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2012 Model Practice Application (Public)Application Name: 2012 Model Practice Application (Public) : Capital MRC : Kanawha County CLEAN Applicant Name: Ms. Krista N. Farley Application Title: Kanawha County CLEAN Please enter email addresses you would like your confirmation to be sent to. krista.n.farley@wv.gov Practice Title Kanawha County CLEAN Submitting LHD/Agency/Organization Kanawha-Charleston Health Department Head of LHD/Agency/Organization Rahul Gupta, MD, MPH, FACP Street Address 108 Lee Street, East Practice Contact Person Krista Farley Title Director of Health Promotion Submitting LHD/Agency/Organization Web Address (if applicable) www.kchdwv.org Provide a brief summary of the practice in this section. This overview will be used to introduce the model or promising practice in the Model Practices Database. Although this section is not judged, the judges use it to get an overall idea about your practice. You must include answers to the following questions in your response:
• Size of population in your health department’s jurisdiction
• Who is your target population/audience, for this practice
• Size of target population/audience, if applicable
• The number or percentage of the target population/audience reached, if applicable
• Describe the nature and gravity of the public health issue addressed
• List the goal’s and objective(s) of the practice and clearly link them to the problem or issue the practice is addressing. Briefly indicate what the practice intends to accomplish overall.
• When (month and year) the practice was implemented.
• Briefly describe how the practice was implemented, what were major activities, and any start-up and in-kind costs and funding services.
• Outcomes of practice (list process milestones and intended/actual outcomes and impacts.
• Were all of the objectives met?
• What specific factors led to the success of this practice?
• Lessons learned from the practice The Kanawha-Charleston Health Department (KCHD) and the Kanawha Coalition for Community Health Improvement (KCCHI) have developed numerous initiatives to ensure that Kanawha County has a CLEAN environment, Clean Living Environment in Appalachian Neighborhoods. The Kanawha-Charleston Health Department instituted a comprehensive clean indoor air regulation on July 1, 2008. To goal of CLEAN is to lessen the mobility and mortality due to second hand smoke in accordance with the Surgeon General and the Institute of Medicine. The objectives are to implement a comprehensive clean indoor air regulation and educate the citizens of Kanawha County through a social marketing campaign and support activities. To save lives of Kanawha County Residents a medical education and social marketing campaign must be undertaken, aggressive enforcement and prosecution with fee structure changes, advocate for tobacco cessation programs and research. While the public health impact of a reduction in second hand smoke is clean there have been significant challenges to the regulation. Many bar and gaming establishment owners were very resistant to the change and the vocal minority engaged the local media to foster activism for the limited number of smoking patrons. The initiatives include a social marketing campaign entitled Eat Drink and Breathe Easy, community events as well as periodic inspections of establishments at nontraditional times such as evenings. The Coalition’s Tobacco Workgroup, which has been active in Kanawha County for fifteen years, developed the social marketing campaign to celebrate the one year anniversary of a Smoke Free Kanawha County to encourage patronage to establishments among non-smokers to the new smoke free establishments. The goal of the marketing campaign was to provide an upbeat and positive message and promoting top of mind awareness of the health effects of secondhand smoke and encourage the public’s continued patronage and support of these businesses as opposed to the negative effects bar owners believed would occur. The cost of the marketing campaign was $5,000 which was funded by the WV Division of Tobacco Prevention and the enforcement of the CIAR is approximately $100,000 annually funded completely by KCHD without any state or federal financial support of these enforcement expenditures. Overflow: Please finish the response to the question above by using this text area. Please be mindful of the word limits. Kanawha County is the largest county in West Virginia with 193,063 citizens and is the home of the largest city and State Capitol of Charleston with 51,400 citizens. The leading cause of death and disease in West Virginia is tobacco use with almost 4,000 West Virginians dying each year from tobacco use and if the current trends continue over 40,000 more residents will die by 2020 because of tobacco. In 2009, West Virginia had the second highest prevalence of smoking with 25.6% and 8.5% smokeless tobacco use according to CDC’s MMWR for November 5, 2010. All fifty-five counties in West Virginia have a clean indoor air regulation in effect with 39 counties prohibiting indoor smoking in all non-hospitality workplaces and restaurants while only 18 counties eliminated indoor smoking in all workplaces including all bars and gaming establishments. The smoking trends in Kanawha County have shown a decline from 25.2% in 2007 to 21.9% in 2009 according to the CDC’s Behavior Risk Factor Surveillance System. The KCCHI’s 2011 Kanawha County Community Health Assessment found 59% supported an increase in cigarette tax which is up from 51% in 2006. West Virginia’s anti-smoking public health efforts rate so low that the American Lung Association gave it an F in the annual assessment of state’s efforts. The economic impact of tobacco use in
West Virginia is estimated to be over $2 billion annually with $1.092 billion in productivity loss and $1.299 billion in healthcare cost. The objectives were achieved with the exception of no tobacco efficacy and the inability to offer our citizens comprehensive smoking cessation programs and medications because of lack of funding and support. The KCHD serves as a public health leader in the state with one of only two full-time health officers in the state, home of state government and the largest media market which provides numerous opportunities to impact public health policy and public perception of smoking. Describe the public health issue that this practice addresses. (350 word limit)
The Kanawha-Charleston Health Department’s CLEAN initiative addresses the alarming rate of smoking in Kanawha County and West Virginia as well as the need for a comprehensive clean indoor air regulation. 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 fifteen 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. Tobacco is the leading cause of death and disease in West Virginia. Almost 4,000 residents die each year from tobacco use and if the current trend continues, over 40,000 more residents will die by the year 2020. According to the Trust for America’s Health West Virginia has the highest average of adult smokers with 26.3% and 21.8% of high school students currently use tobacco. According to the 2009 BRFSS 15.8% of respondents in Kanawha County smoke every day compared to 20.7% for WV while 5.7% smoke some days, 26.3% are former smokers and 52.1% never smoked. The economic costs of tobacco use are incredibly high in West Virginia. These costs are estimated to be $2 billion annually from direct healthcare cost and occupational productivity cost. It is estimated through the Campaign for Tobacco-Free Kids that 410 adults die annually from secondhand smoke. What process was used to determine the relevancy of the public health issue to the community? (350 word limit) The Kanawha Coalition for Community Health Improvement along with community agencies conducted its community health assessment in 2006. The survey covered a wide variety of health topics and was designed to determine the community’s perception of health needs and concerns, and to provide some indication of actual health-related behaviors. The survey also addressed a number of social and economic concerns. The Kanawha Coalition’s comprehensive community health assessment is comprised of four components: telephone survey among randomly selected Kanawha County households, paper/electronic surveys among Kanawha County key informants, data analysis (survey results and existing health statistics) and a community health issues forum. The report is divided into categories including; Community Life; Access to Health Care; Dental Care; Tobacco; Physical Activity; Safety; and Key Health Statistics. Under each category are the community perceptions based
on the results of the telephone survey, comments from key informants, and related health statistics for Kanawha County as compared to State and National data. This report was prepared for release during the 2007 Community Health Issues Forum at which community members are to decide the top health issues around which the Kanawha Coalition will focus its efforts for the next three years. 38% of those responding to the telephone survey said they smoked every day or some days, among those who had smoked during the last twelve months, 25% said they had tried to quit smoking during the past year. When respondents were asked to identify the biggest health problems in Kanawha County the following were ranked highest: obesity (87%), heart disease (84%), high blood pressure (84%), cancer (81%), ATV accidents (78%), diabetes (75%) and lung disease (70%). During the community forum the attendees ranked the top three concerns to work on during the next three years and the issues in which the coalition would focus on were obesity, physical activity and tobacco. How does the practice address the issue? CLEAN encompasses the enforcement of the comprehensive clean indoor air regulation and the use of social marketing with community events to raise the awareness and support of the Kanawha-Charleston Health Department’s goal for a smoke free community. 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.
Is the practice new to the field of public health? If so, answer the following questions. Yes What process was used to determine that the practice is new to the field of public health? Please provide any supporting evidence you may have, e.g. literature review. 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-faceted 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 regulation. The social marketing campaign, community events to support the clean indoor air regulation and the extensive enforcement of the regulation makes it a unique practice that encompasses a variety of support mechanisms. As a follow-up in 2011 KCHD partnered with the American Cancer Society, American Lung Association, American Heart Association, Kanawha Coalition for Community Health Improvement and the Tobacco Free West Virginia Coalition to place a billboard along a major interstate to promote the Clean Indoor Air in Kanawha County. How does this practice differ from other approaches used to address the public health issue? 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 practice also provides a positive community involvement and support into the clean indoor regulation. Is the practice a creative use of an existing tool or practice? If so, answer the following questions. No What tool or practice (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, etc.); did you use in a creative way to create your practice? (if applicable) (300 word limit total)
a. Is it in NACCHO’s Toolbox; (if not, have you uploaded it in the Toolbox)?
b. If you used a tool or practice to implement your practice, how was your approach to implementing the tool unique and innovative for your target area/population?
What process was used to determine that the practice is a creative use of an existing tool or practice? Please provide any supporting evidence you may have, for example, literature review. How does this practice differ from other approaches used to address the public health issue? Who were the primary stakeholders in the practice? Kanawha-Charleston Health Department and the Kanawha Coalition for Community Health Improvement What is the LHD's role in this practice? The Kanawha-Charleston Health Department is actively involved in the Kanawha Coalition for Community Health Improvement since its inception in 1994 and has 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. What is the role of stakeholders/partners in the planning and implementation of the practice? 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.
What does the LHD do to foster collaboration with community shareholders? Describe the relationship(s) and how it furthers the practice's goals. 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. Describe lessons learned and barriers to developing collaborations The Kanawha Coalition for Community Health Improvement is a model community coalition since 1994 with the leadership composed of CEOs and Executive Directors for all major hospitals including mental health, health department, county school and worksite wellness organizations. The Coalition is charged with identifying and evaluating health risks and coordinate resources to measurably improve the health of the people of Kanawha County. The agendas are left at the door and the focus is solely on the health of our residents. Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improves practice.
Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).
List up to three primary objectives for the practice. For each objective, provide the following information: (750 word limit per objective)
1. 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.
2. Decrease the morbidity and mortality from acute coronary syndrome through clean indoor air regulation.
3. 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. • Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
• Data: List secondary and primary data sources used for the evaluation. Describe what primary data, if any were collected for each performance measure, who collected them, and how.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
• Feedback: List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.
1. 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.
Performance Measures: The number of inspections completed, the number of violations found and the number of court cases filed.
Data: In September 2008, two months after implementation there were 769 inspections completed with fifty-six violations in which two court cases were filed. The percentage of violations vs. inspections was 7.28% in September 2008. The percentage continued to decline through the next two years with September 2010 violations were 0.41% of total inspections yet six court cases were filed. Overflow (Objective 1): Please finish the response to the question above by using this text area. Please be mindful of the word limits. 2. Decrease the morbidity and mortality from acute coronary syndrome through clean indoor air regulation. Performance Measures: For each Kanawha County resident, basic information for each patient included the date of hospital admission/discharge, diagnostic code, age, sex, race, associated medical history such as diabetes and smoking status. Data: Data was obtained from the three major acute care hospitals that serve Kanawha County, including the largest in the state. The ICD-9-CM diagnostic codes for myocardial infarction, non=ST segment elevation myocardial infarction, or unstable angina were examined. Evaluation Results: The study included 14,245 hospital patients who were admitted for ACS between January 1, 200 and September 30, 2008. Of them, 8,075 (57%) patients were men; 3,633 (26%) were smokers, and 5,048 (35%) had diabetes. The number of hospital admissions of ACS per year declined over the entire period, from 1,949 patients in 2000 to 1,208 in 2008. This decline was most pronounced among nonsmokers, women, and adults without diabetes. The cumulative decrease in the age-adjusted ACS hospitalization rates between 2000 and 2008 was 37% overall, 36% for men and 39% for women. The patterns of decline over time were similar for men and women. However, when we stratified the age-adjusted rates of hospital admissions for ACS by smoking status, the observed decline of age-adjusted hospital admission rates for ACS was significant only among nonsmokers (both men and women). Declines in the age-adjusted rates for hospital admission of ACS were also noted by diabetes status. Feedback: The study was released through the national media in partnership with the American Lung Association. A press conference was held at the Kanawha-Charleston Health Department to announce the findings. The study was published in the CDC's Preventing Chronic Disease journal in July 2011. Overflow (Objective 2): Please finish the response to the question above by using this text area. Please be mindful of the word limits. Objective 3: 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 ran. Over a thousand people attended the Pack the Park for Public Health Event on July 10, 2010. A billboard was placed in the spring of 2011 to highlight the partnerships with ACS, AHA and ALA as well as local coalitions to promote the clean indoor air in Kanawha County.
Overflow (Objective 3): Please finish the response to the question above by using this text area. Please be mindful of the word limits. What are the specific tasks taken that achieve each goal and objective of the practice? August 28, 2008: Met with Chas. Area Alliance. January 23, 2009: Campaign Planning Meeting February 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. January 23, 2009: Campaign planning team selected language for billboard Feb. 5, 2009: Recruited Emily Frye to develop concepts for billboard and 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 2 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 6am – 7pm, 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.
What was the timeframe for carrying out these tasks? Began in August 2008 with planning the Eat, Drink and Breathe Easy campaign ran through July 2009 with special events and marketing sporadically through 2010 and 2011. Is there sufficient stakeholder commitment to sustain the practice? Describe how this commitment is ensured. The “tide is turning” in Kanawha County from controversy to acceptance and support for our 100% Clean Indoor Air regulations. The Eat, Drink and Breathe Easy campaign April 23, 2009 kick-off event received news coverage which highlighted the owner placing one of the 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 that were blatantly non-compliant with the new CIA regulation. 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 16th between the hours of 6:00 a.m. and 7:00 p.m. 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 and 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. In 2010 a “Pack the Park for Public Health” was held to thank the Kanawha-Charleston Health Department Board of Health Members, sanitarians and other staff for the passage, enforcement and regulation of the clean indoor air regulation. In 2011, a partnership was form with AHA, ACA and ALA to place billboards to promote Kanawha County’s Clean Indoor Air Environment. 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. Describe plans to sustain the practice over time and leverage resources. 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. 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 about smoking. As stated in the report, most comprehensive smoking restrictions often originate at the local level and many states have enacted
comprehensive statewide smoke-free laws only after numerous communities have adopted such laws. In West Virginia, the grassroots effort to ensure smoke free environments is essential in engaging the public and garner support. KCHD has also received support from NACCHO and CDC for strategic planning in the area of tobacco prevention and control to set a five year strategic plan to ensure a Smoke Free Kanawha County. The Kanawha-Charleston Health Department and the Kanawha Coalition for Community Health Improvement's partnership
continues to enhance the smoke free environment in Kanawha County and demonstrates the sustainability of community based initiatives. Through using the media outlets in Kanawha County the reach is extensive throughout West Virginia since these outlets reach a majority of the population.
Practice Category Choice 1: Practice Category Choice 1, Part 2: Tobacco Practice Category Choice 2: Practice Category Choice 2, Part 2: Marketing. Branding and Promotion Practice Category Choice 3: Practice Category Choice 3, Part 2 Social Media Check all that apply. I am a previous Model Practice Applicant Colleague in my health department E-mail from NACCHO NACCHO Web Site NACCHO Exchange NACCHO Connect |
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