tobacco FREE Lake County · 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,

TOBACCO FREE

LAKE COUNTY

6/30/2014 Preventing Youth Initiation and Promoting

Adult Cessation

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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

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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

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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-

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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

https://sites.google.com/site/lakecountymath/ypar-lcbag-videos

http://gardnercenter.stanford.edu/our_work/yell.html

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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.

http://lcbag.org/initiatives/student-programs

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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

http://www.lcbag.org/

http://www.chd.dphe.state.co.us/HealthIndicators/Default.aspx

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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

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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

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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.

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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.

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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

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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.


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

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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.


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.


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.


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

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.


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

[email protected]

719-486-7486

Full Circle of Lake County, Inc Alice Pugh, Director

[email protected]

719-486-2400

City of Leadville Jaime Stuever, Leadville Mayor

[email protected]

719-486-2571

Lake County School District Cheryl Wells, School Nurse

[email protected]

719-486-2028

Leadville Police Department Dan Hanson, Officer

[email protected]

719-486-1365

West Central Mental Health Center Anna Lauer Roy, Clinician

[email protected]

719-486-0985

Lake County Public Health Agency Colleen Nielsen, Director

[email protected]

719-486-4152

Jane Heins, Nurse

[email protected]

719-486-4143

Lake County High School Christina Gosselin, Principal

[email protected]

719-486-6970

Karl Remsen, Math Teacher

[email protected]

719-486-0746

mailto:[email protected]










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.


Lake County School District




Provide educational materials

to clients/ program participants

(e.g. provide second-hand

smoke information to parents

or distribute information about

e-cigarettes to families).








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.






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).





Provide a space for cessation

support groups to meet


City of Leadville



Offer wellness incentives to

participants of cessation program



Refer community members/clients

to local cessation support groups






Refer clients or community

members to the Colorado Quitline

or other statewide web or phone

cessation support tools


City of Leadville







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






We provide information to

clients/participants about health

risks of tobacco







Offer wellness incentives to

participants of cessation program

We provide information to

clients/participants about tobacco

cessation resources







We are trained in the evidence-

based "5A's and an R" brief

intervention and referral tool and

we use it with clients


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


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


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.

Documents

tobacco FREE Lake County · 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,