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Home My WebLink About20121631 RESOLUTION RE: APPROVE APPLICATION FOR COMMUNITY TOBACCO INTERVENTIONS GRANT AND AUTHORIZE CHAIR TO SIGN WHEREAS,the Board of County Commissioners of Weld County,Colorado,pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County,Colorado,and WHEREAS, the Board has been presented with an Application for the Community Tobacco Interventions Grant from the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Public Health and Environment,and the Colorado Department of Public Health and Environment,commencing October 1,2012,and ending June 30,2013,with further terms and conditions being as stated in said application,and WHEREAS,after review,the Board deems it advisable to approve said application,a copy of which is attached hereto and incorporated herein by reference. NOW,THEREFORE,BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado,that the Application for the Community Tobacco Interventions Grant from the County of Weld,State of Colorado,by and through the Board of County Commissioners of Weld County, on behalf of the Department of Public Health and Environment, to the Colorado Department of Public Health and Environment be,and hereby is,approved. BE IT FURTHER RESOLVED by the Board that the Chair be,and hereby is,authorized to sign said application. The above and foregoing Resolution was,on motion duly made and seconded,adopted by the following vote on the 2nd day of July,A.D.,2012. BOARD OF COUNTY COMMISSIONERS WELD COUNTY,COLORADO Sean P.Conway,Chair Weld County Clerk to the Board EXCUSED I � '`4.1)-• ,%illi-m F.Garcia,Pro Tem BY: sz , ."ay In.1 Deputy o erk f.the Bo.T I,11, �� '" ra K mey -70114 APPROVED AS TO FORM: ®' 'SI David E.Lo i County At orney Dougl Radem her Date of signature: -1-3i-I (�+ . L 2012-1631 HL0039 1861 Memorandum TO: Sean P. Conway, Chair G O U N T Y Board of County Commissioners FROM: Mark E. Wallace, MD, MPH,Director Department of Public Health and Environment DATE: May 29, 2012 SUBJECT: Community Tobacco Interventions grant application Enclosed for Board review and approval is the application for funding for the Community Tobacco Interventions grant from the Colorado Department of Public Health and Environment Amendment 35 funding. The time frame for this application is nine months, October 1, 2012 — June 30, 2013. The total amount of the request will be $255,000.00 for this time period. Renewal funding is anticipated for the following two years July 1, 2013 - June 30, 2014 and July 1, 2014 - June 30, 2015, contingent upon grantee performance and subject to appropriation by the Colorado General Assembly. As mandated by the statute §25-3.5-804(3)(b) C.R.S., the Colorado Tobacco Education, Prevention and Cessation Program administers a grant program that funds not-for profit and government agencies to: 1) help people who use tobacco quit; 2) prevent youth from starting to use tobacco; 3) assist in the reduction of and protection from secondhand smoke; and 4) reduce tobacco use among groups disproportionately affected and/or at high risk. This application will focus on four of the seven goals identified in the RFA: Goal One: Work with Federally Qualified Health Centers, Community Health Centers, community mental health centers and/or social service centers to increase referrals to the Colorado QuitLine and promote quit attempts and smoke-free policies among their patients or clients. Goal Four: Work to build support among and mobilize the young adult population and relevant stakeholders to promote prevention and increase cessation attempts. Monitor, document and counter tobacco industry efforts targeting 18-24 year old adults, including but not limited to free samples, discounts, web outreach, and advertising and sponsorships. Promote and implement tobacco-free college campuses, with an emphasis on community colleges, trade schools and regions of the state with high prevalence among 18-24 year old adults. 2012-1631 Goal Five: Work to build and mobilize youth coalitions, implement alternatives to suspension programs such as Second Chance, and strengthen and enforce tobacco-free school laws. Monitor and counter tobacco industry efforts targeting minors, including but not limited to conducting store audits for new and existing products, monitoring industry advertising and sponsorships, and GIS mapping of tobacco retailers. Proposed work within this goal should utilize a positive youth development(PYD) framework Goal Seven: Support the community tobacco coalition and provide education to the public regarding the proven-or evidence-based- practice of raising or keeping tobacco prices high in order to help people quit and to prevent children from starting. Work with the coalition to build support to counter tobacco industry strategies to reduce the price of tobacco at the point of sale, including but not limited to reducing coupons and buy-one-get-one offers. The application will include a budget request for two new Health Communication Specialists to coordinate, implement and evaluate the project; operating expenses including program materials, travel, and meeting expenses. I recommend approval of the grant application. Enclosure Tobacco Education, Prevention and Cessation Grant Program 2012-2013 Request for Applications Weld County Community Tobacco Intervention Needs statement: 1. Describe the specific tobacco-related needs of your population(s). Tobacco use continues to pose a serious health threat to Weld County residents and has implications for our county's future public and economic health.Among the five greatest risk factors for mortality, it is the single most preventable cause of death and disease (Source:World Health Organization).Statewide, each year, over 4,000 Coloradoans die from tobacco-related illnesses, accounting for approximately one of every five adult deaths. According to the Centers for Disease Control and Prevention, for every person who dies from tobacco use, 20 more people suffer with at least one serious tobacco-related illness. Based on these estimates, approximately 250-300 county residents die every year from tobacco-related illnesses (i.e., cancer of the lung and bronchus, chronic obstructive lung disease) and another approximately 5,000-6,000 county residents may suffer from a serious tobacco-related illness (Source: Health Communication Education & Planning Division, Weld County Department of Health & Environment, estimates based on 2010 Census). The relationship between tobacco use, especially cigarette smoking and adverse health outcomes is well known. For example, in the U.S. more deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus(HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined (CDC, 2008). More than 75 percent of all lung cancer deaths can be attributed to smoking and 90 percent of all deaths from chronic obstructive lung disease are due to smoking cigarettes. Weld County data mirrors this trend. For example in Weld County, an average of 175 residents per year die from lung cancer or chronic lower respiratory disease compared to an average of approximately 105 per year from all six causes of death just mentioned (Source: Health Statistics Section, Colorado Department of Public Health & Environment, Weld County Births and Deaths 2010). In 2010, lung cancer and chronic lower respiratory disease accounted for about 14%of all deaths in Weld County. In Weld County, based on recent data,the age-adjusted death rate for lung cancer is trending upward and has nearly doubled since 2000 whereas the age-adjusted death rate for chronic lower respiratory disease has remained about the same. In comparison, age-adjusted death rates from motor vehicle accidents decreased by nearly 50%since 2000 and account for about 3%of all resident deaths (Source: Health Statistics Section, Colorado Department of Public Health & Environment, Weld County Births and Deaths 2010). In 2010, at least 90%of the deaths from lung cancer and chronic lower respiratory disease occurred among non-Hispanic White residents, accounting for 15%of all deaths for this racial and ethnic group. For White Hispanic residents,these two causes of death accounted for about 6%of all deaths. Weld County residents die from lung cancer and chronic lower respiratory disease as young as 25 years of age but the majority of deaths occur later in life, after age 65. Countywide mortality data is not available by income level but national data shows lower income levels are associated with higher mortality rates. The economic costs of tobacco use are equally devastating.The impact of cigarette smoking and other tobacco use on chronic disease, which accounts for the majority of the nation's spending on health care, is also well documented (Anderson, 2010). In addition to the high public health costs of 1 treating tobacco-related diseases, tobacco use costs billions of dollars annually in lost productivity due to sickness. In fact, it is estimated that each year, nationwide, smoking costs$193 billion dollars in health care and lost productivity (Source: USDHHS Surgeon General's Office).Although countywide dollar estimates of the costs of tobacco use are limited, tobacco costs Weld County government and taxpayers every year. For example, according to the 2010 Weld Community Health Survey, 21 percent of adult smokers report their health was fair or poor compared to only 9 percent of non-smokers.Also, twice as many adult smokers report having depression or anxiety compared to non-smokers(29%vs. 14%, respectively). Nationwide, higher rates of tobacco use are related to several social and demographic factors. Predictors of smoking cigarettes,for example, include younger adult age groups, lower income or education level, and having friends or parents who smoked. Predictors of smokeless tobacco include male gender, rural residence, and younger adult age among other factors. Although progress has been made in Weld County over the last decade in reducing tobacco use, smoking rates for some groups of residents have stagnated or may even be on the rise again. An estimated one out of four Weld County priority populations—low socioeconomic groups such as the uninsured or lower income levels groups, young adults especially straight to work 18—24 year olds, and youth 14-18 years when most people initiate use-currently smokes cigarettes and about one out of ten Weld County men/young men use smokeless tobacco products(Sources: Weld County Department of Public Health & Environment, 2010 Weld Community Health Survey; Weld County Prevention Partners, 2011 Weld Healthy Kids Colorado Survey). Several subgroups of the county's 252,000 residents are more uniquely affected by tobacco and are even targeted by the tobacco industry to initiate tobacco usage. Some groups, such as youth 14 to 18 years and young adults between the ages of 18 and 24 years, have a higher risk of exposure to tobacco product promotion, which can lead to initiation and higher rates of tobacco usage compared to other segments of the population. Other groups, such as rural/agricultural, low SES, and behavioral health populations face cultural and environmental influences that can lead to persistent tobacco usage. In summary, these groups smoke more, suffer more, spend more and die more from tobacco use. Nearly all tobacco use begins in childhood and adolescence (USDHHS, 1994). Nationally, about nine out of ten adults smokers who smoke daily report that they started smoking by the age of 18 years and nearly all first use of cigarettes occurs by 26 years of age (USDHHS, 2012). Most young smokers become adult smokers and one-half of adults smokers die prematurely from tobacco-related diseases (USDHHS, 2012, p.20).As Weld County's population continues to grow and its demographic make continues to change, reaching these priority populations with tobacco prevention interventions and cessation services is very important. Lastly, the tobacco industry outspends tobacco prevention efforts by 20 to 1.The tobacco industry marketing and promotion expenditures are about 12 billion whereas state tobacco program budgets are less than 1 million (Source: www.http://www.cdc.gov/WinnableBattles/Tobacco). 2 2. Cite relevant data that demonstrate the community attitudes and norms about tobacco use and tobacco control policies (for example, local survey results). Two recent probability-based local health surveys (one for adolescents and one for adults) provide the most up-to-date county-level information on community attitudes and norms about tobacco use.As part of a multi-year substance abuse prevention grant, Weld County Prevention Partners organized a county-wide sample of the Healthy Kids Colorado Survey in fall 2010.A total of 1,741 high-school students participated across nine Weld County high schools. The survey included questions about tobacco use, attitudes, and norms and had an overall response rate of 64%.The adult health survey is an ongoing survey sponsored by Weld County Department of Health & Environment and was conducted in fall 2007 and 2010. The Weld County Community Health Survey is a mail-based stratified random sample survey of all residents including those living in trailer homes and with general delivery P.O. boxes.A total of 2,226 completed the 2007 survey and 3,383 completed the 2010 survey. Response rates for the surveys were 32%and 41%, respectively. HIGH SCHOOL YOUTH BEHAVIOR AND ATTITUDES In terms of cigarette smoking, local data indicate that more Weld County youth try smoking and more Weld County youth become persistent smokers by the time they graduate from high school. It is estimated that nearly half of Weld County 12th grade students have tried smoking compared to only about one-third of all Colorado students (2011, Colorado YRBS). In general,the most frequent age of first use for Weld (and Colorado) high school students is between the ages of 15 and 16 years old; however, boys have a tendency to try smoking a little younger than girls- between 11 and 14 years. By 12`h grade, 1 out of 4 Weld County seniors are current smokers.This rate is slightly higher than for all Colorado seniors (22%). Unlike other Colorado seniors, however, nearly 1 out of 10 Weld seniors report being frequent smokers (i.e., smoked all 30 days of the previous month) whereas only 1 out of 20 Colorado seniors report being frequent smokers. Smokeless tobacco use among youth is more prevalent in Weld County compared to Colorado overall and the nation. More Weld County students reported recent use of smokeless tobacco compared to other Colorado high school students. Overall, 11%of Weld students compared to 9%of all Colorado students reported recent use of smokeless tobacco products. Smokeless tobacco products are more frequently used by Weld male high students (18%of males report recent use compared to only 5%of females). The rate of daily smokeless tobacco use among Weld County male high school students is higher than other Colorado high school students. Overall, 6%of Weld County male high school students report using smokeless tobacco daily compared to about 4%of all Colorado students. A major concern is the daily usage rate among Weld County White, non-Hispanic males.Their rate daily use of smokeless tobacco is twice the rate of all Colorado students-9%versus 4%. A large percentage of Weld County youth do not appear to perceive that smoking a pack or more of cigarettes per day is very harmful. When asked about their perceived risk of harm from frequent daily smoking, only 68%of Weld County high school students said people were at a great risk of harming themselves from smoking one or more packs of cigarettes per day.This level of perception of harm was least pronounced among seniors, Hispanic students, and males. Also, only 71%of Weld County students said it was wrong or very wrong for someone their age to smoke cigarettes. Interestingly, 92%of Weld students said their parents would feel it was wrong (15%) or very wrong (77%)for them to smoke cigarettes. Peer influences have been shown to be associated with tobacco initiation (and other risky behaviors) (USDHHS, 2012). A large proportion of Weld County youth may be at risk for initiating tobacco use 3 because they have friends that smoke. Between 45%and 55%of 9th through 12th grade students have at least one close friend who smoke cigarettes. Most of those students report they have between 2 and 4 close friends that smoke cigarettes. YOUNG ADULT TOBACCO USE 2010 Weld Community Health Survey data for several young adult populations revealed that: --The overall cigarette smoking rate for any type or age of student is 19%.The prevalence of smokeless tobacco use among students is 8%compared to 5%among non-students. --Young adults between 18 and 24 years have a higher smoking rate, which is 16%, compared to adults 25 and older(13%). --Tobacco use is more prevalent among young adult 18 to 24 year old non-students (18%) in Weld County compared to their student counterparts (12%). --Interestingly,the smoking rate for students 25 years and older was quite high—23%-and smokeless tobacco use is also much more prevalent among 18-24 college students(9%) compared to their non- student counterparts (3%). ADULT TOBACCO USE Although cigarette smoking rates among Weld County adults have declined in recent years, as of 2010, approximately 12 to 15 percent of Weld County adults were current smokers compared to 17 percent of adults statewide. Weld County's 2010 rate was much lower than prior year estimates which have remained around 17-18 percent since 2006.The most likely explanation is due to the Federal Government's increase in the Federal tobacco excise tax from $0.61 to $1.01 per pack that went into effect in April 2009.This effect of the tax increase may have been enhanced by the down economy experienced in 2008. Although the countywide adult rate of current smokers has decreased to its lowest rate in decades, the smoking rate among low SES populations and residents with behavioral health issues remains high— about one out of four. For example, the smoking rate for residents reporting household incomes of less than $25,000 was 24%.The smoking rate among residents reporting household incomes between $25,000 and $49,999 was 13%and for residents reporting incomes greater than $50,000 the smoking rate was only 9%. CESSATION SERVICE NEEDS Findings from the 2010 Weld Community Health Survey indicate that more tobacco cessation services are needed in the county. Residents were asked whether or not anyone in the household needed or used a variety of community services including tobacco cessation services during the previous 12 months. Among the 3,226 responders to this question, only 1% indicated that someone needed and used cessation services whereas 7%said that someone needed but did NOT recently use cessation services. A better understanding of the need for cessation services in the county can be gleaned by examining the responses to this question for respondents who are current smokers. Nearly 75%of current smokers said they did not need tobacco cessation services, 5%said they needed and used tobacco cessation services, and about 20%said they needed but did not use tobacco cessation services in the previous twelve months. In the Greeley/Evans area, 7%of current smokers said they needed and used tobacco cessation services and 26%said they needed but did not use tobacco cessation services. Generally,four times as many Weld County smokers needed but did not use tobacco cessation services as had used those services. In addition to the smokers who said they needed these services, we know from other state and local data that at least half of current smokers have tried or are considering quitting smoking. ADULT ATTITUDES ABOUT YOUTH SMOKING 4 The 2010 Weld Community Health Survey also revealed that a large proportion of residents (85%) are concerned about youth tobacco use. Most residents expressed strong to moderate concerns about this issue. Some subgroups of residents seemed to be more concerned about youth smoking such as lower income groups, lower education groups, Hispanic/Latino residents,females, and residents living in the Greeley/Evans area. 3. List the 2020 Tobacco Goal (s) your project addresses and how they address the tobacco-related needs of your community. The Weld County Tobacco Prevention and Control Program addresses four Colorado 2020 Tobacco Goals.They are: • State Goal 1 which addresses the cessation success gap affecting low SES youth and adult smokers This goal will address unmet need in the community around tobacco cessation services especially with low SES adult populations by working in Year 1 with three community partners: Sunrise Community Health Center, the FQHC located in the Greeley/Evans area, Northrange Behavioral Health's New Integrated Primary Health Clinic,the community mental health center, and Weld County Department of Public Health & Environment's Public Health Services programs including the Nurse Family Partnership, family planning, sexually transmitted infection clinic, prenatal clinic and the tuberculosis program. For health centers with electronic medical record systems, we will work with them to assess and improve their tobacco cessation referral systems. For other organizations we will work with them to embed tobacco cessation assessment and QuitLine referrals into their systems, as well as, assist them in developing a quality improvement plan, practice facilitation with them and provide expert feedback. In addition,we will work with these organizations on expanding and strengthening their tobacco-free policies to reduce exposure to the health hazards of tobacco and improved health of patients, employees, and visitors.We will collaborate with these organizations to intervene and educate their patients/clients about smoking cessation strategies and help them to support patients/clients in avoiding tobacco by encouraging a tobacco-free environment. • State Goal 4 which addresses tobacco prevalence and initiation among young adults, especially straight-to-work young adults. In order to meet the tobacco-related needs of our community which has a higher than average population of youth,young adults and people with low socioeconomic status,this project will engage directly with the young adult population in their environment such as at community colleges, trade schools and other areas. Because advocacy and community mobilization is such a key component in tobacco control in this population, much effort will go into recruitment of this population to join the Tobacco Free Coalition of Weld County and to form a separate young-adult task force that will be charged with monitoring, documenting and countering the tobacco industry efforts to target them. Additionally,the program and the task force will work to promote and implement tobacco-free campus policies. • State Goal 5 which addresses initiation among youth, especially high burden and low SES populations 5 In order to meet the tobacco-related needs of our community pertaining to the reduction of youth initiation,this project will engage directly with middle and high school low SES populations. This project will use advocacy and community mobilization as key components for tobacco control among this population. We will recruit high burden and low SES youth to serve on the Tobacco Free Youth Coalition of Weld County.The project will charge youth coalition members with monitoring, documenting and countering the tobacco industry's efforts to target them, and it will train them to increase the awareness and knowledge of tobacco retailers about the laws and importance of preventing tobacco sales to anyone under the age of 18. After conducting an environmental scan to determine the tobacco issues at their schools, youth coalition members will be tasked with educating school administration about ways to strengthen and enforce tobacco-free school laws. Additionally,this project will contract with the Rocky Mountain Center to provide trainings and educational opportunities to Weld County school districts to implement alternatives to suspension programs. • State Goal 7 which seeks to put Colorado among one of the top 10 states with the higher pricing for tobacco products. Our community recognizes the importance and evidence that higher prices mean for reducing use especially among youth. Our community has consistently shown in surveys (2007 and 2010 Weld Community Health Survey) as well as in formalized policy,that it fully supports and understands the significance of tobacco control especially for youth.Youth, young adults and high risk/low socioeconomic populations make up a large percentage of the population of Weld County and this goal would directly and strongly address the tobacco disparity in these groups.The Tobacco Free Coalition of Weld County in collaboration with state partners as well as this project will work to educate the community and promote the strategies to achieve this State Goal. 4. Describe how your proposal satisfies an unmet need within the target population(s) or community(ies)to be served. (BOH Required Question) Similar to the state tobacco program,the Weld County Tobacco Prevention and Control Program identified three target populations most in need in order to reduce overall prevalence—current smokers, with a focus on low SES smokers, youth aged 14 to 18 whose smoke rates remain high compared to statewide rates, and young adults aged 18—24 years who have some of the highest smoking rates overall. Unmet need in the three target populations was identified based on quantitative and qualitative data. • Tobacco prevention and treatment programming was identified as one of six major health issues of concern during our county's ongoing community health assessment process. The community- based Public Health Improvement Plan Steering Committee identified the six over-all priorities for Weld County after reviewing the 2010 Community Health Assessment data and other county level health data during our planning process Feb—June of 2011. The Steering committee reviewed the overall burden of each area, assessed the capacity and the ability of the communities to address these issues. 6 • The issue of youth tobacco use was also identified as a community issue of concern by a large proportion of residents (>75%) completing the 2007 and 2010 Weld Community Health Surveys and by the Tobacco Free Coalition of Weld County's 2009 Needs Assessment Case Study. • Many Weld County residents who are current smokers are in need of tobacco cessation services as was identified in the 2010 Weld Community Health Survey. Project Narrative: 1. Describe the tobacco control best practices used in the project. According to CDCs Best Practices for Comprehensive Tobacco Control Programs, "successful public health practice has demonstrated that active and coordinated involvement of a wide range of societal and community resources must be the foundation of sustained solutions to pervasive problems like tobacco use"(p.22). In fact, some of the most highly recommended population-based approaches recommended by the Task Force come from studies in which strategies for smoking cessation and prevention of initiation were combined with efforts to mobilize communities and integrate these strategies into synergistic and multi-component efforts. Additionally, research has demonstrated the importance of grassroots community support and involvement when implementing policy interventions, such as increasing the unit price of tobacco products and creating tobacco-free environments (p.22). In general, Weld County's prevention efforts have always tried to combine/integrate efforts within and across our disease prevention programming. Several population-based best practices outlined by the Task Force are being used. They include working with partners to: • Increase the use of proactive telephone cessation support services (quit lines) (Goal1) • Expand the use and effectiveness of reminder systems for healthcare providers (Goal 1) • Support combinations of efforts to mobilize local communities to identify and reduce the commercial availability of tobacco products to youth (Goals 4, 5) • Promote clean indoor air legislation prohibiting tobacco use in indoor public and private workplaces (Goals 1, 4, 5) • Support local efforts to increase tobacco product excise taxes in order to promote tobacco use cessation and to reduce the initiation of tobacco use among youth (Goal 7) Source: Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs-2007. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; October 2007. 2. Describe the planned strategies for each chosen goal area (as defined in the Tobacco Education, Prevention, and Cessation Tobacco Strategic Plan, 2012-2020). State Goal 1:The cessation success gap affecting low SES youth and adult smokers decreases by 50 percent. Objective 1.1: By June 30, 2013, calls by Weld County residents to the Colorado QuitLine cessation services will increase by 5%of baseline. 7 Objective 1.2: By June 30, 2013, at least 2 targeted Weld County service organization serving priority populations will either develop, implement, monitor, protect, strengthen, and/or expand their policies to protect their clients/consumers from secondhand smoke exposure. For State Goal I our strategies are: Comprehensive tobacco cessation treatment: Comprehensive tobacco cessation treatment is an important component of successful tobacco control programs.With this goal, our program will provide evidence-based cessation treatment services (i.e., more QuitLine referrals) for low SES primarily adult individuals looking to end their tobacco dependence.The program will implement supplemental community-based tobacco cessation classes that are evidence based in conjunction with QuitLine interventions three times per month at Sunrise Community Health Center, North Range Behavioral Health and at the Weld County Department of Public Health and Environment. Health systems change: For this strategy, we will focus on actions that move our partners toward making necessary improvements at the system level to create an environment in which change can take place around tobacco use and exposure.The health system is a key area in which major strides can be made to reach the low income tobacco user. In this strategy we will work with the Federally Qualified Health Centers (and other providers)to assess and improve their intake to assure that tobacco usage is a primary question that is always asked and acted upon. In addition, health care providers will be trained in the importance of using this flagging system and utilizing the 5 A's (Ask, Advise,Assess,Assist and Arrange).Through implementing a system-wide approach to cessation at the provider level, many more low-income/high risk populations can be served to increase cessation attempts. Organizational Policy: Policy will be aimed at priority organizations serving low SES populations in order to create an environment in which change can take place. We will collaborate with 3 health care partners, Sunrise Community Health Center, North Range Behavioral Health Center and the Weld County Department of Public Health and Environment,to support them in modifying their environments by strengthening their tobacco-free policies on an on-going basis. State Goal 4:Tobacco prevalence and initiation among young adults, especially straight-to-work, decreases by 50 percent. Objective 4.1: By June 30, 2013, increase community support by mobilizing at least 2 targeted young adult communities to promote behavior change around tobacco use with their populations. Objective 4.2: By June 30, 2013, at least 2 Weld County college campus partners will promote, implement, or expand tobacco-free college campus policies. For State Goal 4 our strategies are: Community mobilization:Community mobilization around young adults is necessary to have maximum impact and influence on this high need population. Community mobilization includes coalition and capacity building and engagement with community members, including youth, parents, stakeholders and decision makers. Our program's strategies will include community 8 engagement and recruitment to the Tobacco Free Coalition of Weld County as well as developing a Young Adult Task Force. Countering the tobacco industry: The tobacco industry spends billions of dollars annually to market its products. Ninety percent of these dollars are spent at the point-of-sale.While we will never be able to outspend the industry, communities and statewide organizations can invest in activities and initiatives that counter tobacco industry marketing.The Young Adult Task Force in conjunction with the Tobacco Free Coalition of Weld County will monitor, document and counter tobacco industry tactics occurring in Weld County. School/organizational policy:This strategy is aimed at working with several priority organizations serving young adults (i.e., colleges and trade schools) recognizing that local level change at the system level will help environmental and societal change take place.The Weld County Tobacco Prevention and Control program will collaborate with the local community college (Aims Greeley and Fort Lupton) as well as the University of Northern Colorado and other key trade schools serving low SES young adult populations in order to promote, provide assistance and help them implement a tobacco-free campus policies. State Goal 5: Initiation among youth (14—18 years), especially high burden and low SES populations, decreases by 50 percent. Objective 5.1: By June 30, 2013, increase community support by mobilizing at least 8 Greeley-area youth to activate/sustain a youth coalition aimed at monitoring, reducing and countering tobacco industry marketing practices in the Greeley area. Objective 5.2: By June 30, 2013, at least two low SES school districts in Weld County will promote, implement, or expand tobacco-free school policies and/or alternatives to suspension programs. For State Goal 5 our strategies are: Community mobilization: Our program's strategies will include the recruitment of high burden and low SES youth to participate in a Tobacco Free Weld County Youth Coalition. We will prepare youth coalition members to work with policy makers, community leaders, merchants and other adult decision makers and help them identify successful activities to have maximum impact and influence. Countering the tobacco industry: In order to counter tobacco industry youth-focused marketing, youth coalition members will conduct neighborhood and tobacco retail store surveys to document the presence of the tobacco industry in their communities. Youth leaders will use the information they collect to increase the awareness and knowledge of tobacco retailers, community boards and agencies that provide services and/or programs to youth on evidence based initiatives to counter industry tactics. School policy:The Weld County Tobacco Prevention and Control program will collaborate with tobacco Weld County school boards and school administrators to promote, provide assistance and help to implement tobacco free school policies and evidence based alternatives to suspension programs. 9 State Goal 7: Colorado is among the 10 states with the highest price for tobacco products. Objective 7.1: By June 30, 2013,TFWC and WCDPHE will increase community support for evidence- based tobacco pricing strategies by working with at least 2-4 strategic partners on collaboration and coalition building. Objective 7.2: By June 30, 2013,Tobacco-free Coalition of Weld County (TFCW)will educate the public and community stakeholders about the pros and cons of price increase campaigns to reduce initiation of tobacco. For State Goal 7 our strategies are: Community mobilization: Community mobilization will include coalition and capacity building and engagement with community members by supporting the (TFCWC) by convening meetings, providing technical assistance, doing recruitment, professional development and promotion of the coalition and its events, and subcontracting with CTEPA for coordination and guidance. Advocacy: Advocacy at the community level involves supporting community-driven coalitions to educate, build membership, and partnerships that support making tobacco less accessible,through various means including price and/or other barriers. It also involves being advocates in support of funding for tobacco prevention and control efforts.This program will provide education to community members and leaders regarding the importance of high tobacco price and will provide support and technical assistance through collaboration to the tobacco coalition for their goals of advocacy regarding this strategy. 3. Describe how the project will change the context in which individuals live, learn, work and play. Our vision is that through multiple evidence-based project interventions, Weld County's Tobacco Prevention and Control Program will eventually reduce the social acceptability of tobacco use among Weld residents but especially young residents, help more tobacco users quit, and prevent initiation of tobacco use altogether. The project also will result in more environmental changes by helping to advance local tobacco-free policies and support statewide efforts around price increases. We also envision participating in statewide mass media education campaigns and helping Colorado expand access to its very successful QuitLine cessation services to help tobacco users quit. Our focus on preventing youth tobacco use initiation are intended to reshape the environment in which Weld County youth live in order to support tobacco-free norms. The tobacco industry spends millions of dollars per year in Colorado, 90 percent of which is spent on in-store marketing and discounts. Young people are more susceptible to the influences of tobacco advertising than adults, so industry efforts to market tobacco at corner stores and keep prices artificially low serve to lure young smokers. Unfortunately, insufficient enforcement of laws banning tobacco sales to minors makes it easy for Colorado kids to purchase tobacco products. In conclusion, we would like to prevent the toll that tobacco takes on Weld County residents. In the long term, the ultimate aims of this project's efforts are to accelerate the declines in cardiovascular mortality, reduce chronic obstructive pulmonary disease, and make lung cancer a rare disease. In 10 addition, project efforts aim to protect Weld County children and youth from secondhand smoke in order to prevent health conditions such as asthma attacks and lung and ear infections. 4. Describe potential challenges to implementing the proposed project(s) and how you will address them. Although we anticipate that overall project implementation will go smoothly, we know from experience that finding the right people, making contacts, and just getting started, especially after budget reductions that slowed down our tobacco programming efforts, may be challenging. But we still have community-based and organizational tobacco infrastructure in place to move forward and relationships that have been previously established and are still intact. We know,for example,that working with health care providers is always a challenge but we already have identified a provider champion who is part of the North Colorado Health Alliance, a key health department ongoing partner. And, we know working with youth is challenging but we have the capacity to re-energize our previously established youth group. 5. Describe the coalition and how the implementation team will ensure the coalition is knowledgeable about evidenced-based tobacco control best practices? Tobacco Free Coalition of Weld County(TFCWC) has been in existence since the mid-1980s under a variety of names and with varying levels of involvement and interest from community members.The vision of the coalition is to "make Weld County free from the burdens of tobacco"and mission is to "empower the residents of Weld County to create a tobacco free environment through education, prevention and a commitment to the health of the community."Recently, based on local community assessment data and national best practices,the coalition has been focusing on youth prevention with an emphasis on youth access issues especially. The current board of directors are: Herb Daggers, President and adult leader of Boy Scouts of America;Joe Sellers, Vice President and former council member of Ault, Colorado,former smoker and volunteer cessation class facilitator; Carole Anderson,Treasurer, former Greeley City Council member and former smoker; Bob Guthman, Secretary, former Director of Centennial Area Health Education Center,former UNC Community Health Education Program faculty, and current WCDPHE Board of Health member. The membership includes former smokers, college age and high school youth, and people from diverse socioeconomic backgrounds. Our current members also include doctors, dentists, police officers, students,teachers, retired volunteers, people of the Colorado Tobacco Education and Prevention Alliance (CTEPA), the State Tobacco Education and Prevention Partnership (STEPP), American Cancer Society (ACS), American Lung Association (ALA), American Heart Association (AHA), Group to Alleviate Smoking Pollution (GASP), Weld County Prevention Partners(WCPP), United Way of Weld County, Centennial BOCES, Hispanic Women of Weld County(HWWC), Catholic Charities of Northern Colorado, University of Northern Colorado and the Drug, Alcohol, and Tobacco Education Program (UNC DATE), Island Grove Treatment Center, Northrange Behavioral Center, the CSU Extension Office, Weld School Districts, service clubs including Kiwanis and Rotary, and other interested groups and individuals. 11 The TFCWC is community driven. Its members have stayed active and continued to meet monthly even during the last three years of reduced support for tobacco programming at the state and national levels. In 2009, TFCWC applied for 501(c)3 nonprofit status with the federal government and received approval for that status in 2011. The coalition has a website at www.tobaccofreeweld.com . Current coalition members' are highly knowledge about evidence-based tobacco control best practices. Several members with a high degree of expertise in CDCs best practices have been involved with the coalition since its inception. In addition, monthly meetings routinely include guest expert speakers who are knowledgeable about best practices as well. Moving forward, the implementation team will work the coalition to promote even further understanding of evidence- based practices as well as the state's strategic plan. 12 a00 ) y Y a u '., t no es El L O a O o0 aa e " .. U N V it N 0 G u 0 a) V 0 a) p.i 'O O '.U2'!- a bR0 0 td O ~ m L" .. 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Ell▪; :et .0 - z A a oo F -o •E c b 4a :,..r `m 8 EL LolE a 7o°10/SIC" w, $ ° a � E S8 o °' '� t Ia .5 os 4 o s g a h 0 Q0. a a �a s a5 tz o as 40 ctzrxc7 ° ❑ ❑ v) o ❑ ❑ dFwaFaBcoc.) -3w °c8a ' Tobacco Education Grant Application June 25, 2012 Budget Narrative Direct Operating Expenses Printing and copying : $1500.00—Educational materials, flyers, brochures for all goals; meeting materials for coalition meetings; toner for printer Postage/shipping: $500.00- postage for regular mail and shipping for supplies Supplies: $500.00- office supplies, purchased brochures and materials, calculators, etc Computer equipment: laptop ($1500) and projector $1950)for presentations for both staff and contractors; iPAD ($500)for tracking and recording meeting minutes and participation- Staff development: required travel to 2 state meetings—Attend tobacco state conference to increase knowledge base in Tobacco Control Field for 2 people Meeting expenses: Training/presentations to staff at health and social service agencies 10 @$150/meeting for Quitline = 1500; meetings with clinics for tobacco free campus 6@ $125.00 =$750.00; Young adult task force 5 @ 150.00=750; Meeting @ college campuses to discuss tobacco free campus policies-4 @$125/meeting =$500: Youth Coalition meetings—9 meetings @ $100=$900: Tobacco Free Coalition of Weld County meetings -9@ $150=$1400. Other program costs: Incentives for youth coalition members 15 x$25.00=$375; focus group incentives 30 (10/group) x$25.00=$750; Tobacco coalition incentives 30 x$.25 =$750. Travel: Mileage: 6000 miles x.50 for local travel for 2 fte and contractors. Lodging: hotel for 2 fte for 4 nights @ $125.00 for state meetings; 4 meals @ $15.00 for 2 fte Contractors: Outreach and education for Health Alliance clients for cessation 6hr/wk x 2 people x $20.00/hour-$9000.00;Train the trainer course for contractors and staff—5 @ $200.00=$1000; CTEP coalition support for policy work$18,700.00; Youth Coalition leader to recruit and lead group—10 hr per week @ $20.00$7600.00; RMC curriculum trainings—2day for 30 people; 1 day training for 25 on Second Chance or Tobacco Free schools policy; % day for 25 on overview of school based tobacco initiatives-$5150.00 Other costs: Media/advertizing: $12,000—public information and education on tobacco goals/initiatives Stipends: Focus group coordinator—young adults—3@$2500=$7500.00; stipends for colleges/businesses to do campus assessments 3@$2500.00=$7500.00; task force leaders to do outreach/store assessments(5 x 1/hr/mo@ $20.00 for 9 mo -$900.00;youth store audits—2 per quarter=6 with 5 youth @ $20.00 per hour= $600.00; stipends for health agencies to complete assessments of EMR and pt intake forms 4 @ $3000.00=$12,000; Tobacco Free Weld coalition stipend for expenses related to policy work. - $2500.00. Indirect Costs: 17.77% (18) for building overhead, purchasing, computer services and HR, and business office management of grant . APPLICATION BUDGET FORM Template for Tobacco Education Community Grant Check only one: 0 Year 1(Oct 1,2012-.June 30,2013) APPLICANT: 0 Year 3(luly 1,2011-lune 30.2012) PROJECT TITLE: SOURCE OF FUNDS Tobacco Community Education Requested Other Source' Other Source' CDPHE Some 1 Source 2 PERSONAL SERVICES FTE Monthly Monthly #of WCDPHE If applicable, funding Name Position %Effort Salary Benefits Months source name juan HES II 1.00 $4,149.00 $1,651.00 9.0 $52,200.00 $0.00 $0.00 rachel HES II 1.00 $4,149.00 $1,651.00 9.0 $52,200.00 $0.00 30.00 0.00 $0.00 $0.00 0.0 $0.00 $0.00 $0.00 Marjorie OTIII 0.25 $3,088.00 $1,204.00 9.0 $9,657.00 $0.00 $0.00 0.05 9.0 $0.00 $0.00 $0.00 0.0 $0.00 $0.00 $0.00 Subtotal Personal Services 2.30 $114,057.00 $0.00 $0.00 DIRECT OPERATING COSTS Unit Quantity Rate Printing/Copying Month $ 500.00 $500.00 $0.00 $0.00 Postage/Shipping 500.00 $ 0.45 $225.00 $0.00 $0.00 Telephone,Fax,Internet Access $0.00 $0.00 $0.00 Supplies incentives 50.00 $ 10.00 $500.00 $0.00 $0.00 Computer Equipment laptop/pad 2.00 $ 1,000.00 $2,000.00 $800.00 Computer Equipment I I protector 1.00 $1,950 $1,950.00 Staff Development 2.00 $ 1,000.00 $2,000.00 $0.00 $0.00 Meeting Expenses $ 150.00 $5,500.00 $0.00 $0.00 Other Program Cost-incentives 74.00 $ 25.00 $1,850.00 $0.00 $0.00 Subtotal Operating Costs $14,525.00 $800.00 $0.00 TRAVEL Unit Quantity Rate Mileage 6000.00 $ 0.50 3 3,000.00 $0.00 $0.00 Lodging day 4.00 $ 125.00 $ 500.00 $0.00 $0.00 Meals day 4.00 $ 15.00 $ 60.00 $0.00 $0.00 Other Travel $ - $0.00 $0.00 Subtotal Travel Costs $3,560.00 $0.00 $0.00 CONTRACTUAL Unit Quantity Rate Consultant -Joe and Juan cessation 2 300.00 $ 30.00 $ 9,000.00 $0.00 $0.00 Train the trainer cessation for contractors 5.00 $ 200.00 $ 1,000.00 $0.00 $0O0 CTEPA coalition support 1.00 $ 18,700.00 $ 18,700.00 Youth Coalition Leader 380.00 3 20.00 $ 7,600.00 RMC 1.00 $ 5,150.00 $ 5,150.00 $0.00 $0.00 Subtotal Contractual Costs $41,450.00 $0.00 $0.00 OTHER COSTS Unit Quantity Rate Outreach/advertizing 6.00 $ 2,000.00 $ 12,000.00 $0.00 $0.00 Stipend for focus group facilitator I 3.00 $ 2,500.00 $ 7,500.00 Stipends for college/agencies to do assessments 3.00 $ 2,500.00 $ 7,500.00 Stipends- task force leaders 45.00 $ 20.00 $ 900.00 $0.00 $0.00 Stipends for youth store audits 30.00 $ 20.00 $ 600.00 Tobacco coalition stipend 1.00 $ 2,500.00 $ 2,500.00 Stipend assessment of health agencies 4.00 $ 3,000.00 $ 12,000.00 $0.00 $0.00 Subtotal Other Costs $43,000.00 $0.00 $0.00 CDPHE Same 1 Source2 TOTAL DIRECT COST: $216,592.00 $800.00 $0.00 INDIRECT COSTS: 18% Of Contractual $41,450.00 $7,349.09 INDIRECT COSTS: 18% Of All Other $175,142.00 $31,052.68 Total Indirect Cost(Calculated on Amount Requested from CDPHE Only) $38,401.76 TOTAL AMOUNT REQUESTED FROM CDPHE $ 254,994 I I 'Other: Please indicate additional funding sources it applicable. JUL 0 2 20'.2 Signature of Authorized Representative Date Rev.10.22.08 ggO/o7- / Hello