Monitoring the tobacco use epidemic V: The environment: factors that influence tobacco use.

OBJECTIVE: This environment paper (V of V) summarizes important surveillance and evaluation systems that monitor influences on tobacco use such as smoke-free laws and other legislation, excise taxes, mass media, and a broad range of tobacco control activities, discusses their strengths and weaknesses, and makes recommendations for enhancement.
METHODS: We summarize and expand on the recommendations from the Environment Working Group of the National Tobacco Monitoring, Research, and Evaluation Workshop prioritized surveillance needs. This group rank-ordered surveillance needs various environmental influences, considering both the perceived importance of each environmental influence and the adequacy of the current surveillance systems. Based on this ranking and subsequent discussion, the group identified key priorities for enhancement.
RESULTS: The group arrived at two key priorities: (1) develop and implement a national system for local tobacco control ordinance surveillance, and (2) develop and implement a comprehensive program monitoring system that is used by all states and supported by all funding agencies. Other environmental influences recommended for priority monitoring include cigarette prices and tobacco countermarketing.
CONCLUSION: Systematic surveillance and monitoring of key program inputs and outputs and environmental influences is central to understand the effectiveness and cost-effectiveness of tobacco control efforts.