The Coalition, Inc. FY2014
Tobacco Prevention and Control Coalition
Narrative-Form Needs Assessment Outline
FY2014
Coalition Name: The Coalition, Inc.
Submission Date: 7/15/14
Part I – Geographic / Target Population and Coalition Overview
Angelina and Nacogdoches Counties are located deep within the piney woods of
East Texas. They are unusual for many reasons. They are rural, poor, and
undereducated with a number of small communities and no large cities. They are
spread over a large timber forest thus making the delivery of services a nightmare. Both
are serviced by the Brazos Transit District, a public transportation system, within the
Lufkin and Nacogdoches city limits only.
Angelina County is 120 miles north of Houston and 220 miles southeast of
Dallas. Angelina County has a population of 87,597 estimated by the Census Bureau
for 2012. Angelina County has 864 square miles of land area and a population density
of 100 people per square mile. Primary industries are manufacturing, healthcare,
education, agriculture and tourism. The largest employers are Brookshire Brothers,
Lufkin Industries, Lufkin ISD, Lufkin State Supported Living Center, Memorial Health
System of East Texas, and Pilgrim’s Pride. The healthcare industry is one of the fastest
growing industries in the county and has become a regional medical center for the East
Texas area.
Table 1.1
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Angelina County’s racial demographics are (represented in Table 1.1, above):
62.6% white, 14.5% African American, 20.5% Hispanic/Latino, and 2.4% other. Those
with less than a high school education in Angelina County are 23.9%; 30.94% have
graduated from high school and .09% have a bachelor’s degree or higher. The median
household income in Angelina County is $39,325 with 18.4% living below the poverty
level. The average family size is three. Sixty-nine percent own their own homes and
11.2% rent their homes. According to the Texas Department of State Health Services
Health Facts Profile 2009, the total population in Angelina County without health
insurance is 21,396 (31.5%).
Nacogdoches County has a population totaling 66,034 estimated by the
Census Bureau for 2012. Nacogdoches has the distinction of being the Oldest Town in
Texas. Nacogdoches is located 150 miles northeast of Houston, 220 miles southeast of
Dallas, and 80 miles southwest of Shreveport, Louisiana. Nacogdoches County has a
diversified industrial base: manufacturing, health care, education, retail trades, tourism
and agriculture being the primary industries. The manufacturing industry includes such
operations as feed and fertilizer, valves, business forms, electrical parts, transformers,
motor homes, poultry processing and sealing components. The two largest employers in
the county are Pilgrim’s Pride (poultry processing) with 1,725 employees and Stephen
F. Austin State University (higher education) with 1,609 employees.
Table 1.2
Nacogdoches County’s racial demographics are (represented in Table 1.2,
above): 61.1% white, 18.2% African American, 18.2% Hispanic/Latino, and 2.5% other.
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Those with less than a high school education in Nacogdoches County are 19.5%;
80.5% have graduated from high school and 24.1% have a bachelor’s degree or higher.
Nacogdoches County has a median household income of $35,378 with 24.1% living
below the poverty level. The average family size is three. Fifty-nine percent own their
own homes and 21.3% rent their homes. According to the 2009 Health Facts Profile
from the Texas Department of State Health Services, the total population in
Nacogdoches County without health insurance is15,593 (28.5%). The poverty
population of Nacogdoches County has been designated as a Medically Underserved
Population (MUP) with a whole county poverty population as approved by the Governor
as of February 2010.
Lufkin is the county seat of Angelina County and the largest town, with a
population of 35,067. It has been named a micropolitan area by the Bureau of Census.
Lufkin ISD is a Class 5-A district with eleven elementary schools, one middle school,
one high school and one alternative school. The district has 535 classroom teachers.
Lufkin is experiencing white flight to the smaller communities who do not have the racial
mix. The Hispanic population is the fastest growing group in the Lufkin schools.
The Lufkin ISD records indicate the racial demographics to be: 47.3% white,
30.2% African American, 21.1% Hispanic and 1.4% other. Of the Lufkin ISD students
73.3% are considered economically disadvantaged. Lufkin is home to Angelina College
with a student enrollment of approximately 6,000 students.
Central, located in the northern part of Angelina County, does not have an
incorporated city. It is a small rural community focused on the school district and the
only major employer, the Lufkin State School, which employs over 1,100 people. The
majority of the residents are employed outside of Central. The Diboll community,
located on Highway 59 South also has a large employer, Georgia Pacific, who employs
500, many of which are Hispanic. The population of Diboll is 4,776.
Hudson is another small rural community in Angelina County, with 4,731
residents, located on Highway 94 West. Lockheed Martin Vought Systems is the
largest employer. Most of the residents are employed in Lufkin. Huntington, located on
Highway 69 South, has a population of 2,118. There is no major industry in Huntington.
Most of the residents are employed elsewhere in the county, primarily in Lufkin. The
poverty population of Huntington has been designated as a Medically Underserved
Population (MUP).
Zavalla, located in the southernmost part of the county on Highway 69 South, is
the smallest town with a population of 713. Zavalla’s major industry is recreation from
Lake Sam Rayburn. Residents are employed in recreation-related business, by the
school district, or in Lufkin.
Nacogdoches serves as the county seat for Nacogdoches County. It is one of
the largest towns in the region with a population of 33,405 individuals. Nacogdoches
Independent School District records indicate the racial demographics to be: 24% white,
43.5% Hispanic/Latino, 29.2% African American, and 3.3% other. Of the Nacogdoches
ISD students 78.63% are considered economically disadvantaged. Nacogdoches is
proud to be home to Stephen F. Austin State University (SFASU) founded in 1923. In
addition to the Nacogdoches County residents, there are approximately 13,000 SFASU
students.
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Nacogdoches County has many small communities. Garrison is a small town
of 907 residents and served by Garrison ISD, with 671 students; Cushing is a
community of 621 people and served by Cushing ISD, a predominately white district of
496 students; Appleby, a community of 480 is served by the Nacogdoches
Independent School District. Other smaller communities within the county are Central
Heights, located in north central Nacogdoches County, is served by Central Heights
ISD, a predominately white school district of 861 students; Chireno, a small community
of 393 people, is served by Chireno ISD, a school district of 350 students; Douglass,
located in south Nacogdoches County is served by Douglass ISD, a white rural school
district of 362 students; Etoile, located in southeastern Nacogdoches County is served
by Etoile ISD, a predominately white rural school district of 123 students; Martinsville in
eastern Nacogdoches County is served by Martinsville ISD, a predominately white rural
district of 322 students; and Woden located in the southeastern part of the county is
served by Woden ISD, a predominately white rural district with 814 students.
The Coalition, a 501 C(3) organization, is a group of concerned citizens and
parents intent on eliminating the use of harmful substances by influencing public policy,
laws, attitudes, and behaviors. This organization was established in 1988 by the
superintendents of the six school districts in Angelina County who saw drugs as a
problem and wanted a county-wide prevention program. The Coalition has collaborated
with the Texas Department of State Health Services since 1999 when it was then the
Texas Commission on Alcohol and Drug Abuse. We were one of eleven grant
recipients in the state who received the first community coalition grants that TCADA
awarded and continue to receive this funding.
Part II – Prevention Resources, Capacities and Gaps
1. What prevention resources currently exist in your target community? Please
discuss the following specifically, and how you can engage them in assisting the
coalition.
a. Prevention Resource Center (PRC)- Alcohol & Drug Abuse Council of
Deep East Texas – This grant was just awarded but we have always
worked with the Alcohol & Drug Abuse Council.
b. Other Coalitions (DFC and CCP Coalitions, other tobacco coalitions) CCP for Angelina County, of which The Coalition is the grant recipient and
CCP for Nacogdoches County, of which the Alcohol & Drug Abuse Council
is the grant recipient.
c. Other state or federally funded prevention providers- The Alcohol & Drug
Abuse Council and The Coalition work together for Red Ribbon Week,
Recovery Oriented Systems of Care, and the Executive Director serves on
The Coalition board.
d. School Programs (Communities in Schools, etc.)- Lufkin ISD has a School
Health Advisory Council, of which The Coalition is a member. We provide
drug prevention information at events that they sponsor and suggest ways
to integrate drug prevention in health programs. Youth Prevention
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e.
f.
g.
h.
i.
j.
International, which covers grades 1-3, is provided as part of the Alcohol
and Drug Abuse Council’s prevention services.
Community Programs and Services (YMCA, Goodwill, etc.) in Angelina
County are Burke Center MHMR, Angelina County & Cities Health District,
Lufkin Dream Center, Boys and Girls Club, Salvation Army, and Goodwill.
The Coalition works with these groups through the Interagency Coalition.
The Interagency Coalition includes all of the social service agencies in
Angelina County which has monthly meetings and publishes an
Interagency Brochure. The Interagency Brochure is bilingual and updated
yearly in print form (10,000 brochures printed) and monthly on The
Coalition’s website. It includes the phone numbers for the following:
emergency services, education training, employment, housing, medical,
family services, transportation and alcohol/drug abuse. The Coalition
notifies members of meetings and acquires speakers for the meetings.
Parent programs (PTA, etc.)- The PTAs are active and The Coalition is
involved in coalition anti-tobacco efforts via the Kid’s Expo. The PTA has
been well represented there each year since 2010. We will also be
approaching the organization about presentations on prevention to
parent/teacher groups and gatherings and becoming involved in health
fairs and other activities.
Direct Prevention Service Providers are the Alcohol and Drug Abuse
Council YPU, YPI, Preventing Abuse by Reaching Today’s Youth
(PARTY) covers youth and adult prevention needs in a twelve county
region, which includes Angelina and Nacogdoches counties. DETCOG
STAR, Boys and Girls Club of Deep East Texas are two others to which
we provide tobacco no use presentations.
Treatment Providers- The only treatment provider is the Alcohol and Drug
Abuse Council OSAR, Outpatient and the Lufkin Dream Center. His Most
Excellent Way, Greyson’s Place, Celebrate Recovery, and Alcoholics
Anonymous are available after treatment. The Coalition is a member of
the Recovery Oriented Systems of Care (ROSC) in Angelina County,
meets monthly with the ROSC, and works with these groups providing
Recovery Day in the Park in September, which is National Recovery
Month.
Healthcare providers- Angelina County has two hospitals: Memorial
Health System of East Texas and Woodland Heights Medical Center. The
Coalition has representation on the board from Memorial Medical System
and Woodland Heights has representation on the Drug-Free Business
Partnership Committee. The hospitals provide The Coalition with drug
related statistics for assessment. The Healthy Nacogdoches Coalition is a
part of Nacogdoches Memorial Hospital and provides smoking prevention
information. Local clinics, such as East Texas Community Health
Services and the Cushing Clinic have utilized our services.
Higher Education Prevention- Angelina County has a community college,
Angelina College. The Coalition board has representation from Angelina
College and we plan to continue our collaboration with the Great American
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SmokeOut and the Angelina College Fitness Fair. Stephen F. Austin State
University participates on the Healthy Nacogdoches Coalition as a
tobacco committee member.
k. Law Enforcement- The Coalition board has representation from the Lufkin
Police Department, the Nacogdoches Police Department, and the
Angelina County Sheriff’s Department. The Coalition works with the
Angelina County Sheriff’s Department and the Nacogdoches Police
Department on tobacco compliance checks.
2. Identify and explain existing smoke free ordinances and organizational/school
policies.
The cities of Lufkin and Nacogdoches have comprehensive smoke free
ordinances. All four of the hospitals in Angelina and Nacogdoches counties are
smoke free campus. All schools have tobacco free policies.
3. What prevention gaps exist in your target community?
A predominately rural geography of the region, country lifestyles and traditions,
and the socio-economic challenges combine to create equally daunting gaps and
barriers. 26% of the adult population smokes and smokeless tobacco is
traditional in the region.
In order to address these issues, we need to establish a presence in the outlying
communities as well as the county seats and deal with the issues of that rural
population.
PART III – Community Consumption Patterns
The Texas School Survey of Nacogdoches ISD elementary students, grades
4-6, tell us the following:
 69% of students believe tobacco use is “very dangerous” (76% statewide)
 14% reported they had been offered cigarettes ( 9% statewide)
 7% reported some or most of their close friends use snuff or chewing tobacco
(5% statewide)
 8% reported general tobacco use at least once during their lifetime (5%
statewide)
 7% reported smoking cigarettes at least once during their lifetime (4% statewide)
 2% reported lifetime use of smokeless tobacco products (1% statewide)
 20% of district elementary students said some or most of their close friends
smoke cigarettes (11% statewide)
The Texas School Survey of Nacogdoches ISD secondary students, grades 712, tell us the following (represented in Table 3.1, below):
 54% of Nacogdoches ISD secondary students believe that tobacco use is “very
dangerous” (57% statewide)
 31% reported general tobacco use at least once during their lifetimes (28%
statewide)
 13% said they had used a tobacco product during the past month (11%
statewide)
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


12% reported they had smoked cigarettes during the past month (10% statewide)
2% reported smoking cigarettes on a daily basis (2% statewide)
81% of students said their parents strongly or mildly disapprove of kids smoking
(85% statewide)
Table 3.1
The Angelina County Environmental Strategies Survey of secondary students,
grades 6, 8, 10, and 12, tell us the following (represented in Table 3.2, below):
 36.4% of Angelina County secondary students believe that tobacco use is “very
harmful or harmful”
 26.3% reported general tobacco use at least once during their lifetime
 14.8% said they had used a tobacco product during the past month
 63.9% of students said their parents strongly or mildly disapprove of kids
smoking
In the past 17 years in Angelina County, the youth tobacco rates have gone down
substantially due to education efforts from 27.5% in 1994 to 11.2% in 2011.
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Table 3.2
Of the most recent report from the Behavioral Risk Factor Surveillance Systems
(BRFSS) in 2010, only data at the Regional level is available. It shows several modifiable risk
factors for chronic disease are more prevalent in the DSHS Region 4/5N than statewide:
BRFSS
2010
Reg
4/5N
Texas
Current
Smoker
Uses Cigarettes
or Smokeless
21.4%
26.0%
15.8%
18.3%
No Leisure
Diabetes Time Physical
Activity
11.9%
37.0%
9.7%
26.7%
Obesity (BMI
30 or
greater)
33.5%
31.8%
In the recent 2013 County Health Rankings report, Nacogdoches County was
found to be ranked 167/232 of ranked Texas counties and Angelina County was found
to be ranked 189/232. The County Health Rankings measure the health of nearly all
counties in the nation and rank them within states. The Rankings are compiled
using county-level measures from a variety of national and state data sources.
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The tobacco related health consequences in Angelina and Nacogdoches
counties result in higher rates of lung and bronchus cancers, heart attacks, strokes,
chronic pulmonary obstructive disease, emphysema, and many other cancers. Children
of smokers suffer with higher incidents of respiratory infections, asthma, and Sudden
Infant Death Syndrome.
Estimated New Cases of Lung and Bronchus Cancers5
Plus Rate per 100,000
2003 – 2006 Texas Cancer Registry
Texas
Public Health Region
Or
Metropolitan Statistical Area (MSA) or Public Health Region
(PHR)
51,009
Angelina County/Nacogdoches County
66.9
407,176
cases/100,000
350 cases/100,000
Source: Texas Cancer Registry, Selected Cancer Facts by PHR, 2007,
http://www.dshs.state.tx.us/tcr
Estimated Number of First Heart Attacks (Myocardial Infarction)Per Year
Plus Rate per 100,000
Local Hospital Discharge Data (list dates covered)
Hospital Name
Dates
# First Myocardial
Infarctions
Memorial Health System of East
01/01/2009314
Texas
12/31/2009
Nacogdoches Memorial Hospital
01/01/201069
12/31/2010
Woodland Heights Medical Center
01/01/2014163
07/01/2014
Source: Memorial Health System of East Texas and Nacogdoches Memorial
Hospital
Estimated Number of Lung Cancer Deaths
Plus Rate per 100,000
2003-2006 Texas Cancer Registry
Texas
Public Health Region Or MSA
38,717
Angelina County/Nacogdoches County
51.2 deaths/100,000 407,176
231 deaths/100,000
Source: Texas Cancer Registry, Selected Cancer Facts by PHR, 2007,
http://www.dshs.state.tx.us/tcr
*An estimated 80 – 90% of these deaths are due to smoking
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U.S. DHHS, The Health Consequences of Smoking: a report of the surgeon general,
Atlanta, GA. Centers for Disease Control and Prevention, Office of Smoking and Health;
2004.
PART IV – Community Consequences
Please identify the patterns in each of the following data sources, if available.
You may also include data on additional consequences and/or focus on the
consequence data that you find to be most relevant to your community. Highlight
any identified disparities in community consequences.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
q.
r.
Citations for underage tobacco possessionCitations for selling tobacco to minors – 2 out of 60
Asthma rates-8.9% at risk – 1,741 sample size
Cancer rates – 4,677 new cancer cases; 1,766 deaths in HSR 4/5
Heart disease rates – 5.7% at risk – 1,741 sample size
Emergency room visits for heart attacks - 5.7% at risk – 1,741 sample size
Emergency room visits for asthmaHealthcare costs associated with tobacco-related diseasesNumber/percentage of restaurants that are smoke free- 100% in Lufkin
and Nacogdoches
Number/percentage of bars that are smoke free- 100% in Lufkin and
Nacogdoches
Number/percentage of campuses that are smoke free – All of the ISDs in
Angelina and Nacogdoches are smoke free and both Angelina College
and Stephen F. Austin University are smoke free. All 4 hospitals, all
colleges and universities, and three businesses.
Number of tobacco retailers and geographic location – 41 retailers in
Nacogdoches county
Cost of cigarettes - $6.89
Total number of cigarette sales Quitline use rates Youth truancy rates – 13% for Angelina County
Tobacco use and consequence disparity data
Other data sources identified
Part V – Intervening Variables
Please discuss each of the following intervening variables. Include the effect on
your community as well as the evidence of each variable (i.e. the contributing
factors) in your community.
A. Retail Access- On the latest Angelina County Environmental Drug Survey
students stated that it was not easy to obtain tobacco from retail
establishments
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B. Enforcement – Students from the Angelina County Environmental Drug
Survey felt that parents and the police would catch them using tobacco,
but were neutral about teachers, counselors and school officials catching
them.
C. Social Access – Youth stated that they had access of tobacco through
friends, at parties, at a friend’s home and lastly when someone else
bought it, such as an older friend or sibling as stated in the Angelina
County Survey.
D. Social Norms (Includes Perceived Risk) – 54% of Nacogdoches ISD
secondary students and 36.4% of Angelina County secondary students
believe that tobacco use is “very harmful or harmful.”
E. Promotion – Through observation it is determined that promotion is most
heavily geared toward consumers at the gas pump and at convenience
stores. There is also a discernible lack of “We card” signs. This indicates
that the audience of choice for merchants is younger and wants
convenience. They want to be able to offer cigarettes at cut rates (sales
are always posted) that are obtainable at a counter or window when you
pay for gas, and they do not want anyone who purchases illegally to fear
retribution. In addition, electronic cigarettes are more and more heavily
promoted in our counties as well.
F. Pricing – Pricing maintains the state level in order to help merchants avoid
losing customers. Sales are unavoidable, and local discount stores have
installed vending machines to allow for quick and easy access as well.
Cigarettes can be purchased at discount rates at “dollar stores” and a
myriad of other discount outlets, as well as the convenience stores.
Part V – Community Readiness
Please describe the readiness of each of the following sectors in your community
to implement your strategies. These answers can be based on coalition feedback
and community member interviews. This information may help you identify
potential allies or community perceptions and knowledge, which you can
describe here.
The latest coalition member survey tells us the following:
a. Youth – somewhat knowledgeable
b. Parents - knowledgeable
c. Business community - knowledgeable
d. Media - knowledgeable
e. Schools - knowledgeable
f. Youth-serving organizations – somewhat knowledgeable
g. Law enforcement agencies- knowledgeable
h. Religious or fraternal groups- somewhat knowledgeable
i. Civic or volunteer groups – somewhat knowledgeable
j. Healthcare professionals- knowledgeable
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k. State, local, tribal governments - knowledgeable
l. Other organizations interested in substance abuse prevention knowledgeable
Part VI – Putting it all Together
Please develop a summary of the findings from your community needs assessment.
Briefly discuss alignment with evidence-based strategies and the goals outlined in
your Statement of Work. Also indicate opportunities for community change, such as
setting a smoke-free ordinance goal or increasing specific data collection where your
needs assessment indicates there is a gap.
Angelina and Nacogdoches counties are rural, poor, and undereducated which are
risk factors for using tobacco. Nacogdoches ISD secondary schools reported 12%
had smoked cigarettes in the past month and 14.8% of Angelina County secondary
students reported using a tobacco product in the past month. In the recent 2013
County Health Rankings report, Nacogdoches County ranked 167/232 of ranked
Texas counties and Angelina County was found to be ranked 189/232.
These statistics show that we must meet the following goals:
 Prevent tobacco use among young people
 Promote compliance and support adequate enforcement of federal, state and
local tobacco laws
 Increase cessation among young people and adults
 Eliminate exposure to secondhand smoke
 Reduce tobacco use among populations with the highest burden of tobaccorelated health disparities
 Develop and maintain statewide capacity for comprehensive tobacco prevention
and control
Our most pressing goal is to provide cessation counseling and classes, encourage
businesses to establish tobacco free campuses, and advertise the Quitline to the
community.
Part VII – Logic Model
Please attach a copy of your logic model to this document, using the following format
or a similar format.
Consequences
Use Patterns
Intervening
Variables
Contributing
Factors
Strategies
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