Tobacco Prevention and Control Coalition Narrative-Form Needs Assessment OutlineFY2014

Coalition Name: Wichita TPCC

Submission Date: July 15, 2014

Part I – Geographic / Target Population and Coalition Overview

1. Provide an overview of the target area, including geographic boundaries, zip codes, counties, etc.

Wichita County is described as an urban community with a population of 130,835; with a total area of 606 square miles, the county is comprised of the cities of Burkburnett, Electra, Iowa Park and Wichita Falls, which is the county seat. Wichita Falls is the principle city of the Wichita Falls Metropolitan Statistical Area, which encompasses all of Archer, Clay and Wichita Counties and is the highest population area with in sixteen counties. Wichita County borders the State of Oklahoma, and includes Sheppard Air Force Base, Midwestern State University and Vernon College.

Above is a map with county boundaries and zip codes.

Our target area are the towns of Burkburnett, Electra, Iowa Park and Wichita Falls.

2. Provide demographic information about the target community.

According to the US Census Bureau American Community Survey from 2007-2011, Wichita County has a total population of 130,835, which is comprised of 51.3% male and 49.7% female. The median age is 34.1 years, with 8% of those being between the ages of 15 and 19; 7% are under 5 years of age. The race composure is as follows: White (80.6%), Black or African American (10.7%), American Indian and Alaska Native (0.8%), Asian (2.2%), Native Hawaiian and Other Pacific Islander (0.1%), and other races (3.3%). Sixteen percent are of Hispanic or Latino descent. Families made up 66% of the households in Wichita County, of which 49% are married couples and 17.5% are other families. According to the US Census Bureau American Community Survey from 2007-2011, the per capita income (in 2011, inflation-adjusted dollars) for Wichita County is $23,292, which is $2,256 lower than the state average. The median household income (in 2011, inflation-adjusted dollars) for Wichita County is $44,786, which is $6,134 below the average for Texas. The median family income (in 2011, inflation-adjusted dollars) is $54,646, which is $5,358 below the average for Texas. Families below the poverty level are 10%, as compared with 13.2% state-wide.

Description of community-wide health status According to the Texas Department of State Health Services death statistics for the state of Texas, the leading cause of death in Wichita County is diseases of the heart (24.5%), followed closely by cancer (20.6%), chronic lower respiratory diseases (7.0%), and stroke (5.7%). During the one year period from 2007 to 2008, the death rate for health disease increased by 8.8%. There was a slight increase in chronic respiratory diseases in that same time period.

According to the Texas Department of State Health Services Texas Cardiovascular Health and Wellness Program, the Wichita Falls Metropolitan Statistical Area (MSA) prevalence rate for stroke is 5.7%; the Texas average is 2.8%. The prevalence rate for cardiovascular disease is 8.8%; the Texas average is 8.3%. Heart disease prevalence rates for the community are 6.1%; the Texas average is 6.7%. The risk factor prevalence of current smokers is 28.2%. The cardiovascular disease and stroke age-adjusted mortality rates (per 100,000) for 2001-2005, shows disproportionate outcomes for African Americans.

According to the Selected Metropolitan Area Risk Trends (SMART) from the Behavioral Risk Factor Surveillance System (BRFSS) for 2010, the percentage of adults in Wichita County reporting selected health risks are as follows: adults reporting general health as fair or poor (19.1%), which is higher than Texas (17.4%); adults reporting having smoked at least 100 cigarettes in their lifetime and currently smoke (19.8%), which is higher than Texas (15.8%).

The leading industries in Wichita County were educational services, health care and social assistance followed by retail and industry. The average life expectancy in Wichita County is 75.1 years of age according to the Community Health Status Indicators 2009; the median for all US counties is 76.1 years of age. The leading causes for death in Wichita County are as follows: Ages 15-24: injury, homicide, suicide, cancer; Ages 25-44: injury, cancer, heart disease, suicide, HIV/AIDS, homicide; Ages 45-64: cancer, heart disease; Ages 65 and older: heart disease, cancer.

The Youth Risk Behavior Survey (YRBS) data at the national level is used to draw conclusions about the youth in the Wichita County community as well. Data in that survey indicated that

44.7% of youth had tried cigarette smoking, 18.1% had ever smoked cigarettes on at least one day during the last 30 days, and 6.4% has smoked cigarette on 20 or more days during the last 30 days.

In April of 2011, the Wichita Falls Wichita County Public Health District (WFWCPHD) produced a report entitled Results of Local Health System and the Community Health Status Assessment for Wichita County, Texas. In June of 2012, a subsequent report entitled Wichita County Health Facts was released. The County Health Rankings are also reviewed and disseminated each year. These reports were the basis for the Community Health Improvement Plan (CHIP) developed by the Health Coalition of Wichita County. The findings of the assessment indicate some areas of weakness for Wichita County. Twenty-five percent and released in June 2013 of Wichita County’s population indicated current smoking compared to 18.5% for Texas. According to data the residents of Wichita County have good access to primary care providers; however, Wichita County had comparatively high mortality rates on a number of causes of death associated with lifestyle choices such as smoking.

Those populations who are disproportionately affected by cardiovascular disease (CVD), stroke, and other tobacco related diseases include African Americans, Hispanics, undereducated individuals, adults and children in poverty. The cardiovascular disease and stroke age-adjusted mortality rates (per 100,000) for 2001-2005, follows with the state and national trends with disproportionate outcomes for African Americans. For example, the age adjusted mortality rates for CVD for African American’s in the Wichita MSA is 27% higher than their White and Hispanic peers. The same holds true for stroke, with the rate being 45% higher than their peers. The trend is the same for heart disease, with the African American population at 21% higher mortality rates than others in the Wichita MSA.

There may be specific barriers that are faced during the course of the activities of this proposal. Those individuals experiencing health disparities in our community include African Americans, Hispanics, undereducated individuals, adults and children in poverty. Each population will have unique needs while some of the needs span all groups experiencing disparities. According to the 2005-2009 census profile, 12% of the population spoke a language other than English and of those that spoke another language, 43% reported they did not speak English very well. Providing language appropriate materials as well as Health District translators for these individuals will help to address the barrier faced by those who do not speak English as their primary language. Another issue facing many in the disparate group includes a low literacy level. A survey conducted by the United Way of Greater Wichita Falls and the Wichita Adult Literacy Council found that among citizens in Wichita County, 23% are functionally illiterate. Educational material will be developed in appropriate reading levels to address those with lower literacy levels. Educational programs will be located in individual communities with the support of trusted community leaders.

3. Provide information about your coalition to explain your how the coalition formed and the coalition’s purpose and role in the community.Our coalition is still in the process of forming. A first meeting is scheduled for August 2014.

4. Provide any other relevant information about your targeted area or population that you have identified.

Wichita Falls is not unlike other communities in the state and nation, there are several factors that contribute to population-level chronic disease burdens impacted by tobacco use. The lack of a comprehensive smoking ordinance is one of the leading barriers to tobacco free living in our area. An ordinance was passed in 1994, which called for separate smoking and non-smoking areas in places such as restaurants. The ordinance disallowed smoking in public buildings, but did not impact establishments that only cater adult clientele. In 2005, an attempt was made to develop a more comprehensive smoking ordinance; at that time, there was not support from City Council for an ordinance revision.

In fact, Wichita Falls achieved a score of 87.5 points with 1 bonus point out of a possible 104, earning a recognition level of silver on the Texas Council on Cardiovascular Disease and Stroke; Heart and Stroke Healthy City Recognition program. The leading reason for not achieving gold status was the lack of a strong smoking ordinance.

Wichita Falls has an adult tobacco use rate of 19.8% according the BRFSS in 2010, as compared to the national average of 17.3%. Some of our youth obtain their tobacco products either from their parents or friends. According to the Wichita Falls Independent School District 2006 Texas School Survey of Drug and Alcohol Use, 31% of 10 th graders reported experimental use of tobacco products as compared to 27% statewide. In our community, some youth are sometimes seen in public places sharing cigarettes with their peers.

Part II – Prevention Resources, Capacities and Gaps

1. What prevention resources currently exist in your target community? Please discuss the following as specifically as possible in regards to how they are engaged or could be engaged in assisting the coalition’s efforts.

a. Prevention Resource Center (PRC): Abilene Regional Council on Alcohol and Drug Abuse (ARCADA) offers substance abuse resources in our county. We will contact them by August 1st. Behavioral Health Group is a non- profit community based organization providing substance abuse services.

b. Other coalitions (DFC and CCP Coalitions, other tobacco Coalitions, etc.) The Health Coalition of Wichita Falls, North Texas Planning Council; the Wichita County TPCC currently does not know of any others but will continue to research this.

c. Other state or federally funded prevention providers: Community Healthcare Center, North Texas State Hospital, Indigent Healthcare

d. Schools and/or school programs (Communities in Schools, etc.): School: Wichita Falls ISD, City View ISD, Iowa Park ISD, Burkburnett ISD and Electra ISD

Programs: Communities in Schools, Pals, athletics, student council, taking four Rider High School Peer, Assistance & Leadership (PALS)students to Say What! Youth Tobacco Conference. Contacted all school counselors in the WFISD school system at the end of last year. We have begun contacting school principals in the county for the next school year to implement TATU in the schools.

e. Community programs and services: YMCA, Boys and Girls Clubs, The RAC, Straight Street, Youth Opportunity Center, Pueblo Boxing, Faith Based Organizations, Faith Mission, Faith Refuge, Public Housing, Interfaith ministries We have begun the TATU program in the Boys and Girl’s Clubs. We have

discussed the TATU program at the RAC on Iowa Park, as well as hosting Freshstart classes there.

f. Parent programs (PTA, etc.): There is a PTA within the WFISD. Athletic Booster clubs and Band Booster clubs exist as well.

g. Direct prevention service providers: Wichita Falls – Wichita County Public Health District, Behavioral Health Group, MSU Vincent Health Center,

h. Treatment Providers: Helen Farabee, Employee Assistance Program (EAP) Associates, We will be taking over the City of Wichita Falls EAP smoking cessation classes beginning this month. Red River Hospital, North Texas State Hospital

i. Healthcare providers: Clinics of North Texas, North Texas State Hospital, United Regional Health Care System, Red River Hospital., Kell West, Electra Memorial Hospital, and other independent physician’s groups. We have begun offering Freshstart cessation classes through the Clinics of North Texas. The providers are able to schedule the patients into classes through the EHR system and classes will be held at the Clinics of North Texas. United Regional is currently offering cessation classes of their own, they charge $25.00 per class.

j. Higher Education Prevention: A health care center is offered for free due to a medical fee applied to tuition at Vernon College. Midwestern State University has a mental health counseling center, this free for students. Vincent Health Center is also available to students. This is available at available at a low cost to students

k. Law Enforcement: D.A.R.E, Jail and Jail Annex of Wichita County, Juvenile Detention, Teen Court

l. Others identified: American Cancer Society, Leadership Wichita Falls, Rotary Wichita Falls, Kiwanis Club, Elk’s Lodge, Lion’s Club, Junior League, Youth Leadership Wichita Falls, Jaycees, Shriners, Optimus Club, The Food Bank

2. Identify and explain existing smoke free ordinances and organizational/school

policies.Attached to this document is a copy of the Wichita Falls Smoke Free Ordinance. The schools in Wichita Country comply by the Texas Tobacco Free Schools Act of 1995.

3. What prevention gaps exist in your target community? While teaching Teens Against Tobacco Use (TATU) we noticed a gap in teen cessation. The youth that are smoking do not like being tobacco users and know the harmful effects of it. However, there are no classes in the community to successfully help them quit. Wichita TPCC is researching options to best fit our community for this need. We also have a need for a faith based outreach. With the help of our regional coordinator we are working on a faith based outreach.

PART III – Community Consumption PatternsOverall, the ranking of the Wichita Falls-Wichita County Health District went from 152 in the state to 151, out of a total of 232 ranked counties. This was based on a composite of mortality, morbidity, health factors, health behaviors, clinical care, social and economic factors, and physical environment. Improvements were seen in all composite categories, except for mortality – where the district remained the same at 176th in the state. The adult smoking rate increased from 20% to 21% (data source is 2012 BRFSS data); the adult obesity rate also increased from 31% to 33% (data source is 2010 CDC data), yet the physical inactivity rate dropped from 31% to 29%.  Some new indicators were also added this year - food environment index, access to exercise opportunities, severe housing problems, and number of mental health providers.  

The Wichita Falls-Wichita County Health District (WFWCHD), within a public health system, is pro-active in identifying and addressing issues facing the health and well-being of our community. Over the past two years, the district has joined with many other health facilities, organizations, businesses, and agencies to form the Health Coalition of Wichita County to actively address these issues to make a significant difference in the lives of families and individuals in the community.

PART IV – Community Consequences

Data Type

AlreadyHave

Where to Find

Target Groups

Unlikelyto Get

Availability

Date

Person Responsible for Dat

a

Column1 Column2

Underage youth smoking rates

No

School surveys conducted in school districts, Tobacco Youth Survey

Youth

No

Underage youth chewing tobacco use rates

No

School surveys conducted in school districts, Tobacco Youth Survey

Youth

No

Underage tobacco rates (All tobacco products combined)

No

School surveys conducted in school districts, Tobacco Youth Survey

Youth

College stude

No

Possibly from local university

College

Yes

nt use rates

sources Age

Population

Adult smoking rate

Yes

Most recent data is the 2010 BRFSS results for Wichita County. New data is being collected

Sample of the adult population

No

19.70%

Adult chewing tobacco use rates

Yes

Most recent data is the 2010 BRFSS results for Wichita County. New data is being collected

Sample of the adult population

No

Adult tobacco use rates

Yes

Most recent data is the 2010 BRFSS results for Wichita County. New data is being collected

Sample of the adult population

No

Citations for underage tobacco possession

No

Local police and sheriff's departments

Youth

No

Citations

No

Local police and sheriff's

Youth

No

for selling tobacco to minors

departments

Asthma rates

Yes

2010 BRFSS data

Adult

Cancer rates

Yes

State data and cancer registry data.

NCI link

http://statecancerprofiles.cancer.gov/cgi-bin/quickprofiles/profile.pl?48&047

State Map Link

http://www.cancer-rates.info/tx/

Heart disease rates

Yes

DSHS

ER visits for heart attacks

No

Local hospital data

ER visits for asthma

No

Local hospital data

Healthcare costs associated with tobacco-

No

Could use national data to approximate costs

Adult

Yes

related diseasesDetails of Current smoke-free ordinance (if applicable)

Yes

Wichita Falls comprehensive smoke free ordience

All No

Number/percentage of restaurants that are smoke-free

Don't

know

Should be available

Number/percentage of bars that are smoke-free

Don't

know

Should be available

2 barsNumber/percentage of hospitals that are smoke-free

Yes

United Regional; after July 17 the following due to ordiance: North Texas State, Red River, and Kell west. Electra Memorial is out of city limits

Number/perce

Yes

MSU is tobacco and e cigarette free. Vernon college WF campus is as well; Started 6/18

ntage of campuses that are smoke-freeNumber of tobacco retailers

yes

Cost of cigarettes

yes

$5 per packLocal regulations on tobaccoadvertising on store windows

yes

 Complies currently with state comptroller regulations

new city ordinanceLocal regulations regarding distance between tobacco retailers and schools

Don’t know

http://texastobaccolaw.org/law

The measurement of the distance between the sign containing an advertisement forcigarettes or tobacco products and an institution listed in Subsection (a) is from the nearestproperty line of the institution to a point on a street or highway closest to the sign, alongstreet lines and in direct lines across intersections Outdoor advertising is prohibited within 1,000 feet of a church or school

Cessation services

Yes

TPCC- FreshStart, Dear Oaks EAP, United Regional Respiratory care department.

availableQuitline use rates from your area

No

Youth truancy rates

No

School districts

Youth

Yes, in near term

Tobacco tax receipts

No

State comptroller, County, and City

All Yes, in near term

Other data:

Part V – Intervening Variables

Please discuss each of the following intervening variables. Include the effect on your community as well as the evidence of each variable (i.e. the contributing factors) in your community.

A. Retail Access: Tobacco is everywhere in Wichita County. Even Dollar General sells tobacco products. Purchasing tobacco is almost as convenient as purchasing fast food due to the easy access. (See Needs Assessment chart and all the registered tobacco retailers).

B. Enforcement: It is hard to gauge enforcement due to the lack of participation in the Youth Compliance Checks.

C. Social Access: Just like retail access, social access is the same. While the national social norm is towards non-smoking, the area norm for youth is towards smoking. The recently passed ordinance will help shift that social norm, but, because the of the strong prevalence of smoking in bars and restaurants social access and pressure is virtually everywhere.

D. Social Norms (Includes Perceived Risk): It is not uncommon for our health educators to hear in our Teens Against Tobacco Use (TATU) trainings about youth starting smoking at 10, 11 or 12 years of age. It is not uncommon to hear of a parent buying cigarettes for their child because he or she cannot purchase them yet. The social norm of “it’s cool,” is not why most youth or adults smoke, it is due to boredom or stress factors. The Program Manager was at a tobacco

presentation recently and spoke with a sixteen year old who said he began smoking at ten due to an abusive home. He said the smoking was the only thing he had to escape.

E. Promotion: The promotion seen by the Wichita TPCC is the large signage provided to the tobacco retailers by the tobacco companies as a part of their contract. There is a rise of E-Cigarette advertising on doors of gas stations and grocery stores. We have also noticed more magazine, in particular women’s magazines, advertisements for e-cigarettes that are in a similar fashion to those that were banned before the tobacco settlement.

F. Pricing: The pricing of cigarettes and taxes on cigarettes are relatively inexpensive compared to other states making accessibility to adults and minors easy. In a town with a high socioeconomic factor; the low cost of tobacco makes for a high rate of tobacco usage.

Part V – Community Readiness

Please describe the readiness of each of the following sectors in your community to implement your strategies. These answers can be based on coalition feedback and community member interviews. This information may help you identify potential allies or community perceptions and knowledge, which you can describe here.

a. Youth: The youth that we have come in contact with seem excited to be a part of

a change. Many students are looking forward to the Say What! Conference to gain the knowledge needed to pass along to fellow students when school starts. The students involved at the Boys and Girls Clubs are excited to have the role of TATU presenter and teach the younger students.

b. Parents: The parents of the involved students recognize what a great opportunity it is to have their child involved in the anti-tobacco movement. Not only to help make the community healthier, but for the leadership opportunities and skills training for their children.

c. Business community: The readiness of the business community is slow. The recently passed comprehensive smoking ordinance makes some businesses unwilling to working with our coalition. They see the ordinance as a business destroying entity. There are some businesses who have taken a proactive move and gone smoke free before the ordinance.

d. Media: The media has been quite helpful in disseminating information for our FreshStart smoking cessation class. Our two local television stations allowed our health educators to come in for interviews to tell the public about our new classes. In our first session, every single participant were people who came due to the television interviews.

e. Schools: Three out of the five schools in our county were very eager to get involved with our anti-tobacco programming. Even though all three agreed narcotics were more the issue; the administrators were still excited to work with the Wichita County TPCC. The lack of readiness for the other two schools came from the outside intervention from UT Austin for the Youth School Survey.

f. Youth-serving organizations: The Boys and Girls Clubs of Wichita Falls and Burkburnett are very excited to have the programming available to their students. They recognize the importance of education and the challenges that their students face when it comes to tobacco. Some other youth organizations are not as excited to participate. Straight Street, a primarily teen center, said that it wasn’t really the appropriate programming for them.

g. Law enforcement agencies: The Wichita Falls Sheriff’s Department had to cover a policing shortage in Electra, Texas. Officers had reservations with the possible liability concerning the minors being used in the controlled buys because some of the tobacco retailers are located in unsafe environment. The manner in which the Texas Safety school contacted both our Police Department and Sheriff’s Office immediately turned the Chief and Sheriff off. They were contacted first without working in conjunction with the local TPCC; TPCC operates out of the local health department. The health department already had a close working relationship with these law enforcement agencies.

h. Religious or fraternal groups: The Wichita County TPCC is currently gathering information on the faith based community in Wichita County. We are eager and ready to work with them and realize this is a gap in the community that has not been assessed.

i. Civic or volunteer groups: Having a prior established relationship is the strategy to implementing any tobacco programming in civic or volunteer based group. Many of these organizations have had too many programs come once with a great idea or program but not come back. These organizations rely on trust and relationships for their community readiness.

j. Healthcare professionals: Due to an established relationship with the Wichita Falls-Wichita County Public Health Department working with health professionals in the community has been relatively easy. There is already a good relationship established, it is just a matter of setting up an appointment with the right individual.

k. State, local, tribal governments: The Wichita County TPCC is contacting all of the city governments within the county. We are currently providing the tobacco cessation programming for the city of Wichita Falls employees, and are working on getting classes set up in Electra for the community, hosted by the Electra Library. We are still working on Burkburnett and Iowa Park.

l. Other organizations interested in substance abuse prevention: Many substance abuse programs in town deal mainly with illegal substances or prescription abuse and are not as worried about tobacco addiction, so they do not focus on it.

Part VI – Putting it all Together

Part VII – Logic Model

Logic ModelTheory of Change

Problem Statement Strategies Interventions OutcomesBut why? But why here? Short-Term Intermediate Long-Term

Wichita county

being plagued

disproportionate amount of health effects related to tobacco use.

Because an above average amount of citizens within the county use tobacco products

It is a social norm to use tobacco products without thinking or being educated about the consequences. Use begins at a young age due to the ease of access socially. It is not viewed as morally wrong to sell to or buy tobacco products for someone underage.

Change of culture though community outreach and education

Educate Literature and information is received by the community.Public sees change is coming from media.

More tobacco related citations are issued.Less minors are sold to.Word spreads about enforcement.

Use of quit line increases.More patients receive NRT and begin quit process.Doctors begin to refer.Increase in youth participation.

Culture changesNegative social norms start to change.

Tobacco becomes less accessible to minors.Retailers stop selling to minors

More people successfully stop using tobacco.

Fully functional

Overall reduction in the use of tobacco products.

Tobacco related health problems see a reduction.

% of new smokers

CessationHealth FairsMedia

Bolstering enforcement of laws through the Synar grant.

EnforceStore ticketsMIP tickets

Getting UT to convert local FQHCs to the E-tobacco protocol

Free NRTQuit lineDR billing codes

Creating youth Conference

Please develop a summary of the findings from your community needs assessment. Briefly discuss alignment with evidence-based strategies and the goals outlined in your Statement of Work. Also indicate opportunities for community change, such as setting a smoke-free ordinance goal or increasing specific data collection where your needs assessment indicates there is a gap.Overall, the ranking of the Wichita Falls-Wichita County Health District went from 152 in the state to 151, out of a total of 232 ranked counties. This was based on a composite of mortality, morbidity, health factors, health behaviors, clinical care, social and economic factors, and physical environment. Improvements were seen in all composite categories, except for mortality – where the district remained the same at 176th in the state. The adult smoking rate increased from 20% to 21% (data source is 2012 BRFSS data); the adult obesity rate also increased from 31% to 33% (data source is 2010 CDC data), yet the physical inactivity rate dropped from 31% to 29%.  Some new indicators were also added this year - food environment index, access to exercise opportunities, severe housing problems, and number of mental health providers.  Source: County Health Rankings by the University of Wisconsin Population Health Institute

Please see attached compressive smoke free ordinance.

Second hand smoke in public

coalition leadership groups-Say What Youth gain knowledge to

strengthen their coalition.youth coalition is in place.

decreases.

Citizens are now protected from second hand smoke in public

Less health related side effects due to second hand

YMCAYouth coalition

Smoking in public is a social norm, and widely enjoyed.

Potential legislation of this nature is unpopular because citizens feel that it infringes on their rights. They fear that once this is taken away then more is to come.

Last smoking related legislation was passed in 1994

City passed comprehensive smoke free ordinance.

Educate stake holders about the new ordinance.

Present information to hotel, restaurant, and bar owners.

Health coalition influence bars to go smoke free early.

Use media to educate citizens about ordinance and changes

Meet with business owners.

Help businesses implement smoke free policy before 2 yrs .

Present information to city officials

Get youth involved to present message

Seemingly large opposition to the anti-smoking legislation

Buzz spread about new ordinance

Garnering support from officials and business owners.

Message is better received because it is youth delivered

Movement gains support and strength with public awareness

Legislation is passed

Citizens, officials, and businesses alike support ordinance after see that no negative outcomes arise.

Health department and coalition earn confidence that will prove useful in their future endeavors.

Logic ModelTheory of Change

Problem Statement Strategies Interventions OutcomesBut why? But why

here?Short-Term Intermediate Long-Term

weight and

babies due to

Teen/preg moms smoking

Teen perception of invincibility.. low income, lack of education

OBGYN- Quit line, teen pregnancy prevention

Contact OBGYN/ clinics regarding quit line

Pregnant moms quit smoking, or reduce in number

Less children born premature and with low birth weight due to smoking

Healthier children and community

Talk to school counselors re quit lineAdvertising campaign

Adult smoking is 19.7% in W. County. It is higher than TX Average, and

Leading cause of preventative death in W.F at

opposed to 15.8% in TX

doubles the # of kids who end up smoking

Teen smoking

Ease of access to tobacco of

income

People don’t want to quit

Socio-economic status

Small town social norms

The lower socio economic population will have a higher percentage of anti-tobacco advertising

Insurance incentives may cut smoking

Smokers realize how much smoking costs and attempt to reduce the amount of smoking to save money

Better understanding of health risks associated with smoking, and how stopping now can reverse/stop health issues from getting worse

Sales go down in lower income areas

Lower costs for company insurance plans, incentives to have tobacco free workplaces

Tobacco users save money

Enroll in quit line

Less economically disadvantaged smokers

Tobacco free workplaces

Find other outlets for entertainment

Stop smoking

Quit line referral

Less teen smoking

Less teen smoking

Less teen tobacco users

Lower tobacco use rates

“

“

Lower usage rates

Educate lower socio-economic status, bilingual

Change norms through education and enforcement

Target advertising to lower income, bilingual populationsTarget businesses with high population of smoking employees/ insurance incentivesIncrease awareness of cost of smoking

_____________________Increase awareness through media campaign about health risks and benefits of quitting now

Advertisements/posters at doctor’s offices and clinics

e-tobacco ordinances/legislation Establish an e-cig 18 and

up policy with retailers, including id check

Enforcement/ positive peer pressure

Teen ambassadorsSchool/youth programsMIP enforcement

Retailers, no enforcement

Advertising/tv as well as others, no regulation

Retail sales cigs are a big moneymaker

Many stores selling e-cigs

Limit/reduce sales

Regulations on e-tobacco

Talk to retailer like Walgreens, to ask to prevent sales

Pass ordinance where tobacco is only available in liquor stores

Raise legal age to purchase tobacco to 21

Legislation against e-tobacco advertising similar to that of tobacco ads

The more difficult it is to access, the less it will be acquired

Decline in knowledge of what is available

Lower tobacco use rates

“

“

Decline in sales

involvement in Lower usage rates

More interested in treatment then prevention

Treatment vs. prevention

E-Tobacco Protocol

Introduce doctors to E-Tobacco protocol and how it can benefit them with pay codes

Improve health outcomes of patients

Integration of e- protocol, quit line referrals begin

Quit line referrals