PROJECT SUMMARY Outline of Strategic Plan for Identifying and Eliminating Tobacco- Related Health Disparities in Clinch County, Georgia

Transcription

1 PROJECT SUMMARY Outline f Strategic Plan fr Identifying and Eliminating Tbacc- Related Health Disparities in Clinch Cunty, Gergia Prepared fr: Ware Cunty Bard f Health Prepared by : Dr. Simne Charles, Ph.D. Dr. Stuart Tedders, Ph.D Gergia Suthern University Jiann-Ping Hsu Cllege f Public Health

2 BACKGROUND 140 acres f tbacc was harvested in Clinch Cunty in 2007 (Center fr Agribusiness and Ecnmic Develpment, UGA) a farm gate value f $417, 690 Tbacc use is mre prevalent in rural cmmunities when cmpared t urban cmmunities 14% f the adult ppulatin in Gergia smke (Behaviral Risk Factr Surveillance System 2006) There are 10,000 tbacc-related deaths in Gergia yearly The Sutheast Health District (which includes Clinch Cunty) has cnsiderably higher smking prevalence when cmpared t statewide smking prevalence Rural cmmunities d nt have prper access t health care and they als may nt have the mnetary resurces t alleviate the prblem Participants in the develpment f this plan helped identify the needs and issues related t tbacc use, cessatin, and initiatin in Clinch Cunty Thrugh the data cllectin and strategic plan we seek t determine current trends in Clinch Cunty and t begin understanding the factrs that cntribute t these disparities The data will prvide the framewrk fr prpsing specific interventin strategies designed t reduce identified disparities The GOAL f the Strategic Plan is t: 1. Prevent smking initiatin by Clinch Cunty yuth 2. Prmte quitting amng Clinch Cunty adults 3. Eliminate expsure t secnd-hand smke 4. Identify and eliminate tbacc-related health disparities amng ppulatins DATA COLLECTION In rder t accmplish the Gals, a participatry strategic planning prcess was used. Assessment included analyzing data, which included identifying and assessing tbacc-related health disparities using varius indicatrs. The data cllected frm the assessment and the input f the calitin members and additinal data cllectin effrts were used t develp a strategic plan utlining best practices apprach t health prgram develpment and implementatin. The Strategic Plan was develped using a participatry prcess invlving the frmatin f Clinch Cunty Tbacc Disparities Calitin.

3 The Calitin is ethnically diverse and cnsists f cmmunity leaders, public health practitiners, and plicy influencers, juvenile justice wrkers, nurses, teachers, and Sutheast Health District persnnel. The purpse f the Calitin is t: Organize a sustainable grup f stakehlders Build cmmunity capacity Develp key relatinships Create a cllabrative vehicle t implement the strategic plan t address health issues in Clinch Cunty Assist in develping and administering data cllectin instruments such as adult/yuth surveys and key infrmant questins. Mbilize the cmmunity, and ther relevant parties t implement the strategies fr addressing tbacc issues in Clinch Cunty. Data Cllectin Prcess Data cllectin was cnducted t btain data n tbacc use and tbacc use behavir in Clinch Cunty. A SWOT (Strength, Weaknesses, Opprtunities, and Threats) analysis was cnducted using key infrmant interviews, survey questinnaires, and fcus grup data Key infrmant interviews asked questins that revlved arund yuth smking behavir, adult smking behavir, cmmunity descriptins that facilitate r culd help address the issue f tbacc smking and smking initiatin in Clinch Cunty. The key infrmants were chsen by the Clinch Cunty Public Health Department Nurse Manager. They included individuals such as the Superintendent f Schls, the Directr f Clinch Cunty Family Cnnectins, the City Manager, Lcal Dentists, Clinch Cunty 4-H Leaders and Industry presidents Surveys were distributed t adults and yuth. A ttal f 326 adults participated in the surveys. A ttal f 494 yuth participated in the surveys Survey questins revlved arund secnd hand smking behavir, media expsure, tbacc use, tbacc cessatin, attitudes twards the risks f tbacc use, initiating smking in yuth Surveys were given t adults thrugh varius avenues in Clinch Cunty fr example, parents and teachers f the Public Schl System, the Clinch Cunty Health Department, Adult Educatin prgrams (GED). Surveys were given t kids by their teachers in the public schl systems and an incentive was ffered t the highest number f surveys returned in a classrm

4 Fcus grups were cnducted with varius grups f cmmunity members t slicit infrmatin abut risk, perceptin and ideas fr strategies fr addressing tbacc use The participants f the grups included male emplyees f Slash Pine Plant, pre-natal s and wmen with families, high schl, middle schl, and GED students, alng with senir citizens Based n data analysis f surveys and fcus grup data we identified critical issues frm which initial gals and strategies fr addressing and eliminating identified tbacc-related health disparities were develped Gals and strategies were shared with the Calitin, priritized, and refined with the input f the Calitin, particularly the Department f Human Resurces, Health Prmtin Directr The Calitin put int place the culturally cmpetent strategies that were f immediate pririty. The strategies were implemented and evaluated by the Calitin and the Gergia Suthern University faculty OUTCOMES Key Infrmant Outcmes Frm these interviews, sme f the cmmn issues were: Lack f activities t engage the yuth N unified apprach t address the issue Easy access t tbacc prducts fr all ages Abilities within the cmmunity t facilitate tbacc preventin prgrams Critical Issues identified were: 1. Lack f sustained funding t address tbacc use in the cmmunity 2. Cmmunity grups vary in their readiness t crdinate and implement tbacc preventin and cntrl activities. Mst cmmunities d nt cnsider tbacc use and SHS expsure pririty issues when facing many mre acute issues. 3. There is a pr understanding f tbacc issues in the cmmunity and lack resurces t increase awareness amng their ppulatins. 4. The cmmunity varies in its invlvement and supprt f preventin prgrams. 5. The cmmunity culd build n established relatinships, particularly the Churches and Schls, t cnvey culturally apprpriate anti-tbacc messages. 6. The yuth can be their wn vice and mtivatr. Yuth incentives t facilitate change. 7. Lack f cunty and schl cntractrs experienced in wrking with culturally diverse ppulatins arund tbacc use issues.

5 8. Lack f safe spaces and general cmmunity prgrams Adult Survey Outcmes Frm the adult survey analysis, sme key findings were: 29% f the adults admitted t smking at least 100 cigarettes in their lifetime 12% f the adults smke every day 12% f the adults smke 5 cigarettes per day 75% f smkers smked everyday with 78% f them using 5 cigarettes r mre 24% f adults felt that there were minimal benefits t quitting smking after smking a pack f cigarettes a day 61% were cntemplating stpping smking 48% f adults actually tried t stp smking Critical Issues identified were: 1. Adequate cmmunicatin is needed, and these messages must be cnsistent with literacy levels (46% f smkers have a high schl diplma r less) a. Tbacc is addictive b. Several quitting ptins are available c. Tbacc cessatin ptins are cvered by Medicaid 2. Need fr increased efficiency f quitting prgrams 3. Increase awareness f quitting help ptins and tbacc-related illnesses 4. Increase media cverage f tbacc-related issues (i.e., televisin, PSA) 5. Emplyer-based tbacc use prgram (74% f respndents are full-time r part-time emplyed) Yuth Survey Outcmes Frm the yuth survey analysis, sme key findings were: 12% f yuth participants d nt perceive tbacc as addictive 24% f yuth participants stated definitely that peple wh smke have mre friends 11% f the yuth participants thught that smking makes them lk cl 49% f yuth participants thught the smking helps a persn lse weight 28% f yuth participants think that it is at least prbably safe t smke fr 1-2 years if they quit afterwards

6 23% f yuth participants said that smking is allwed in their hmes and 37% said that smking is allwed in their vehicles 42% f yuth participants said that they lived with smene wh smkes 34% f yuth participants have a friend that smkes cigarettes 29% f yuth participants indicated they had puffed a cigarette 17% f yuth participants said they use smkeless tbacc prducts 27% f yuth participants indicated sme likelihd f smking in next 5 years 29% f yuth participants wh have smked a whle cigarette were 13 r 14 years ld Amng the 76 students reprting t have chewed tbacc, 22% were between the ages f 13 and 14 when they first used this prduct The majrity f the parents (64%) spke f the dangers f tbacc with less frequency than smetimes 54% f yuth indicated that their schl des nt have special grups r classes fr students wanting t quit using tbacc Critical Issues identified were: 1. Adequate cmmunicatin is needed: a. Tbacc is addictive b. Tbacc use shuld nt be used as a weight lss tl c. Tbacc use is nt cl and des nt help yu gain friends d. Expsure t secnd-hand smke in the hme is hazardus t health 2. Parental training n tbacc-related illness, smking and tbacc prducts and secnd-hand smke expsure 3. Lack f schl prgrams t assist students wh want t quit smking (nt nly preventin) 4. Media cverage f tbacc-related illnesses (i.e., televisin, PSA) Fcus Grup Outcmes Each f the seven fcus grups (cnducted n Octber 28, 2008) discussed certain themes, which included tbacc use, factrs influencing quitting, suggestin fr prgrams, and general thughts. Critical Issues identified were: 1. Tbacc use as a stress relief, relaxatin, and easing bredm were all cmmnly mentined gains frm smking. Participants wh expressed n desire t stp smking expressed reluctance t frg these psitives.

7 2. There is a lack f ptins fr activities fr stress relief r engagement f adults r yuth 3. Culture - In a rural culture f hunting, and being utdrs smking and chewing is a favred pastime passed dwn frm generatin t generatin. Chewing tbacc is viewed as part f the hunting experience. 4. A matter f chice. 5. Scial pressures - Smking behavir f thers. Respected persns such as caches and family members smke. Yuth are expsed t tbacc use at an early age. Peers als strngly influence tbacc use. Way f fitting in and being cl. Friends and family acceptance. 6. Persns have an early start 7. Addictin cupled with a lack f willpwer supprts tbacc use 8. Perceptins that it is nt an issue 9. Ready access either frm family members, friends, r stres. Stre wnership influences access DISPARITIES Tbacc-Related Health Disparities Independent and dependent variables were taken frm the adult surveys and gruped in rder t facilitate the analysis The independent variables were race, gender, educatin, and husehld incme Dependent variables were quality f life, secndhand smke, smking rules in the hme, smking status, benefits f quitting smking even after 20 years f the behavir, effects f secndhand smke. Findings included: Whites are almst 6 times mre likely t be satisfied with their quality f life cmpared t nn-whites 49% f nn-white participants indicated there was a health benefit t lng-term smkers wh make the decisin t quit smking cmpared t nly 23% f white respndents White respndents were 2.7 times mre likely t perceive an assciatin between respiratry prblems in children and expsure t secndhand smke. There is a significant difference in perceptin. A higher prprtin f less educated (<high schl (HS)) respndents agree that it is beneficial t stp smking even after a lng-term addictin. In fact, these individuals appear t the twice mre likely t hld this view than mre educated (>HS) individuals A higher prprtin f educated individuals (>HS) believe that secndhand smke can cause heart disease than less educated (<HS)

8 Respndents with mre than a high schl diplma are mre likely t perceive an assciatin between respiratry prblems in children and secndhand smke Over 40% f respndents with mre than a high schl educatin perceive an assciatin between SIDS and secndhand smke as cmpared t less educated subjects Survey participants reprting a higher incme (>$25,000) are mre likely than lwer incme (<$25,000) participants t be satisfied with their life A higher prprtin f higher incme (>$25,000) participants d nt allw smking in their hmes cmpared t lwer incme (<$25,000) participants Lwer incme (<$25,000) participants were almst 3 times mre likely t be a self-reprted smker cmpared t higher incme (>$25,000) participants A large prprtin f lwer incme grups (<$25,000) perceived a benefit t quitting after a lng-term addictin cmpared t higher incme (>$25,000) participants The lwer incme grup (>$25,000) was 60% less likely t perceive an assciatin between secndhand smke and respiratry prblems in children cmpared t higher incme (>$25,000) participants Critical Issues identified were: 1. There is a need fr increased educatin and awareness training fr whites cmpared t nnwhites 2. There is a need t educate men abut the harmful effect f secndhand smke particularly amng children 3. Educatin level was a strng determinant fr smking and smking risk perceptin with higher percentages f smkers being adults with less than a high schl educatin 4. Yuth were identified as ne f disparate grups in Clinch Cunty with nnwhite children facing a higher risk f expsure t secndhand smke cmpared t white children Disparate Grups Disparate grups were identified as: 1. White males with <$25,000 incme and less than sme cllege was identified as ne f the disparate grups in Clinch Cunty 2. Yuth in middle schl f parents with less than/with high schl educatin, primarily nnwhite yuth

9 STRATEGIC PLAN Outline Using the infrmatin gathered frm the ppulatin assessment, as well as the Cnsumer Health Prfile fr Clinch Cunty, the strategic plan was develped The Plan utlines strategies t reduce tbacc-related health disparities and create greater equality and parity within Clinch Cunty The strategic plan will be used as a guide fr future activities t identify and eliminate tbacc-related health disparities in Clinch Cunty The Plan cntains 5 general categries: 1. Cmmunity strategies including cmmunity develpment, cessatin strategies and ensuring prgram wnership 2. Schl strategies 3. Public awareness/media advcacy and literacy strategy 4. Plicy and enfrcement strategies 5. Assessment and evaluatin strategies Adult prgrams shuld be reduced cst r free and facilitated, in part, thrugh the majr emplyers Yuth prgrams can be administered thrugh the schl systems in cnjunctin with the ther schl and yuth cmmunity prgrams Cmmunity prgrams can be run thrugh the Bys Scuts, schl system and the religius rganizatins, private physician practices, cunty health department and hspital, and ther rganizatins within the cmmunity The Calitin The Clinch Cunty Calitin will be an essential grup t help implement the Strategic Plan. They will cntinue t cnvene in rder sustain an nging dialgue abut tbacc issues and supprt the wrk utlined by the Strategic Plan.

10 TOP PRIORITY ISSUES OBJECTIVE #1: T increase the number f schl districts that adpts a 100% Tbacc Free Schl Plicy in Clinch Cunty Strategy 1.1: Increase teen participatin in calitin t implement specific strategies fr reducing risk amng yuth ppulatin Create and build membership f yuth calitin Yuth calitin t utline charges f teen calitin Strategy 1.2: Train teen calitin t effectively discuss specific strategies fr reducing risk amng yuth ppulatins Train yuth calitin members n tbacc use preventin and have yuth make presentatins t full calitin and schl bard Outline peer mentring activities and yuth-fcused prgrams utilizing peer mentring Yuth calitin t implement ne nn-smking schl-wide acitivity Strategy 1.3: Increase awareness f NOT and ATS, Quit Line, and enfrcement prgrams in schls Educate yuth, schl administratrs and schl staff by presentatins and/r trainings n the imprtance f having NOT and ATS prgrams in schls Distribute materials n Quit Line fr yuth and adults at schl and schl functins Educate faculty, staff and peers n schl plicy by presentatins and/r trainings fr students, staff and visitrs Strategy 1.4: Prgram Sustainability Identify funding surces fr sustained prgram develpment, assessment, and evaluatin Establish relatinships with cmmunity health care prviders t supprt tbacc use reductin effrts Hst meetings with health care prviders OBJECTIVE # 2: T increase the number f wrksites that implements a plicy t prhibit tbacc use in the wrk place in Clinch Cunty Strategy 2.1: Create a marketing strategy fr increasing cmmunity awareness arund tbacc Publish findings f strategic plan and tbacc use disparities prject in lcal newspaper Create 3 public service annuncements (PSAs) that include targeting identified tbacc-related disparate ppulatins lw incme, white males and yuth Air PSAs n lcal radi statin and in apprpriate cmmunity venues Distribute tbacc-related printed educatinal materials in cmmunity

11 Publish strategic plan n Public Health Department and Clinch Memrial Hspital websites Strategy 2.2: Train calitin t effectively discuss specific strategies fr reducing tbacc risk amng partnering agencies Cnduct training fr Calitin n Tbacc 101, Smke Free Air Act, Tbacc Free Wrksites, and ther identified training needs Meet with key business leaders t identify pprtunities t create tbacc free envirnments Identify 5 t 7 lcal businesses willing t begin mvement t a tbacc free wrksite including wrksites that emply identified disparate ppulatin Assist lcal businesses in develping, adpting and implementing a mdel plicy fr a tbacc free wrk site Hst events fr increasing cmmunity awareness arund tbacc-related issues Cnduct baseline data n tbacc awareness in cmmunity OTHER PRIORITY ISSUES Other specific strategies are utlined in a separate dcument. PROJECT EVALUATION Evaluatin f Prgram Evaluatin methds include quantitative and qualitative data cllectin frm surveys and fcus grups. Surveys will be dispensed at varius intervals after the implementatin f the Strategic Plan.