2010 Model Practice Application (Public)

Eat, Drink, Breathe Easy

Kanawha-Charleston Health Department

The Kanawha-Charleston Health Department’s comprehensive clean indoor air regulation was expanded on July 1, 2008 to include all bars and gaming establishments. While the public health impact of a reduction in second hand smoke due to this is clear there have been significant challenges to enforcing the clean indoor air regulation (CIAR) due to resistance from bar and gaming establishment owners. The vocal minority has engaged the local media to activism for the limited number of smoking patrons. The Kanawha Coalition for Community Health Improvement’s Tobacco Workgroup, which has been active in Kanawha County for 15 years, developed a social marketing campaign to celebrate the one year anniversary of a Smoke Free Kanawha County and encourage patronage among non-smokers to the smoke free establishment. It was determined that emphasis of this campaign would be upbeat and positive as opposed to the negative effects bar owners believed would occur. Protect the health of those who patronize Kanawha County establishments by promoting continuation of the stronger Clean Indoor Air Regulation enacted by the Kanawha-Charleston Board Health on July 1, 2008. Develop a “thank you” campaign for businesses so that they will realize the economic benefits of being smoke free and assist with the continuance of the CIAR by promoting top of mind awareness of the health effects of second hand smoke and encourage the public's patronage and support of smoke free establishments. Identify businesses that voluntarily went smoke-free prior to the regulation and business owners with whom to work on developing a media campaign. Develop a social marketing media campaign to include website development, fact sheet distribution, billboards, radio public service announcement including testimonials, newspaper advertisement and window decals for the doors of establishments. In other words, counter the vocal minority with majority activism to highlight the desire of citizens to have smoke free environment. Outcomes of Eat, Drink and Breathe Easy include media placements, coalition meetings, meeting with partners to promote messages, overall decrease in violation rate during inspections to less than 5%, more compliance with almost 100% compliance during follow-up visit for clean indoor air. A kick-off event was held at a local bar to highlight the smoke free environment and the perceived increase in patronage from non-smokers and families in previously smoking businesses. A number of bar owners called and requested additional window decals for use in their establishment. Many of the owners felt it was the right thing to do for the citizens. Ultimately, the falling rates of hospital admission rates from acute coronary syndrome at three local hospitals in Kanawha County.

The Kanawha-Charleston Health Department comprehensive clean indoor air regulation was implemented on July 1, 2008 to include all bars and gambling establishments. The Surgeon General's Report in 2007 regarding the health consequences of second hand smoke establishes a positive health impact smoke free environments have. The Kanawha Coalition for Community Health Improvement’s Tobacco Workgroup, which has been active in Kanawha County for 15 years, developed a social marketing campaign to celebrate the one year anniversary of a Smoke Free Kanawha County and encourage patronage among non-smokers to the smoke free establishment. It was determined that emphasis of this campaign would be upbeat and positive as opposed to the negative effects bar owners believed would occur. It was determined that the best approach would be direct communication with local restaurant, bar and gambling establishment owners.The Kanawha Coalition for Community Health Improvement conducts triennial needs assessment to determine the top health concerns for the residents of Kanawha County. Over the last 15 years of the Coalition's rankings, tobacco use and smoking has always been one of the top three issues identified through telephone surveys, key informant questionnaires and a public health issue forum. The Coalition's Tobacco Workgroup has been active since the Coalition conception. The 2007 Kanawha County Community Health Assessment found 32% of respondents regularly smoke or someone in their household smoke while 9% use smokeless tobacco, 51% supported an increase in cigarette tax and 61% supported the elimination of secondhand smoke from all bars and gambling establishments in Kanawha County.Many residents and business owners were completely against the expansion of the Clean Indoor Air Regulation to bars and gaming establishments and the social marketing campaign highlighted the positive effects of the regulation. Media outlets were highlighting disgruntled bar owners who were blatantly disregarding the CIAR and the kickoff event provided an opportunity for positive messaging. According to a bar owner, this campaign was needed to show the public how smoke free regulations helps businesses and believes that it is good for smokers and non-smokers alike in hopes of encouraging people to stop or slow down their smoking. The campaign and enforcement enhanced the opportunity for the majority to silence the vocal minority. Social Marketing campaigns are common practice in public health but the combination of elements makes this a unique approach. The website, radio, newspaper, billboard, window decal, and direct communication with local business owners provided a multi-facted approach. The billboard showed women sitting enjoying an evening out within a smoke-free environment. The placement of the billboard was essential and one was placed by the casino as you enter Kanawha County from a county where there is very weak regualtion.The project focused on business and economic development instead of the poor health statistics and dangers of tobacco and served as a counter marketing campaign to the bar owners vocal minority media coverage. The Kanawha-Charleston Health Department encourages open communication with the public daily and have enhanced communication channels through the use of Twitter and Facebook. The goal of KCHD is to expand our services to include tobacco cessation and prevention programs as a follow-up to the project and CIAR. The Kanawha Coalition for Community Health Improvement's Streeting Committee consist of top executives from local hospitals, schools, wellness organizations, non-profits, social service organizations, and other key stakeholders to ensure a comprehensive approach to community health. The Kanawha-Charleston Health Department's Executive Director and Board Chair serves on the Coalition Steering Committee.

The Kanawha-Charleston Health Department is actively involved in the Kanawha Coalition for Community Health Improvement and have been working hand in hand for a number of years to address the tobacco control issues in Kanawha County. The Kanawha-Charleston Health Department is responsible for inspections and enforcement of the Kanawha County Clean Indoor Air Regulation of 2008. The Coalition provides a neutral setting for objective dialogue where individual organizational agendas are laid aside and joint strategies are developed for the betterment of the community. The coalition provides an opportunity for resource and information sharing to develop comprehensive approaches instead of multiple single focused activities throughout the county. The Coalition and Health Department received input from the American Cancer Society, American Lung Association, American Heart Association, Kanawha County Schools, RAZE Representatives, and other community organizations.

Marketing material production and dissemination including media buys: $3,924.00 Website maintenance and enhancements: $385.00 Postage for mailing to bars: $180.00 (in-kind KCHD provided mailing addresses and labels) Kick-Off Event at Local Establishments: $136.00 WVU Graphic Arts Department for Logo Development: $375.00 in-kind Personnel: $2,500 in-kind from the Kanawha Coalition for Community Health Improvement $5,000.00 from WV Division of Tobacco Prevention $2,600.00 from Smoke Free Initiative of West Virginia In-Kind support from the Kanawha Coalition for Community Health Improvement and the Kanawha-Charleston Health Department

Aug. 28, 2008: Met with Chas. Area Alliance. Jan. 23, 2009: Campaign Planning Meeting Feb. 19, 2009: Campaign Planning Conference Call March 9, 2009: First contact with Cold Spot owner (First made by Cheryl Jackson, RTPCC) April 13, 2009: Meeting with Bill Smeedy, Cold Spot owner. Shared campaign concept and materials. He approved and agreed to host Campaign window sticker kick-off. Scheduled event for April 23. April 20, 2009: Did mailing labels for all Kanawha County bars from KCHD. Jan. 23, 2009: Campaign planning team selected language for billboard Feb. 5, 2009: Recruited Emily Frye to develop concepts for billboard & window sticker. Emily is a visiting Instructor at West Virginia University. She recently graduated from WVU with a Masters Degree in Graphic Design. Feb. 15, 2009: Received billboard/window sticker concept ideas. Feb. 17, 2009: Approved contract with LAMAR for billboard production / site Feb. 17, 2009: Registered website through homestead.com Began site development www.healthykanawha.org Feb. 20, 2009: Approved concept/artwork for billboard Feb. 23, 2009: Artwork to billboard company and to Image by Design for window stickers (both needed two weeks production time) Feb. 27, 2009: Recruited college students for radio spot testimonials (Robin Tabor coordinated, WV State U, Institute) March 3, 2009: Radio Script finalized March 5, 2009: Radio Spots taped March 6 – April 3, 2009: Billboard placement (Actually remained up through May 18th) March 6, 2009: Website operational / ongoing March 16-22, 2009: Radio spots air April 23, 2009: Business Window Sticker kick-off at Cold Spot April 24, 2009: Charleston Gazette article featuring Kick-Off event 47 - :30 sec. commercial aired on WCHS 58 between 6 AM – 7 PM, Reach 13,400 listeners. Frequency of times heard by each, averaged 4.6 Billboard had a daily effective circulation of 50,072 Extending campaign beyond original grant cycle through additional funding from the Smoke Free Initiative of WV Extended Campaign Dates: May 14 – June 14: Billboard June 7-13: Radio spots V100 June 1-5: Mailing of window labels to bars and gaming establishments The campaign is continuing to run in limited avenues such as newspaper ads.

The “tide is turning” in Kanawha County from controversy to acceptance and yes, even support for our 100% Clean Indoor Air regulations. The Eat, Drink and Breathe Easy campaign April 23 event at the Cold Spot received news coverage which highlighted owner, Bill Smeedy placing one of our campaign stickers on his front door. This “very positive” Charleston Gazette article was a welcome change from previous stories covering only the few disgruntled bar owners (mainly one – The Black Hawk) that were blatantly non-compliant with the new CIA regulation. According to Mr. Smeedy this campaign was needed to let the public know about how smoke-free regulations can actually help businesses like his. We also had an Interview with Metro News which played on WCHS 58 on Metro News broadcasts throughout April 23–24. The Cold Spot was packed by the “usual crowd” (around 40) when we announced the campaign and its purpose. It was well received by everyone there, especially two men who had recently quit smoking. One of these men said his quitting was due to the CIA regulation! Twenty Coalition members also attended the event. Three members of our local Board of Health attended and reported that they found it a very positive, fun evening and were pleased by the response of the “regulars” at the bar. Board members have expressed that they will not consider making changes to the existing regulation and are currently addressing any non-compliance issues with the assistance of local police authorities. Another component of our campaign was our radio commercials. We paid for forty-seven 30 second commercials which played during the week of March 16 between the hours of 6:00 AM and 7:00 PM on WCHS 58 (Talk Radio). The commercials included recorded “testimonials” from a couple of young adults praising smoke-free restaurants and bars. Additional funding to run the commercials an additional week and keep the billboard up another month was requested and received from the Smoke-Free Initiative of WV to continue the Eat, Drink and Breathe Easy billboard and radio ads. Additionally, our Coalition was contacted by Tri-State CW Television to see if we could possibly expand our Eat, Drink and Breathe Easy Campaign message by advertising on television. Follow-up informational meetings are being scheduled. Through these measures we intend to continue our efforts to promote Kanawha County’s smoke-free status and encourage patronage of our smoke-free businesses. As the leader in CIAR regulation in the state of WV, the Kanawha Charleston Health Department serves as the model for many counties in West Virginia, especially those surrounding counties who have had difficulty passing any regulation. KCHD will continue to strongly enforce the CIAR while expanding services to include tobacco cessation and prevention programs as funding becomes available. The ultimate goal would be for the entire state of West Virginia to pass CIAR in the future but a bill was introduced this legislative session and it is feared it will be full of preemptions and exceptions like the bingo exemption in the current legislation. The CDC's MMWR Morbidity and Mortality Weekly Report for February 5, 2010 highlighted the practice of state preemption of local smoke-free laws. The Healthy People 2010 objective to eliminate state laws that preempt stronger tobacco laws has shown improvement yet two states, Rhode Island and Montana enacted new laws containing preemptive provisions and we want to ensure that West Virginia is not added to that list. State laws set a minimum standard and allow for local officials to enact more protective ordinances. Local ordinances and regulations usually are more stringent and can tailor laws to address local circumstances. State laws also tend to eliminate the public debate and news media coverage of local ordinances, such as we have seen in Kanawha County, which serves as an important educational opportunity and contributes to changes in social norms abou

To protect the health of those who patronize Kanawha County establishments by promoting continuation of the stronger Clean Indoor Air Regulation enacted by the Kanawha-Charleston Board Health on July 1, 2008. Protect the health of those who patronize Kanawha County establishments by promoting continuation of the stronger Clean Indoor Air Regulation enacted by the Kanawha-Charleston Board Health on July 1, 2008. CIAR Inspections, Violations and Complaints.Number of inspections, violations and complaints recorded. Feedback from sanitarians and the community. Enforcement of CIAR regulation, organize meetings, and enhance partnership with coalition members. A limited number of bar owners completely disregarded the regulation which made it difficult for other establishment owners to comply without losing business.In July 2008, there were 244 inspections with violations found at 8.2% and of those 25% were in response to complaints received. In June 2009, there were 277 inspections with 3.9% violations found and of those 2% were in response to complaints received. In December 2009, there were 299 inspections and of those only 3.6% were in response to complaints received. From July 1, 2009 to December 31, 2009 there were 9 cases filed in magistrate court, 5 cases were dismissed, 1 received a pretrial diversion order, 1 convication, 1 circuity court decision upholding the magistrate court decision and there are four cases pending. The public health impact can be shown through the sharp decline of acute coronary syndrome at the three local hospitals. Develop a “thank you” campaign for businesses so that they will realize the economic benefits of being smoke-free. Identify businesses that voluntarily went smoke-free prior to the regulation and business owners with whom to work on developing a media campaign.Campaign componenets developedCampaign portfolioDifficulty engaging bar owners who feared loss of business. Development of social marketing messages to encourage a healthy lifestyle. Some bar owners found it very helpful and requested additional materials.Multi-faceted campaign components developed and endorsed by the WV Division of Tobacco Control who provided additional opportunities for outreach.Placement and outreach of the Eat, Drink and Breathe Easy Campaign to include website development, fact sheet distribution, billboards, radio public service announcements including testimonials, newspaper advertisement and window decals for the doors of establishments. Number of radio ads, number of newspaper ads, number of billboards, number of hits to website and public comments to the KCHD. March 6, 2009 to June 5, 2009 was the time the marketing campaign ranMedia outreach numbers including frequency and daily effective circulation.Working with the local media outlets.Number of bars requested additional decals.Website: 247 hits since opperational with 200 during the week of radio ads being aired.