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TOBACCO FREE
LAKE COUNTY
6/30/2014 Preventing Youth Initiation and Promoting
Adult Cessation
Page 1
Table of Contents
I. Introduction Letter of Welcome 2
Community Based Action Research 3
Tobacco in Lake County 7
II. Action Plan Tobacco Retail 10
Family Use and Exposure 12
School Policies 13
Tobacco Free Parks 14
Support for Adult Cessation 16
Youth-Adult Partnerships 18
III. Capacity Assessment Community Partners 20
Tobacco Education and Outreach 21
Adult Tobacco Cessation Support 22
Existing Tobacco Cessation Programs 23
2013 Policy and Program Scan 24
Page 2
TO B A C C O I N U S E
L A K E C O U N T Y
R E TA I L E N V I R O N M E N T
FA M I LY E X P O S U R E
S C H O O L P O L I C I E S
T O B A C C O F R E E PA R K S
A D U LT C E S S AT I O N
Y O U T H PA R T N E R S H I P S
I. Introduction
Welcome to the Lake County 2014 Tobacco Free Lake County Report.
This document highlights six focus areas that can guide our coalition’s work to curb tobacco use in Lake
County. It also attests to the intellectual and leadership abilities of our high school students. From statistical
analysis, survey development and administration, teamwork, retail mapping, interviewing, public speaking,
digital media production, and writing; students demonstrated that they care about making a difference in their
community and have the abilities to do so. This report was prepared by LCBAG staff with help from our
youth interns. Many of the ideas were inspired
by Lake County youth who engaged in learning
and leading.
From December 2013-June 2014, Lake County
Build a Generation conducted this assessment
to learn about tobacco prevention and cessation
possibilities in Lake County. Partnering with
our local high school, we placed students at the
forefront of this work. From analyzing Healthy
Kids Colorado Survey Data, conducting
supplemental surveys of the student body,
extending student research in a 5-week after
school program, and hiring interns, youth made
important commitments and insights regarding
tobacco use in Lake County.
It is our hope that this report guides timely,
meaningful and effective actions to curb
tobacco use in Lake County.
Sincerely,
Erin Allaman
Director of Research and Evaluation
Lake County Build A Generation
Page 3
Researchers
Gerardo Carrasco
Dominic Griego
Briana Jaramillo
Berlie Mascarenez
Tori Stamps
Quintin Vigil-Highhawk
Walter Valdez
Erin Allaman
Rachelle Collins
Karl Remsen
WHY DIGITAL MEDIA?
RESEARCHERS WERE EQUIPPED WITH IPADS.
THE TABLETS SUPPORTED VIDEO EDITING,
NOTE TAKING, AND PHOTOGRAPHY. THEY ALSO
DISPLAYED SURVEY FORMS, AND GAVE ACCESS
TO WEB-BASED POPULATION LEVEL DATA
IPADS PROMOTED STUDENTS’ MEDIA
LITERACIES. STUDENT RESEARCHERS
COULD DRAW ON THEIR OWN FUNDS OF
KNOWLEDGE WITH MEDIA (FROM EASE WITH
TOUCH SCREENS TO SELECTING IMAGES AND
MUSIC FOR VIDEOS) WHILE ENGAGING IN
CRITICAL MEDIA LITERACY TO BECOME
PRODUCERS, RATHER THAN CONSUMERS, OF
MEDIA MESSAGES.
COMMUNITY BASED ACTION RESEARCH
Overview
Lake County Build a Generation’s longest-running project has
been an environmental change initiative for, tobacco and other
drug prevention (ATOD). Working with a coalition of agencies,
Lake County Build a Generation has worked to understand–and
address–the root causes of addiction in our community.
During 2013-14, LCBAG worked on an assessment project to
understand youth initiation and adult cessation, with regard to
tobacco. This tobacco assessment was funded through by a grant
from a State Tobacco Education & Prevention Partnership grant
(STEPP) from the Colorado Department of Public Health and
Environment.
This initiative had three parts.
Students in two statistics classes at Lake County High School analyzed data from Healthy Kids Colorado
and created digital stories to explain the stories they saw in the data.
A series of seven focus groups that were held with youth and adults in the Spring of 2014 to understand
adult use, knowledge about tobacco use and interest in cessation support.
A team of six youth researchers who conducted a retail assessment, interviews with key community
leaders, and a Photovoice project to understand
youth initiation.
Youth Adult Partnerships
For the youth initiation prevention components of
the tobacco assessment, Lake County Build A
Generation staff member Erin Allaman worked
with Lake County High School math teacher Karl
Remsen to create the project. In December, two
of his high school statistics classes analyzed our
local Healthy Kids Colorado Survey data. With
guidance from Karl and Erin, they looked for
patterns and trends that resonated or challenged
their own experiences and then analyzed the
statistics. Using poetry, they worked in small
groups to write “I am” poems. These poems began
to tell a story about alcohol, tobacco and other
drug use as well as other topics. Their culminating
project was to create digital stories using a web-
Page 4
based video editing program, Animoto, to tell the story they found in the statistics.1
Students from these statistics classes were invited to participate in a 5-week after-school program to focus on
tobacco. Seven students enrolled and six completed the program, earning a $100 stipend for their research
work.
Both phases of the youth initiation assessment followed a Youth Participatory Action Research (YPAR)
model. YPAR engages youth in research and leadership through partnerships with adults. As youth explore
their communities using research tools, they gain a deeper understanding of their community and develop the
skills they need to become advocates for change.
Youth Participatory Action Research
For the five-week after school program, Erin led the youth researchers through the Youth Engaged in
Learning and Leading curriculum; a youth research
resource developed by Stanford’s John W. Gardner’s
Center for Youth and their Families.2
The first meeting covered roles and responsibilities,
group norms and their interest in tobacco. All of the
researchers came to the group with a personal story
about how tobacco affected them and their families-
from parents or grandparents who smoked to personal
stories about their own addiction to tobacco. They all
wanted to make a positive change in their community
and learn more about the topic.
Over the next few weeks, they would use the iPads to
conduct a scavenger hunt and retail inventory of
tobacco sales in Lake County, conduct a panel
interview with officials from Lake County Public
Health, City Council, their High School, a parent and
multi-unit housing resident, the new school safety
officer and Leadville Police Department.
Transitioning from data collection to analysis, they reviewed national and state statistics about tobacco use
and second hand exposure from the Colorado Department of Public Health and Environment website,
photographs and survey summaries from the scavenger hunt, and interview summaries from the panel of
interviews
Using reflective worksheets, researchers developed themes. They completed individual reflection and toured
data “stations” to compare their ideas with the primary data sources. Then, we came together as a group and
mapped out our general findings. Themes included:
A high concentration of tobacco retail near where youth hang out
1 Student videos can be viewed at: https://sites.google.com/site/lakecountymath/ypar-lcbag-videos
2You can access the Youth Engaged in Learning and Leading (YELL) curriculum guide at:
http://gardnercenter.stanford.edu/our_work/yell.html
Page 5
A higher rate of tobacco use among adults than youth
An increasing presence of electric cigarettes at school
A focus on punishment rather than education and cessation support in schools
The youth research team then synthesized their findings into Photovoice projects. Selecting a photograph, or
taking a new one, they created a visual representation of their findings through image. Then, they turned to
their data set to substantiate their claim using statistics and collective experiences. Finally, they made
suggestions about what our community should do or consider doing to counter tobacco.3
Image to Action
The students presented their findings at an Image to Action event in March. Erin provided an overview of
the research process and then attendees visited the Photovoice exhibit. Researchers stood next to their
photographs, which were printed and mounted on large foam boards and arranged in a circle in part of the
room. For more than an hour, adult attendees engaged in in-depth conversations with researchers about their
photographs and knowledge about
tobacco in our community. This
included Leadville’s Mayor Jaime
Steuver, LCBAG Staff, Public Health
Director Colleen Nielsen, teacher
Karl Remsen and Coalition members
Mary Cannell, Marco Peinado and
Kelly Hofer. Full Circle’s boys group
also attended: Rohan Roy and Makali
Beck along with about 10 middle
school boys group were able to view
the projects and learn more about the
risk of tobacco use.
Following the exhibit and small
group conversations, we came
together as a full group and discussed next steps. Drawing from the post-it note comments left on the
photovoice projects and notes taken during the conversations, the image to action even was successful in
developing a tobacco prevention plan and building greater youth leadership. It was successful because adults
came ready to listen to youth’s ideas and the Photovoice projects were a good entry point for conversation.
Youth researchers also came prepared with knowledge, demonstrated commitment to their projects and
maturity in conversations with adults and younger students. Many commented that they were impressed, and
this allowed all of us to re-envision youth as leaders in community initiatives.
Next steps that were proposed by the group:
Include all tobacco in future work: chew, cigarettes, e-cigarettes
3 More information about this process can be viewed in a Prezi at: http://lcbag.org/initiatives/student-programs
Photovoice is an evidence-based practice. See: Wang, Caroline, and Mary Ann Burris. "Photovoice: Concept, methodology,
and use for participatory needs assessment." Health education & behavior 24.3 (1997): 369-387.
Page 6
Address tobacco retail: explore e-cigarette regulation including what stores can sell, what rules are
there about them? The city should be proactive on raising prices so tobacco is not affordable
Revisit school policies and consistent enforcement: help kids quit when they are caught with tobacco,
while also enforcing rules around tobacco and marijuana because it reinforces an important message
from adults that it’s wrong to use these substances
Build on the power of youth as leaders: older students teaching younger students and students as
advocates for changes in city and county
Continue to learn more about tobacco: Consider community norms about where people can/should
people be allowed to smoke, the connection between tobacco, marijuana and other addictions
Focus on positive: offer positive, healthy, affordable options for kids
Focus Groups
In addition to the youth prevention research, Rachelle and Erin conducted focus groups to learn about the
cessation resources currently available to tobacco users, attitudes and knowledge about tobacco in our
community, and to develop additional cessation support for current tobacco users.
From March-June 2014, we conducted seven focus groups with adult tobacco users and health providers:
Health and Human Services
Lake County Government Employees
Rocky Mountain Family Practice Medical Providers
West Central Mental Health Providers
Lake County High School Students (2 groups)
Current Tobacco Users
These focus groups helped us understand the needs and interests of tobacco users, youth, and how to support
medical providers with training and resources to support tobacco cessation throughout our community.
During June 2014, Erin and two Tobacco Youth Interns, Dominic Griego and Walter Valdez compiled this
report. They reviewed the retail assessment, focus group summaries, photovoice projects, population-level
data from CDPHE’s Colorado Health Indicators database, and collected additional survey data about tobacco
use in parks.
Population Level Data
Our research team also referred to the 2013 Lake County Build a Generation Risk Assessment, 2011 Lake
County Public Health Assessment and Improvement Plan and the Colorado Department of Public Health’s
Colorado Health Indicators data portal.
The reports are available at the Lake County Build A Generation website: www.lcbag.org
The Colorado Health Indicators are at:
http://www.chd.dphe.state.co.us/HealthIndicators/Default.aspx
Page 7
THIS PICTURE SHOWS TOBACCO RETAIL IN
LAKE COUNTY. IN THE UNITED STATES,
PEOPLE SPEND 193 BILLION DOLLARS ON
HEALTH CARE BILLS BECAUSE OF TOBACCO.
THERE IS A BIG INCOME LOSS BECAUSE PEOPLE
ARE SPENDING MONEY ON TOBACCO
PRODUCTS. IN THE END PEOPLE EITHER DIE
FROM HEALTH PROBLEMS OR THEY ARE IN
DEBT BECAUSE OF THE HEALTH CARE BILLS
CAUSED BY TOBACCO. IS THERE A WAY TO
PREVENT THIS IN LAKE COUNTY?
-BRIANA JARAMILLO
TOBACCO IN LAKE COUNTY
Populations that demonstrate higher rates of tobacco use and are most vulnerable to tobacco marketing
include youth, low-income workers, adults who have less than a college degree and young adults who go
directly to workforce from high school.4 Leadville’s workforce demographics place the Leadville/Lake
County’s population at greater risk for tobacco
use.
The educational attainment of Lake County’s
adult population is lower than statewide
averages. In Lake County, an estimated 80.8%
of residents have a high school education and
21.7% have a Bachelor’s degree or higher. Lake
County is home to many who work lower-
paying service jobs in neighboring Eagle and
Summit Counties. Lake County’s social and
economic statistics reflect the struggles of a
community whose economic foundation is not
local. The average commute from 2008-2011
was 35 minutes: placing much of the workforce
out of county.5 In 2012, median household
income in Lake County was $42,768, 77% of
the median household income for the state of
Colorado, $55,530.6
In 2012, 21.7% of residents lived in poverty,
compared to 12.2% in the state. In 2012, 27%
of Lake County’s children (approximately 500
children) lived in poverty (state=18%).
Youth Initiation in Lake County
Youth tobacco use has continued to decline in
Lake County. Middle and high school students
report lower rates of 30 day use and lifetime
cigarette smoking than in previous years. Along
with national trends, there has been a steady decline in cigarette smoking in recent years. Lake County
students try cigarettes at similar rates to young people across the country: 32% of 10th graders and 44% of
12th graders reported that they had smoked a cigarette in their lifetime. However, regular use is declining:
12% of high school seniors reported smoking in 2012, while too few 10th, 8th and 6th graders smoked in the
last 30 days to report percentages. Like cigarettes, smokeless tobacco use has fallen off among students-- less
4 STEPP Grantee Training. Fall, 2013.
5 U.S. Census
6 U.S. Census
Page 8
05
1015202530
Youth Exposure to Tobacco in Region 13 compared to
Colorado (%)
Region 13
Colorado
than 3% reported 30-day use in 2012. 7 Lake County’s youth cigarette use rate is similar to state averages: in
Colorado 15.7% of high school students use cigarettes (2011) and in Lake County 12% do.8
However, more specific inquiry by Lake County High School Students showed that our young people
continue to be exposed to tobacco
marketing, retail and adult use.
Electric cigarette (e-cigarette) use is
an emerging pattern in youth
initiation of tobacco products. A
survey of LCHS students in the 2013-
2014 school year showed that 29% of
high school students have tried e-
cigarettes and of those who use e-
cigarettes, 85% use on at least a
weekly basis. LCHS students report
using them at home and school and
almost half consider them healthier
than regular cigarettes.
In a retail assessment, youth researchers also found that many tobacco retailers are places where youth hang
out or near youth hangouts. Prior to the Image to Action event where youth researchers presented their
Photovoice projects, there was little awareness among city or county officials that retail licensing was an
option. Moreover, while schools to have tobacco-free campus policies, school efforts focus on discipline
rather than education, prevention and
cessation.
Adult Tobacco Use and Youth Exposure
Lake County’s adult tobacco use rate of
20.6% is slightly higher than the statewide
average (16.9%) and lower than its
grouping in Region 13 (24.3%)9
When it comes to youth exposure to adult
tobacco use, youth experience far higher
rates of exposure in Region 13, where
Lake County is situated, than in the rest of
the state. For example, the percent of
children (aged 1-14 years) who rode in a
car with someone who was smoking in the
past 7 days 2008-2010 was 11.4%, more
7 Healthy Kids Colorado Survey (HCKS), Monitoring the Future (MTF), Youth Risk Behavior Surveillance System
(YRBSS) 8 Colorado Health Indicators. Colorado Department of Public Health.
http://www.chd.dphe.state.co.us/HealthIndicators/indicators.aspx?dID=5&sdID=28&cID=65&rID=13 9 Region 13 includes Lake, Chaffee, Fremont and Custer counties
Page 9
than double the state rate of 5.5%. Children were also more likely to live in homes where someone had
smoked in the past 7 days 2008-2010 in the Upper Arkansas region (6.6%) than statewide (3.7%).10 A
higher percent of women smoked during the last three months of pregnancy in Region 13 as well (Region 13
19.4%, Colorado 8.4%).
In focus groups, adults and youth demonstrated knowledge that tobacco use led to significant health concerns
for users and those exposed to second hand smoke. Many knew family members who suffered from poor
health because of tobacco use. Youth respondents shared that they all knew family members who smoked, in
cars and in homes. While some had family members who smoked outside of their home, many felt powerless
to ask parents, grandparents and other relatives to not smoke near them.
Several themes emerged from our assessment of youth initiation and adult cessation of tobacco. These
include
A need for increased regulation of the tobacco retail environment
Outreach and education concerning youth exposure to tobacco from family members and in multiunit
housing
Enhanced tobacco-free policies and prevention practices in the Lake County School District
Addressing tobacco-free parks and trails through city policies that would support enforcement of
park rules
Greater support for adult cessation through health practitioner training, local support groups and
employer wellness programs
Ongoing development of youth-adult partnerships in tobacco-free advocacy work
10
Colorado Health Indicators.
Page 10
II. ACTION PLAN
THE RETAIL ENVIRONMENT
Youth researchers conducted a retail assessment. Using iPads, they set off in teams on a scavenger hunt
to discover Leadville/Lake County’s tobacco retail environment. They found that many places that sell
tobacco are near to youth hangouts. High school students also frequent our convenience stores to
purchase lunch and snacks-making some convenience stores youth destinations.
Youth researchers surveyed 10 retail stores (one store denied them access). Almost all of the tobacco
retailers in Lake County are located on the main corridor through town- situated on the north and south
ends of Highway 24. Most of these retailers are convenience stores, but also include a liquor store and
grocer.
During the scavenger hunt, youth researchers created a description of the retail environment. They
found that 8 of 9 retailers had “a lot” of advertising, which youth researchers thought was mostly
directed toward adults. This included ads on store doors, building walls, and ads with multi-pack
discounts. All stores had “power wall” and branded displays.
Page 11
MANY PLACES THAT SELL TOBACCO ARE PLACES
THAT TEENS CAN EASILY ACCESS. 57% OF THE
PLACES THAT SELL TOBACCO IN LEADVILLE ARE
PLACES WHERE YOUTH HANG OUT, OR WITHIN ½
BLOCK AWAY FROM YOUTH HANGOUTS. HERE WE
SEE INSIDE A CONVENIENT STORE WITH MANY ADS
AND BRANDS OF CIGARETTES POSTED ON THE
WALL AS WELL AS E-CIGARETTES BEING
DISPLAYED AT EYE LEVEL FOR KIDS. I BELIEVE
SOMETHING NEEDS TO BE CHANGED ABOUT THE
RULES IN ADVERTISING AND THE PLACES THAT
THEY PUT ITEMS FOR DISPLAY.
–DOMINIC GRIEGO
When it came to youth appeal, 57% of tobacco
retailers were within ½ block of a young hang
out and 86% were within 1 block of where
youth spend time. Within the stores, youth
researchers reported that tobacco was marketed
to appeal to youth through unavoidable
advertising near food and at the counter, as e-
cigarettes in flavors on the counters and low-
cost flavored cigars and cigarillos. E-cigarettes
were most noticeable: they were located near
the counter, at eye-level for kids.
At the Image to Action event, youth researchers
presented these findings. The mayor and public
health officials were in attendance. They were
unaware of the city and county’s capacity to
regulate tobacco, but concerned at the
connections they saw between retail
availability, youth appeal and the absence of
efforts to protect youth from tobacco marketing.
They were interested in learning what other
communities have done to curb youth exposure
to tobacco in retail stores, and to learn more
about their ability to regulate tobacco retail.
Through our work with the Colorado
Department of Health and Environment, we
learned that there are proven and promising
policies that can limit youth exposure to
tobacco retail and advertising. These policies
can include zoning, coupon bans, advertising
limits and taxes.
R E C O M M E N D E D A C T I O N S T E P S
Work with City and County officials to pass proactive regulation of tobacco retail that address
advertising, placement of advertisements, redemption of coupons, promotion through discounts, and
youth-appeal items
Youth engagement in educating policy makers about impact of tobacco
Page 12
THIS PICTURE SHOWS US THE KIND
OF CIGARETTES THAT CAN EASILY BE
SEEN BY PEOPLE IN LAKE COUNTY. IN
THE UPPER ARKANSAS REGION,
11.4% OF CHILDREN AGES 1-14 RIDE
IN CARS WITH PEOPLE WHO HAVE
BEEN SMOKING AND 6.6% LIVE WITH
PEOPLE WHO SMOKE- DOUBLE THE
STATE AVERAGES. KIDS WHO ARE
AROUND PEOPLE THAT SMOKE ARE IN
DANGER OF SECOND HAND SMOKE.
-TORI STAMPS
FAMILY TOBACCO USE AND EXPOSURE
As detailed in the introduction, Lake County youth
experience far higher rates of exposure to adult tobacco use
than in the rest of the state. Lake County youth are at greater
risk for second hand smoke exposure in cars and homes than
their peers across the state.
Interviews and focus groups revealed that many youth are
concerned about the health of their family members who
smoke, and their own health because they are exposed to
second hand smoke. Some young people told stories of
convincing loved ones to quit smoking, while others relayed
the struggle of being powerless to change the behavior of
adults in their families. Others struggled with the burden
tobacco placed on their family economics, considering the
cost of tobacco products and the impact of health costs related
to tobacco use.
We considered regulations for multi-unit housing
complexes and learned that there are currently are no
regulations to limit tobacco use in city or county multi-unit
housing. Future efforts to limit indoor smoking are
compounded by rules limiting marijuana use to private
residences. This presents a challenge in improving indoor
air quality and protecting young people from second hand
smoke.
From a youth perspective, this topic raised interesting
possibilities such as the potential influence young people
could have in shifting their adult family member’s
behavior, and empowering young people to advocate for
their health within family circles.
R E C O M M E N D E D A C T I O N S T E P S
Greater enforcement of current policies, including
Colorado’s Clean Indoor Air act, in workplaces
Explore multi-unit housing bans
Education to parents and families about second hand smoke exposure
Support to students who would like adults in their lives to quit smoking
Page 13
THIS PICTURE SHOWS A STUDENT AT
LAKE COUNTY HIGH SCHOOL NOT
REALLY CARING ABOUT GETTING
CAUGHT WITH TOBACCO. 12% OF
SENIORS SMOKE CIGARETTES AND
THE POLICY FOR HAVING TOBACCO
AT SCHOOL IS SUSPENSION. THE
POLICY SHOULD BE CHANGED FROM
PUNISHMENT. THE SECOND TIME A
STUDENT IS CAUGHT THEY SHOULD
SIT DOWN AND TALK ABOUT WHY
THEY USE TOBACCO AND THE HARM
THAT COMES WITH USING TOBACCO.
-GERARDO CARRASCO
SCHOOL POLICIES
Insights from youth researchers, focus groups with youth and youth researcher interviews of school
officials revealed that there is more work that can be done
in the Lake County School District to prevent youth
tobacco initiation.
High school students explained that they knew that
tobacco was not allowed in schools. However, they had
witnessed teachers using chewing tobacco and observed
peers (mostly male) regularly using electric cigarettes
during school. E-cigarettes were easily disguised by
students and youth agreed that the flavors encouraged
experimentation. They brought this up in an interview
with their principal and they discussed the challenges of
enforcing school tobacco-free policies.
Student researchers suggested that more education to
students and teachers about the risks of tobacco (and
especially e-cigarettes), what school policies are related
to tobacco, and revisiting consequences for possessing
tobacco products on campus would be beneficial to
students.
Youth also reported that tobacco is easy to get from older
friends and family, and even parents in some instances.
Students reported that little was known about the risks of
e-cigarettes and they had even witnessed elementary age
students trying them. These stories may be isolated, but
also should be taken as cautionary. While cigarette use is
declining among students, flavored products and e-
cigarettes are providing new gateways to tobacco use
among youth in Lake County.
R E C O M M E N D E D A C T I O N S T E P S
Continue to enforce tobacco free campus policies
Explore models for restorative policies including tobacco cessation support for students
Provide education about e-cigarettes and risks of tobacco use to students and families
Page 14
Increase youth media literacy about tobacco marketing that targets youth
Increase awareness of school administration about e-cigarette use
Clarify school policies around tobacco use for youth and adults
Involve youth leaders in providing education to students of all ages and families about tobacco
products
TOBACCO FREE PARKS
By: Walter Valdez and Dominic Griego
Since Lake County started receiving a tobacco
prevention grant, we wanted to see how parks
are affected by tobacco products. We met with
Lake County and Leadville City officials, and
also surveyed 56 people in the community to
see what they thought about tobacco use.
Our first step was meeting with officials of
Lake County and the City of Leadville. We
learned that tobacco use at parks in Lake
County is a big concern. With LCBAG, we also
looked at the current rules at the Huck Finn
Park. The rules state that Alcohol, Drugs, Tobacco products and smoking are prohibited.
We also learned that the parks are owned by the county but they are in city limits so there was some
confusion was about who creates and enforces the regulations for the parks. We found out that the police
can give fines and tickets to underage violators dealing with tobacco, drug, and alcohol use. The City,
however, cannot enforce outdoor tobacco use for adults over 18 as easily, as this use is legal in the city
limits.
During the meeting a weather shelter was proposed to be placed at Huck Finn Park; LCBAG asked
community members through a survey if they thought it would encourage drug, alcohol, and tobacco
use. We found that youth (ages 10-17) were the most concerned with the shelter as they thought it would
encourage drug, alcohol, and tobacco use.
Another concern was how enforcement would
be handled. To maintain a healthy and safe
place to be at, we asked what community
members thought would be more effective. Our
choices were; fines and ticketing, signs, public
education, and police patrol. We found that
Page 15
community members thought fines and ticketing would be the best option to enforce these rules. Next it
was signs, then public education, and the one that the community said would not help enforce the rules
was police patrol around the park.
During the Tobacco survey, we asked if someone was caught violating the rules at the parks, what
consequence should they face.
The four answers they could pick
from were; community service,
banning from the park, a fine up to
$1000 or jail time. The top
consequence that was chosen was
community service and the least
favored consequence was jail
time.
We propose if the consequence
were to be community service and
the person(s) were caught using
tobacco products, using drugs, or drinking alcohol, they must clean areas of litter related to their
violations
We also asked the community where they think tobacco free places should be. From our survey,
community members feel that playgrounds, the community field, picnic areas, and the skate board park
should be tobacco free. A majority of them also said that Campgrounds and Rodeo Grounds should be
the less restrictive on tobacco use. After our meeting with City of Leadville and Lake County officials,
we can see that tobacco is being looked at more, especially at our parks. We do see some concerns with
tobacco use, but our hope in the future is that these concerns will reduce and that the parks in Lake
County will be even more of safer and healthier place to be at.
R E C O M M E N D E D A C T I O N S T E P S
Create community service requirement for a violation and make recommendation to City Council
Continue to work with City and County to coordinate enforcement of park rules
Make sure rules are clearly posted at all parks
Propose a tobacco free policy for the City of Leadville. This will help the police enforce Lake
County Parks and Recreation rules about tobacco free parks.
Page 16
Adult Cessation Partners
Rocky Mountain Family Practice
Dr. Lisa Zwerdlinger
Tyler Nortan, P.A.
Amy King, P.A
St.Vincents Hospital
Karen Rhinehart
Andy Hofer, P.T.
Jackie Duba, P.A.
Lake County Health and
Human Services
Colleen Nielsen
Janen McGee
Lake County Wellness Committee
Tamara Moses
QUITLINE SAMPLE MARKETING
SUPPORT FOR ADULT CESSATION
Through our focus groups with adult tobacco users
who work and live in Lake County, we learned that
most adult tobacco users in Leadville have tried to quit
smoking or would like to quit. Most of the tobacco
users we talked to smoked cigarettes while some used
chewing tobacco. Many were sensitive about their
tobacco use, knowing that it was not viewed positively
by their families and people that they encountered in
the community. Many had experienced negative
interactions with the public for smoking and were
concerned that health campaigns might villanize them
for using tobacco. The understood that tobacco was not
healthy, but were clear that “tobacco was bad” but this
should not encourage people to be rude and
demeaning to smokers.
We learned in focus groups that the Quitline was
not always an accessible cessation support in Lake
County. There is not widespread marketing of the
Quitline, and if often feels too distant. Many adult
tobacco users explained that they would rather
have a local support group where they and their
family members (often their spouses also smoked)
could receive support. They acknowledged that
tobacco cessation was difficult and would like to
get help with the weight gain and help with
alternative ways to reduce stress.
There are also workplace cultures within Lake
County and other employers that encourage
tobacco use. Employees find their work stressful
and turn to cigarettes as an excuse for a work
break, way to connect with colleagues and way to
relieve stress.
In our conversations with health care providers we
learned that there is a strong interest in training to
help their clients quit smoking. West Central and
Rocky Mountain Family Practice screen all clients,
Page 17
but are open to more training in how to support adult cessation. Likewise, Lake County Health and
Human Services providers were also interested in training that would prepare them to provide
organization-wide tobacco screening and cessation support.
We learned of a few important features that would augment adult tobacco cessation support.
One would be a consistent approach to tobacco cessation that all health providers could follow.
Second would be an independent tobacco cessation support office or provider where health
providers could directly refer clients. An important piece is that the tobacco cessation support
provider would be direct provider-provider referral.
Third, health providers would appreciate having more resources to direct their clients to-
including a brochure of local resources, culturally-specific Quitline resources (e.g. pregnant
women, Spanish-language speakers, youth, etc).
Fourth, they would also like to see more stress reduction and “fun” events that could help
encourage and support adults who were interested in adult cessation.
Rocky Mountain Family Practice providers also alerted us to the University of Colorado School of
Medicine’s “Tar Wars” program. They suggested that their medical residents could provide youth
tobacco prevention outreach as part of their monthly rotation in Leadville.
R E C O M M E N D E D A C T I O N S T E P S
Train health providers to screen and support adult cessation
Expand availability of Quitline brochures in schools and health provider offices
Support tobacco cessation in Lake County wellness program. Use as a pilot that could be expanded
to other employers.
Create local support group that had provider-provider referral and paid behavioral support
coordinator/ counselor. Provider-provider referrals
Consider pairing tobacco cessation with Get the Lead Out
Fund wellness supports and stress reduction opportunities with cessation program
Extend state cessation and prevention campaigns to Lake County.
Page 18
Out of the entire high school
only 12% of seniors smoke
cigarettes and 30% of all
LCHS students have tried e-
cigarettes. 20% of Lake
County adults smoke. Adults
and youth smoke differently.
Adults smoke where we can
see them while youth smoke
but they just hide it.
-Quintin Vigil-Highhawk
“YESTERDAY WAS GREAT HEARING
THE MESSAGES THAT THE KIDS WERE
GIVING OUT ABOUT TOBACCO. IT
WAS VERY POWERFUL TO HEAR
THEM TALK ABOUT IT TO OUR
GROUP AND GREAT TO SEE THE
INTEREST THAT WAS SHOWN BY THE
FULL CIRCLE KIDS.
THE WHOLE RIDE HOME THEY
WANTED TO TALK ABOUT WHAT THEY
HAD JUST LEARNED ABOUT
TOBACCO. IT WAS GREAT TO SEE
THEM ENGAGING WITH THE OLDER
STUDENTS AND LISTENING TO WHAT
THEY HAD TO PRESENT.”
YOUTH ADULT PARTNERSHIPS
The youth participatory action research model that was used to
engage youth on this tobacco assessment starts with the assumption
that youth can and should be involved in creating knowledge about
issues that affect them, and full participants in the decision-making
and crafting of policies that affect them.11
In this assessment work, Lake County High School students
demonstrated the power of youth leadership in countering tobacco.
For example, they provided insight on an issue that would otherwise
be difficult; the prevalence of e-cigarettes was developed through a
youth-generated survey in Mr. Remsen’s class, Berlie and Dominic’s
digital story, and a Photovoice presentation.
Quintin’s Photovoice project displayed on this page also reminds us
that youth can provide an important perspective on adult practices:
where youth use is often hidden, adult tobacco use is very visible to
youth in our community. These patterns in adult and youth use
suggest that partnering with youth is a powerful way to uncover
“hidden” tobacco use, and advocate for policy changes to make adult
use less present in
young people’s
lives.
Adult-youth
partnerships can
continue to be a
guiding tenet in
Lake County
tobacco prevention. This work supports positive
youth development, serves as a protective factor
against addiction, and teaches adults to overcome
stereotypes of youth while addressing the ways adult
behaviors impact young people.
In this project, youth researchers demonstrated the
power older students have to influence younger
students. The image to action event and subsequent
presentations made to Full Circle’s middle school
groups by high school researchers were a great
example of youth leadership in tobacco prevention.
Youth participants in focus groups also shared
11
How Participatory Action Research can Promote Social Change and Help Youth Development:
http://cyber.law.harvard.edu/sites/cyber.law.harvard.edu/files/KBWParticipatoryActionResearch2012.pdf
Page 19
important stories of how they were able to convince parents to quit smoking.
Several models for youth-adult partnerships were piloted in this assessment work: school-community
partnerships tied directly to the statistics curriculum, after school programs where researchers earned
stipends, and paid summer internships. Going forward, we can and should continue to elevate the
abilities, skills and interests of young people to ensure that they have a seat at the table in tobacco
prevention in Lake County.
R E C O M M E N D E D A C T I O N S T E P S
Sustain youth membership on LCBAG steering committee
Work with community partners to explore ways that high school youth can provide outreach
to .peers, younger students and families.
Display Photovoice exhibit at youth and family friendly events
Engage youth and parents in future policy changes and advocacy
Page 20
III. Capacity Assessment
The capacity of Lake County agencies to work on each of Lake County’s seven health indicators was
measured with a survey that was distributed online and asked each agency specifically about its capacity on
helping to 1. prevent youth initiation through education and outreach and 2. Support adult tobacco cessation.
We received responses from the following organizations:
COMMUNITY PARTNERS
Lake County Parks and Recreation Amber Magee, Program Director
amagee@co.lake.co.us
719-486-7486
Full Circle of Lake County, Inc Alice Pugh, Director
director@fullcircleleadville.org
719-486-2400
City of Leadville Jaime Stuever, Leadville Mayor
lvmayor@leadville-co.gov
719-486-2571
Lake County School District Cheryl Wells, School Nurse
cwellsleadville@qwestoffice.net
719-486-2028
Leadville Police Department Dan Hanson, Officer
danhanson@leadville-co.gov
719-486-1365
West Central Mental Health Center Anna Lauer Roy, Clinician
annal@wcmhc.org
719-486-0985
Lake County Public Health Agency Colleen Nielsen, Director
cnielsen@co.lake.co.us
719-486-4152
Jane Heins, Nurse
jheins@co.lake.co.us
719-486-4143
Lake County High School Christina Gosselin, Principal
cgosselin@lakecountyschools.net
719-486-6970
Karl Remsen, Math Teacher
kremsen@lakecountyschools.net
719-486-0746
Page 21
CAPACITY: TOBACCO EDUCATION AND OUTREACH
Display the Tobacco Photovoice
Exhibit to raise community
awareness about Tobacco (for 1
week).
Lake County Parks and Recreation
Full Circle of Lake County
City of Leadville
Leadville Police Department
West Central Mental Health Center
Lake County High School
Lake County Public Health Agency
St. Vincent’s General Hospital-Clinic
Host a brochure display with
information about the
Colorado Quitline or other
local or statewide cessation
tools.
Full Circle of Lake County
Lake County School District
West Central Mental Health Center
Lake County High School
St. Vincent’s General Hospital-Clinic
Provide educational materials
to clients/ program participants
(e.g. provide second-hand
smoke information to parents
or distribute information about
e-cigarettes to families).
Full Circle of Lake County
Lake County School District
West Central Mental Health Center
Lake County High School
Lake County Public Health Agency
St. Vincent’s General Hospital-Clinic
Rocky Mountain Family Practice
Provide support to youth
working on policy change in
Lake County in order to make
it more difficult for Lake
County youth to start smoking.
Lake County Parks and Recreation
Full Circle of Lake County
Lake County School District
West Central Mental Health Center
Lake County High School
Other
Full Circle of Lake County: presenting Choose Not to Use
curriculum (youth) and One Step curriculum (Parents)
Lake County High School: Help engage students in data work
Lake County Public Health Agency: We are open to suggestions
Page 22
CAPACITY: ADULT TOBACCO CESSATION SUPPORT
Help recruit employees or
community members to become
trained in cessation support
(LCBAG can cover costs for
training travel expenses).
West Central Mental Health Center
Lake County Public Health Agency
St. Vincent’s General Hospital-Clinic
Rocky Mountain Family Practice
Provide a space for cessation
support groups to meet
Lake County Parks and Recreation
City of Leadville
Lake County High School
St. Vincent’s General Hospital-Clinic
Offer wellness incentives to
participants of cessation program
Lake County Parks and Recreation
West Central Mental Health Center
Refer community members/clients
to local cessation support groups
Full Circle of Lake County
Lake County High School
Lake County Public Health Agency
St. Vincent’s General Hospital-Clinic
Rocky Mountain Family Practice
Refer clients or community
members to the Colorado Quitline
or other statewide web or phone
cessation support tools
Full Circle of Lake County
City of Leadville
Lake County School District
West Central Mental Health Center
Lake County Public Health Agency
Lake County High School
St. Vincent’s General Hospital-Clinic
Rocky Mountain Family Practice
Other
Full Circle of Lake County: Currently advertise and refer to
the Quitline
Lake County Public Health Agency: We are open to
suggestions
Page 23
CAPACITY: EXISTING TOBACCO CESSATION PROGRAMS
We ask clients/ participants if they
use tobacco products
Full Circle of Lake County
West Central Mental Health Center
Lake County Public Health Agency
St. Vincent’s General Hospital-Clinic
Rocky Mountain Family Practice
We provide information to
clients/participants about health
risks of tobacco
Full Circle of Lake County
West Central Mental Health Center
Lake County High School
Lake County Public Health Agency
St. Vincent’s General Hospital-Clinic
Rocky Mountain Family Practice
Offer wellness incentives to
participants of cessation program
We provide information to
clients/participants about tobacco
cessation resources
Full Circle of Lake County
West Central Mental Health Center
Lake County High School
Lake County Public Health Agency
St. Vincent’s General Hospital-Clinic
Rocky Mountain Family Practice
We are trained in the evidence-
based "5A's and an R" brief
intervention and referral tool and
we use it with clients
St. Vincent’s General Hospital-Clinic
Other
Full Circle of Lake County: We would like to collaborate
on any prevention initiatives
Lake County Public Health Agency: We would consider
using 5As and an R in house with training
Page 24
2013 SCAN OF EXISTING LAKE COUNTY DOCUMENTS WITH
TOBACCO INFO
Lake Region
13
Colorado Notes
CDPHE
Health
Indicators
Percent of
adults aged
18+ years
who
currently
smoke
cigarettes,
2008-2010
20.6% 24.3% 16.9% Adults appear to
smoke at rates
higher than state
averages, although
youth do not. It
would be
interesting to
understand when
regular use is
beginning. It
would also be
interesting to
understand if
certain sub-
populations are
more susceptible
to use beginning
in their late teens
or early 20s.
Percent of
children
(aged 1-14
years) who
rode in a car
with
someone who
was smoking
in the past 7
days 2008-
2010
11.4% 5.5% This appears to be
an issue worth
exploring. It
would be
interesting to
know if this is
particularly an
issue with
particular sub-
populations.
Percent of
children
(aged 1-14
years) who
live in homes
where
someone had
smoked in
6.6% 3.7% This appears to be
an issue worth
exploring. It
would be
interesting to
know if this is
particularly an
issue with
Page 25
the past 7
days 2008-
2010
particular sub-
populations.
Percent of
women who
smoked
during the
last three
months of
pregnancy
2008-2010
19.4% 8.4% This appears to be
an issue worth
exploring. It
would be
interesting to
know if this is
particularly an
issue with
particular sub-
populations.
Age-adjusted
incidence rate
of lung and
bronchus
cancer (per
100,000
population)
2007-2009
60.5% 50.9%
6th
8th 10th
12th
2012 Lake
County
Healthy Kids
Colorado
Survey
During the
past 30 days,
on how many
days did you
smoke
cigarettes?
Too small
to report.
Too small
to report.
8% said they
had smoked,
but the
number who
had smoked
on all 30 days
was too small
to report.
29% said
they had
smoked,
but the
number
who had
smoked on
all 30 days
was too
small to
report.
There is an
increase in past-30
day use as
students move
through high
school, though the
rates of students
using daily
appears to be low.
During the
past 30 days,
on how many
days did you
use chewing
tobacco,
snuff, or dip?
Too small
to report.
Too small
to report.
7% said they
had used, but
the number
who had used
on all 30 days
was too small
to report.
The
number
who had
used was
too small to
report.
Smokeless
tobacco appears to
be less of an issue
with students than
cigarettes—and, as
might be expected,
use is higher with
males than
females.
Page 26
How old
were you
when you
smoked a
whole
cigarette for
the first time?
17% said 15
or 16 years
old, which
was the most
common
answer.
15% said
15 or 16
years old,
which was
the most
common
answer.
It seems students
are most often
trying tobacco in
their Sophomore
or Junior Year, so
it might make
sense to target any
education efforts
to Freshman.
If you wanted
to get some
cigarettes,
how easy
would it be
for you to get
some?
20% say it
would be
“very easy”
or “sort of
easy”
20% say it
would be
“very easy”
or “sort of
easy”
65% say it
would be “sort
of easy” or
“very easy”
93% say it
would be
“sort of
easy” or
“very easy”
Students’
perception of how
easy it would be to
get cigarettes
increases pretty
dramatically
through high
school.
During the
past 30 days,
how did you
usually get
your own
cigarettes?
Too small
to report.
Too small
to report.
Too small to
report.
Most
common
answers
were “I
gave
someone
else money
to buy
them for
me” (10%)
and I
borrowed
them from
someone
else (13%).
It might be worth
exploring
advertising about
the penalties of
purchasing
tobacco for
minors.
How much
do you think
people risk
harming
themselves
(physically or
in other
ways), if they
smoke one or
more packs
of
48% said
“no risk” or
“slight
risk”
17% said
“no risk” or
“slight
risk”
13% said “no
risk” or “slight
risk”
15% said
“no risk” or
“slight
risk”
Is the 6th-grade
data a weird
anomaly?
Page 27
cigarettes per
day?
How wrong
do your
parents or
guardians
feel it would
be for you to
smoke
cigarettes?
3% said
“not
wrong” or
“a little bit
wrong”
2% said
“not
wrong” or
“a little bit
wrong
5% said “not
wrong” or “a
little bit wrong
12% said
“not
wrong” or
“a little bit
wrong
Overall,
perception of
parent disapproval
seems strong.
How wrong
would most
adults in your
neighborhood
, or the area
around where
you live, feel
it is for kids
your age to
smoke
cigarettes?
5% said
“not
wrong” or
“a little bit
wrong”
5% said
“not
wrong” or
“a little bit
wrong”
17% said “not
wrong” or “a
little bit
wrong”
29% said
“not
wrong” or
“a little bit
wrong”
Perception of
community
disapproval seems
less strong.
2013 LAKE
COUNTY
RISK
ASSESSME
NT
Youth tobacco use has continued to decline in Lake
County. Middle and high school students report lower rates
of 30 day use and lifetime cigarette smoking than in
previous years. Along with national trends, there has been a
steady decline in cigarette smoking in recent years. Lake
County students try cigarettes at similar rates to young
people across the country: 32% of 10th graders and 44% of
12th graders reported that they had smoked a cigarette in
their lifetime. However, regular use is declining: 12% of
high school seniors reported smoking in 2012, while too
few 10th, 8thand 6thgraders smoked in the last 30 days to
report percentages. Like cigarettes, smokeless tobacco use
has fallen off among students--less than 3% reported 30-
day use in 2012.30
This paragraph
notes the declines
in overall
population—but it
would be
interesting to be
able to
disaggregate this
data and see if
there are sub-
populations in
which these
declines don’t
exist.
2012 LAKE
COUNTY
PUBLIC
HEALTH
ASSESSME
NT AND
IMPROVEM
ENT PLAN
Radon, a colorless, odorless gas that can
move up from the ground and become
trapped inside houses, is an issue because
it is the second leading
cause of lung cancer in the U.S. Smokers
exposed to radon have an especially high
risk of developing lung cancer. Of the 128
households in Leadville that conducted
Tobacco use in
Lake County
might be
especially risky
because of the
high rate of houses
with radon gas.
Anecdotally, it
Page 28
radon tests between 2005-2009, 47.9%
had levels over the EPA recommended
limit.
seems radon is an
issue that few
Lake County
residents are
aware of, and the
relationship
between radon and
tobacco use also
does not seem to
be something
understood very
well by residents.
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