Tobacco 21 Logic Models

Figure 1: Generic T21 Logic Model

Evaluators can use this model as a guide and tailor it to best fit the evaluation needs of each state and jurisdiction. Provided are examples of points to include in a T21 logic model. This model covers six categories: inputs, activities, and outputs, as well as short-term, intermediate, and long-term outcomes. The inputs for this T21 model are the T21 law, funding, partners, networks, surveillance and monitoring systems, cessation resources, and the evaluation of staff efforts and time. Activities for this model can involve policy development and finalizing its components, development and distribution of media campaigns, communication materials and signage, and training personnel on enforcement and inspections. Outputs can include advertisements and press releases, educational sessions for the T21 law, signage distribution, inspection protocols, and compliance checks. Short-term outcomes in this model can encompass increased awareness and understanding of T21 law, as well as increased enforcement of activities related to the law. Intermediate outcomes can be an increase in support for T21 law, increased change in social norms for underage tobacco use, increased compliance with T21 law, decreased availability of tobacco products to youth under 21, and decreased sales of tobacco products. Long-term outcomes can include reduction of the following: tobacco use initiation, tobacco use prevalence, and tobacco-related morbidity and mortality for youth under 21. This logic model also covers sections for both unintended consequences and an environmental context that gives states and jurisdictions an opportunity to discuss specific issues related to implementation of the T21 law in their area.

Figure 2: California T21 Logic Model

It uses six categories: inputs, activities, and outputs, as well as short-term, intermediate, and long-term outcomes. California’s inputs are the statewide implementation of their T21 law and cessation quitline, as well as surveillance of the public’s attitudes/behaviors of the law and surveillance of tobacco sales to youth. Activities in this model involve distribution of warning signs and educational materials to retailers and employees about T21 law, promoting quitline to youth tobacco users, educate public about T21 law and quitline, conduct compliance checks, and educating American Indian communities about age of sale disparity. Outputs in this model include warning signs posted in all tobacco retailers, distribution of training materials to retailers, promotion of quitline to underage tobacco users, advertisements notifying the public of T21 law, demand letters to retailers who violate the law, and educational materials to American Indian communities. Short-term outcomes in this model cover increased awareness and support for the T21 law among the public and underage tobacco users, increased perception to youth that tobacco use is dangerous and difficult to obtain, increased awareness and compliance of T21 law to retailers, increased call volume to quitline for tobacco users, and increased awareness among American Indians of disparity in age of sale and health consequences. Intermediate outcomes in this model include decreased illegal sales and ability to obtain tobacco products for youth under 21, decreased sales of tobacco products, decreased susceptibility of experimentation of tobacco products, increased quit attempts for all tobacco users, and increased number of tribal compacts or policies with age of sale as 21. Long-term outcomes for this model involve increased age of tobacco use initiation, decreased tobacco use initiation and tobacco use prevalence for youth and adults, decreased tobacco consumption, decreased exposure to secondhand smoke, decreased tobacco-related morbidity and mortality, and minimized tobacco-related disparities among American Indian population. California utilized the environmental context section and highlighted state excise tax rates, rates of tobacco use, national media campaigns, state tobacco control funding, utilization of quitline services including cessation insurance coverage, and spending on tobacco products. They also make note that references to tobacco products and use include that of e-cigarettes and other electronic smoking devices.

Figure 3: Hawaii T21 Logic Model

This model covers six categories: inputs, activities, and outputs, as well as short-term, intermediate, and long-term outcomes. The inputs for Hawaii’s logic model are as follows: T21 law, funding from CDC and other coalitions, external partnerships with public health departments and organizations, state-based networks like military bases and youth coalitions, surveillance and monitoring systems (HYTS, YRBS, BRFSS, SYNAR, etc.), and cessation quitline services. Activities in Hawaii’s logic model involves enacting the T21 law, developing and distributing educational materials, educating the public and those who work with youth about the T21 law, creating enforcement infrastructure, training enforcement personnel, creating and distributing signage, promotion of cessation resources, broadening underage enforcement activities, and monitoring the following: evaluation, research, and surveillance efforts on quitline users and sales of tobacco products. The outputs for Hawaii’s model include fact sheets tailored to every audience about the law, training sessions to discuss implementation and enforcement of the T21 law, dissemination plan for tobacco-related procedures, development and distribution of signage, number of calls to quitline, advertisements to promote the T21 law and quitline services, revised protocols and contracts, and focus groups. Short-term outcomes for this model cover increased awareness and understanding of T21 law, increased consistency between tobacco-related military policies and T21 law, increased enforcement, decreased commercial supply of tobacco products to minors, decreased intention to start smoking or switch to a different product, increased quit intentions, and increased understanding about the attitudes of tobacco users. Intermediate outcomes include increased favorable public opinion and compliance of T21 law, decreased tobacco product sales to persons under 21 years, increased change in social norms around underage smoking, decreased smoking initiation and tobacco product switching, decreased daily smoking, and increased calls to cessation resources and quit attempts for youth under 21. Long-term outcomes in the model encompass decreasing tobacco use prevalence among minors and military, increased sustained cessation for youth under 21, decreased tobacco product exposure among youth, decreased health effects of tobacco use, decreased tobacco-related health disparities, and improved economic return on investment. Hawaii also provided a space to discuss an increased need to understand the unintended consequences when a T21 law is implemented.