The Board spent $26.2 million from FY 1999-2000 through FY 2001-02.

Some tobacco control projects have been successful, others less so.

Tobacco control projects statewide sometimes duplicate efforts.

The Board should ensure it funds effective tobacco control projects.

Key Facts
and Findings

Board Expenditures

Currently, the Board is supported by funds the State received from the November 1998 Master Settlement Agreement with tobacco manufacturers. In May 2002, the State securitized its annual tobacco settlement payments and spent the resulting $1.3 billion. Therefore, beginning in FY 2003-04, tobacco funds will no longer be available to fund the Board.

As shown in Figure 1, the Board spent $26.2 million from FY 1999-2000 through FY 2001-02, including $19.4 million on competitive grant projects, $6.1 million on the three statutorily required programs, and $724,000 on administration. Grant projects included an anti-tobacco media and counter-marketing campaign, and community coalitions organized by local public health departments.

Figure 1
Board Expenditures

The Board’s FY 1999-2000 through FY 2001-02 expenditures focused on prevention projects, cessation projects, and a combination of prevention and cessation projects, as shown in Figure 2.

Figure 2
Focus of Expenditures

Project Outcomes

When measured against their individual program goals, the outcomes of projects have been mixed.

Two of the Center for Tobacco Research and Intervention’s five projects achieved their objectives. One of these successful projects is the Wisconsin Tobacco Quit Line, a toll-free telephone service that provides cessation information and counseling. The Quit Line is the most expensive of the Center’s Board-funded projects, with expenditures of $1.5 million from FY 1999-2000 through FY 2001-02. From May 2001 through June 2002, the Quit Line received more than 24,000 calls.

The Center’s successful regional outreach project employed six regional outreach specialists to help health care providers, schools, and community organizations implement tobacco cessation strategies. In December 2001, the Center reported that its regional outreach specialists had trained more than 5,000 Wisconsin health care providers in cessation strategies; sent cessation information to more than 3,000 primary care physicians in cooperation with the State Medical Society; clarified cessation benefits with each of the health maintenance organizations participating in the Medical Assistance and BadgerCare programs; and promoted the Quit Line and other local resources. Project expenditures were $1.0 million from FY 1999-2000 through FY 2001-02.

The Center’s three other projects, for which expenditures totaled $667,000, achieved only some of their objectives. For example, through FY 2001-02, the Center spent $357,400 for a survey to measure adult tobacco use. Because of difficulties with the survey instrument and unexpected results, data did not meet initial expectations.

The Medical College spent $500,000 for 19 research projects in FY 2000-01. Ten of these projects accomplished at least some of their objectives. For example, the Smoking Cessation Clinic, for which FY 2000-01 expenditures were $106,000, assessed 155 patients and trained a medical resident and an intern in smoking cessation techniques. A less successful project was the $9,000 Stress Kit project, which sought to reduce relapse rates among women who had quit smoking. This project planned to recruit 100 women but enrolled only 12.

Outcomes of the Board’s competitive grant projects, for which expenditures totaled $19.4 million over the past two fiscal years, have been similarly mixed. For example, the Media and Counter-marketing project, which spent $6.8 million through FY 2001-02, resulted in greater recall of anti-tobacco messages and knowledge about tobacco industry advertising practices. Another project, which is one of two Young Adult Pilot studies, aimed to reduce smoking rates among UW-Oshkosh students by 4.0 percent but reported achieving a reduction rate of 29.0 percent. That project’s expenditures were $216,000 through FY 2001-02.

In contrast, several competitive grant projects encountered difficulties in meeting their objectives because they were unable to recruit enough participants. For example, a second Young Adult Pilot study project to serve 18- to 24-year olds in the workplace anticipated 75 to 100 participants; however, only 12 participants stayed in the study for the six-month period intended to measure cessation rates. Six of these 12 participants were not smoking when the evaluation ended. The program’s expenditures through FY 2001-02 were $94,000.

The number of participants in the Wisconsin Ethnic Network project is unknown, and this competitive grant project did not accomplish its goal to implement tobacco control strategies during the first year of its contract with the Board, which ended in March 2002. Instead, efforts and expenditures were related to building coalitions and developing culturally appropriate advertising materials. The project had expenditures of $551,300 through FY 2001-02.

Project Coordination

The Board has no authority to direct the activities of the Center, the Melvin Program, or the Medical College. In addition, other state programs that are not funded or controlled by the Board, including programs in DHFS and the Department of Public Instruction, have tobacco control elements.

Although the Board has attempted to informally coordinate tobacco control activities, some projects have duplicated efforts. We provide suggestions for improving project coordination.

The Board has not always acted consistently in determining grant periods, monitoring expenditures, and allowing competitive grant recipients to purchase cessation medication. We provide two recommendations for improving the Board’s management of its competitive grants.

Project Evaluations

The Board requires the projects it funds through the competitive grant process to collect information about project effectiveness. For 2003, it approved additional funding for all competitive grant projects that had previously received funding, as well as for three new projects.

The Board has contracted with the UW Comprehensive Cancer Center to monitor and evaluate tobacco control efforts and statewide smoking rates and attitudes, and to assist local coalitions in evaluating their programs. Through December 2002, the Monitoring and Evaluation Program established under this contract has focused on monitoring activities rather than on evaluating results. The UW Comprehensive Cancer Center plans to complete evaluation reports for the Board’s projects in spring 2003.

Recommendations

Our recommendations address the need for the Wisconsin Tobacco Control Board to:

•  use the Monitoring and Evaluation Program’s reports to assist it in making decisions about which projects should receive continued funding (p. 52);
  
  
•  revise administrative rules to either allow competitive grant recipients to purchase medication for the cessation of tobacco use or ensure that grant funds do not pay for medication expenses (p. 52);and
  
  
•  use consistent grant periods and monitor grant recipients’ expenditures on a regular basis so that unspent funds can be reallocated to other tobacco control projects (p. 53).
  
  

Matters for Legislative Consideration

The Legislature will need to decide funding for the 2003-05 biennium. For example, it could allocate:

• $25.0 million annually, the amount stipulated in 2001 Wisconsin Act 109;

• less than the $15.3 million the Board received in each year of the current biennium; or

• $15.0 million annually, as proposed by the Governor.

The Legislature could also consider ways to improve coordination among the State’s anti-tobacco efforts. For example, it could give the Board explicit authority to determine how the Melvin Program, the Center, and the Medical College spend the Board’s funds, or consider the Governor’s proposal to eliminate the Board and consolidate efforts within DHFS.