Gallatin County Healthy Lungs Program

Gallatin County Healthy Lungs Program

Kaylon Peck

HEA 480W

Grant Proposal

Needs Assessment

Phase 1: Social Assessment:Gallatin County, Kentucky was established in 1798 as Kentucky’s 33rd county. Its county

seat is Warsaw Located on the banks of the Ohio River; Gallatin is a part of the “Golden

Triangle,” of Cincinnati, Louisville and Lexington and covers 101.23 in land area in square

miles, (2010 US Census). According to the county website (2014), Gallatin County has been

proclaimed the Racecar Capital of the State, with the attraction of the Kentucky Speedway and

Bluegrass Motorsports Park. Also, with the Ohio River being located right next door, water

sports and boating is a popular attraction.

According to the U.S Census Bureau (2010), with a total population of 8,589, Gallatin

County shows little diversity with a majority of the county population being white (94%), 1.3%

African American, 0.1% American Indian and Alaska Native, and 0.2% being of the Asian race.

The male and female population is very close. This consists of a population of a male population

of 50.2% and a female population of 49.8%. Of the population ages 18 to 24 years, 28.9% had

less than a high school degree and 43% had a high school degree, while only 7.4% had a

bachelor’s degree or higher. In the population ages 24 or older, 13.4% didn’t earn a degree from

high school, 18.7% had some college, but no degree, and 6.8% had at least a bachelor’s degree.

The U.S census gave a poverty rate for the population 25 years and over for whom poverty status

is determined by educational attainment level (2010). Residents with less than a high school

diploma were 32.5% considered in poverty and only 2% with a bachelor’s degree had poverty

status. The median household income is estimated at $43,860. Overall, 19.5% of the population

lives below the poverty level while 80.5% live either right at or above the poverty level.

Phase 2: Epidemiological Assessment:A. Health Assessment:

According to the Center for Disease Control (2014), cigarette smoking causes more than

480,000 deaths every year in the US. Smokers have an increased chance of developing

cardiovascular disease, respiratory disease, and cancer.

Smoking can have an impact on someone’s quality of life. When a person begins to

smoke, damage to the body is happening right away. Of lung and bronchus cancer in Gallatin

County, the death rate is 98 deaths per 100,000 populations. Compared to Kentucky’s 75 cancer

deaths per 100,000 populations, Gallatin County is higher. In 2011, the Kentucky Cancer

Registry had reported 18 total cases of lung and bronchus cancer out of the 8,547 population at

risk throughout Gallatin County. (Kentucky Cancer Rates, 2010)

B. Behavioral/Environmental Assessment:County Health Rankings & Roadmaps (2014) reported 45% of adults smoke >=100

cigarettes or are currently smoking. The Institute for Health Metrics and Evaluation (IHME)

analyzed a performance of all 3,143 US counties for smoking prevalence. The smoking

prevalence of females in Gallatin County had a value of 27.9% and national rank of 2,902. The

males on the other hand had a value of 31.9% and a national rank of 2,939. (IHME, 2013)

Although it may be a personal decision to start smoking or continue to smoke, the

environment around may influence your decision. A study at Dartmouth College found that

children who had at least one parent who smoked were four times more likely to buy cigarettes

versus the children who grew up in a household that was smoke free. According to the Healthline

website, there are environmental "triggers" that can cause an individual to smoke. These

behaviors began by casually smoking at parties when drinking alcohol. (Rufener, B. 2012)

The behavioral target is smoking. The environmental target is prevalence of households

in which adults smoke.

Phase 3: Educational & Ecological Assessment:With smoking being the actual behavior that contributes to lung cancer, cardiovascular

disease, and other types of diseases, there are other contributing factors that can play a role in

beginning the smoking habit. Teens may start to smoke because they think they will look cool,

adults may smoke as a stress reliever; others may smoke because it helps to control their weight

or they enjoy smoking for the pleasure of it. However, the pressure to start smoking is

everywhere, especially in the media. (Health Literacy, Why People Smoke)

One specific type of contributing factor that may lead one to start smoking would be the

media advertises smoking everywhere. The tobacco industry spends billions of dollars every year

to make smoking look cool and safe. Two out of three box office hit movies include smoking in

them (American Cancer Society, 2014). The media usually targets adolescent populations, young

adult and college-aged populations, and in established smokers (The Society of Behavioral

Medicine, 2013).

Environmental factors for smoking are everywhere as well. Those who you are around

have the biggest influence on whether an individual picks up the smoking habit or not.

Regarding peer influences, reviews showed a strong association between friends’ smoking and

adolescent smoking. Adolescents with smoking friends are more likely to smoke than those with

only non-smoking friends. Also, children who had both parents who smoked were three times as

likely to smoke themselves. (Leonardi-Bee, Jere, Britton, 2011)

The targeted contributing factors in this case for individuals who smoke would be the

media advertising cigarettes and making them look glamorous, growing up in a household where

everyone smoked or having peers who smoked, and lastly stress on the individual.

Goals and ObjectivesGoal: To reduce the number of premature deaths from smoking in Gallatin County residents.

Outcome Objective: By 2020, reduce the number of lung cancer deaths in the residents of Gallatin County by 20%.

Behavioral Objective: By 2020, reduce the number of adult smokers by 30% in residents of Gallatin County.

Environmental Objective: Reduce the number of households that contain adult smokers by 50% by the year 2016.

Learning Objective 1: Within one year, all middle school aged students will be able to spot 3 different techniques the media uses to advertise smoking.

Learning Objective 2: By the end of session 2, participants will learn 5 techniques on how to cope with stress.

Learning Objective 3: By the end of session 3, participants will have an increased awareness of family/friends influences on smoking.

Learning Objective 4: By end of session 3, participants will have an understanding of any questions they may have on harmful effects of smoking.

Process Objective 1: By the end of 2015, participants will be able to recognize their own intentions of wanting to smoke and be able to resist temptations.

Process Objective 2: At the end of session 2, students will be able to implement 4 healthy ways to relieve stress without smoking.

Process Objective 3: At the end of session 1, participants will be able to combat 3 strategies that will keep them from becoming irritable from withdrawals.

Process Objective 4: At the end of the 6 week program, participants will be able to list 5 harmful chemicals in tobacco.

Implementation Plan

Phase 4: Intervention Alignment:The first type of evidence-based intervention is known as Project EX. This intervention is

a school-based smoking-cessation clinic program for adolescents that stress motivation, coping

skills, and personal commitment. Project EX uses engaging and motivating activities such as

games and yoga to reduce or stop smoking among adolescents and teach self-control, anger

management, mood management, and goal-setting techniques. Adolescents are provided with

accurate information about the social, emotional, environmental, and physiological consequences

of tobacco use. (NREPP, Project EX, 2006) The two main outcomes for this intervention are

tobacco use and Motivation to quit tobacco use.

This type of intervention would be a great intervention for reducing the number of adult

smokers because eventually the adolescents who are currently smoking will grow into adult

smokers. Therefore, ending adolescent smokers and motivate them to not smoke again will be a

good way to reduce adult smokers in the future.

Since the media plays a huge role in the tobacco industry, another type of intervention

that deals with the media would be Media Ready. Media Ready is a media literacy education

program for children ages 6 to 17 years old. The goal of the program is to prevent or delay the

onset of tobacco use as well as alcohol by encouraging healthy beliefs and attitudes about

abstaining from these products. It also helps by enhancing the ability to apply critical thinking

skills in interpreting media messages. The objectives pertaining to tobacco are asking their

intentions to use tobacco. Because the media does play a big part in contributing to tobacco

users, educating the youth on how to spot these messages will hopefully keep them from falling

under their spell and reframe from buying into their product. (NREPP, Media Ready, 2010)

Template A: Activity Description

Activity title Questionnaire

Activity description (2-3 sentences describing what will be done)

A questionnaire to examine the unique influences of media-related cognitions on adolescents’ currents substance use and intentions to use substances in the future, controlling for parental and peer influences.

Learning/resource objective addressed by this activity

Within one year, all middle school aged students will be able to spot 3 different techniques the media uses to advertise smoking.

Target population 6-12 (Childhood) 13-17 (Adolescent), Male/Female, All Ethnic groups

Start and end date(s) of the activity 10 45-minute lessons

Location(s) of the activity School

List of staff and stakeholders/partners and their roles in the activity

Health Educator

List of resources needed to complete the activity Questionnaires

Activity title “your cigarettes may be stressing you out”


This activity is a talk show event. “Guests” include an ex-smoker, psychologist, and a physician. Guests discuss how tobacco use actually increases, rather than decreases, stress. Youth learn healthy ways (skills) to cope with stress. Also, they practice the “healthy breathing” novel-type activity. They are instructed how smoking hurts one's breathing, and are provided with exercises on healthy breathing.


By the end of session 2, participants will learn 5 techniques on how to cope with stress.

Target population 13-17 (Adolescent) 18-25 (Young adult), Male/Female, All Ethnic groups

Start and end date(s) of the activity Session 2 held in a 2 week period

Location(s) of the activity Schools


Ex-smoker, psychologist, physician

List of resources needed to complete the activity Statistics info, graphs, chairs, desk, overhead projector to show demonstrations

Activity title “family and friends confront smokers about their habit”


Session 1 imparts the ground rules for the clinic and discusses reasons for using and quitting tobacco. Also the talk show “family and friends confront smokers about their habit” is completed. The smoker talks about being nagged, whereas the family expresses their worries and how the smoker has become more irritable after becoming a smoker.


By the end of session 3, participants will have an increased awareness of family/friends influences on smoking.





Family Members, Health educator

List of resources needed to complete the activity Bring items that may calm a smoker down when they become irritable, Family photos

Activity title “Is smoking on the menu?”


Discusses the harmful substances in tobacco and how it can injure one's body. Youth also play the game “is smoking on the menu.” Students create a menu of possible categories and order questions regarding the dangers of passive smoke as a group competition.

Learning/resource objective addressed by this By end of session 3, participants will have an understanding of any questions they may have on

activity harmful effects of smoking.





Heath Educator, group of student smokers,

List of resources needed to complete the activity Menus, tables set up like at a restaurant, board with questions answered on it

Template B: Expense Sheet

EXPENSE SHEETCategory Amount

Salaries $40,000.00

SUBTOTAL PERSONNEL$40,000.00

Teacher's manual with audio CD $360.00Student workbook $35 for 5 $175.00Student surveys Free1-day, on-site training, $1,100-$1,300 for up to 25 participants $32,500.00Teacher certification test $25 each $50.00Limited phone and email consultation FreePre- and posttest outcome assessment instruments FreeImplementation design and monitoring consultation $175 per hour $1,050.00Evaluation services consultation $175 per hour $1,050.00SUBTOTAL OPERATING EXPENSES $35,185.00TOTAL EXPENSES (PERSONNEL + OPERATING) $75,185.00

OPERATING EXPENSES (Non-staff costs of implementing programs)

PERSONNEL (include salary and fringe benefits in the amount)

Template C: Logic Model

→ → → → →

INPUTS

-Supervisors

-Staff to conduct training

-School systems

-money

ACTIVITIES

-Questionnaire

-“your cigarettes may be stressing you out”

- “family and friends confront smokers about their habit”

-“is smoking on the menu”

OUTPUTS

-An anonymous questionnaire was administered to students regarding the media

-Held spin-off of talk show event

-Held an intervention involving the family

SHORT-TERM OUTCOMES

-increase awareness in the advertising techniques to glamorize smoking

- increase participants understanding on families views of smoking

-increase participants knowledge on harmful effects of smoking

-decrease stress levels in participants

LONG-TERM OUTCOMES

-Reduce number of premature deaths

-Lung Cancer

INTERMEDIATE OUTCOMES

-reduce the number of adult smokers

-Reduce the number of households that have adult smokers

Context or Conditions: Insert key points from the needs assessment:

- Cigarette smoking causes more than 480,000 deaths every year in the U.S.

-Smokers have an increased chance of developing cardiovascular disease, respiratory disease, and cancer.

-Of lung and bronchus cancer in Gallatin County, the death rate is 98 per 100,000 populations.

-In 2011, 18 total cases of lung and bronchus cancer out of 8,547 populations at risk throughout Gallatin County.

Gallatin County Healthy Lungs Program

Goal: To reduce the number of premature deaths from smoking in Gallatin County residents.

Template D: Timeline

Project Start Date: February 9, 2015

Project End Date: March 23, 2015

Tasks Year 1

MONTHS

J F M A M J J A S O N D

X X Your cigarettes may be stressing you out X X “family and friends confront smokers about their habit” X X “is smoking on the menu” X X

References:Age-Adjusted Cancer Mortality Rates by in, - . (2010). Cancer-Rates.info. Retrieved Sep 22,

2014, from http://cancer-rates.info/ky/"American FactFinder - Community Facts." American FactFinder - Community Facts. N.p., 22

July 2014. Web. 22 Sept. 2014.County Health Rankings & Roadmaps. (2014, January 1). Retrieved September 23,

2014,http://www.countyhealthrankings.org/app/kentucky/2014/measure/factors/9/ mapHealth Effects of Cigarette Smoking. Centers for Disease Control & Prevention. (2014,

February 6). Retrieved September 23, 2014.Hiemstra M, Kleinjan M, van Schayck OCP, Engels RCME, Otten R (2014) Environmental

Smoking and Smoking Onset in Adolescence: The Role of Dopamine-Related Genes. A Findings from Two Longitudinal Studies. PLoS ONE 9(1): e86497. doi:10.1371/journal.pone.0086497

Kentucky Institute of Medicine. The Health of Kentucky: A County Assessment. Lexington, KY; 2007. Authors' analysis of data from Kentucky State Police Crime in Kentucky annual reports (1999-2003).

Leonardi-Bee J, Jere ML, Britton J (2011) Exposure to parental and sibling smoking and the risk of smoking uptake in childhood and adolescence: a systematic review and meta-analysis. Thorax 66:847–856.

Rufener, B. (2012, February 24). Quitting Smoking and Your Environment. Retrieved October 23, 2014.

Shadel, W., Martino, S., Setodji, C., & Scharf, D. (2013). Exposure to Pro-smoking Media in College Students: Does Type of Media Channel Differentially Contribute to Smoking Risk?. Annals Of Behavioral Medicine, 45(3), 387-392. doi:10.1007/s12160-012-9461-7

"Why Do People Start Smoking?" American Cancer Society. N.p., n.d. Web. 22 Sept. 2014.

Documents

Gallatin County Healthy Lungs Program