may include photographs, 

maps, tables, or infographics to give the user a rest and 

highlight key information. Understandable products 

also include adequate white space (i.e., space without 

any graphics or text).125

Smokefree Housing Toolkit for property owners and managers Source: District of Columbia Smokefree Housing

ACCESSIBLE FORMAT 

Accessible products can be used by people with a 

wide range of abilities. They include alternative text 

descriptions and a navigable structure with designated 

styles and headings so they can be used by assistive 

devices such as screen readers. Accessible features such 

as high background contrast, serif typeface, and adequate 

font size can enhance comprehension and increase the 

user's likelihood of taking recommended actions.122,132

Selecting Dissemination Strategies

Dissemination products can only be effective if they 

reach their intended audience.67 Dissemination strategies 

are planned methods to incorporate messages into a 

product and deliver it via a specific channel, as shown in 

Figure 8 on page 30. Channels are the communication 

paths used to get messages and products to the right 

audience. Active strategies encourage higher levels of 

audience engagement.133 For example, interacting with 

the audience through a webinar on how to implement a 

new evidence-based intervention may be more successful 

than simply sharing information on a website.

Putting Evidence into Practice l 28

HOW TO
A CLOSER LOOK: Creating Accessible Documents

Approximately 12 million people in the U.S. have visual disabilities or blindness.134 Many others have 

hearing, speech, physical, cognitive, or neurological disabilities. In 1998, Congress amended Section 

508 of the Rehabilitation Act of 1978 to require that all electronic content (e.g., web pages, presentation 

slides, and PDF documents) produced by federal agencies be accessible to people with disabilities. For 

example, 508-compliant documents must be readable by screen readers (software programs that visually 

impaired people use to read text displayed on a screen with a speech synthesizer or braille display).135

While organizations that do not receive federal funds are not required to meet Section 508 requirements, 

more and more organizations are incorporating the principles of “designing for accessibility” to extend 

the reach and usefulness of their communications. Programs can take the following steps to create 

electronic documents that can be understood by most people include:

• Choosing accessible colors. People with color vision deficiency (sometimes called color blindness) 

often have trouble distinguishing between certain shades of color. Tools such as Coblis can help in 

choosing a color palette that avoids problematic color combinations.

• Ensuring strong color contrast. High color contrast between foreground and background elements on 

electronic documents will help users with low vision recognize text and images. Use the WebAIM 

Contrast Checker to check for adequate contrast between any two colors.

• Using more than just color to convey meaning. For users who cannot perceive color or who are using 

a screen reader, it is important to convey information in text or graphics in multiple ways (e.g.,

color plus boldface type, color plus size, or color plus patterns or shapes).

• Including alt text for graphics. People with visual disabilities may have difficulty viewing photos, 

illustrations, or other types of images. It is important to include alternative (or “alt”) descriptive 

text or captions for each image. Screen readers read the captions aloud so users with visual 

disabilities do not miss important visual information.

• Creating a navigable structure. Whether creating documents or web pages, using designated styles 

and headings will help screen readers decide the right reading order for content elements and 

whether a particular section is a title, heading, subheading, or body text.

• Embedding hyperlinks. It is a best practice to embed hyperlinks in the text rather than pasting the 

full text of URLs into documents. Hyperlink display text should be clear, concise, and meaningful 

out of context. Just as sighted users can visually scan the page for links, people using screen 

readers can pull up a list of all the links with a touch of a button.

• Giving alternatives for audio and video content. When including multimedia content in documents or 

website sites, always provide closed captions or transcripts for users with hearing loss. 

• Designing tables with a clear and logical flow. Tables are a great way to organize data and information, 

but they can be confusing when read by a screen reader. It is important to keep tables as simple 

and logical as possible, using clear and designated column headings, avoiding merged or split 

cells, and designing tables to be read from left to right and top to bottom.

Visit the Web Accessibility Initiative website for more information on designing for accessibility. 

Putting Evidence into Practice l 29

HOW TO
Dissemination is most effective when it includes 

multiple strategies. One study found that partners 

who received information from state programs 

through three separate channels (reports, website, and 

workshop) were more likely to share information with 

colleagues; 84% versus 52% of those that received the 

information in only one way.136

Reviewing Audience Preferences

The most effective dissemination channels are those 

that audience members already trust and use.32 A 

survey of state program staff and partners found 

that most prefer to learn about new resources via 

email, webinars, or in-person trainings.129 Academic 

conferences, social media, and direct mail were the least 

popular ways to receive information. 

Social media can be a helpful tool to share messages 

with the community. But program staff may face unique 

challenges when trying to use social media platforms. 

Organizational barriers such as blocked social 

media sites, strict privacy policies, complex approval 

processes, and technology limitations have prevented 

health department staff from using social media in their 

professional roles.137 Social media will be an important 

channel to watch as 

public health use of 

digital channels continues 

to evolve.

It is also important to 

select strategies that can 

reach audience members 

when they are most 

attentive.32 For example, 

audiences may be more 

likely to check their 

email during working 

hours and social media 

after work. To find out 

what channels audience 

members use most and 

when, programs can talk 

with audience members, 

and review past efforts to 

reach the audience. 

Figure 8. Components of a Dissemination 

Strategy

Weighing the Pros and Cons

Countering the powerful influence of the tobacco 

industry requires constant and evolving dissemination 

efforts.138 Because budgets for dissemination are 

almost always limited, it is important for programs to 

think critically about what is reasonable given their 

time, skills, and resources. 

Many low-cost, effective strategies can help programs 

with small budgets reach audiences. Web-based 

strategies, such as websites and social media, are 

relatively inexpensive and allow audiences to 

Putting Evidence into Practice l 30

HOW TO
access updated information at their convenience. 

Adding website features like interactive data tools, 

infographics, separate pages for different audiences, 

links to social media pages, and compatibility for 

mobile devices can make websites even more useful 

for audiences.32

Virtual Dissemination Strategies

Virtual dissemination strategies like 

online trainings and webinars inform 

audiences about evidence-based 

interventions, share success stories, 

and encourage discussion that can lead 

to action. Virtual strategies are most 

effective when they are:

• Short: Shorter webinars and 

trainings limit distractions. 

It is helpful to keep online 

trainings to no more than four 

hours and include frequent 

breaks. Webinars are generally 

one hour, with 15 minutes 

allotted for introductions and 

questions. 

• Convenient: It is helpful to schedule webinars and virtual trainings with your audience in mind, 

choosing a time appropriate for their schedule and time zones. 

• Limited to a small group: For complex trainings, limiting the number of participants allows time for 

everyone to ask questions and contribute. 

• Interactive: Opportunities to participate keep people interested and engaged. Interactive features 

can include live polls and quizzes, breakout rooms for small discussion groups, and opportunities 

to ask questions and get answers in real time. Some platforms also allow non-verbal ways to 

engage, such as selecting a “thumbs up” or “raise hand” option. 

• Co-presented: Including multiple presenters adds more perspectives and expertise. Co-presenters 

can also help take notes or troubleshoot as problems arise. However, having multiple presenters 

limits each individual presenters time to share and answer questions. 

Available on demand: Programs can record and share their webinars to make sure they can be viewed again. 

Recordings can be sent out through follow-up emails or posted online with clear instructions about who 

to contact with questions. 

Putting Evidence into Practice l 31

HOW TO
However, with the increase of web-based materials 

now available, there is a high level of competition for 

users’ online attention. Some users may have difficulty 

searching for and finding evidence-based health 

information online.139 Programs will also have to 

consider how to drive the audience to the information, 

which may require additional resources. 

Some dissemination strategies, such as trainings, can 

be very effective at encouraging action but take time 

to prepare.53 They also require more of the audience’s 

time to attend, which may not be possible given other 

professional duties.53 Making these kinds of trainings 

free or offering continuing education credits can help 

encourage attendance.

For more examples of strategies effective for audience 

groups, see Table 6 below. For more pros and cons of 

dissemination strategies, see the CDC resource, Best 

Practices User Guide: Health Communications in 

Tobacco Prevention and Control. 

Table 6. Message Content, Products, and Channels to Reach Specific Audience Groups

Audience Message Content Product Channel

Businesses and 

Retailers

• Expected economic impact of intervention

• Community support

• Clear recommendations and action steps

• Webinars

• Trainings

• Fact sheets

• Internet

• Direct mail

• Community forums

Community 

Members

• Success stories

• Expected health impact of intervention

• Flyers

• Press releases

• Social media 

posts

• News media 

coverage

• Social media 

platforms

Community 

Organizations

• Clear recommendations and action steps

• Cost information

• Lessons learned

• Relevance to their priorities

• Toolkits

• Websites

• Social media 

posts

• Internet

• Social media 

platforms

Decision Makers • Stories to accompany data

• Relevance to their priorities

• Cost-effectiveness

• Local impact

• Research briefs

• Infographics

• Press releases

• Press conferences

• News media 

coverage

• Personal contact

Healthcare Providers • Up-to-date health data 

• Potential for improving quality of care 

• Cost-effectiveness

• Successes from other health systems

• Relevance to health system quality 

improvement initiatives

• E-newsletters

• Scientific articles

• Trainings

• Website

• Health system 

intranet 

• Communications 

from professional 

associations

Public Health 

Program Staff and 

Managers

• Guidance for intervention design 

• Implementation steps

• Effectiveness of the intervention

• Cost-effectiveness

• Lessons learned 

• Other organizations using the intervention

• Webinars 

• Trainings

• Research briefs

• Toolkits

• Website

• Email

• Internet

• Communications 

from professional 

associations

Putting Evidence into Practice l 32

HOW TO
Implementing 

Evidence-Based 

Interventions

Implementation is the process of putting an 

evidence-based intervention into practice. Much of 

a program manager’s job is guiding and supporting 

implementation of evidence-based interventions 

in communities. But simply communicating 

information about evidence-based interventions is 

often not enough to change well-established practices. 

Implementation strategies are ways to increase the 

likelihood that implementation will be successful. 

Dozens of different implementation strategies exist, 

ranging from simple actions to complex, multi-part 

strategies.64,140,141 Figure 9 shows examples of strategies 

to implement evidence-based clinical or public health 

interventions. Programs will likely not use all the 

strategies, but in most cases, more than one strategy 

will be used.

Strategies may also change as implementation 

progresses and new challenges arise. For a full list of 

implementation strategies, see the Implementation 

Science article by Powell et al.

Choosing Implementation Strategies

Selecting the right implementation strategies starts 

with understanding the challenges that might 

make implementation more difficult. Matching 

implementation strategies to these challenges can 

increase the likelihood of success. For example, if staff 

lack the skills to implement changes, they may need 

extra training or technical assistance. Examples of 

common challenges programs may face and strategies 

to address them are shown in Figure 10 on page 34. 

A SWOT Analysis (Strengths, Weaknesses, 

Opportunities, Threats) can also help assess potential 

challenges and resources available to support 

implementation. Program staff can also talk to people 

who will make the changes and to members of the 

Figure 9. Implementation Strategies

Adapted from Powell et al. 142

Putting Evidence into Practice l 33

HOW TO
population.143 They can offer valuable insight into 

potential challenges and strategies to overcome them. 

The sections that follow describe in more detail four of 

the most common implementation strategies:

• Providing training and technical assistance to 

those who will implement the intervention 

(e.g., training youth on conducting retail store 

assessments)144

• Adapting an intervention to a different population 

or setting (e.g., adapting a smokefree home 

intervention for tribal communities)145

• Pilot testing an intervention on a small scale to 

assess feasibility and address challenges (e.g., 

testing and revising a new protocol to screen 

and treat patients for commercial tobacco use)

• Scaling up a successful pilot test to a larger 

population or setting (e.g., expanding 

successful health systems changes to a larger 

healthcare system)

Figure 10. Matching Challenges and Implementation Strategies

Adapted from National Cancer Institute;64 Patient-Centered Outcomes Research Institute;73 Brach et al.85 

Questions to Select 

Implementation Strategies76

The following questions can help 

program staff and stakeholders choose 

implementation strategies:

• Why do stakeholders want to 

implement the evidence-based 

practice? How will it benefit them?

• What barriers might prevent them 

from implementing the practice?

• Which strategies could help 

overcome these barriers?

What combination of strategies is most likely 

to help them sustain the changes? 

Putting Evidence into Practice l 34

HOW TO
Providing Training and 

Technical Assistance

Successful implementation relies on 

clearly communicating an evidence-based 

intervention’s core components—the 

ingredients that are essential to produce 

the desired results—to those who will 

use it.146 One way to do this is through 

training and technical assistance.56,146

Training teaches users the core skills 

to implement an evidence-based 

intervention. Technical assistance (TA) 

builds on training and can include 

hands-on coaching, onboarding new 

staff, and providing ongoing support 

such as retraining and skill building.147

For example, Wisconsin developed a TA program in 

which outreach specialists gave presentations and 

created resources to teach healthcare providers to 

integrate commercial tobacco use treatment into 

routine patient visits.148

Training and TA together lead to better implementation 

outcomes than training alone.146 By helping practitioners 

master and apply their skills, TA can improve the quality 

with which they deliver evidence-based interventions.147

One study estimated that learners use only 5% of skills 

taught through training but 95% of skills learned from 

ongoing coaching.149

Effective training and TA is delivered by skilled experts 

who have thorough knowledge about the intervention.150

Some skilled program staff may be able to provide 

training and TA. Programs may also partner with 

researchers, nonprofits, or trained specialists outside the 

program. For example, the Public Health Law Center

provides in-person and online training and resources 

that focus on commercial tobacco control laws and 

policies. Counter Tools offers assessment tools, webinars, 

strategic consulting, and software training to help 

implement retail interventions.

Planning for Training and TA

Creating a training and TA plan can help training 

material match the needs of practitioners. An effective 

training and TA plan describes:93

• Which areas require training and skill-building

• What training will be provided

• Who will attend the training and who will lead

• Where or how to provide training (e.g., in 

person, online, or via webinar)

• How to measure the quality of training and TA

• How training supports core components of the 

intervention

Choosing Training and TA Formats

In-person training works best for demonstrating new 

interventions, role-playing exercises, and providing 

individualized help, but costs more than online 

training.151 Less expensive online formats can deliver 

material more consistently and offer convenient 

opportunities for refresher training and updates, but do 

not usually include TA.90 Having an online format of 

trainings accessible is helpful for times when in-person 

training is not feasible. Email, instant messaging, and 

videotaped feedback can provide some of the advantages 

of in-person training at lower cost. Using a mix of 

training and TA formats can allow for some customized 

information while keeping costs down.

Effective training and TA can also include other 

methods such as:

• Attending conferences152

Putting Evidence into Practice l 35

HOW TO
• Train-the-trainer approaches, where 

practitioners learn about the evidence-based 

intervention and then train their peers89

• Mentorship programs, where experienced 

partners provide hands-on learning153

• Peer networking and training with Communities 

of Practice, where practitioners can learn 

together89

Measuring Training and TA Effectiveness

Evaluating training and TA can help improve training 

quality and show its impact.154 Assessing skill levels 

before and after training helps assess where users have 

mastered skills and show areas for improvement. These 

skills assessments allow the trainer to respond by 

providing constructive feedback or tailoring training 

to participants’ needs. Regularly checking in with 

participants after trainings can also help programs 

quickly see if training has led to practice changes.154

Adapting Interventions

Researchers do not always develop and test new 

interventions in the real-world settings where they 

will be implemented. But interventions are unlikely 

to work equally well in different settings and may 

require planned changes, or adaptation.64 Adapting 

interventions can help programs:155

• Meet the needs of a new population and setting

• Reach more people

• Deliver interventions at lower cost

• Simplify the intervention

Carefully planning adaptations, 

rather than making unplanned, 

accidental, or reactive changes, is 

important.156 Adapting an evidencebased intervention to a different 

setting includes identifying the 

intervention’s core components and 

elements that are adaptable. Adaptation 

also includes tracking fidelity to the 

original intervention. Fidelity is the 

extent to which the intervention 

was implemented as intended by the 

original developers.2

Identifying Core Components

Before deciding to adapt an intervention, it is important 

to determine if the change would affect a core 

component. Core components are the elements that are 

essential to make an intervention effective. They can 

include the content, how it is delivered, and how it affects 

change.64 If an adaptation changes the core components 

too much, the intervention may be less effective.2

Reviewing the logic model, theory of change, and study 

protocol can also help identify core components, which 

may be likely found in the scientific article about the 

intervention.157

Deciding What Changes to Make

Minor changes are usually possible, such as using new 

data, customizing materials for a new population or 

setting, or changing recruitment methods.64,108 Other 

changes can be more difficult to make, such as:158

• Changing the order or length of activities

• Adding activities that address other risk factors 

or behaviors

• Changing who delivers the evidence-based 

intervention or how it is delivered

• Substituting materials or activities

• Changing the setting or population

These types of changes require more cautious 

consideration than minor adjustments. 

Putting Evidence into Practice l 36

HOW TO
Improving Implementation through Cultural Adaptations

A community’s culture can influence whether an intervention is likely to be effective in a new setting.76

Culture refers to a population’s behaviors, beliefs, values, and roles. It is based on characteristics such as 

race, ethnicity, gender, socioeconomic status, religion, or geographical region.159 Adapting an evidencebased intervention to fit a population’s culture is important because it:

• Respects the population’s values and identity159

• Decreases risk of unwanted surprises due to cultural misunderstanding159

• Builds community support and trust159

• Helps reduce tobacco-related disparities2

Cultural adaptations may address cultural features that are easily noticeable (e.g., music, clothing, and 

cultural references) or deep-seated characteristics (e.g., values, attitudes, and beliefs).57 Read more about 

developing cultural humility on page 42 and from CDC’s Networking2Save national networks, which 

focus on preventing commercial tobacco use and cancer in eight populations.

When adapting an intervention, it is important to 

consider:

• What will be modified

• Whether the changes are consistent with the

original intervention

• The reasons for and goals of the adaptation

• Who will participate in the change

The success of changes can also be affected by whether 

commercial tobacco use is as high a priority in the new 

population as in the original, local implementation 

capacity is strong, and the intervention is compatible 

with the new social and cultural context.76

Pilot Testing

Sometimes implementing a full-scale evidence-based 

intervention can be risky or premature. For example, an 

organization or community may not be fully ready for 

change, or it may be unclear whether an intervention is 

adaptable to a different population or setting. Piloting 

an intervention on a limited basis can be a good way to 

learn whether it is likely to work in the long term or on 

a larger scale. 

Pilot testing can:

• Give users the opportunity to try out an

intervention85

• Develop and refine implementation of a new

intervention160

• Speed up an existing intervention’s adaptation

or improvement through a purposeful trial and

learning process rather than trial and error93

• Test changes on a small scale before

implementing system-wide changes161

• Create organizational buy-in if the pilot is

successful73

For example, Pennsylvania worked with the state quitline 

vendor National Jewish Health and the Department of 

Corrections to pilot a commercial tobacco cessation 

program. The program was for incarcerated women at 

one of 24 state correctional institutions. After evaluating 

the pilot, Pennsylvania developed a toolkit for scaling 

up the program and provided cessation classes for 

incarcerated people across the state to support the 2019 

enactment of commercial tobacco-free policies for all 

state correctional institutions.162

Putting Evidence into Practice l 37

HOW TO
A CLOSER LOOK: Disseminating and Implementing Retail Interventions in 

Santa Clara County, CA

In 2010, Santa Clara County passed 

a comprehensive tobacco retail 

licensing law, which decreased 

the number of retailers selling 

commercial tobacco.163 However, 

because the ordinance only 

applied to unincorporated areas, 

it did not have the same impact 

in the county’s cities, where 95% 

of its 1.9 million residents live. 

And despite an interest in retail 

interventions, the cities found it hard 

to prioritize commercial tobacco 

control and lacked the time and 

resources to implement and enforce 

interventions. Using funds from the 

state’s commercial tobacco tax, the 

county Department of Public Health 

focused on dissemination and 

implementation strategies to help the cities reduce the influence of commercial tobacco in retail stores.

Beginning in 2011, the county provided both grant funding to cities and support through an 

independent expert who provided city staff with technical assistance in researching retail interventions, 

educating the community, developing ordinances, and planning for how changes would be 

communicated and enforced. The county also helped cities enforce retail interventions by agreeing to 

administer retail licensing programs for each city that adopted an ordinance that mirrored the county’s, 

at no cost to the city. This arrangement promoted consistent regulations and decreased the cities’ 

administrative responsibilities. 

The department also launched the Healthy Cities project in 2016 to disseminate evidence-based 

healthy living interventions, including reducing youth access to tobacco in retail stores. As part of the 

initiative, they created a dashboard to help cities prioritize evidence-based interventions and compare 

their progress with others. It showed cities opportunities for improvement and celebrated successes, 

motivating cities to adopt as many interventions as possible on the dashboard.164

Since they began D&I efforts, 9 of the county’s 15 cities have adopted a commercial tobacco retail 

intervention, with more planned in the coming months.164 Cities have adopted retailer licensing, reduced 

the density of commercial tobacco outlets, limited sales near schools, limited flavored tobacco products, 

banned the sale of vaping products, and limited sales in pharmacies. 

Map of Santa Clara County, CA and the 15 cities not covered by its comprehensive tobacco 

retailer licensing ordinance

Putting Evidence into Practice l 38

HOW TO
Using Plan-Do-Study-Act Cycles

The Plan-Do-Study-Act (PDSA) model, which 

healthcare organizations commonly use to better 

deliver commercial tobacco cessation, can help 

programs assess whether a pilot is successful. The four 

phases of the PDSA cycle are:165

• Plan: Identifying the problem and developing a 

plan to change

A CLOSER LOOK: Pilot Testing the Ask and Act Smoking Cessation Model

People who smoke value 

their doctor's advice 

to quit smoking.166 The 

American Academy 

of Family Physicians 

(AAFP) wanted to help 

healthcare providers 

integrate commercial tobacco cessation into their primary care practices, so in 2011 it launched Ask and 

Act, a pilot project to recruit and train office champions to implement cessation activities.167 The office 

champion was usually a non-physician staff member who would educate patients, develop cessation plans, 

and monitor patient progress. Beginning with just 49 family medical practices, champions received training 

and educational materials and were required to submit an implementation plan, monitor progress, and 

communicate their results.168 The pilot project was the first of three 13-month pilot testing cycles.169

At the end of the first pilot phase, the clinics increased their documentation of commercial tobacco use 

from 82% to 90%, and the percentage of patients offered cessation assistance increased from 48% to 72%. 

Nearly all (98%) of the clinics were confident that they could sustain the changes.168 Based on this initial 

success, AAFP recruited another 50 practices from around the country in 2012.170 The second pilot phase 

achieved similar rates of successful documentation and a dramatic 107% increase in cessation assistance, 

from 36% to 74%. Clinics also noted any implementation challenges and identified the project materials 

they found most useful.170

Using this feedback, AAFP undertook a third pilot phase, recruiting 20 Federally Qualified Health 

Centers (FQHCs) that treat underserved and uninsured populations. Over 40% of FQHC patients use 

tobacco, more than twice the national rate.169 The goals were to meet or exceed previous pilot outcomes 

and to reduce smoking prevalence among FQHC patients by 10%–20%.171 AAFP collected data from 

three clinics about what materials, changes, and activities were most useful and used it to make 

adjustments during the course of the project.169 At the end of the implementation period, screening and 

advising rates reached project goals. The FQHC phase also identified special challenges such as patient 

health literacy, need for affordable cessation medication, and authorization from insurance companies.171

With findings from all three phases, AAFP has expanded the Ask and Act project to integrate cessation 

into behavioral health practices in 2015.169 Its longer-term goal is to bring these changes to all family 

medical clinics and residency programs.169,170 Learn more about integrating cessation into primary care 

practices in AAFP’s Treating Tobacco Dependence Practice Manual. AAFP has also adapted the Ask 

and Act model to increase adult vaccination rates and is exploring its use in addressing other chronic 

conditions including obesity, diabetes, and substance use disorders.169

Putting Evidence into Practice l 39

HOW TO
• Do: Carrying out the plan to address the problem

• Study: Monitoring and learning from the changes

• Act: Incorporating the changes or test other 

changes in new PDSA cycles

Continuously measuring change, refining the 

plan, and testing over many PDSA cycles can help 

successfully implement and adapt interventions.2,172

Learn more about using PDSA cycles at the National 

Implementation Research Network’s Improvement 

Cycles Module on the Active Implementation Hub. 

The Rhode Island Department of Health used PDSA 

cycles to develop QuitWorks-RI, which uses electronic 

health records (EHR) to refer patients who want to 

quit commercial tobacco to the state quitline for free 

cessation services. Over the course of three PDSA cycles, 

QuitWorks-RI grew from a plan for a single group of 

providers, to a plan for the entire provider staff, and 

finally to involvement of the full clinical team.173

Scaling up Successful Interventions

Even the most effective, well-implemented evidencebased interventions will have little impact on 

commercial tobacco use if they only reach a small 

portion of the population.2 Scaling up is the process 

of expanding an intervention to more populations or 

settings.174 Scaling up can also help reach traditionally 

underserved groups. 

In commercial tobacco control, scaling up could 

include implementing health systems changes in new 

clinics or expanding smokefree protections to new 

workplaces. Scaling up can improve the effectiveness, 

affordability, and sustainability of evidence-based 

interventions.175 Programs can get started by 

determining if scaling up is a good option. Scaling up 

also includes identifying barriers and facilitators to 

expanding an evidence-based intervention.

Deciding Whether to Scale Up an Intervention

It may not be realistic or beneficial to scale up all 

interventions. Factors to consider when deciding to scale 

up an intervention include:87

• Population size and characteristics 

Some interventions may be designed for 

specific populations. Its is important to ensure 

the intervention is appropriate for other 

populations and if it would need to be adapted 

for different groups. 

• Complexity

Interventions with multiple components are 

harder to scale up effectively because they 

can be more costly and difficult to manage. 

Choosing those parts which have the greatest 

potential impact can improve the likelihood of a 

successful scale-up.

• Cost

Scaled up interventions can be more expensive to 

sustain because they require more training, TA, 

and information technology to carry out. Webbased interventions can be good candidates for 

scaling up because they are relatively inexpensive 

and not limited to a geographic area.

Criteria for Scaling up 

Interventions96

Evidence-based interventions that meet the 

“CORRECT” criteria listed below are most 

likely to be successfully scaled up:

• Credible: Based on sound evidence 

• Observable: Users can see the results in 

intervention

• Relevant: Address persistent or 

important problems

• Relative advantage: Better than existing 

interventions so that users agree costs 

outweigh benefits 

• Easy to implement: Simple to put into 

action rather than complex and 

complicated

• Compatible: Fits well with potential 

users’ values, norms, and facilities

• Testable: Can be tested on a small 

scale prior to large-scale adoption

Putting Evidence into Practice l 40

HOW TO
Identifying Barriers and Facilitators to Scaling Up

Programs may run into unexpected challenges as 

scale-up efforts get underway, often because they do 

not fully understand the resources and constraints of 

the new setting.176 Thinking through possible barriers 

and supports before scaling up is important to achieve 

success and maintain confidence among partners.176

Common barriers to scaling up include lack of available 

funding, staff, time, or organizational support.96,177

Stakeholders with different interests and values may 

also want to take different approaches to scaling up.177

Absence or loss of a program champion or leader can 

also be a barrier to scaling up.177

Scaling up is easiest when:96

• The organization believes there is a need for the 

evidence-based intervention

• The organization has the capacity to adopt the 

intervention (including staff technical skills, 

training, leadership support, and evaluation 

capacity)

• No other major changes are on the horizon

It is important to assess the adopting organization in 

these three areas before starting a scale-up project. 

An organization is unlikely to be strong in all three 

areas, but that does not mean it is not a candidate for 

scale-up. Programs can begin scale-up efforts in areas 

where the organization is strongest (e.g., with a strong 

and committed leadership) while building capacity 

in other areas (e.g., training staff on needed skills).96

Selecting a program champion, finding alternative 

sources of funding and staffing, and mobilizing 

existing resources can also make scaling up easier.96

Sharing success stories with stakeholders can help raise 

awareness and credibility that can pave the way for a 

smooth expansion.178

Creating a Scale-Up Strategy

Evidence-based interventions can be scaled up in 

different directions, shown in Figure 11. Vertical 

scale-up is the adoption of an intervention at a higher 

level, such as expanding it from a community to 

statewide.96 Horizontal scale-up is the replication of 

the intervention at additional sites across the same 

system levels, such as replicating an intervention across 

departments, organizations, or communities.97

To be sustainable, usually both types of scaling up are 

needed.97 Learn more about scaling up projects on the 

ExpandNet/WHO website.

Figure 11. Scaling-Up Activities

Source: World Health Organization96

Putting Evidence into Practice l 41

HOW TO
Reaching Priority 

Populations through 

D&I

Reaching populations most affected by commercial 

tobacco use and secondhand smoke exposure is critical 

to reducing commercial tobacco use overall.1 Yet these 

groups often face barriers to accessing the most effective 

interventions. For example, some groups are less likely 

to use commercial tobacco cessation treatment. These 

include certain racial and ethnic minorities; lesbian, 

gay, or bisexual people who smoke; and people without 

health insurance.44 Commercial tobacco advertising, 

which is most heavily targeted to priority populations, 

can compete for attention and make commercial tobacco 

use seem acceptable.179 Historical and ongoing cultural 

discrimination can lead to mistrust of outside researchers 

and program staff.2

Efforts to test evidence-based interventions have also 

traditionally left out population groups who experience 

tobacco-related disparities by:2

• Implementing interventions only in highresource settings with adequate infrastructure, 

capacity, training, and funding to take part in 

data collection

• Not engaging community participants and 

cultural advisors during the entire process

• Lacking shared roles and responsibilities, 

ownership, and mutual respect between 

researchers and the community

• Using research methods that are not informed by 

the population’s cultural practices or beliefs

Implementing interventions that meet the needs 

of communities takes thoughtful planning and 

consideration. Learning about priority populations, 

developing cultural humility, and using communitybased D&I strategies can help all communities benefit 

from evidence-based commercial tobacco control.

What are Tobacco-Related 

Disparities?

Tobacco-related disparities are differences 

among population groups in the patterns, 

prevention, and treatment of commercial 

tobacco use, secondhand smoke exposure, 

and health outcomes.1 Disparities also can 

occur in community resources to reduce 

commercial tobacco use.1 Disparities affect 

groups of people who have systematically 

faced health challenges based on their:30,49

• Age

• Disability

• Education

• Geographical region

• Health insurance status

• Income

• Mental health and substance use status

• Military status

• Occupation

• Race and ethnicity

• Sex

• Sexual orientation and gender 

identity

Learning about Priority Populations

Priority populations may have been excluded from or 

underrepresented in the intervention test population, 

so learning about these groups is an important first step 

for D&I efforts. They may be different from the test 

population in important ways, including:

• Community resources and strengths103

• Barriers to participation in evidence-based 

interventions59

• Community health priorities59

• Cultural values59

Putting Evidence into Practice l 42

HOW TO
A CLOSER LOOK: Disseminating a Smokefree Homes Program through 2-1-1

Although smokefree laws protect large portions of the U.S. population, the home remains a primary 

source of secondhand smoke exposure for many people, particularly youth.180 Low-income families are 

more likely to be exposed at home than families with higher incomes.181,182 Researchers from the National 

Cancer Institute’s State and Community Tobacco Control Research Initiative sought a better way to reach 

low-income families with smokefree information. They partnered with 2-1-1 helplines, which connect 

more than 12 million people to housing, food, and utility assistance each year, to disseminate the 

“Smoke-Free Homes: Some Things are Better Outside” program.183,184 The program encourages families 

to adopt smokefree home rules by providing a coaching call and toolkit with fact sheets, action steps, 

promotional materials, and a smokefree home pledge. 

By having 2-1-1 staff enroll callers in the program and deliver coaching, the researchers were able to 

disseminate smokefree home information directly to low-income families through a channel they 

already used and trusted. Although the program fit with the 2-1-1s’ mission to empower clients with 

information to improve their lives, 2-1-1 staff lacked experience delivering commercial tobacco control 

information.184 The project supported 2-1-1 staff by providing:184

• A combination of in-person training and webinars, including a general overview for all staff and 

webinars tailored by staff role (e.g., recruiter, program coach)

• An implementation toolkit

• Mock phone sessions with staff to review how to screen for eligibility and record data

• Ongoing technical assistance to troubleshoot issues

• Monthly booster calls to discuss progress and challenges

• A web-based tracking tool to track enrollment and program delivery in real time

2-1-1 dissemination of the program reached over 2,300 people.184 Most lived in rental homes without a 

smokefree rule.184 Sixty percent of those reached for follow-up signed the smokefree home pledge, 83% 

developed a list of reasons to create a smokefree home, 87% had a family talk, and 30% called a quitline.184

Learn more at Emory University’s Smoke-Free Homes Project web page.

Web banner from Smoke-Free Homes Project web page

Putting Evidence into Practice l 43

HOW TO
• Communications preferences185

• Community history59

• Traditional tobacco use for religious or cultural 

purposes

D&I strategies or the intervention itself may need to be 

tailored to address these differences. 

To begin learning about priority populations, program 

staff may need to explore new data sources. State and 

national surveys are valuable for monitoring commercial 

tobacco use trends, but they often do not focus on 

smaller cultural groups.186 For example, most surveys 

do not include sexual orientation and gender identity 

questions, and some lump ethnicities into one large 

group, missing important differences between groups.186

Information about specific groups can be gathered from 

community assessments, focus groups or interviews 

with community members, or discussions with partners 

who work with the priority population. Learn more 

about community assessments on page 15.

Building Cultural Humility 

Cultural humility is a lifelong process of self-reflection 

to increase understanding of others by not only learning 

about their culture, but also examining one’s own beliefs 

and values. It is different from cultural competence, 

which has been criticized as too focused on gaining 

knowledge and “achieving” competence rather than a 

continual process of learning and self-awareness.187

Staff and D&I partners can practice cultural humility 

by:187

• Taking a cultural self-assessment to begin to 

recognize their own cultural values and biases 

and how those affect others

• Using mindfulness techniques to intentionally 

pause and recognize their own thoughts and 

emotions and those of others

• Thinking about the culture and experiences of 

people from the community

• Forming meaningful and diverse partnerships 

that represent the people in the community

• Learning about the group’s historical experiences, 

especially related to commercial tobacco

• Avoiding stereotyping and acknowledging that 

people from the same group may have different 

experiences and values

Learn more in the article, Cultural Humility: Essential 

Foundation for Clinical Researchers and Community 

Tool Box toolkit, Building Relationships with People 

from Different Cultures.

Disseminating to Priority Populations

Poorly communicated information can keep priority 

populations from benefitting from the latest evidencebased interventions. The following steps can help 

programs disseminate evidence-based interventions to 

priority populations:

• Share information about the harms of commercial 

tobacco use

Educating people about how commercial 

tobacco use harms their community can 

increase their interest and motivate them 

to use evidence-based interventions.138 It is 

important to share evidence the audience 

considers credible, which may include personal 

experiences.138

• Work with population groups to create relevant 

messages

Some members of priority population groups 

may dismiss information about evidence-based 

interventions that they feel are too costly or a 

poor fit with their community.2 Well-crafted 

dissemination messages describe how the 

intervention fits with the audience’s goals, beliefs, 

and culture.

• Tailor and test dissemination products

When possible, it is best to feature members of 

the audience in visuals and use the audience’s 

native language.32 Pretesting with audience 

members can help gauge whether materials 

resonate with them and make sure they share 

the same message as the English version.32

• Use trusted messengers

Evidence-based information that is delivered 

by trusted members of the community may be 

better received than information shared from 

more traditional evidence sources.73

Putting Evidence into Practice l 44

HOW TO
• Choose channels used by the audience

Using channels popular among the audience 

is the best way to make sure they receive 

messages. For example, almost 95% of teens 

have or use a smartphone, and many are online 

almost constantly.188 The use of smartphones 

among low-income Americans has doubled 

since 2013, though still lags behind use among 

those with higher incomes.189 Some cultures 

may prefer low-tech methods like face-to-face 

communication.190

Implementing in Low-Resource 

Settings

Implementing commercial tobacco 

control interventions can be challenging 

in communities with limited funding, 

staff, information technology, or physical 

infrastructure to support the changes.2

Programs working to implement 

evidence-based interventions in lowresource communities can take the 

following steps:

• Consider community resources

It is important to begin efforts by 

reviewing community resources, 

including social networks, 

communications channels, 

the political and physical 

environment, transportation, and 

competing programs.191 Programs 

can think strategically about 

how these existing resources 

might be used to help support 

implementation.

• Create community ownership

Working with community 

members as equal partners in 

every step of implementation is 

critical to increase the likelihood 

that evidence-based interventions 

will reach and have an impact on 

the people who can benefit most 

from them.192 Some programs 

have created mini-grants for 

communities to implement 

evidence-based interventions.193

• Involve the community in adapting interventions

Community members are the experts on their 

communities. They can help decide what 

adaptations are needed so community members 

will accept the new intervention.194 Because the 

community’s resources may be quite different 

than the original intervention, extensive changes 

may be needed.185

• Train community members to be implementers

Low-resource communities may need training to 

carry out changes, especially if non-traditional 

partners are making changes (e.g., if social service 

Putting Evidence into Practice l 45

HOW TO

Fact sheet to disseminate data on menthol as part of the Beautiful Lie Ugly Truth campaign 

Source: Association for Nonsmokers – Minnesota
agencies are delivering commercial tobacco 

cessation assistance).184

• Meet critical community needs

Some populations may find it hard to prioritize 

commercial tobacco control when facing other 

critical issues like inadequate housing, food 

insecurity, or public safety. Working to address 

these issues through multi-component 

interventions may be necessary.195

Fact sheet adapted for Spanish-speaking populations to educate about smokefree housing rules and commercial tobacco cessation assistance 

Source: CDC

Putting Evidence into Practice l 46

HOW TO
Evaluating D&I 

Strategies

D&I evaluation is different from program evaluation. 

Program evaluations are usually broad and assess 

many program components. They can help to make 

judgments about the program, improve effectiveness, 

and inform future program development. D&I 

evaluation looks at whether D&I strategies help to 

increase use of a specific evidence-based intervention.2

If an intervention does not work as planned, it is 

important for programs to know whether the failure 

resulted from an ineffective intervention or from poor 

dissemination and implementation of an otherwise 

good intervention.2

 This information can help show 

where D&I efforts are meeting or missing their goals 

and improve future efforts. 

Evaluating D&I activities does not have to require a 

lot of additional time or resources. Programs can add 

D&I to their overall evaluation plan and use existing 

data collection activities to gather information about 

D&I efforts. For example, they can add D&I questions 

to existing surveys or track dissemination through 

ongoing website or social media monitoring.158

Tracking Dissemination

To evaluate dissemination activities, programs can 

monitor whether practitioners receive, accept, and 

use dissemination messages and materials. Surveys 

can also help assess changes in awareness of the 

intervention or changes in attitudes and behaviors 

toward using it. For example, an evaluation of a 

campaign to encourage healthcare providers to help 

patients quit smoking measured the percentage of 

providers who viewed the ad and the ad’s impact on 

their perceptions. Most of these viewers agreed that 

the ads caught their attention and made them consider 

doing more to help their patients quit.196 They were 

also more likely to assess their patients’ commercial 

tobacco use and to be aware of the quitline and other 

available cessation benefits.

Many tracking tools are available to help programs 

monitor dissemination. Free services like Google 

Analytics can track web page views, and website 

plug-ins can be installed to help track views and 

downloads of PDF documents like reports. Many 

social media platforms have their own tools to track 

mentions and followers (e.g., Twitter Analytics and 

Facebook Insights). Simple sign-in sheets at in-person 

events like trainings are an easy, low-tech way to track 

how many people received a message. Learn more 

about evaluating the reach of health communications 

activities in the CDC resource, Best Practices User 

Guide: Health Communications.

Measuring Dissemination

Dissemination evaluation assesses whether 

dissemination activities were successful by 

measuring:197

REACH: Whether the audience received the 

message

• The percentage of the audience of 

who received the information

• The number of people who accessed 

the dissemination product (e.g.,

website views, PDF downloads, or 

social media mentions)

• The number of people who 

participated in presentations, 

trainings, or other events

EFFECTIVENESS: Whether the audience will use the 

message

• How well the intended audience 

understood the message

• Whether the dissemination product 

is easy to use

• How recipients used the information

Putting Evidence into Practice l 47

HOW TO
Monitoring Implementation

Evaluating implementation helps programs understand 

whether and how a community is using a new 

intervention. Understanding how interventions 

are implemented can help figure out why expected 

outcomes were (or were not) achieved. Table 7 below 

lists common measures for evaluating implementation. 

Programs might use surveys to assess openness to 

change or examine how closely implementation 

matches the intervention.198 Administrative data can 

also help assess whether the intervention is being 

used. The best sources of implementation data depend 

on the type of intervention. For example, cessation 

interventions might rely on healthcare system data and 

provider surveys, while retail efforts might focus on 

collecting store assessment data.

Table 7. Sample Implementation Measures

Outcome Definition Measures

Appropriateness Whether the intervention is a 

good fit for the problem, setting, 

provider, or user

• How relevant the intervention is to the needs of the 

community

• How compatible the intervention is to the practitioners’ 

skill sets, role or job expectations

Feasibility Whether the intervention could be 

successfully implemented in the 

setting

• Resources or supports for using the intervention

• Barriers to using the intervention

Acceptability Belief among stakeholders that 

intervention is agreeable or 

satisfactory

• How easy the intervention is to use

• How useful the intervention is to their work

• How likely practitioners are to use the intervention 

Adoption Decision to use an intervention • Number of practitioners who report using the intervention

• Characteristics of those who report using the intervention 

Penetration Integration of the intervention into 

the setting

• Proportion of intended audience who receives intervention

• Proportion of practitioners who deliver the intervention

• Characteristics of those who receive and do not receive 

intervention 

• Participant responsiveness

Fidelity Whether an intervention is 

delivered consistently and 

according to plan

• Adherence to the intervention protocol

• Amount of exposure to the intervention (e.g., number of 

evidence-based cessation counseling sessions)

• Quality of intervention delivery

Cost Financial cost of implementation 

strategies

• Cost of carrying out D&I strategies

• Cost savings of replacing or reducing expensive or 

ineffective interventions

Sustainability Whether an intervention and its 

benefits are maintained over time

• Proportion of practitioners who continue to use the 

intervention in the long term

• Extent to which intervention components are incorporated 

into an organization’s policies or practices 

• Reasons for continuing or discontinuing implementation

Source: Adapted from Proctor et al.199

HOW TO
Sustaining EvidenceBased Interventions

Practitioners invest a lot of time and resources into 

implementing a new intervention. Sustaining the 

intervention maximizes their investment and helps the 

most people. Sustainability is the ability to continue 

an evidence-based intervention and its benefits over 

time.31 Sustainable evidence-based interventions 

maintain their effectiveness over time and are adaptable 

to changes like staff turnover and shifting community 

priorities. Programs know they have achieved 

sustainability when practitioners accept the new 

intervention as the norm.83

Planning for Sustainability

Just like implementation, sustaining an evidencebased intervention does not just happen on its 

own. It takes careful planning and action on the 

part of the D&I team to make sure supports are in 

place to sustain the new intervention. Planning for 

sustainability starts with understanding the factors 

that influence the likelihood a new intervention will 

be sustained. These factors include:

• Stable and consistent funding

• Strong partnerships and collaborations

• Organizational resources and capacity

• Ongoing program evaluation

• Ability to adapt the intervention to meet 

changing environment and needs

• A supportive internal and external environment 

The Program Sustainability Assessment Tool (PSAT)

can help public health programs measure capacity for 

sustainability in each of the eight domains shown in 

Figure 12. Although the tool was originally designed 

to focus on program sustainability, this term is used 

loosely to mean any set of organized activities, such as 

those used to carry out an evidence-based intervention. 

Strategies to Increase Sustainability

After taking the assessment, programs can review results 

and identify areas to improve. Some areas are easier 

to address than others. Programs can make the best 

use of resources by focusing on areas that align with 

stakeholder priorities and are most feasible to change. 

Creating an action plan with steps to improve helps hold 

the program and partners accountable. 

Although practitioners are ultimately responsible for 

sustaining the intervention, program staff can help by: 

• Planning for adequate funds to both implement 

and maintain a new intervention84

• Helping secure multiple funding sources201

• Training new staff and offering booster trainings 

for existing staff85

• Evaluating how the intervention is used and 

disseminated, adapting when needed202

• Monitoring external context for changes that 

will impact sustainability202

• Sharing positive early results with stakeholders 

to maintain enthusiasm and support92

Download action plan templates and learn more about 

sustainability at sustaintool.org.

Figure 12. Sustainability Domains

Source: Sustaintool.org200

Putting Evidence into Practice l 49

HOW TO
Ending Ineffective Interventions

Over time, evidence-based interventions can become 

ineffective, harmful, or unnecessary.63 More effective 

or efficient interventions may also become available. 

In these cases, ending use of the intervention may 

be better than sustaining it. For example, research 

has found that partial smoking bans in a home 

are no more effective at reducing tobacco use than 

allowing smoking.203 The decision to end an ineffective 

intervention can also help scarce public health 

resources be used wisely.11

An estimated 30% of healthcare spending is 

unnecessary, and about 25% of program staff in 

state health departments have reported continuing 

ineffective programs.11,204 Commercial tobacco control 

staff are less likely to report continuing ineffective 

programs than staff in other areas, possibly due to the 

strong evidence base for many commercial tobacco 

control interventions.11

“Unlearning” an intervention can bring challenges.63

Stakeholders may disagree about its value or assume 

that “more is better” when it comes to a familiar 

intervention, especially if it was designed to benefit 

a priority population.2,63 Similarly, people who use 

tobacco may believe that 

they will be receiving 

ineffective services 

without the intervention.63

Continuing even a lowvalue intervention may 

provide some benefit, 

and funders and other 

stakeholders may view 

completely ending an 

intervention as a waste 

of their investment. 

New funding priorities 

can create mistrust 

and frustration 

among community 

organizations.205 Staff who 

are emotionally attached 

to an intervention that 

they have used for a long 

time may also resist ending 

it.63 They may also be reluctant to end it if they believe 

they lack the resources, training, or time to deliver a 

replacement intervention.63

Programs can address these challenges by deciding 

whether to completely end the intervention, keep parts 

of it, or replace it with something else.63 This decision 

involves considering:63

• Evidence in support of continuing or ending the 

intervention

• Availability of other, more effective interventions

• Barriers to de-implementation (e.g., resistance 

from stakeholders)

• Population and setting of the intervention

• Possible outcomes of de-implementation

If the decision is made to end the use of the 

intervention, it can be reduced gradually while 

increasing the use of a more effective alternative using 

other D&I strategies.63

To help decide whether an existing intervention should 

be ended, see the Substance Abuse and Mental Health 

Services Administration resource, Do We Need to 

De-Implement an Existing Program? A Checklist to 

Inform Decision Making.

Putting Evidence into Practice l 50

HOW TO
PROVIDING SUPPORT

How Can Commercial Tobacco Control Programs 

Support D&I?

Efforts to put evidence into practice are most successful when they have had support from a variety of sectors, like 

organizational, community, and statewide public health programs.206 State programs can help support D&I efforts by 

taking the following actions:

Administrative Support

8 Become a “learning organization” that continuously identifies new knowledge and uses it to improve their 

current practices

8 Dedicate staff time for D&I activities and include D&I responsibilities in staff job descriptions

8 Include D&I activities in program evaluations

8 Assess what support is needed to sustain evidence-based interventions and where ineffective interventions

could be ended

Coordination & Collaboration

8 Create a variety of dissemination products to share information about evidence-based interventions with 

implementation partners such as health department staff, healthcare providers, business owners, and 

community members 

8 Identify potential partners that can help adapt, scale up, or pilot test evidence-based interventions

8 Involve stakeholders in assessing evidence, creating dissemination products, planning implementation 

strategies, and evaluating D&I efforts

8 Ask members of priority populations about the best communications channels and messengers to deliver 

information about evidence-based interventions

8 Form partnerships to address critical needs that may prevent at-risk communities from adopting evidencebased interventions (e.g., quality housing, safety, or healthy retail)

Training & Technical Assistance

8 Train commercial tobacco control staff on finding evidence, assessing the strength of evidence, communicating 

about evidence to stakeholders, and how to implement evidence with quality

8 Train those who will implement the intervention (e.g., training providers on how to talk to patients about 

tobacco use) and provide ongoing technical assistance to address potential challenges

8 Bring together peer organizations so practitioners can learn from others with similar experience

8 In low-resource communities, train non-traditional partners to help implement interventions

Putting Evidence into Practice l 51
CASE STUDIES

California Case Study

California scales up health systems change statewide.

California takes action to bring evidence-based cessation 

treatment to the entire state 

Despite significant smoking declines in California, 

prevalence remains high among some groups. From 

2016 to 2017, 19% of American Indians living in 

California, 23% of low-income African Americans, 

and 34% of Whites that did not complete high school 

smoked.207 The state realized that strategies to reach 

people who smoke are especially needed to keep 

making progress to reduce commercial tobacco use. 

In 2016, California funded a one-year pilot project 

called CA Quits to integrate evidence-based 

commercial tobacco cessation treatment in 15 public 

hospital systems. The project showed promise as a 

way to address gaps in cessation treatment statewide, 

including in rural areas with limited resources. In 2018, 

the project team proposed a five-year scale-up of the 

CA Quits initiative. The new project would implement 

health systems changes statewide by engaging three 

sectors: local health departments, Medi-Cal managed 

care plans, and safety-net health care systems that 

serve people regardless of their ability to pay or 

insurance coverage. The California Tobacco Control 

Program funded the scale-up and supported CA Quits 

by encouraging collaboration, providing technical 

assistance and training, and evaluating progress. 

CA Quits prepares to scale up by learning the landscape 

The pilot program was successful, but CA Quits knew 

there might be challenges integrating treatment into 

new settings. To prepare for these challenges, the project 

team gathered information about commercial tobacco 

use treatment in the state. They asked stakeholders in 

the three sectors about their priorities and strategies 

to address commercial tobacco use, tailoring messages 

for potential partners based on what they learned. For 

example, local health departments wanted to address 

disparities, insurance plans were interested in the business 

case for cessation, and health systems were focused on 

improving quality metrics. CA Quits reviewed the county 

commercial tobacco control plans and identified 31 

plans with cessation objectives. CA Quits focused their 

outreach and partnership development across the three 

health sectors in these counties. 

Using existing state infrastructure helped engage 

partners because it showed they would not have to start 

from scratch. For example, the California Smokers’ 

Helpline provided foundational cessation services in 

each new setting. “It has to be easy for providers and 

systems to adopt. That’s why working with the Helpline 

was a key part of this. The Helpline is available free 

statewide. You start with a basic model for folks, find 

out what they need—and what can you build up around 

that?” said CA Quits Project Director Elisa Tong.

California emphasizes collaborative implementation 

Collaboration is a key strategy used by CA Quits to 

scale up the integration of cessation services in 

healthcare systems. The project created learning 

collaboratives and workgroups on implementing 

commercial tobacco cessation best practices to help 

partners learn from their peers. These groups created a 

learning environment where participants can exchange 

ideas and address challenges together. The structure 

Putting Evidence into Practice l 52
CA Quits uses a peer learning structure to share implementation strategies for health systems change

also allows participants to choose strategies most useful 

for them and adapt them to their setting. 

California supports scaling up ideas with strong 

technical assistance and training 

The CA Quits team includes specialists with knowledge 

of the three sectors and other key areas like quality 

improvement, data, and communications. To bring in 

more expertise, CA Quits hosts speaker bureaus for 

external specialists such as state partners, pediatricians, 

and experts on emerging products to present on issues 

important to the participants.

CA Quits also created a training curriculum covering 

topics such as quality improvement, partnerships, 

disparities, and emerging trends. To plan the courses, 

CA Quits conducted an initial needs assessment and 

surveys participants after they complete courses. One 

frequent request was for help electronically connecting 

health systems to the Helpline. The program worked 

closely with health systems to review choices and 

support information technology needs. California 

Tobacco Control Program Chief April Roeseler says, 

“I’m a believer that you need strong technical support; 

that’s going to be the driver to adopt any new policy or 

thing that you’re working on.” 

California plans to reach more health systems in the 

future

In the first year, CA Quits recruited 11 public hospital 

systems and 10 federally qualified health centers to join 

learning collaboratives, and 14 insurance plans to form a 

commercial tobacco workgroup. The project has reached 

nearly 65% of the 31 counties with a cessation objective. 

In the future, CA Quits plans to continue expanding 

health systems change to safety-net health systems in 

all 58 counties in the state.

“I’m a believer that you need 

strong technical support; that’s 

going to be the driver to adopt 

any new policy or thing that 

you’re working on. ”

— April Roeseler

Putting Evidence into Practice l 53

CASE STUDIES
Nebraska Case Study

Tobacco Free Nebraska disseminates resources to help public housing go smokefree.

Nebraska recognizes the gap between clean indoor air 

laws and smokefree public housing

The health hazards of secondhand smoke exposure 

have been known for decades, yet gaps in smokefree 

protections still exist.206 Multi-unit housing residents are 

disproportionately exposed to smoke from commercial 

tobacco use.208 Because secondhand smoke moves across 

apartments and cannot be fully removed through filters 

or ventilation, going smokefree is the only effective way 

to eliminate secondhand smoke exposure.209 In 1997, the 

Kearney, Nebraska, public housing authority was one 

of the first in the U.S. to make its properties smokefree. 

Despite this early effort, the creation of smokefree public 

housing was nearly at a standstill for the next decade. 

After Nebraska passed its Clean Indoor Air Act in 

2008, the state’s commercial tobacco control program, 

Tobacco Free Nebraska, recognized that the law did 

not extend to public housing and saw an opportunity 

to fill that gap. “By focusing on smokefree policies in 

multi-unit housing, we can have that bigger impact and 

provide protection from secondhand smoke exposure 

for everyone living in that building,” said Amanda 

Mortensen, Tobacco Free Nebraska’s program manager. 

The program reached out to public housing agencies, 

surveying their needs, and disseminating resources to 

help them create smokefree environments. These efforts 

helped the public housing agencies understand the 

importance of smokefree properties. 

Tobacco Free Nebraska smokefree housing window cling

Program reaches out to public housing authorities 

Since public housing authority staff gather every year at 

the National Association of Housing and Redevelopment 

Officials (NAHRO) state conference, Tobacco Free 

Nebraska bought a vendor booth and ad space in the 

conference program. This small investment allowed 

the program to start building relationships and begin 

a dialogue about smokefree housing. Tobacco Free 

Nebraska also became a member of NAHRO and gained 

access to a directory of housing agency contacts, which 

helped them keep communication lines open after the 

conference ended. 

At first, the housing staff at the conference had doubts 

about a smokefree rule. They were especially worried 

about the legality of limiting smoking, potential loss of 

tenants, and possible implementation and enforcement 

costs. At a later conference, Tobacco Free Nebraska 

held presentations and a panel on creating smokefree 

housing with public housing agencies that had already 

implemented a policy, together with legal aid, and fair 

housing organizations. Having public housing directors 

share their experiences about going smokefree resonated 

with other housing agencies with similar concerns. 

Participating in the conference every year has helped 

Tobacco Free Nebraska maintain relationships with 

public housing authorities and serve as a trusted resource 

for creating smokefree properties.

Nebraska develops dissemination products by listening 

to public housing authorities

The program conducted an online survey to find 

out whether the state’s public housing agencies had 

smokefree requirements, what they covered, and the 

benefits and challenges of going smokefree. They 

learned that public housing directors believed that it 

was illegal to prohibit smoking on their properties, that 

Putting Evidence into Practice l 54

CASE STUDIES
enforcement was difficult, and that resident turnover 

would increase. To respond to these concerns, Tobacco 

Free Nebraska created fact sheets that described how 

landlords have the right to limit smoking and how 

smokefree housing reduces cleaning costs and the risk of 

fire. Mortensen said, “Taking time to listen to questions 

and concerns is important to develop messaging that 

really resonates with the housing agencies.”

The public housing agencies also needed guidance on 

how to make the changes, so the program compiled and 

mailed out a three-ring binder of resources on how to 

implement smokefree housing. Housing directors liked 

the binder because it helped them understand the steps 

to go smokefree and learn about available resources. 

Tobacco Free Nebraska also served as a resource if they 

had additional questions. The mailing also included 

materials to help property managers educate tenants. 

Door hangers in English and Spanish announced the 

start date and reminded tenants of the new rules. Instead 

of “no smoking” signs, window clings and stickers 

positively stated, “Proud to be a Smoke-Free Property.” 

Budget-conscious housing agencies appreciated free 

promotional yard signs for smokefree properties. 

Evidence-based resources help local housing authorities 

prepare for federal changes 

In 2016, the Department of Housing and Urban 

Development (HUD) announced a rule requiring all 

public housing to go smokefree within 18 months. To 

help agencies fully follow the rule, Nebraska printed 

and distributed new HUD smokefree resources to 

housing directors. Because Nebraska’s agencies were 

already familiar with smokefree requirements and how 

to implement them, they were ready for the change: as 

of 2016, 87% of respondents surveyed from Nebraska’s 

108 public housing agencies already had some form of 

smokefree rule in place, compared with 19% nationally.210

Nebraska’s dissemination efforts have shifted the 

attitudes of public housing agencies from skepticism to 

enthusiasm. In 2015, the program conducted a followup survey that found that most housing directors 

agreed that smokefree public housing is legal, reduces 

property rehab costs and fire risk, and improves air 

quality and tenant health. The program is also helping 

public housing agencies positively enforce smokefree 

Putting Evidence into Practice l 55

CASE STUDIES

Page from Tobacco Free Nebraska smokefree housing brochure

requirements by offering quitline and cessation resources 

to address violations. Tobacco Free Nebraska hopes that 

by sharing the successes of smokefree public housing, 

privately owned low-income housing communities will 

also learn about the health and economic benefits of 

smokefree multi-unit housing and adopt similar rules.
CASE FOR INVESTMENT

Why Invest in Putting Evidence into Practice?

Over five decades of research have identified proven, effective interventions to reduce commercial tobacco use.1,3

With additional effort and support, these interventions could have a large-scale impact on health.211 Dissemination 

and implementation (D&I) strategies can help achieve this goal by providing more and better information about what 

works and putting effective interventions into practice.56

History and Adoption

Interest in evidence-based healthcare and public health 

began in the 1970s when research discovered that many 

medical treatments were not evidence-based.16 This 

discovery spurred the growth of Implementation 

Science, the study of how to increase use of evidencebased interventions in clinical and public health 

settings to improve population health.64

Commercial tobacco control has been at the 

forefront of this research, since many commercial 

tobacco control interventions are first tested in states 

and communities. The National Cancer Institute 

published the first guidance for commercial tobacco 

control practitioners in 1991 with the Tobacco 

Control Monograph series.25 Five years later, the U.S. 

Department of Health and Human Services created 

the Community Preventive Services Task Force to 

develop recommendations on which public health 

interventions work, including commercial tobacco 

control. In 1999, the CDC released the first Best Practices 

for Comprehensive Tobacco Control Programs report 

to provide evidence-based recommendations for state 

programs to reduce commercial tobacco use.26 Since 

then, CDC has published two more editions of the Best 

Practices (2007, 2014) and seven Best Practices User 

Guides to provide evidence-based guidance for states 

and communities.1,29-35

As a result of these efforts, the prevalence of cigarette 

smoking among U.S. adults has decreased by more 

than half since the first Surgeon General’s Report 

was published on the dangers of smoking, from 

42% in 1965 to 14% in 2019.4,212 Yet evidence-based 

commercial tobacco control interventions are still not 

reaching many people who need them.4 New projects, 

like the Advancing Science & Practice in the Retail 

Environment (ASPiRE) Center, aim to strengthen 

the evidence base and increase use of evidence-based 

interventions.

38

Scientific Evidence

When fully and consistently implemented, evidencebased commercial tobacco control has enormous 

potential to save lives and reduce healthcare costs.6-10

The sooner evidence-based interventions reach 

practitioners, the sooner they can be implemented and 

improve community health outcomes. D&I strategies 

have led to major accomplishments, including the 

rapid adoption of quitlines and widespread adoption 

of smokefree air laws.4,37 D&I strategies bring these 

interventions to populations that need them most, 

helping to reduce health disparities.12 Access to the 

most up-to-date scientific information is even more 

critical to continue reducing commercial tobacco use as 

new tobacco products emerge on the market, patterns 

of tobacco use continue to change, and states face 

challenges to protect tobacco control achievements.4

Investing in D&I can help overcome barriers to 

successfully put evidence into practice and fill 

remaining gaps in commercial tobacco control. 

Practitioners with access to and support for using the 

evidence are better able to implement evidence-based 

interventions.

72 Without this support, strategies are 

likely to experience a “voltage drop” when interventions 

tested in controlled research settings are implemented 

in the real world.43

Putting Evidence into Practice l 56
Cost

Tobacco use is the leading cause of preventable death 

and disease in the U.S.3

 Cigarette smoking alone costs 

more than $300 billion per year in the U.S., including 

$170 billion in healthcare costs and approximately $156 

billion in annual productivity losses.3,14 D&I efforts that 

put effective commercial tobacco control interventions

into practice have great potential to reduce this burden. 

In 2020, CDC invested nearly $70 million in state 

commercial tobacco control programs.13 Yet states 

have cut their funding for commercial tobacco control 

and in many cases do not allocate Master Settlement 

Agreement funds toward reducing commercial tobacco 

use.213 As a result, gaps remain in implementation of 

proven interventions like smokefree laws, funding for 

state quitlines, and use of evidence-based cessation 

treatments.4

 Dissemination and implementation increase 

the likelihood that the money invested into research will 

lead to real improvements in the public’s health.51

Investing in D&I strategies can help programs 

save money by preventing spending on ineffective 

interventions.214 Investing in D&I can also speed up 

the process of moving from expensive, low-value 

interventions to more cost-effective ones.214

Sustainability

Nearly 40% of public health practitioners report 

that effective interventions often or always end that 

should be continued.11 D&I strategies help increase 

the likelihood that evidence-based interventions will 

be tried, adopted, implemented, and sustained.215 By 

adapting commercial tobacco control efforts to fit 

community needs, they help overcome implementation 

challenges that lead effective interventions to end too 

soon or never be implemented at all. By involving 

stakeholders throughout the process, D&I strategies 

help communities take ownership of commercial 

tobacco control activities. D&I can also increase the 

likelihood of sustaining benefits of evidence-based 

interventions by integrating new interventions into 

routine practice and community norms.216

Through training and technical assistance, D&I builds 

community capacity to disseminate, implement, 

and sustain evidence-based interventions. Scaling 

up effective interventions to reach more people and 

settings also helps secure resources and maintain health 

benefits over time.175

Disseminating relevant, understandable information 

also counters the perception that other health issues 

take priority over reducing commercial tobacco use.4

Clear guidance about how to close remaining gaps can 

energize and empower communities and funders to 

take on tobacco. Programs built on a solid foundation 

of evidence-based interventions are better able to 

show the impact and cost-effectiveness of commercial 

tobacco control to the public and future funders.

Putting Evidence into Practice l 57

CASE FOR INVESTMENT
RESOURCES

Commercial Tobacco 

Prevention and Control

Behavioral Risk Factor Surveillance System (BRFSS)

Publisher: Centers for Disease Control and Prevention

Summary: State and local data about health risk 

behaviors, health conditions, and use of preventive 

services that can inform audience research 

https://www.cdc.gov/brfss

Best Practices for Comprehensive Tobacco Control 

Programs—2014

Publisher: Centers for Disease Control and Prevention

Summary: Interventions and funding recommendations 

to plan state commercial tobacco control programs 

http://bit.ly/bp_2014

Best Practices User Guide: Health Communications 

in Tobacco Prevention and Control (2018)

Publisher: Centers for Disease Control and Prevention

Summary: Steps for state commercial tobacco control 

staff and partners to develop effective health 

communications

http://bit.ly/cdc_communications

Best Practices User Guide: Health Equity in Tobacco 

Prevention and Control (2015)

Publisher: Centers for Disease Control and Prevention

Summary: Steps that state commercial tobacco control 

staff and partners can take to promote health equity 

and reduce tobacco-related disparities

http://bit.ly/cdc_healthequity

Best Practices User Guide: Partnerships in Tobacco 

Control and Prevention

Publisher: Centers for Disease Control and Prevention

Summary: Steps that state commercial tobacco 

control staff and partners can take to form strategic 

partnerships and coalitions

http://bit.ly/cdc_partnershipsguide

Best Practices User Guide: Program Infrastructure 

in Tobacco Prevention and Control (2017)

Publisher: Centers for Disease Control and Prevention

Summary: Steps that state commercial tobacco control 

programs can take to build strong infrastructure

http://bit.ly/cdc_programinfrastructure

The Community Guide

Publisher: Community Preventive Services Task Force

Summary: Collection of evidence-based 

recommendations for more than 22 health topics, 

including commercial tobacco

https://www.thecommunityguide.org/topic/tobacco

Counter Tools (2019)

Publisher: Counter Tools 

Summary: Training and technical assistance for retail 

interventions 

https://countertools.org/

Keep It Sacred

Publisher: National Native Network

Summary: Evidence-based commercial tobacco control 

information for tribal populations

keepitsacred.itcmi.org 

Hospital Community Benefits and Tobacco 

Cessation: A Toolkit

Publisher: American Lung Association

Summary: Recommendations for using hospital

Community Health Needs Assessments to promote 

cessation

https://bit.ly/ala_benefitsandcessation

MPOWER (2019)

Publisher: World Health Organization

Summary: Six strategies to help countries implement 

effective interventions to reduce commercial tobacco use

https://bit.ly/who_mpower

Putting Evidence into Practice l 58
National Tobacco Control Programs in Action 

(2019)

Publisher: Centers for Disease Control and Prevention

Summary: Case studies of successful evidence-based 

interventions implemented by state programs

https://bit.ly/cdc_programsinaction

Networking2Save: CDC’s National Network 

Approach to Preventing and Controlling Tobaccorelated Cancers in Special Populations 

Publisher: Centers for Disease Control and Prevention

Summary: Consortium of national networks focused on 

tobacco-related disparities in priority populations

http://bit.ly/cdc_networking2save

Public Health Law Center

Publisher: Mitchell Hamline School of Law

Summary: Training and technical assistance resources 

on a variety of chronic disease topics, including 

commercial tobacco control

https://publichealthlawcenter.org/

PLACES Project

Publisher: Centers for Disease Control and Prevention

Summary: Local level data on chronic disease risk and 

outcomes for counties, places, census tracts, and zip 

codes throughout the U.S. 

https://www.cdc.gov/places

Scientific Evidence Briefs

Publisher: Centers for Disease Control and Prevention

Summary: Summaries of scientific evidence and evidencebased best practices in commercial tobacco control and 

prevention

http://bit.ly/cdc_briefs

Smoke-Free Homes Project (2014)

Publisher: Emory University

Summary: Intervention to reduce secondhand smoke 

exposure in homes, implemented with 2-1-1

http://smokefreehomes.emory.edu

Standardized Tobacco Assessment for Retail 

Settings (STARS) Tool

Publisher: Counter Tobacco

Summary: Store assessment tool to collect information 

about tobacco retailers

http://bit.ly/countertobacco_stars

State Tobacco Activities Tracking and Evaluation 

(STATE) System

Publisher: Centers for Disease Control and Prevention

Summary: Current and archived state-level data, maps, 

and fact sheets on commercial tobacco use 

https://www.cdc.gov/statesystem/index.html

Surgeon General’s Reports on Smoking and 

Tobacco Use (2020)

Publisher: Centers for Disease Control and Prevention

Summary: Links to the Surgeon General’s reports on the 

health consequences of commercialtobacco use with 

evidence-based recommendations

https://bit.ly/cdc_sgr

Taking Stock of Tobacco Control Program and Policy 

Science and Impact in the United States (2017)

Publisher: Journal of Addictive Behaviors and Therapy

Authors: Farrelly MC, Chaloupka FJ, Berg CJ, et al.

Summary: Overview of major commercial tobacco control 

accomplishments and implementation gaps

http://bit.ly/farrelly_takingstock

Tobacco Control Monograph Series (2017)

Publisher: National Cancer Institute

Summary: Evidence-based guidance about emerging 

commercial tobacco control issues

https://bit.ly/nci_monographs

Tobacco Control Network Resources

Publisher: Tobacco Control Network

Summary: Webinars, podcasts, success stories, and 

other tools to help state commercial tobacco control 

programs implement evidence-based interventions

http://tobaccocontrolnetwork.org/resources

Putting Evidence into Practice l 59

RESOURCES
Treating Tobacco Dependence Practice Manual: A 

Systems Change Approach (2017)

Publisher: American Academy of Family Physicians

Summary: Tips and templates for healthcare providers who 

want to make health systems changes

http://bit.ly/aafp_practicemanual

General D&I

Assessing Community Needs and Resources (2018)

Publisher: Community Tool Box

Summary: Overview of methods for assessing community 

strengths and weaknesses

https://bit.ly/ctb_assessingneeds

Building Capacity for Evidence-Based Public 

Health: Reconciling the Pulls of Practice and the 

Push of Research (2018)

Publisher: Annual Review of Public Health

Authors: Brownson RC, Fielding JE, Green LW

Summary: Strategies to build state program capacity to 

implement evidence-based public health interventions 

http://bit.ly/brownson_capacity

Checklist to Assess Readiness for Implementation 

(CARI) (2011)

Publisher: The Hospital for Sick Children

Summary: Checklist to assess readiness to implement an 

evidence-based intervention

http://bit.ly/barwick_CARI

Cochrane Database of Systematic Reviews

Publisher: The Cochrane Library

Summary: Databases of evidence to inform healthcare 

decision making, including systematic reviews 

https://www.cochranelibrary.com

Community Health Assessment Toolkit (2017)

Publisher: Association for Community Health 

Improvement

Summary: Nine-step toolkit to conduct a community 

health assessment and develop implementation strategies

https://bit.ly/healthycommunities_toolkit

Conference on the Science of Dissemination and 

Implementation in Health

Publisher: Academy Health

Summary: Annual conference to share the latest 

research on disseminating and implementing health 

interventions

http://bit.ly/academy_annualconference

Cost-Effectiveness Analysis (CEA) Registry (2018)

Publisher: Center for the Evaluation of Value and Risk in 

Health

Summary: Collection of public health interventions and 

their cost-effectiveness

https://bit.ly/cea_registry

County Health Rankings & Roadmaps (2019)

Publisher: County Health Rankings

Summary: Database of county-level health indicators 

http://www.countyhealthrankings.org/

Criteria for Choosing Promising Practices and 

Community Interventions (2018)

Publisher: Community Tool Box

Summary: Checklist for assessing evidence quality and fit 

with the community

https://bit.ly/ctb_promisingpractices

Cultural Humility: Essential Foundation for Clinical 

Researchers (2013)

Publisher: Applied Nursing Research

Authors: Yeager K, Bauer-Wu S

Summary: Practical guidance to enhance cultural humility

http://bit.ly/yeager_culturalhumility

Putting Evidence into Practice l 60

RESOURCES
Dissemination and Implementation Research in 

Health: Translating Science to Practice (2018)

Publisher: Oxford University Press

Authors: Brownson R, Colditz G, Proctor E, eds.

Summary: Textbook on planning and carrying out D&I 

efforts

http://bit.ly/brownson_translatingscience

Developing a Plan for Assessing Local Needs and 

Resources (2020)

Publisher: Community Tool Box

Summary: Guidance on how and why to develop a plan to 

assess the community 

https://bit.ly/ctb_developingaplan

Building Relationships with People from Different 

Cultures

Publisher: Community Tool Box

Summary: Information on how to learn about and build 

relationships with people from other cultures 

http://bit.ly/ctb_relationships

Evaluation Guide: Writing SMART Objectives

Publisher: Centers for Disease Control and Prevention

Summary: Guide to creating specific, measurable, 

actionable, realistic, and time-bound objectives

http://bit.ly/cdc_smartobjectives

Evidence-Based Behavioral Practice (2018)

Publisher: Evidence-Based Behavioral Practice

Summary: Online training modules for planning and 

implementing evidence-based interventions

https://ebbp.org

Evidence Informed Public Health (2021)

Publisher: National Collaborating Centre for Methods 

and Tools

Summary: Tools to find, assess, and use evidence

https://www.nccmt.ca/tools/eiph

Healthy Cities

Publisher: Santa Clara County 

Summary: Overview and resources for Santa Clara 

County's Healthy Cities Program to disseminate and 

implement evidence-based interventions

http://bit.ly/santaclara_healthycities

The Healthy Schools Toolkit 

Publisher: Health Equity Works

Summary: Toolkit on assessing systems and messages to 

support implementation to improve health in schools, 

including guidance on conducting a social network 

analysis

https://bit.ly/hew_healthyschools

The Hexagon: An Exploration Tool (2018)

Publisher: National Implementation Research Network

Summary: Tool to assess fit and feasibility of evidencebased interventions and organizational readiness

https://unc.live/2ZEIuIu

Organizational Readiness for Implementing 

Change Assessment (2016)

Publisher: National Institutes of Health

Summary: Questionnaire designed for healthcare settings 

that measures commitment and ability to change

https://bit.ly/nih_assessment

PCORI Dissemination and Implementation 

Framework (2015)

Publisher: Patient-Centered Outcomes Research Institute

Summary: Five-step framework describing how 

to disseminate and implement evidence-based 

interventions

https://bit.ly/PCORI_framework

PCORI Dissemination and Implementation Toolkit 

(2015)

Publisher: Patient-Centered Outcomes Research Institute

Summary: Action steps, worksheets, and examples 

to plan and carry out D&I efforts with a focus on 

stakeholder engagement

https://bit.ly/PCORI_toolkit

Putting Evidence into Practice l 61

RESOURCES
Prevention Research Centers 

Publisher: Centers for Disease Control and Prevention

Summary: Descriptions and contact information for 

26 research centers that develop, test, and evaluate 

public health interventions that can be applied widely, 

especially in underserved communities

https://www.cdc.gov/prc/index.htm

Program Sustainability Assessment Tool (2012)

Publisher: Center for Public Health Systems Science

Summary: Tool to assess capacity for sustainability and 

create a sustainability action plan

https://sustaintool.org

Promoting the Adoption and Use of Best Practices

Publisher: Community Tool Box

Summary: Why, when, and how to promote the use of 

best practices

https://bit.ly/ctb_bestpractices

PubMed

Publisher: U.S. National Library of Medicine

Summary: Database of scientific articles on public health 

topics

https://www.ncbi.nlm.nih.gov/pubmed

Putting Public Health Evidence in Action Training 

Workshop (2017)

Publisher: Cancer Prevention and Control Research 

Network

Summary: Interactive training for program planners on 

selecting and using evidence-based interventions

https://www.cpcrn.org/training

Society for Implementation Research Collaboration

Publisher: Society for Implementation Research 

Collaboration

Summary: Collaborative group of researchers and 

practitioners who share knowledge and host an annual 

conference

https://societyforimplementationresearchcollaboration.org/

Stakeholder Engagement Framework

Publisher: Australian Government Department of Health

Summary: Challenges to stakeholder engagement and 

ways to overcome them

http://bit.ly/au_stakeholder

A Survey Tool for Measuring Evidence-Based 

Decision Making Capacity in Public Health Agencies 

(2012)

Publisher: BMC Health Services Research

Authors: Jacobs J, Clayton P, Dove C, et al.

Summary: Survey to assess state and local public health 

staff capacity to use evidence-based interventions

https://bit.ly/jacobs_measuring

SWOT Analysis 

Publisher: Minnesota Department of Public Health

Summary: Information on how to conduct a SWOT

analysis and community examples

https://bit.ly/mdh_swot

Tool for Assessing Applicability and Transferability 

of Evidence (2017)

Publisher: National Collaborating Centre for Methods 

and Tools

Summary: Questions to assess fit of evidence to local 

context

https://bit.ly/nccmt_tool

Tools for Data Demand and Use in the Health 

Sector: Stakeholder Engagement Tool (2011)

Publisher: MEASURE Evaluation

Summary: Worksheets and step-by-step guidance to 

identify and engage stakeholders

https://bit.ly/MEASURE_stakeholder

Tools for Implementing an Evidence-Based 

Approach in Public Health Practice (2012)

Publisher: Preventing Chronic Disease

Authors: Jacobs JA, Jones E, Gabella BA, Spring B, 

Brownson RC

Summary: Overview of tools to conduct community 

assessments, select evidence, plan D&I efforts, and 

evaluate results

http://bit.ly/jacobs_implementing

Putting Evidence into Practice l 62

RESOURCES
Dissemination

Beyond Scientific Publication: Strategies for 

Disseminating Research Findings

Publisher: Community Alliance for Research and 

Engagement

Summary: Checklist and worksheets to develop a 

dissemination plan and select strategies

https://bit.ly/CARE_strategies

Coblis – Color Blindness Simulator (2018)

Publisher: Colblindor

Summary: Online platform to upload pictures and test 

visibility for people with visual impairments

https://bit.ly/coblis

Contrast Checker

Publisher: WebAIM

Summary: Online tool to assess contrast of text and 

background color for people with visual impairments

https://webaim.org/resources/contrastchecker

Designing for Dissemination: Lessons in Message 

Design from “1-2-3 Pap” (2015)

Publisher: Health Communication

Authors: Cohen E, Head K, McGladrey M, et al.

Summary: Case study on disseminating HPV vaccination 

messages, with lessons on adapting messages and 

selecting dissemination channels

https://bit.ly/cohen_dissemination

Disseminating a Smoke-Free Homes Program 

through 2-1-1

Publisher: Nicotine & Tobacco Research

Authors: Bundy LT, Haardorfer R, Kegler MC, et al. 

Summary: Results of disseminating smokefree homes 

information through 2-1-1 helplines that connect 

callers of low socioeconomic status to assistance

https://bit.ly/bundy_smokefree

Disseminating Policy and Environmental Change 

Interventions: Insights from Obesity Prevention 

and Tobacco Control (2015)

Publisher: International Journal of Behavioral Medicine

Authors: Leeman J, Myers A, Ribisl K, Ammerman A

Summary: Challenges in disseminating policy and 

environmental change information and strategies to 

overcome them

http://bit.ly/leeman_disseminating

Dissemination Planning Tool (2014)

Publisher: Agency for Healthcare Research and Quality

Summary: Six-step tool and guiding questions to create a 

dissemination plan

https://bit.ly/ahrq_planning

Future Directions in Disseminating Research 

Findings to Urban Alaska Native People (2018) 

Publisher: American Indian Alaska Native Mental Health 

Research

Authors: Shane AL, Apok CR, Doyle MJ, Hiratsuka VY, 

Dillard DA

Summary: Lessons learned about sharing information 

with Alaska Native populations

http://bit.ly/shane_directions

Getting the Word Out: New Approaches for 

Disseminating Public Health Science (2018)

Publisher: Journal of Public Health Management and 

Practice

Authors: Brownson R, Eyler A, Harris J, Moore J, Tabak R

Summary: Review of new dissemination channels to share 

research findings with practitioners

http://bit.ly/brownson_disseminating

Google Analytics

Publisher: Google

Summary: Online tool to track interactions with 

webpages and web-based content

http://bit.ly/google_getanalytics

Putting Evidence into Practice l 63

RESOURCES
Guide to Writing for Social Media (2012)

Publisher: Centers for Disease Control and Prevention

Summary: Best practices for using social media and text 

messaging to communicate public health messages

https://bit.ly/cdc_guidesocialmedia

The Health Communicator’s Social Media Toolkit 

(2011)

Publisher: Centers for Disease Control and Prevention

Summary: Guide to communicating through social media 

and other digital channels 

http://bit.ly/cdc_socmedia

Impact and Value: Telling Your Program’s Story 

(2007) 

Publisher: Centers for Disease Control and Prevention

Summary: Guidance for developing success stories 

https://bit.ly/cdc_impact

Implementation Research Toolkit: Disseminating 

the Research Findings (2014)

Publisher: World Health Organization

Summary: Toolkit module 5 of 6, with an overview of 

dissemination products and step-by-step guidance to 

disseminate research

https://bit.ly/who_toolkit

Knowledge Translation Planning Template (2013)

Publisher: The Hospital for Sick Children

Summary: Checklist to plan dissemination efforts

http://bit.ly/hsc_template

Making the Web Accessible

Publisher: W3C Web Accessibility Initiative

Summary: Resources and information on making 

webpages accessible for people with disabilities

https://www.w3.org/WAI

Plain Language: Getting Started or Brushing Up

Publisher: National Institutes of Health

Summary: Information and checklist for writing and 

formatting easy-to-understand documents

https://bit.ly/nih_plainlanguage

Plain Language.gov

Publisher: Plain Language Action and Information 

Network

Summary: Federal guidelines for writing in plain language

https://www.plainlanguage.gov 

The D-Cubed Guide: Planning for Effective 

Dissemination (2011)

Publisher: Australian Learning & Teaching Council

Summary: Strategies to disseminate evidence, including 

assessing readiness for change and budgeting for 

dissemination

https://bit.ly/au_planning

Potent Presentations Initiative

Publisher: American Evaluation Association

Summary: Videos, checklists, and other tools for creating 

effective presentations

http://bit.ly/aea_ppi

SAMHSA American Indian/Alaska Native 

Communication Strategy (2016)

Publisher: Substance Abuse and Mental Health Services 

Administration (SAMHSA)

Summary: Audiences, messages, and channels to 

disseminate evidence to tribal populations

https://bit.ly/samhsa_communication

Section 508.gov 

Publisher: U.S. General Services Administration

Summary: Information on federal requirements for 

accessible documents

https://www.section508.gov

United States Census 

Publisher: U.S. Census Bureau

Summary: Local, county, and state-level demographic 

data that can inform audience research

https://www.census.gov

Putting Evidence into Practice l 64

RESOURCES
Implementation

A Refined Compilation of Implementation 

Strategies: Results from the Expert 

Recommendations for Implementing Change 

(ERIC) Project (2015)

Publisher: Implementation Science

Authors: Powell BJ, Waltz TJ, Chinman MJ, et al.

Summary: A list of 73 strategies to implement clinical and 

public health evidence-based interventions

http://bit.ly/powell_eric

Active Implementation Hub

Publisher: National Implementation Research Network

Summary: Series of interactive learning modules on 

implementation topics, such as implementation stages 

and improvement cycles

https://nirn.fpg.unc.edu/modules-and-lessons

Adapting Community Interventions for Different 

Cultures and Communities 

Publisher: Community Tool Box

Summary: Guiding questions to learn about the 

community when adapting interventions

https://bit.ly/ctb_communityinterventions

Creating Communities of Practice

Publisher: Edmonton Regional Learning Consortium

Summary: Guidance on creating and supporting peer 

networks for implementers to learn from one another

http://bit.ly/ca_cop

Delivering Training and Technical Assistance (2010)

Publisher: Compassion Capital Fund

Summary: Worksheets for designing and delivering 

training and technical assistance

http://bit.ly/ccf_trainingandTA

Do We Need to De-Implement an Existing 

Program? A Checklist to Inform Decision Making

Publisher: Substance Abuse and Mental Health Services 

Administration (SAMHSA)

Summary: Checklist to decide whether to continue or end 

an evidence-based intervention

https://bit.ly/nccmt_checklist

ExpandNet

Publisher: World Health Organization

Summary: Guides for scaling up evidence-based 

interventions

https://expandnet.net 

Evaluation of RE-AIM Dimensions Table

Publisher: Re-AIM

Summary: A 5-part framework to evaluate dimensions of 

implementation

https://bit.ly/reaim_evaluation

Implementation Science at a Glance (2018)

Publisher: National Cancer Institute

Summary: Introduction to core concepts of 

Implementation Science and tips for practitioners who 

want to implement evidence-based interventions

https://cancercontrol.cancer.gov/IS/tools/practice.html

Implementation Science (2018)

Publisher: BioMed Central

Summary: Open access journal publishing the latest 

research on Implementation Science

https://implementationscience.biomedcentral.com

Implementation Science Communications (2018)

Publisher: BioMed Central

Summary: Open access companion journal to 

Implementation Science publishing research on 

increasing implementation strategy uptake 

https://implementationsciencecomms.biomedcentral.com

Putting Evidence into Practice l 65

RESOURCES
Increasing the Scale of Population health 

Interventions: A Guide (2014) 

Publisher: NSW Ministry of Health

Summary: Guide for assessing scalability of evidence, 

creating a scale-up plan, and scaling up interventions

https://bit.ly/nsw_scalability

Implementation Research and Practice (2018)

Publisher: SAGE Publishing

Summary: Open access journal publishing research on 

implementation strategies to address mental health and 

substance use disorders

https://journals.sagepub.com/home/irp

Letting Go: Conceptualizing Intervention Deimplementation in Public Health and Social Service 

Settings (2018)

Publisher: American Journal of Community Psychology

Authors: McKay VR, Morshed AB, Brownson RC, Proctor 

EK, Prusaczyk B

Summary: Overview of de-implementation and criteria 

for identifying interventions to be discontinued

https://bit.ly/McKay_lettinggo

Methods for Translating Evidence-Based 

Behavioral Interventions for Health-Disparity 

Communities (2013)

Publisher: Preventing Chronic Disease

Authors: Napoles A, Santoyo-Olsson J, Stewart A

Summary: Strategies to implement evidence-based 

interventions among priority populations

https://bit.ly/Napoles_methods

RE-AIM

Publisher: RE-AIM

Summary: Information, publications, and tools about 

a 5-part implementation planning and evaluation 

framework

http://www.re-aim.org

Scaling-Up Brief: Readiness for Change (2013)

Publisher: State Implementation & Scaling-up of 

Evidence-based Practices Center 

Authors: Fixsen D, Blase K, Horner R, Sims B, Sugai G

Summary: Elements of organizational readiness necessary 

to scale-up an evidence-based intervention

https://unc.live/39CRlNe

Scaling-up Health Promotion/Disease Prevention 

Programs in Community Settings: Barriers, 

Facilitators, and Initial Recommendations (2010)

Publisher: Patrick and Catherine Weldon Donaghue 

Medical Research Foundation

Authors: Norton W, Mittman B

Summary: Experiences from 10 community-based 

programs in scaling up interventions and lessons learned

http://bit.ly/norton_scalingup

Six Components Necessary for Effective Public 

Health Program Implementation (2014) 

Publisher: American Journal of Public Health

Authors: Frieden TR

Summary: Overview of six elements of effective public 

health programs

http://bit.ly/frieden_components

Training Plan Template

Publisher: Active Implementation Hub

Summary: Worksheet to guide the development of an 

implementation training plan

https://bit.ly/aihub_template

Understanding Mis-Implementation in Public 

Health Practice (2015)

Publisher: American Journal of Preventive Medicine

Authors: Brownson R, Allen P, Jacob R, et al.

Summary: Survey of public health departments about 

incorrectly ending effective interventions or continuing 

ineffective ones

http://bit.ly/brownson_misimplementation

Putting Evidence into Practice l 66

RESOURCES
Case Studies

CALIFORNIA

Building and Scaling-up California Quits: 

Supporting Health Systems Change for Tobacco 

Treatment (2018)

Publisher: American Journal of Preventive Medicine

Authors: Kaslow AA, Romano PS, Schwarz E, Shaikh U, 

Tong EK

Summary: Description of scaling up the CA Quits health 

systems change initiative to safety-net healthcare 

providers

http://bit.ly/kaslow_CAQuits

CA Quits: Redesigning the Health Care System to 

Combat California’s Smoking Disparities (2018)

Publisher: Digital Access to Scholarship at Harvard

Author: Kaslow AA

Summary: Formative evaluation describing the CA Quits 

scale-up initiative and barriers and drivers to scaling up

http://bit.ly/kaslow_redesigning

NEBRASKA

Smoke-Free Public Housing Policies in Nebraska 

(2016)

Publisher: Nebraska Department of Health and Human 

Services

Summary: Findings from a survey of Nebraska’s public 

housing agencies about adoption of smokefree policies

http://bit.ly/nebraska_smokefree

States in Action: Nebraska

Publisher: Centers for Disease Control and Prevention

Summary: Success story describing Nebraska’s efforts 

to reduce secondhand smoke exposure in multi-unit 

housing

http://bit.ly/cdc_nebraska

State Tobacco Control Program Implementation 

Strategies for Smoke-Free Multiunit Housing (2016)

Publisher: Health Promotion Practice

Authors: Kuiper NM, Marshall LL, Lavinghouze R, King BA

Summary: Case study of three states and strategies used 

to reduce secondhand smoke exposure in multi-unit 

housing

http://bit.ly/kuiper_strategies

Putting Evidence into Practice l 67

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

Center for Public Health Systems Science at the Brown School at Washington University 

in St. Louis.

Suggested citation:

Centers for Disease Control and Prevention. Best Practices User Guide: Putting Evidence into 

Practice in Tobacco Prevention and Control. Atlanta, GA: 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, 2021. 

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.