Your supervisor assigned you to a CDC committee that is trying to promote community success stories. Your first assignment is to submit a “success story worksheet” about the required reading: Partnership for a Healthy Community: A Tobacco Prevention Program in Central Aroostook County.
Please complete the CDC Success Stories Worksheet that is available in the Presentation section.
Length: 2–3 pages. There should be intext citations
Partnership for a Healthy Community: A Tobacco Prevention Program in Central Aroostook County
As a part of a tobacco settlement money distribution program, the State of Maine granted 31 communities with significant funding to implement community-based tobacco prevention programs. The primary goal was to reduce tobacco-related chronic diseases. A description of how the partnership was established and how arrays of activities (e.g., tobacco policy assessment, youth advocacy, smoking cessation programs, multiple educational strategies, and environmental modifications) were carried out in central Aroostook County is presented.
A series of scientific studies confirming the relationship between tobacco products and human health convinced the public and politicians about tobacco’s detrimental effects (American Cancer Society, 1998; Centers for Disease Control and Prevention [CDC], 2001; Department of Health and Human Services, 1979; Mokdad, Marks, Stroup, & Gerberding, 2004). The public awareness about tobacco’s effect and tobacco companies’ aggressive marketing led to lawsuits against tobacco companies for the recovery of the states’ Medicaid costs attributed to tobacco.
Three-fourths of Maine residents currently die of four chronic diseases: cardiovascular disease, cancer, chronic lung disease, and emphysema. It has the fourth highest percentage of deaths due to chronic disease. Tobacco risk factors in Maine are among the highest in the nation, as 44% of 18-30 year olds smoke. Three-fourths of Maine adults do not eat the recommended servings of fruit and vegetables. Fewer than one in four people in Maine exercise properly (Maine Bureau of Health, 2000). Therefore, the main focus for the State of Maine has been reducing risk factors for chronic diseases.
Following the tobacco company lawsuits, 45 states, including Maine, were successful in obtaining a Master Settlement Agreement with the tobacco industry, thus receiving approximately $206 million per year over the next 25 years (CDC, 2001). The Maine state legislature dedicated all of the state tobacco settlement funds, $50 million per year, to health programs. Maine was among the top six states in spending the maximum amount of tobacco settlement monies and efforts toward tobacco prevention programs (CDC, 2001). A substantial portion of these funds was allocated to the Partnership for a Tobacco-Free Maine (PTM) programs that work to reduce tobacco use and tobacco-related chronic diseases. As a result, PTM initiated a statewide program with four major objectives: (1) prevent initiation of tobacco use by youths; (2) motivate and assist tobacco users to discontinue use; (3) reduce involuntary exposure to secondhand smoke; and (4) identify and eliminate disparities related to tobacco use. A total of 31 communities (service areas) were funded across the state to support comprehensive community-based tobacco prevention and cessation partnerships under the PTM guidelines (Maine Bureau of Health, 2000) (Figure 1).
PTM recommended certain approaches for local programs to pursue. Focus areas included community partnering, coalition building, leveraging local resources rather than providing direct services, and utilizing CDC’s Division of Adolescent and School Health guidelines for tobacco use, physical activity, and healthy eating. Similar programs were suggested for the community-level initiative that addressed major risk factors for chronic diseases. A statewide multimedia and public awareness campaign including Maine Tobacco Helpline, tobacco treatment medication program, and training of health care providers was initiated for the communities participating in this endeavor (Maine Bureau of Health, 2000).
CENTRAL AROOSTOOK COUNTY (CAC) INITIATIVE
The rate of smoking in Aroostook County is 40% higher than the state average. Among 18-44 year olds, 50% of men and 35% of women smoke. In 2000 the total cost of hospital services for Aroostook residents to treat cardiovascular-related dis eases was $40 million. The prevalence of obesity, diabetes, and hypertension is 20-25% higher than the state average (Maine Bureau of Health, 2000). Consequently, it was imperative for Aroostook County communities to participate in this program.
Aroostook County Action Program (ACAP), a local social service organization, assumed the role of the lead agency. Several other organizations, including the Aroostook Medical Center (TAMC), University of Maine at Presque Isle (UMPI), Aroostook Mental Health Center (AMHC), and School Administrative District (SAD) #1 served as partners to formulate the grant proposal. The partnership carried out two major tasks during the first 17-month project cycle, which included both administrative and program planning components. The administrative tasks included planning organizational structure, finding resources, and collaborating with other local organizations. The program planning tasks included designing education programs, planning media coverage, and policy and environmental change activities. McKenzie and Smeltzer (2001) recommended establishing a committee representing all segments of the target population. Hence, to establish a well-represented partnership, titled Partnership for a Healthy Community, a group of 20-25 volunteer members from various community organizations were recruited through formal as well as informal invitation. An executive committee with 6-10 members was created from the core group to create bylaws, mission, goals and objectives; hire personnel; coordinate grant activities including financial allotment; schedule activities; and organize a partnership. At the opening meeting six working committees-(1) marketing; (2) policy compliance; (3) nutrition/exercise; (4) smoking prevention/cessation; (5) environmental change; and (6) budget-were created. Each committee collaborated with corresponding local agencies, such as the Marketing Committee with the local TV and radio stations and newspapers, the Policy Compliance Committee with the Chamber of Commerce and local businesses, and the Smoking Cessation Committee with local smoking programs at the hospital, AMHC, and schools. This served to integrate tasks with existing programs, thus minimizing extra effort, expense, and personnel. Each committee met separately every week and then updated their activities monthly with the partnership members at large. There was a firm regulation for attendance at the Executive Committee meetings. SAD #1 hired a full-time health education coordinator, who worked with the Youth Advocacy Program (YAP) coordinator.
Figure 1. 31 Partnerships Across the State
The partnership designed multilevel and multiple risk factors programs in multiple settings. “Multilevel” refers to the program offered not only to the target group but also to the related persons around them. Target groups were chosen based on people with critical needs. School children, minority groups such as Native Americans, local health department clients, university students, and worksite employees belonged to the group at the first level. At the second level, friends and families of the target group such as parents, siblings, and peer helper groups were organized for the counseling sessions and training. Lastly, school teachers, counselors, the YAP coordinator, and teacher preparation program students received training and resources to enhance effective tobacco prevention efforts to all 16 townships under the CAC service area. The multiple risk factors program focused on smoking prevention, physical activity, nutrition, policy assessment, and modification of environmental factors. These activities were carried out in a variety of settings including schools; daycare centers; colleges/universities; religious organizations; the Native American health center; hospitals; and community organizations (e.g. Elk Club, Rotary Club), and local businesses.
The Marketing Committee linked with local media and the YAP coordinator from the area high school to develop an antismoking TV ad and a radio station public service announcement that ran during prime time for several weeks. Several high school students also participated in a partnership logo design competition that gave them an ownership and recognition for the effort. Aggressive media coverage was initiated with brochures, flyers, props, pamphlets, and newspaper articles. Nutritional and health displays were made available for educators and community members through the ACAP library.
The Smoking Prevention/Cessation Committee joined the local annual event named Youth Summit, organized by AMHC to strengthen the regular smoking program. Several peer-led sessions were designed by the teacher preparation program students from UMPI to make the subject more palatable for school students at this summit. Several training sessions involving the Freedom from Smoking Program designed by the American Lung Association were offered to UMPI students, educators, and trainers, who later conducted actual smoking cessation programs with the target group at the first level. In addition, the project director educated community retailers about underage sales and tobacco advertising. ACAP case workers aligned with their Teen Pregnancy and Parenting Program and counseled pregnant women and young parents on the effect of secondhand smoke.
The Nutrition/Exercise Committee collaborated with local worksite wellness programs. Several businesses, including a local potato processing plant with 500 employees, participated in the Health Risk Assessment evaluation program followed by Move and Improve, an exercise program and Weight Watchers diet program. These programs were carried out in collaboration with TAMC and a nurse from the Employee Wellness Program at the potato processing plant. At the end of a 6-week Weight Watchers program, employees from the potato processing company had lost a combined total of 1,000 pounds.
The Policy Compliance Committee invited local businesses to participate and conduct a survey on policy assessment. All partnership members volunteered in survey administration. Of the businesses that returned the survey (N=165), 63% had some kind of smoking policy in place. Recommendations were presented to local businesses that ranged from updating old policies to designing new ones for those who did not have any in place.
The Environmental Change Committee started their consultation with local schools, businesses, and townships with the goal of facilitating increases in physical activity and healthy food offering in the local restaurants. Outcomes from this initiative included one school opening its gym for walking, a sidewalk being added to road plans in one of the towns, and a restaurant offering low-fat items on the menu. These isolated events hopefully will motivate other agencies to incorporate similar initiatives, thus providing a ripple effect around the service area.
The Budget Committee allotted $14,000 to support programs sponsored by schools and community-based agencies involving nutrition, physical activity, and smoking. A total of 13 immigrants were awarded based on needs and innovative quality of programs.
The YAP coordinator organized high school students and chaperoned them to attend Camp Kiev, a leadership training camp, to equip students with skills in building self-esteem and health promotion. Students also participated in “Kick Butts Day” to raise awareness about tobacco use. The project director and YAP coordinator participated in community events such as health fairs, employee lunch gatherings, and local club meetings on a regular basis and maintained a very high visibility of the program around CAC.
The implementation and success of the program would not have been possible without coordination among health agencies, businesses, schools, community organizations, and proper funding, as well as a strong commitment between the partnership members. A well-organized executive committee made activities flow in a smooth and orderly manner. Along with health education several other approaches such as social marketing, policy assessment, and environmental change activities were included to ensure multiple exposures to CAC communities and bring about a substantial change in awareness. Community members’ willingness to participate in risk reduction programs during the very first year of the project is an evidence of their awareness about its importance. Policy assessment led to initiation and revision of smoking policies in local businesses. Research has supported both policy changes and antismoking media campaigns as avenues to affect tobacco use patterns in the United States (Blum, 1994, Seigel & Biener, 2000).
Although it takes time to see the long-term outcome, community programs based on best practices have a great potential to achieve their goals. Among the biggest challenges were getting the partnership’s name out to service areas and building a relationship with community members. Despite multiple interventions it was hard to acquire the confidence of communities. It seems crucial to take time to develop solid relationships before launching a massive program all at once. The programmer needs to be diligent about linking interested community programs in the partnership. It is critical to make sure that everyone has a role and is not excluded. In addition, it is important to distribute assignments based on the individual member’s interest and expertise. Getting everybody involved, recognizing their contributions, and celebrating successes with each member of the partnership are the keys to active participation and enthusiasm. One of the lessons learned from this project was not to initiate too many programs at a time. Perhaps starting with third and second level target groups first and phasing out programs for the first level target population in the following year would have allowed enough time to get acquainted with the communities. It would also help in strategic planning of the intervention, making it more systematic, manageable, and efficient.
This project was funded by Maine Bureau of Health, A Healthy Maine Partnership Program, and was presented at the AAHPERD National Convention in Philadelphia, PA, April 2003