Disclaimer

Some of the facts in this example have been fictionalized for instructional purposes.

Step 1.1 Write a problem statement.

Cigarette smoking is the single most preventable cause of premature death in the United States. Each year, more than 400,000 Americans die from cigarette smoking. One in every five deaths in the United States is smoking related (CDC, 1999).

Cigarette smoking is also responsible for 85% of all lung cancer deaths and 30% of all cancer deaths. An estimated 21% of all cases of coronary heart disease can be attributed to cigarette smoking. It is a major risk factor for diseases of the heart and blood vessels; for chronic bronchitis and emphysema; for cancers of the lung, larynx, pharynx, oral cavity, esophagus, pancreas, and bladder; and for other problems such as respiratory infections and stomach ulcers.

Step 1.2 Assess the problem's relevance to your program.

• Reducing the death, disability, and economic costs associated with tobacco use.
• Coordinating national smoking and health activities among federal agencies, voluntary health organizations, professional associations, and other organizations involved in public health.
• Planning, coordinating, and developing targeted national public information and education programs.
• Stimulating tobacco control programs and activities within the private sector and at the national, state, and local levels.
• Coordinating and stimulating federal smoking and health research program activities.
• Monitoring and analyzing trends on tobacco use in the United States.
• Participating in a variety of special issues or smoking policy initiatives.

Step 1.3 Explore who should be on the planning team and how team members will interact.

• American Cancer Society
• American Heart Association
• American Lung Association
• Assistant Principals
• Communities/community leaders
• Healthcare providers
• Other government and voluntary agencies
• Retail associations
• Schools
• State Department of Education
• State Department of Health
• Teachers
• University researchers

Step 1.4 Examine and/or conduct necessary research to describe the problem.

Step 1.5 Determine and describe distinct subgroups affected by the problem.

• African American and Hispanic teenagers
• Retailers
• Teenagers in states with higher teen smoking rates

Step 1.6 Write a problem statement for each subgroup you plan to consider further.

The increase has been greatest among 8th graders. Nearly two-thirds of the 10th- grade students report having tried cigarettes. More than one-fourth of 10th-grade students report having smoked a cigarette during the preceding month, and nearly one in five reports smoking regularly.

Subgroup: retail associations
Currently all states have policies against the sale of tobacco products to minors, but at least one-third of retailers who sell cigarettes do not abide by the policies, and the policies are not regularly enforced.

Subgroup: states with the highest smoking rates for teens
Certain parts of the country are experiencing high smoking prevalence. According to the Behavioral Risk Factor Surveillance System data, Kentucky, Indiana, Tennessee, Ohio, and North Carolina are the top five states with the highest smoking rates for teens.

Subgroup: ethnic groups
Smoking prevalence has increased for white, Hispanic, and African American students (CDC, 1998).

Step 1.7 Gather information necessary to describe each subproblem defined in new problem statement.

Step 1.8 Assess factors and variables that can affect the project's direction.

Weaknesses
The tobacco industry and its political supporters were powerful. The CDC did not have a strong partnership with retailers.

Opportunities
The social and political climate was favorable for seizing the opportunity to decrease the incidence of teen smoking. Because of the many class action suits that were brought against the tobacco industry, the industry had never been in a more vulnerable position as public sentiment ran high against it. Polling data showed that the public wanted to combat past tactics that encouraged teens to start smoking.

Vice President Gore announced a national campaign to educate consumers and help retailers prevent illegal sales of tobacco products to teenagers. The potential for partnerships existed with nonprofit organizations already working to combat teen smoking. The American Cancer Society, American Heart Association and the American Lung Association were organizations that served as partners.

The CDC, Office on Smoking and Health (OSH) formed relationships with individual state governments to implement tobacco control policies. The state official partners were used to disseminate media campaigns and information at the local level.

Threats
The amount of funding available to agencies trying to decrease smoking in the United States was very small compared to the amount of money tobacco companies spent to convince people to smoke.

Of the teens that smoked, 34% said that one of the reasons they began was because cigarette advertising made smoking appealing.

Teenagers and young adults proved to be an ever-changing audience. In order to be meaningful to them, agencies constantly had to adapt and modify their interventions.

Step 2.1 List the direct and indirect causes of each subproblem that may require intervention(s).

• External Contributors
  • Best Friend/Peer Influence
  • Lack of awareness by retailers of the age-at-sale policies
  • Lack of vigilance by retailers about checking teen identification
  • Parent(s) and significant adult(s) who smoked, serving as role models
  • Pervasive promotion by the tobacco industry creating the perceptions that more people smoked than actually did and that smoking was cool
• Internal Contributors
  • Minimization of the perceived hazards of smoking
  • Belief that smoking made one more desirable and attractive
  • Predisposition to taking risks
  • Low self-esteem
  • Susceptibility to peer pressure
  • Perception that tobacco use was normative

The primary factors contributing to the retailers selling tobacco to teenagers included:

• Lack of awareness by retailers of the age-at-sale policies
• Retailers concerned about loss of income
• Demand created by tobacco marketing
• Lack of enforcement by law officials of age-at-sale policies
• Inconvenience of checking ID of tobacco product buyers

Step 2.2 Prioritize and select subproblems that need interventions(s).

• Teenagers' belief that smoking makes one more desirable and attractive.
• The lack of awareness among retailers of age-at-sale policies.

Step 2.3 Write goals for each subproblem.

A related goal was to increase the awareness of age-at-sale laws and policies among retailers who sold tobacco products.

Step 2.4 Examine relevant theories and best practices for potential intervention(s).

Health Communication/Education

• Social marketing
• Use of celebrities that appealed to teenagers (sports stars, people involved in the music industry)
• School sponsored programs
• Law related education
• Media literacy campaigns

Health Policy/Enforcement

• Improve enforcement of current laws/policies
• Support new laws/policies to restrict the sale of tobacco products
• Legislate tougher punishments for violating the law

Step 2.5 Consider SWOT and ethics of intervention options.

Health Communication/Education

Strengths

• CDC and partners had experience and previous success in this area.
  
• This intervention was shown to increase awareness, change beliefs and attitudes.

Weaknesses
Required a good deal of funding.

Opportunities
Partners and government were interested in this type of intervention.

Threats
There were many messages and products competing for teenagers' attention.

Health Policy/Enforcement

Strengths
Laws with punishments could force people to comply.

Weaknesses
Enforcement was difficult and expensive.

Opportunities
The public and politicians were in support of these measures.

Threats
The tobacco industries fought any new measures.

Ethics
Often the small business owner was punished for trying to make a profit, but the larger corporation was left untouched.

Step 2.6 For each subproblem, select the intervention(s) you plan to use.

• It could increase awareness and change attitudes, beliefs and intentions.
• It could reach teenagers and retailers through a variety of channels.
• OSH had experience with media campaigns for teenagers and had collaborated with the private sector in developing the Media Campaign Resource Center for Tobacco Control, which provided guidance and technical assistance in use of materials.

Step 2.7 Explore additional resources and new partners.

• American Cancer Society
• American Heart Association
• American Lung Association
• CDC, Division of Adolescent and School Health
• National Cancer Institute
• National Institutes of Health
• National Retailers Association
• Public and private schools - grades 5-12
• Radio and television broadcasting networks
• State and local health agencies

Step 2.8 Acquire funding and solidify partnerships.

Internal communication included e-mail, telephone, print, and face-to-face meetings. Program staff held regularly scheduled meetings. Attendees included the program director, creative director, and other interested agency staff. Partners occasionally participated in the meetings. Agenda and minutes were distributed to staff along with an edited version for partners.

Step 3.1 For each subproblem, determine if intervention is dominant.

Teens were important for direct intervention because studies indicated increasing smoking rates among high school students. This group was also selected because it was one of the high priority populations for the President of the United States and the Office on Smoking and Health (OSH). Adolescence is the time when most persons begin to smoke. By targeting this age group, there was a chance to stop the initiation and further development of tobacco addiction.
Retailers directly controlled the access and availability of tobacco products to teens. Therefore, retailers were vital in enforcing the age-at-sale policy.

Step 3.2 Determine whether potential audiences contain any subgroups (audience segments).

• Female vs. male
• Grade level
• Smokers vs. those who had never smoked

Ways of segmenting the retailers included:

• Large retailers (corporations) vs. small retailers (corner stores)
• Those located within one mile of a school vs. those at a greater distance

Step 3.3 Finalize intended audiences.

The second primary target audience was retailers who have businesses within one mile of a school where cigarettes could be purchased.

The OSH identified senior high school teachers as a potential secondary audience because of their link with the Class of 2000. Teachers were a promising secondary population to target because they spent a substantial amount of time with teenagers and were potential role models. Teachers were also in a good position to enforce no-smoking regulations at school.

Step 3.4 Write communication goals for each audience segment.

Communication goals were determined as follows:

• Increase the number of Class of 2000 students who believe smoking makes someone less desirable and attractive.
• Increase the number of retailers who are aware of the age-at-sale policy regarding tobacco sales to teenagers.

Step 3.5 Examine and decide on communication-relevant theories and models.

Step 3.6 Undertake formative research.

Audience research was completed with those in the target audiences, and characteristic data were gathered from partners. Secondary data was collected from commercial market and health research data.

Step 3.7 Write profiles for each audience segment.

Below is a profile of the Class of 2000:

• They had a strong need to be accepted by their peers.
• They felt a need to satisfy everyone's expectations, which was difficult when the expectations conflicted with each other.
• They listened to credible sources such as famous athletes, teachers, coaches, and peers.
• They learned better from alternative teaching methods (e.g., videos and computer-related media and informal discussion groups) than from formal lecture methods or reading books.
• Smoking appealed more to rebellious teenagers if authorities frowned on it.
• They tended to believe that smoking had no immediate effect on the lives of teens.
• Although they knew about the risks of smoking, as well as about other unhealthy behaviors, they did not personalize the message because they felt invincible or believed that it did not apply to them.
• The preferred media channels for this population were television, radio, and print media.

Possible settings for reaching the Class of 2000 included:

• Billboards
• Churches
• Community gathering places, businesses, malls, local swimming pools, neighborhood watch groups
• Community recreation centers
• Homes, worksheets (via television, radio, newspapers, magazines, direct mail, doorknob hangers)
• Internet
• Places of entertainment such as movie theaters, sporting events
• Retail outlets such as malls, clothing stores, shoe stores
• Schools
• Waiting areas such as bus stops, airports, doctors' offices, health clinics
  

Below is a profile of retailers:

• Some believed it was not their responsibility to prevent teen smoking.
• Some sold loose cigarettes.
• Many viewed government agencies (e.g., FDA) and celebrities as credible sources.
• Many were concerned about lost revenue if they could not sell cigarettes to teens.

Settings for reaching retailers included:

• Billboards
• Home (via radio and television PSAs)
• Trade association newsletters, magazines
• Workplace (direct mail brochures)

Settings for reaching teachers included:

• Billboards
• Teacher conferences
• Workplace (school meetings, school newspapers, direct mail)

A comprehensive approach was used to communicate with the target audiences. It included interpersonal, small group, organizational, community and mass media communications. Activities included:

Interpersonal

• Teachers talked to each student who was suspected of smoking about its dangers and the unattractiveness of it.
• One-on-one counseling or a student peer program to reinforce the idea that smoking is unattractive was provided.
• Discussion between students and teachers on fact sheets that described negative effects of smoking on one's appearance was promoted.

Small Group

• Teachers led a classroom discussion after showing students the PSAs.

Organizational

• Flyers showing the unattractiveness of smoking were posted in all senior high schools within a specific school district.
• Contests to reward the high school that had the most seniors who pledged to be non-smokers were held.
• Poster contests were held in schools to promote "Smoke-Free Class of 2000" programs and web sites
  (Internet: http://www.smokefree.gov:80).

Community

• Students distributed posters and materials about the age-at-sale policies to local retailers.
• A student letter-writing campaign requesting retailers, who sell tobacco near schools to be aware of the age-at-sale policy and to not sell tobacco to teens, was created.

Mass Media

• A web page called the Surgeon General's Report for Kids about smoking, which includes facts about teenagers and smoking, was created. This web page included examples of what teenagers were doing to stamp out tobacco use around the country and a message about how smoking is not attractive.
• A direct mail brochure for retailers on the age-at-sale policy was distributed.
• Radio and television PSAs were aired to educate retailers about the age-at-sale policy.
• An ad was placed in a trade publication about the age-at-sale policy.
• Print, radio, and television PSAs were aired to illustrate how unattractive smoking was to Class of 2000.
• Billboards that advertised "Smoke-Free Class of 2000" programs were posted.

Step 3.8 Rewrite goals as measurable communication objectives.

• By graduation, increase the number of Class of 2000 students who believe smoking makes someone less desirable and attractive by 40%.
• By the year 2000, increase the number of retailers who are aware of the age-at-sale policy regarding tobacco sales to teenagers by 50%.

Step 3.9 Write creative briefs.

Objective(s)
By graduation, increase the number of Class of 2000 students who believed smoking makes someone less desirable and attractive by 40%.

Obstacles

• There were many products and messages competing for the attention of teenagers.
• Teenagers were impacted by peer pressure (especially by best and closest friends).
• Smoking was seen as rebellious and attractive.
• Teens tended to believe that smoking had no immediate affect on their lives.
• They did not personalize the anti-smoking messages.
• They believed they were invincible.

Key Promise
If you do not smoke you will be healthy, well liked and physically attractive to others.

Support Statements/Reasons Why
Tobacco use is the leading cause of preventable death in the United States (CDC, 1994). Cigarette smoking is also responsible for 85% of all lung cancer deaths, 30% of all cancer deaths, and an estimated 21% of all cases of coronary heart disease. Smoking is a causal factor in one of every six deaths in the United States (390,000 deaths annually). It is a major risk factor for diseases of the heart and blood vessels; for chronic bronchitis and emphysema; for cancers of the lung, larynx, pharynx, oral cavity, esophagus, pancreas, and bladder; and for other problems such as respiratory infections and stomach ulcers.

Tone
Light and humorous, hip, appealing to teens, informative

Media
Radio, television and print PSAs, Internet

Creative Considerations
Additional creative considerations included:

• Teen support groups were encouraged, teens seemed to listen to each other (and others like them) more often than authority figures
• Up-to-date graphics needed to be used in all print PSAs and postings in order to catch the attention of this target audience

Target Audience - Retailers
Retailers

Objective(s)
By the year 2000, increase the number of retailers who are aware of the
age-at-sale policy regarding tobacco sales to teenagers by 50%.

Obstacles

• Checking IDs was inconvenient.
• Money was a strong motivator.
• Tobacco companies provided incentives.

Key Promise
If you follow the law, you won't be punished and you will be a good community citizen.

Support Statements/Reasons Why

• It's the right thing to do.
• You want to preserve your businesses' reputation by not breaking the law.

Tone
Straightforward, serious and factual

Media
Brochures

Step 3.10 Confirm plans with stakeholders.

All communication efforts were discussed with appropriate stakeholders and partners. The formative research results were revealed and the necessity and importance of evaluation was emphasized. Information needs and desires from stakeholders were obtained and approval to continue with the program was given. Furthermore, the campaign timeline was distributed and discussed to ensure timing was realistic and feasible for all involved.

Step 4.1 Draft timetable, budget, and plan for developing and testing communication mix.

A Gantt chart was used to keep track of all tasks, persons responsible, and dates for completion. Some examples of tasks included in the Gantt chart were:

• Develop and test concepts, messages and materials.
• Duplicate PSAs, brochures, posters, fact sheets, and ads for trade publications.
• Prepare materials for distribution.
• Contact state education officials and retailers.
• Hold a media briefing.
• Send brochures to retailers.
• Send ads to trade publications.
• Send teacher discussion guides.
• Send PSAs to radio and television station managers.
• Send web page addresses to Internet search engines.
• Distribute PSA video and related materials to school health officials.

Step 4.2 Develop and test creative concepts.

• Cigarette advertisers had created a myth that smoking made one more attractive, and they were lying.
• Smoking harms your appearance (e.g. stains teeth, wrinkles skin, yellows fingers).
• Kissing a person who smokes tastes disgusting.
• For retailers, there was a financial penalty for not obeying the age-at-sale policy.
• Retailers had a responsibility to contribute to the health of teens.

Focus groups were conducted with students and retailers to inform the smoking campaign. The purpose of the focus groups was to obtain feedback about concepts as preliminary ideas to use as a starting point in developing a specific message.

Step 4.3 Develop and pretest messages.

Step 4.4 Pretest and select settings.

Step 4.5 Select, integrate, and test channel-specific communication activities.

• Ads in trade publications for retailers
• Brochures for retailers
• Discussion guide for teachers on unattractiveness of smoking
• Fact sheets for teachers and students
• Posters for students
• Print, television and radio PSAs for students
• Web page for students

The Class of 2000 was targeted through the use of PSAs, a web page, fact sheets and posters. Discussions about the unattractiveness of smoking were also used with the students.

The retailers were targeted for awareness of age-at-sale policy with direct mail brochures and ads in trade publications.

Step 4.6 Identify and/or develop, pretest, and select materials.

A PSA of teenage actors talking about the unattractiveness of smoking was proposed.

A direct mail brochure for retailers, in which a minor was depicted purchasing cigarettes from a retailer, was made. A black and white message in bold print showed the age-at-sale policy with a detailed listing of the fines.

A web page that included facts about teenagers and smoking, graphic pictures of how smoking harms one's appearance, and specific suggestions on more important qualities that make a person attractive (e.g. friendship, kindness), was created.

A series of 40 one-on-one interviews were conducted with Class of 2000 to pretest the web page, radio and television PSA scripts, and storyboards.

After showing the web pages, PSA and other materials (posters, fact sheets), the interviewers requested feedback from students on the PSAs and the approach used in the PSAs. In general, the feedback was positive. The PSAs were informative and the message characteristics (style, tone, appeal, source, and channel) were well accepted.

A series of 20 one-on-one interviews were conducted with retailers to pretest direct mail brochures and the ads in trade publications. The brochures and ads were informative and well accepted by the retailers.

Step 4.7 Decide on roles and responsibilities of staff and partners.

• Campaign materials, including brochures, posters, fact sheets, radio and television PSAs and ads for trade were duplicated.
• The Surgeon General's web page was created.
• A discussion guide for teachers was generated and duplicated.

After the print materials and web page were created and the PSAs duplicated, the campaign kickoff was scheduled. A checklist was developed to keep activities on schedule. Some items from the preparation checklist follow:

• Notify all program partners and gatekeepers of the kickoff activity and campaign schedule.
• Contact national broadcast media representatives to schedule a press conference.
• Obtain a conference room to hold a partner briefing the day before the press conference.
• Advise staff on how to answer questions about the smoking campaign.
• Prepare a web page demonstration.

Step 4.8 Produce materials for dissemination.

After organizational clearance of messages and materials was obtained, the following tasks were accomplished

• Campaign materials, including brochures, posters, fact sheets, radio and television PSAs and ads were duplicated.
• The Surgeon General's web page was created.
• A discussion guide for teachers was generated and duplicated.

Step 4.9 Finalize and briefly summarize the communication plan.

Cigarette smoking is the single most preventable cause of premature death in the United States, killing more than 400,000 Americans annually. It is also responsible for various cancer deaths and is a major risk factor for numerous diseases of the heart and blood vessels.

In an attempt to increase the number of Class of 2000 students who believed that smoking made someone less desirable and attractive, and increase the number of retailers who were aware of the age-at-sale policy regarding tobacco sales to teenagers, a 2-year communication campaign was launched in November 1998. Various community representatives and public and private organizations were involved in this effort. Some of the partners included the American Cancer Society, American Lung Association, American Heart Association, retail associates, teachers, schools, healthcare providers, and the State Department of Education.

A Gantt chart was used to keep track of all tasks, persons responsible, and dates for completion. Concepts were developed based on information gathered on students and retailers - the target audiences. Some messages that were portrayed in the concepts included information supporting the fact the smoking harms an individual's appearance (by staining her/his teeth, yellowing their fingers), and that retailers have a responsibility to contribute to the health of teens. The concepts and messages were pretested with the intended audiences and feedback was gathered. Modifications were made where and when necessary so that the messages were accepted by the intended audiences. Settings for exposure varied based on the audience targeted.

The communication plan was shared with appropriate stakeholders. These individuals were involved in the creation of the plan, as well as informed with its progress.

A mass media and an interpersonal approach was decided upon for the smoking campaign. It was agreed that the combination of these approaches was best for creating and building awareness and affecting attitudes. Numerous materials were developed as a way of reaching large audiences in various settings through different media.

A quasi-experimental design was selected because this approach consisted of a pre and post-test intervention. Data analysis and reporting plans were developed and shared with appropriate stakeholders and staff.

The communication and evaluation plans were executed, feedback and lessons learned were documented, the program was modified based on feedback received and the above information was disseminated to all involved.

Step 4.10 Share and confirm communication plan with appropriate stakeholders.

Stakeholders were informed, as well as involved in the communication plan. Meetings were conducted during which program materials, partners, staff, and tracking measures were reiterated and discussed. Attendees were given a preparation checklist for a way to organize completed and "to do" tasks.

Step 5.1 Identify and engage stakeholders.

Step 5.2 Describe the program.

• By graduation, increase the number of Class of 2000 students who believed smoking made someone less desirable and attractive by 40%.
• By the year 2000, increase the number of retailers who were aware of the age-at-sale policy regarding tobacco sales to teenagers by 50%.

To achieve the above objectives the following intervention was designed.

The Office on Smoking and Health chose a mass media and interpersonal approach for the smoking campaign because the combination was best for creating and building awareness and affecting attitudes. The following materials were developed as a way of reaching a large audience in various settings through different media:

• Ads in trade publications for retailers
• Brochures for retailers
• Discussion guides for teachers on the unattractiveness of smoking
• Fact sheets for teachers and students
• Posters for students
• Print, television and radio PSAs for students
• Web page for students

Step 5.3 Determine what information stakeholders need and when they need it.

The stakeholders were interested in the following information:

• Did retailers change their behavior?
• Did the class of 2000 change their behavior?
• Was the intervention cost-effective?
• Were teenagers, teachers and retailers exposed to the materials and messages?

Step 5.4 Write intervention standards that correspond with the different types of evaluation.

• By graduation, increase the number of Class of 2000 students who believed smoking made someone less desirable and attractive by 40%.
• By the year 2000, increase the number of retailers who were aware of the age-at-sale policy regarding tobacco sales to teenagers by 50%.
• The cost of the intervention was relative to the impact.
• X% of the target audience(s) saw the intervention.

Step 5.5 Determine sources and methods that will be used to gather data.

The following chart illustrates the various evaluations used during this campaign and sources and methods used to accurately assess campaign data.

Step 5.6 Develop an evaluation design.

The evaluation design selected for this intervention was a quasi-experimental design, during which a pre and post-test intervention was conducted.

Intervention Components for the student groups:

X₁: Web page

X₂: PSAs (radio, television and print)

X₃: Worksheets

Intervention Components for the retailer groups:

X₁: Direct mail brochures

X₂: PSAs (radio and television)

X₃: Print advertisement

This quasi-experimental approach involved:

• Conducting baseline observations
• Exposing Group 1 to intervention components. This group consisted of Class of 2000 students in addition to retailers who sold tobacco products.
• Not exposing Group 2, which was comprised of students and retailers with similar characteristics to those in Group 1. For example, each group consisted of individuals who were close in age, gender and demographic makeup.
• Observing both Groups 1 and 2. This occurred after Group 1 was exposed to the intervention components.
• Comparing the findings (using identical instruments in both observations) on the same variables at both T₁ and T₂.
• Determining whether the communication mix increased the number of Class of 2000 students who believed that smoking made someone less desirable and attractive, and whether it increased the number of retailers who were aware of the age-at-sale policy regarding tobacco sales to teenagers, in Group 1 (exposed) over Group 2 (unexposed).

To view additional evaluation information and designs, please see "Resources".

Step 5.7 Develop a data analysis and reporting plan.

Methods for gathering and reporting data to stakeholders and campaign team members are noted below:

Data analysis

• Logs were entered into a spreadsheet for cross-tabulation and frequency calculation.
• Data from the mail surveys was entered into a spreadsheet for frequencies and cross-tabulation.
• Comparison of the number of times and the time of day PSAs were aired was documented.
• Percentages and cross-tabulations of television and radio PSAs were documented to analyze variables such as number of spots and times aired.
• Frequencies from tracking sheets to record who had received information on the program were documented.
• A weekly count of the number of web page hits was recorded.
• Frequencies from mail survey of students' beliefs were noted.

Reporting

• Two reports on focus group findings (from each target audience - students and retailers.
• Two reports of PSA airings logs (from each target audience - students and retailers).
• One report of web page evaluation.
• Two reports of mail surveys (from each target audience - students and retailers).

Step 5.8 Formalize agreements and develop an internal and external communication plan.

The roles of all involved with evaluation were clarified and formalized. Additionally, the internal and external communication plans were established. Internally, communication was accomplished via inter-office mail, email, telephone, on-site meetings (including all involved office/organization staff and partners) and/or individual meetings as necessary. Externally, communication was accomplished much the same way. Meetings were held at mutually convenient locations and meeting minutes were disseminated to staff and partners. Furthermore, email, direct mail and the telephone were utilized to aid in communication.

Step 5.9 Develop an evaluation timetable and budget.

Step 5.10 Summarize the evaluation implementation plan and share it with staff and stakeholders.

Staff and stakeholders were given a summarized evaluation plan. It was compiled to inform the aforementioned individuals about how the evaluation activities were to be completed, as well as to answer questions that were previously raised by stakeholders. This document contained information on intervention standards, the budget, a timetable and the evaluation methods and design.

Step 6.1 Integrate communication and evaluation plans.

It was imperative that communication and evaluation were integrated throughout the campaign. To ensure that integration occurred, planning meetings (involving program members, stakeholders and other interested parties) were scheduled and held throughout the campaign for developing programs, monitoring progress, eliciting feedback, making adjustments and keeping communication lines open.

Step 6.2 Execute communication and evaluation plans.

The communication and evaluation plans were executed. This campaign was launched in November of 1998. Actual implementation lasted approximately 2 years, with evaluation completed in December of 2000.

Step 6.3 Manage the communication and evaluation activities.

Program management encompassed two areas. The first involved managing the participatory process, which was directed towards continuously developing, implementing, evaluating and refining pieces of the campaign. The second involved the intervention activities themselves, which included various media and interpersonal communication activities.

Step 6.4 Document feedback and lessons learned.

Some examples of the lessons learned included:

• The distributors of the PSAs learned that gatekeeper review was needed in the development phase of their campaign. Representatives of the channels that program planners wished to use could have contributed ideas, thereby eliminating some of the barriers to airing the PSAs.
• PSAs received little airtime because television and radio station managers did not see any incentive in frequent airings and PSAs were not in standard format.
• The posters were well received, but the fact sheets were not. Most students were already aware of the basic facts about tobacco use.
• The timing of the kickoff for the program should be better coordinated with other organizations involved. For example, kickoff could have coincided with the American Cancer Society's Great American Smokeout.

Step 6.5 Modify program components based on evaluation feedback.

Certain parts of the campaign were modified based on evaluation feedback. The changes that were made are noted below:

• PSAs were re-edited in standard format.
• In order to ensure that the PSAs would be aired at certain times, the possibility of purchasing airtime was agreed upon.
• More posters were printed because they were well received.
• A provision was made to ensure that the campaign, when run again, would coincide with the American Cancer Society's Great American Smokeout.

Step 6.6 Disseminate lessons learned and evaluation findings.

After the campaign was completed, sponsors, collaborative organizations, and project managers met to discuss lessons learned and a future dissemination plan for project findings. After the meeting, it was decided to distribute executive summary reports to all partners and present key findings at the American Public Health Association conference. A complete report was sent to the CDC. The main goal of the presentations and reports was to present lessons learned from the media campaign, as follows:

• Continuously update Gantt charts in order to have an accurate picture of project progress.
• It is imperative that the audience identify with the PSA.
• The target audience needed to be included during development of the PSA, message concepts and choice of communication channel.

For the smoking campaign, several reports and presentations were compiled for different audiences:

• Completed report for the CDC
• Executive summary for collaborating partners
• Journal article that emphasized the process of the smoking campaign
• Newspaper article for local, state and school newspapers
• Presentation at a health communication conference