Tobacco Prevention and Control Coalition
Narrative-Form Needs Assessment FY2014
Coalition Name: Brazos County Tobacco Free Together
Submission Date: 08/15/2014
Part I – Geographic / Target Population and Coalition Overview
1. Provide an overview of the target area, including geographic boundaries, zip codes, counties,
etc.
Brazos County, TX is a medium sized county located in east-central Texas. Its 586 square miles
are boarded on the northwest by highway TX-OSR, on the southwest by the Brazos River, and on
the East by the Navasota River (Google Maps, 2014). Zip codes that fall in Brazos County are
77859, 77808 to the north; 77807, 77803, 77802, and 77801 in the center; and 77840, 77845,
77868, and 77866 to the south (Zipmap, 2014). Popular features of Brazos County are Texas
A&M University and associated places such as the George Bush Library and Kyle Field, the
Northgate District of College Station, and Downtown Bryan (BCS Convention and Visitors
Bureau, 2014). Additionally, Brazos County is located within driving distance to major Texas
cities such as Dallas, Houston, and Austin. Texas A&M University is the county’s largest
employer. Other large employers are Bryan and College Station Independent School Districts,
St. Joseph Regional Hospital, and Sanderson Farms (College Station).
2. Provide demographic information about the target community.
The population of Brazos County was estimated to be 203,164 in 2013, with an average of 332.8
persons per square mile (U.S. Bureau of the Census, 2014). The majority of this population
(88.0%) lives in Bryan or College Station. The median age of residents is 24.8 years old, and
20.6% of the population is 17 years old or younger. The residents of Brazos County are 49.3%
female and 50.7% male. They are 58.2% White non-Hispanic, 11.2 % African American, and
24.1% Hispanic/Latino. The majority of residents are educated, with 84.8% having completed
high school, and 38.7% having completed a bachelor’s degree or higher. The median household
income in the county in 2012 was $40,064, and about 30% of residents live below the federal
poverty level. The county’s unemployment rate is 4.9% (U.S. Bureau of the Census, 2014).
Additionally, it is important to note that these statistics should be interpreted with caution as
they are augmented by the large and transitory student populations of Texas A&M University
(52,827 students in spring 2014) and Blinn College (16,780 students in spring 2014) (Blinn
College, 2014; Texas A&M University, 2014).
3. Provide information about your coalition to explain your how the coalition formed and the
coalition’s purpose and role in the community.
The Brazos County Tobacco Free Together Community Coalition is built upon the previous
Brazos County Tobacco Coalition that had been in place and operating in Brazos County from
2008 –February of 2013. Many of the original members of the coalition have changed jobs or are
no longer in our area. When the opportunity for funding presented itself, BVCASA contacted the
local Health Department who headed up the original coalition with the desire and hope they
would join with BVCASA if funding was received to help revitalize and restructure the existing
coalition. Upon receiving funding we have worked hard to increase membership and
representation of the community on the coalition. The Coalition now has representation from
The Brazos County Health Department, American Cancer Society, American Heart Association,
The City of Bryan, The Brazos Valley Council on Alcohol and Substance Abuse, Bryan ISD, KRHD
ABC 40, Neal Recreation Center, The Boys and Girls Club of The Brazos Valley, Public Resource
Center for Region 7, Every Day Life Boy’s Facility, local churches and the Texas A&M AgriLife
Extension Service. We are continuously recruiting representation to ensure that we have a
diversified representation of the community on the coalition. The goal of the coalition is to be
the leader in a movement to educate and empower the citizens of Brazos County to take control
of our City and our health by providing the knowledge and resources needed to ultimately make
Brazos County Smoke Free.
4. Provide any other relevant information about your targeted area or population that you have
identified.
We are a rural community that is largely driven by the University. Bryan and College Station are
the two cities that closely mirror in size and ultimately comprise the county however they vary
greatly in socio economic status. Texas A&M University is centrally located in College Station, TX
and is the focal point of both communities. Because of the university, College Station’s SES is
substantially higher than that of Bryan as most of the key University personnel are residents of
College Station. The University drives our local economy as it is the primary employment agency
within the county with everything revolving around it. Our population has a very high
concentration of young people due to the college, with many of them coming from rural
communities because of Texas A&M being an Agricultural based school. The further you get
away from the university the more visibly evident the difference in SES becomes between the
two cities. The coalition feels that targeting the teen to young adult population is a huge area of
opportunity and will allow us to have the largest impact and position us to be able to foster
change in the community norms around tobacco use.
Part II – Prevention Resources, Capacities and Gaps
1. What prevention resources currently exist in your target community? Please discuss the
following as specifically as possible in regards to how they are engaged or could be engaged in
assisting the coalition’s efforts.
a. Prevention Resource Center (PRC)
We are fortunate to have the PRC for Region 7 here at BVCASA .We work alongside of its
members on a daily basis. There are members of the PRC on the coalition and the EPI
work group. The PRC conducts 250 monthly tobacco compliance checks to ensure that
tobacco retailers have the necessary signage and are following and complying with all
rules and regulations. The coalition will continue to use the data that’s collected from
the PRC to help ensure retailers are in compliance with all tobacco regulations
.
b. Other coalitions (DFC and CCP Coalitions, other tobacco Coalitions, etc.)
BVCASA has a CCP Coalition in addition to the TPCC in our community. BVCASA also
houses a DFC and an additional CCP coalition that operates in Robertson County, a
neighboring county. Having other coalitions here on site serves as a vital resource as it
always lends to the sharing of information, research and best practices. In addition,
having a working relationship with the other coalitions provides access to resources
within the community where otherwise it may be difficult to make the necessary
contacts and develop the appropriate relationships with key community personnel.
c. Other state or federally funded prevention providers
To our knowledge there are no other state or federally funded tobacco prevention
providers in our county.
d. Schools and/or school programs (Communities in Schools, etc.)
We currently have an excellent relationship with both school districts within the county.
This year proved to be more challenging having started the project late we were unable
to secure participation from either district for the School Survey or for the youth
receiving education piece of the project. We have met with representatives from both
districts and both have expressed full support of the TPCC project and have expressed
their interest in whatever services and resources that we can provide with the start of
the new school year this August. We currently have a youth group at Bryan High School
(VKOT) Vikings Kicking Out Tobacco, who before school was out, met weekly on campus.
e. Community programs and services (YMCA, Boys and Girls Clubs, etc.)
The coalition has an excellent relationship with several community programs within
Brazos County. We currently have one of our youth group sponsors serving as the
Supervisor of Operations at the local Boys and Girls Club. Tobacco Education
presentations are provided regularly at the Boys and Girls Club of The Brazos Valley,
Neal Recreation Center as well as the Lincoln Recreation Center. These programs serve
as after school care as well as provide meals and recreation for children within the
county during the summer. All three of these programs have strong ties to local schools
and collaborate with other agencies within the community to ensure that the students
who attend the programs have access to all the necessary resources.
f.
Parent programs (PTA, etc.)
The coalition does not currently have any direct affiliation with any specific parent
programs within our county at this time. We understand that this is an area of
opportunity to help ensure that the parents of the students within the community are
adequately educated on the dangers associated with all forms of tobacco use.
g. Direct prevention service providers
BVCASA provides several prevention programs within our Community. We currently
offer YPS-TND and ALLSTARS to the local middle schools and high schools. Both are
Evidenced based curriculums that provide education and help teach invaluable
resiliency skills. BVCASA have been offering and providing these services. The TPCC is
required to implement a curriculum within the middle school population to also
increase awareness and education on the dangers associated with tobacco. The
curriculum that will be taught is TNT, It is also an evidenced based curriculum that
mirrors TND with the only difference being the specific focus on tobacco.
h. Treatment Providers
We have 3 main treatment facilities in Brazos County, BVCASA, La Hacienda and
Medpro. We obviously have a strong working relationship with BVCASA but have a huge
area of opportunity with the other treatment facilities within the community. The
coalition understands that most clients who are in treatment have dual addictions with
tobacco being one. We want to be able to collaborate with these entities to be able to
help provide tobacco education to the clients and even staff of these facilities. The
coalition also understands the need to ensure that these facilities have adequate
tobacco/ E Cigarette policies in place.
i.
Healthcare providers
The coalition has representation from the Brazos County Health Department. We still
have a huge opportunity to recruit other health care professionals to be a part of the
coalition. We have begun conducting Health Care Consultations and are actively working
to recruit new members to ensure that we have representation on the coalition. We are
also working to promote the E Tobacco Protocol in effort to make referrals to the
Quitline more effective and efficient. We feel that having participants of the coalition as
Health Care Providers will make it easier to promote the project as it adds credibility
and validity.
j.
Higher Education Prevention
The Coalition currently has representation from Texas A&M University which is the
largest Institute of higher learning in our county. We understand that by having the
support of the University we position ourselves to have access to many invaluable
resources from data, staff to student volunteers for community activities. PPRI, the
(Public Policy Research Institute) serves as our contracted evaluator and they are
located on the campus of TAMU. We currently still have an area of opportunity at Blinn
College which is a local Jr college. BVCASA has a CCP specifically with the focus on
Blinn’s Campus so that provides a very good opportunity to have access to key
administrators and personnel.
k. Law Enforcement
The coalition currently does not have representation from any of the local law
enforcement agencies. We will work to recruit as the support from the local agencies as
we understand it will be very beneficial with ensuring that the necessary enforcement is
in place and visible within the community. We also want our local law enforcement
agencies participation with the Texas School Safety Center’s Tobacco Enforcement
Program. Getting them on board with this project will help ensure that retailers are
adhering to tobacco laws and regulations and provide a source of accountability to
retailers.
l.
Others identified
2. Identify and explain existing smoke free ordinances and organizational/school policies.
We identified the top 20 employers in Brazos County, all of which are smoke free
facilities indoors, and requested information on other policies regarding tobacco use
they had in place. It was found that two major employers in the area do not even hire
tobacco users. These two campuses are Reynolds and Reynolds, employing an estimated
1400, and Scott & White Healthcare, employing an estimated 475. Eight employers have
benefits plans that advantage non-tobacco users by having them pay less for insurance
premiums. These eight employers include Texas A&M, the area’s largest employer
(22000), Sanderson Farms (1800), St. Joseph Regional Healthcare (1500), Wal-mart
(600), College Station Medical Center (585), Kent Moore Cabinets (415) and Blinn
College (350). In addition to these eight, two more companies, Brazos Valley Community
Action Agency (600) and CC Creations (200), are currently developing plans to benefit
non-users.
Notably there are five employers in the top ten that do not provide any benefits to
those that choose to abstain from tobacco. Even more outstanding is that all five of
these employers are government funded entities, Bryan ISD (2090), College Station ISD
(1100), City of Bryan (900), City of College Station (715) and Brazos County (600).
State law requires all public schools to be smoke free indoors but the policies for our
two districts are identical and as read in the Student and Employee Handbook are as
follows:
Bryan ISD & College Station ISD Employee Handbooks:
State law prohibits smoking or using tobacco products on all district-owned property
and at school-related or school-sanctioned activities, on or off campus. This includes all
buildings, playground areas, parking facilities, and facilities used for athletics and other
activities. Drivers of district-owned vehicles are prohibited from smoking while inside
the vehicle. Notices stating that smoking is prohibited by law and punishable by a fine
are displayed in prominent places in all school buildings.
Bryan ISD & College Station ISD High School Student Handbooks:
The district and its staff strictly enforce prohibitions against the use of tobacco products
by students and others on school property and at school-sponsored and school-related
activities.
There are seven noteworthy private schools in Bryan, Texas, five of the seven have
specific tobacco use policies publicly found in their school’s handbook, the other two
are smoke free campuses as well but do not have specific writing regarding the issue.
We are currently in contact with these two institutions to implement a policy into their
handbooks.
Texas A&M University is located at the heart of our community and has a very extensive
policy disallowing smoking on their campus. Blinn College also disallows smoking on
their campus excluding parties in a privately owned vehicle.
3. What prevention gaps exist in your target community?
The coalition has identified several areas of opportunity to improve community
resources and increase education within our county. One of the biggest opportunities is
to ensure that we are targeting the pre k – elementary aged population as there are no
programs that specifically focus on education and building resiliency skills before the
age that most smokers begin. Though very little data about smoking is regularly
collected for kids under 12, the peak years for first trying to smoke appear to be in the
sixth and seventh grades (or between the ages of 11 and 13), with a considerable
number starting even earlier(SAMHSA HHS, Results from the 2012).
In 2012, five percent of eighth grade students reported having had their first cigarette
by the end of fifth grade (ages 10 to 11), and 15.5 percent had tried smoking by the end
of eighth grade. A 2011 nationwide survey found that one in ten high school students
had smoked at least one whole cigarette before the age of 13.5(Johnston, LD, 19752012. Volume I, Secondary school students, 2013). This data specifically speaks to the
importance of educating students as early as possible to prepare them to handle the
pressure that they will face to use as early as 4th and 5th grade. If we wait until the
students are in middle school we have failed desperately at ensuring they are educated
enough to make a conscious decision about their personal tobacco use.
We also have identified the need for more resources in our lower economic areas. There
are currently no free cessation classes available, which is a problem for many residents
within the county. We understand that as we continue to work as a coalition, other gaps
will become visible that may have previously been overlooked or were previously not an
issue.
PART III – Community Consumption Patterns
Please provide the epidemiology of tobacco use in your community, including past 30day adult and youth use rates of tobacco products and e-cigarettes. Highlight any
identified disparities in consumption patterns as well as any gaps in data. Consider using
charts and graphs with brief narrative to explain the impact on the community.
In Texas’ Public Health Region 7, 15.2% of the population was at risk for being a current
smoker or using smokeless tobacco in 2010. Rates of smoking or smokeless tobacco use
risk were similar in Region 7 to the same rates in Texas, but were statistically
significantly lower than the nationwide at-risk rate.
Education level did produce statistically significant differences in percent at-risk for
smoking or using smokeless tobacco in Region 7 in some comparisons. Those who
graduated high school were more at risk for tobacco use than those who had earned a
college degree or higher (21.4% v. 5.9%). Additionally, those who had completed some
college were more at risk for smoking or using smokeless tobacco than those who had
earned a college degree or higher (23.8% v. 5.9%). Other comparisons of education
level did not result in statistically significant differences.
Education Level and % At Risk for
Tobacco Use
25
% At Risk
20
15
10
5
0
No High School
Diploma
High School
Graduate
Some College College or Higher
Education Level
Males in Region 7 were more at risk for smoking or using smokeless tobacco than
females (17.9% v. 12.4%), but this difference was not statistically significant. No
statistically significant differences in percent at-risk were found for racial groups, but
African Americans (19.0%) were more likely to smoke or use smokeless tobacco than
White (16.7%) and Hispanic (12.4%) residents. Minor differences were found in age
group categories as well, but none were statistically significant. People between 45 and
64 years of age had the highest percent at risk (17.8%), followed by people ages 30-44
(16.4%), people ages 18-29 (13.9%), and finally by people over the age of 65 (9.1%). No
differences in income level were statistically significant, but people earning between
$25,000 and $49,000 per year had the highest percent at risk for smoking or using
smokeless tobacco (22.9%), followed by those earning less than $25,000 per year
(18.2%) and those earning more than $50,000 per year (10.0%).
The percent of residents of Region 7 who are at-risk for using tobacco has steadily
decreased over time. In 2002, 29% of the population of Region 7 was at risk for smoking
or using smokeless tobacco. By 2010 the percent at-risk had dropped to 15.2%.
Additionally, Region 7 had a higher percent at-risk than both Texas and the nation until
2006, but has since fallen below the Texas and nationwide levels of risk. Results suggest
that over time, residents of Public Health Region 7 are becoming less at risk for smoking
or using smokeless tobacco.
Percent At-Risk for Tobacco Use
35
30
& At-Risk
25
20
Region 7
15
Texas
Nationwide
10
Linear (Region 7)
5
0
2002
2003
2004
2005
2006
Year
2007
2008
2009
2010
Note: Data for the years 2005, 2007, 2008 and 2009 are missing. Additionally, the
National at-risk percentage for the year 2006 is missing.
These results should be interpreted with caution for two reasons. First, they are not
specific to Brazos County but represent the population of Public Health Region 7, which
contains Brazos County and other surrounding areas including Milam, Bell, Williamson,
Travis, Hays, and McLennan counties. Second, these data come from a survey of adult
residents, so caution should be taken in generalizing these data to youth. Data on youth
tobacco use are a part of the Texas Youth Tobacco Survey, and have not been released
to the public at this time and do not include Brazos County in the current year.
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. Citations for underage tobacco possession
According to the Texas Juvenile Justice Department the citation code 161.252 HSC is for
Possession, Purchase, Consumption, or Receipt of Cigarettes or Tobacco Products by
Minors Prohibited. There was only one case in Brazos County in 2008 with this offense.
Of course this is not to say that there have been no other minors using tobacco.
There are a number of reasons why more cases of this specific tobacco offense is not in
the data:
If on school property, school officials may have a specific way to address the issue
before/instead of law enforcement involvement
Local law enforcement and juvenile justice department may decide not to refer
for the tobacco related offense
youth
Referred youth may possess tobacco, but may have also been referred for more
serious offense(s) so that would be the main focus over the tobacco possession
Referred youth may possess tobacco, but the specific code used was more general, like
Violation of Probation
b. Citations for selling tobacco to minors
Our coalition did not have direct access to data at this time. We reached out to The
Texas School Safety Center to see if this data was available but were unable to get it at
this time.
c. Asthma rates
Exposure to tobacco smoke is a modifiable factor that can be controlled in order to
reduce future risk to asthma (GINA, 2014). An estimated 16.4 million adults 18+ and 7.0
million children aged 17 and below were affected by asthma in 2008 (BRFSS, 2008).
Observing the Behavioral Risk Factor Surveillance System (2006-2010) estimates for the
U.S., the percent of adults with asthma is 13.20% (31,061,484 of 235,375,690 adults
18+). In Texas, adults with asthma declines to 12.51% (18,473 of 147,667 adults 18+).
However, asthma prevalence in Brazos County surpasses state and nation percentage
values. For instance, the percent of adults with asthma in Brazos County is 15.80%
(23,329 of 147,667 adults 18+). From BRFSS 2006-2010 estimates, Brazos County is
displaying a large percent of adults with asthma and at-risk of exposure to tobacco
smoke even compared to regional asthma estimates (Region 7 has 13.06% of adults with
asthma; 276,296 of 2,115,224 adults 18+). In short, the figure below visually illustrates
the large asthma prevalence in Brazos County compared to state and national percent’s.
Percent of Adults with Asthma
United States
13.20%
Texas
12.51%
PRC 7
13.06%
Brazos County
15.80%
0.00%
2.00%
4.00%
6.00%
8.00% 10.00% 12.00% 14.00% 16.00% 18.00%
Source. Behavioral Risk Factor Surveillance System 2006-10
Furthermore, in the next figure the number of hospital discharges for asthma in the
Brazos County (2011) displays a yearly account. The 4 quarters in the figure represent
the time periods when data was collected. Together, the 4 quarters of data collection,
show a yearly account of 152 hospital discharges for asthma in 2011. A curved line in the
figure helps to see a momentary depression in the discharge numbers, but ultimately
increased asthma discharge numbers is a concern.
Hospital Discharges for Asthma, 2011
60
49
50
42
40
35
30
26
20
10
0
Quarter 1
Quarter 2
Quarter 3
Source: Texas Department of State Health Services, 2011
D .Cancer rates
Quarter 4
The Texas Department of State Health Services for 2013 has projected 13,901 new
cancer cases and 4,830 deaths to cancer in Central Texas (i.e., Health Service Region 7).
Of cancers, the most associated to tobacco smoke is lung cancer. Oral and throat cancer
can also result from tobacco smoke. Texas Cancer Registry (2013) reported from 200610 that lung cancer was consistently one of the top 5 cancers in Health Service Region 7
(HSR 7–defined by 30 counties of which Brazos is included). Of the 10,815 average
annual number of all cancer cases in HSR 7 13.44% had lung cancer (1453 cases).
Comparing lung cancer incidence rates between Texas and HSR 7 (i.e., same region
covered by the Prevention Resource Center 7 or PRC 7), the Texas Cancer Registry will
illustrate HSR 7 having a lung cancer rate of 76.9 (rate per 100,000) compared to 78.2
for the State among men. Among females, the lung cancer rate is 50.4 for HSR 7 and
49.0 for the State.
More to the county-level, the State Cancer Profiles (2006-10) depicts lung cancer in
Brazos County with an annual incidence rate of 60.0 (per 100,000 population from the
American Community Survey 2006-10). In the same data source, Texas is given an
annual incidence rate of 61.60 and as a nation the annual incidence rate was 64.90. For
PRC 7 (i.e., HSR 7 or Region 7) the annual incidence rate was 62.50. Also, rates reported
from the State Cancer Profiles (2006-10) are age adjusted incidence rate of lung cancer
adjusted to 2000 U.S. standard population age groups. In summary, lung cancer
incidence rate (per 100,000) by race/ethnicity is illustrated below from the State Cancer
Profiles 2006-10.
Lung Cancer Incidence Rate by Race/Ethnicity (Per 100,000)
34.6
34.3
37.5
42.4
Hispanic / Latino
American Indian / Alaskan Native
43.4
22.9
0
0
33
Asian
36.2
40.4
0
68.2
Black
73.6
82.5
87.6
65.6
61.1
61.8
57.4
White
0
10
United States
20
Texas
30
40
Region 7
Source: State Cancer Profiles. 0 = no data was available.
50
60
70
Brazos County, TX
80
90
100
Lung Disease mortality
Lung disease, also a leading cause of death in the U.S., is a necessary estimate to help
triangulate the reach tobacco has in the county. Nationally, the death rate for lung
disease (per 100,000 population) is 42.40 (age-adjusted to year 2000 standards) with a
crude death rate of 44.04 (133,806 deaths from 303,844,430 population). From the
same data source, National Vital Statistics System 2006-10, Texas had an age-adjusted
death rate of 42.77 and a crude death rate of 34.74 (8,438 deaths from 24,289,585
population). Regionally (Region 7), the death rate (age-adjusted) from lung cancer was
38.35 (per 100,000 population) with a crude death rate of 30.76 (867 deaths from
2,820,031 total population). At the county-level, Brazos had slightly lower estimates of
36.74 as an age-adjusted death rate and 21.16 (39 deaths from 185,258 population) as a
crude death rate. For convenience, a visual summary of stats is provided below.
Lung Disease Mortality, 2006-10
50
42.77
45
40
42.4
38.35
36.74
35
44.04
34.74
30.76
30
25
21.16
20
15
10
5
0
Brazos
Crude Death Rate (Per 100,000 Pop.)
PRC 7
Texas
US
Age-Adjusted Death Rate, Lung Disease Mortality (Per 100,000 Pop.)
Lung cancer is not the only cancer associated to tobacco use. In fact, the Mayo Clinic
Nicotine Research Program recognizes the following cancers caused by tobacco use: lip,
oral cavity, pharynx, esophagus, pancreas, larynx (voice box), cervix, urinary bladder,
and kidney cancers. Of these additional cancers, pancreas cancer made the top 5 of
average annual cancer deaths in HSR 7 (2006-2010) according to the Texas Cancer
Registry. Pancreas cancer claimed 229 deaths compared to 1071 deaths from lung
cancer. Expected new cases and deaths in Brazos County are presented below based on
projection conducted January 2014 by the Cancer Epidemiology and Surveillance Branch
of the Texas Department of State Health Services. From the figure below, excluding lung
cancer, Brazos County is expected to have 101 cases and 41 deaths.
Expected New Cancer Cases and Deaths, Brazos County
180
160
140
66
120
100
80
60
90
40
20
0
4
5
15
16
Esophagus
Pancreas
6
16
Oral Cavity
and Pharynx
6
2
Larynx
Expected New Cases
2
6
24
7
26
Cervix Uteri
Urinary
Bladder
Kidney and
Renal Pelvis
7
Lung and
Bronchus
Expected Deaths
In conclusion, the people most at-risk for lung cancer according to Cancer Research UK are those whom:



Smoke the most cigarettes per day
Smoke over long periods of time, and
Start smoking young.
d. Heart
Although many people relate smoking to lung cancer and problems with breathing (i.e.,
asthma), there are health issues related to smoking and the heart. In fact, according to
WebMD people who smoke are two to four times more likely to experience heart
disease. As a result, data on heart disease becomes helpful in triangulating the number
of people in Brazos County experiencing heart disease because of smoking. In Brazos
County, 2,429 (or 1.64%) adults 18+ were diagnosed with coronary heart disease or
angina. Meaning, a doctor had to inform a patient of their heart disease condition. The
percent of heart disease among adult 18+ was lower in Brazos County compared to
Region 7 (3.88%; 82,037 of 2,115,224), according to the BRFSS (2006-10). At the State
and Nation level, the same pattern is seen, namely the gradual increase of a percent of
the population with heart disease. Visually, the gradual increase can be seen in the
figure below.
Percent Adults with Heart Disease
United States
Texas
Region 7
Brazos County, TX
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
Interestingly, 2012 percent of adults with heart disease among the Medicare population
also esemble a somewhat different pattern. Namely, the general sense of county to
state estimates increasing in percent of adults with heart disease, with the exception of
Region 7 estimates. For example, the Texas Medicare population (2012) had 30.91%
adults with heart disease (723,446 beneficiaries with heart disease of the 2,340,725
total Medicare beneficiaries) while the U.S. had 28.55% of adults with heart disease
(9,744,058 beneficiaries with heart disease of the 34,126,305 total Medicare
beneficiaries). Region 7 experienced a 27.22% (76,933 beneficiaries with heart disease
of 282,638 total Medicare beneficiaries) of adults with heart disease in 2012, according
to the Centers for Medicare and Medicaid Services (2012). In Brazos County, the percent
of adults with heart disease was 29.60% (4,449 beneficiaries with heart disease of
15,029 total Medicare beneficiaries).
2012 Medicare Population with Heart Disease
32.00%
31.00%
30.00%
29.00%
28.00%
27.00%
26.00%
25.00%
Brazos County, TX
Region 7
Texas
United States
When observing mortality rates associated to heart disease, the same gradual increase
is seen when going from county-level to nation-level. For instance, the age-adjusted
death rate (per 100,000 population) for the Brazos County was 178.54 with a crude
death rate of 105.26 (per 100,000 population). The age-adjusted death rate is based on
the year 2000 standard, while the crude death rate is based on the number of deaths
divided by the population during 2006-10. For the Brazos County crude death rate of
105.26 there was a total population of 185,258 and an average annual deaths of 195
from 2006-10. At the region level (Region 7), the age-adjusted death rate for heart
disease was 169.21 with a crude death rate of 139.71 (3,940 of 2,820,031). In
comparison, Texas had an age-adjusted death rate related to heart disease mortality of
192.10 and a crude death rate of 158.43 (38,482 of 24,289,585). At the national level,
the U.S. had an age-adjusted death rate for heart disease at 190.86 and a crude death
rate of 201.53 (612,327 of 303,844,430). Below is a visual depiction of the age-adjusted
and crude death rates.
e. Emergency room visits for heart attacks and asthma/ Healthcare costs associated with
tobacco-related diseases
Our coalition did not have direct access to data concerning emergency room visits in the
area; however, using hospital discharge data provided by the Texas Department of State
health Services, the team is able to reconstruct a fairly robust picture of how often
Brazos County residents sought emergency care for Asthma and Heart Attacks. The lone
shortcoming of these data is that they only contain inpatient data; therefore any patient
who is seen in the emergency room and immediately discharged is not present.
However, for heart attacks and severe asthma, this is assumed to be a rare event. In any
case, the distribution of hospitalization vs. discharge for emergency room patients
should remain roughly consistent over time, making the use of these measures
appropriate as a long-term solution.
Figure ?? Brazos County Hospitalizations
As Figure?? Indicates, residents of Brazos County were admitted into the hospital in an
emergency for a heart attack 158 times over the last year and 133 times for asthma
attacks. In each case the illness was either the admitting or primary diagnosis.
Surprisingly, about once a month someone is admitted to the hospital for a heart attack
without being classified as an emergency—most likely the individual was presenting
with another illness and further tests confirmed the heart attack. The emergency heart
attacks alone cost $16.7 million dollars while the emergency asthma attacks cost $3.7
million for a collective total of over $20 million. To place the total cost into context, this
represents approximately $100 for every man, woman and child in Brazos County, even
before accounting for lost wages, productivity and additional stress placed upon the
family.
Number/percentage of restaurants that are smoke free
All restaurants in Bryan and College Station are smoke free by law. However, in Bryan
there is no fine associated with smoking in a restaurant. This includes both the person
smoking and the business. Since there is no fine for the act, a law enforcement agent
does not have an action he can take so the responsibility is totally on employees and/or
business owners to enforce the ordinance.
a. Number/percentage of bars that are smoke free
All bars in College Station are smoke free by city ordinance but the same cannot be said
for those in Bryan. Bryan still allows smoking in bars as of now but the American Cancer
Society, through the Smoke Free Bryan Coalition, is trying to change that currently. Bars
in College Station generally have outdoor areas, especially the ones located in our bar
district known as North Gate, where people will go outside to smoke.
b. Number/percentage of campuses that are smoke free
All of our campuses are smoke free. This includes all four hospitals, both school districts
in their entirety and our two college campuses. The private and charter schools referred
to previously are also all smoke free. Blinn does allow smoking in privately owned
vehicles on campus. It is assumed this is because they would have trouble enforcing the
rule if people on campus were smoking in their car. Similarly, Texas A&M is a smoke free
campus but on any given day you will find students and sometimes employees smoking
on campus. The coalition sees this as an area of opportunity with enforcement to ensure
that the policies on the campuses are being adhered to and that there are
consequences in place for failing to. We also understand the opportunity to update
policies making sure they include E cigarettes and adding agency level, campus level and
possibly legal consequences in the actual policy for those committing violations.
c. Number of tobacco retailers and geographic location
Brazos County is home to 135 tobacco retailers according to the Comptroller of Public
Accounts. As shown in Figure???, they are concentrated slightly more in impoverished
areas (as measured by SNAP usage), thought the difference is not overwhelming.
d. Cost of cigarettes
Our state has a $1.41 excise tax per pack of cigarettes sold, ranking us 25th out of all 50
states and DC. The average tax of all states is $1.54 but this data is strictly on state
taxes, in other states counties may add to these taxes and many do. Brazos County does
not tax the sale of tobacco any further than the states excise tax so the county does not
profit from the sale of tobacco. We have sources saying that a single pack of cigarettes
can range from $1.80 to $4.00. If you look at the low end of this range you’ll notice that
it is only $0.39 over the excise tax for cigarettes in our state. At this cost many people
can afford to start smoking but if you look at long term costs for everyday smokers who
buy upper middle of the range cigarettes at $3.00 a pack, like Marlboro Reds, then you
can see a significant cost of a person’s income.
e. Total number of cigarette sales
The coalition does not have direct access to this data at this time
f.
Quitline use rates
The coalition is waiting to receive this data from DSHS
g. Youth truancy rates
Figure 4.P - BRAZOS COUNTY YOUTH TRUANCY
Reflects: Formal Referrals between FY2010 - FY2014 where
Failure to Attend School is the Primary Disposition Offense
RACE
Black
Hispanic
White
Total
Frequency
29
38
14
81
Percent
35.8
46.9
17.3
100.0
Frequency
27
54
81
Percent
33.3
66.7
100.0
Frequency
36
45
Percent
44.4
55.6
81
100.0
SEX
Female
Male
Total
AGE
10-15
16-18
Total
In Figure 4.P the citations for failing to attend school are shown, they are separated by
age, race and sex. The data is only for when failure to attend school is the primary
disposition offense however. The data is limited by that stipulation but it gives an
accurate representation of the at risk populations by showing the demographic of
students that are more likely to be truant, the percentages should be the same if you
look at cases where there was a secondary offense of truancy. This data came from the
Texas Juvenile Justice Department.
h. Adult smoking rates
According to County Health Rankings (2014), the adult smoking prevalence rate in
Brazos County is 13%. As evident in the selected sample size of 321, it is less than the
state estimate of 17%. The prevalence rate is the estimated percent of the adult
population that currently smokes every day or ‘most days’ and has smoked at least 100
cigarettes in their lifetime. Furthermore, the results are based on the Behavioral Risk
Factor Surveillance System (BRFSS) that provides data representing the population over
18 years of age living in household with a land line telephone.
i.
Adult Smokeless tobacco rates
The BRFSS data for 2010 for smoking cigarettes or smokeless tobacco for central Texas
reveals that the Region 7 is 15.2% at risk (confidence interval of 12 to 19). The
respondents for the survey were 18 years and older. In the table below, women (at
12.4%) are at 69% lesser risk than the male population (at 17.9%).
% at risk
Sample size
Texas
Nationwide
Public Health Administrative
Region 7
95% CI lower
limit
95% CI upper
limit
17,945
18.3
17.1
19.6
448,020
19.3
19.1
19.6
1,435
15.2
12.0
19.0
Gender
Male
560
17.9
13.2
23.8
Female
875
12.4
8.6
17.7
Race/Ethnicity
White
1,004
16.7
13.0
21.1
Black
128
19.0
11.1
30.7
Hispanic
248
12.4
5.9
24.3
Age Group
18-29 Years
95
13.9
6.8
26.2
30-44 Years
290
16.4
10.4
24.9
45-64 Years
591
17.8
14.0
22.3
65+ Years
440
9.1
5.5
14.7
Source: Texas BRFSS 2010
j.
College Student use data
The National Survey on Drug Use and Health: Summary of National Findings suggests
that enrollment in college reduces the likelihood of smoking than for those not enrolled
full time in college. This difference in smoking pattern was similar in both males and
females of this age group and decreased than the previous year 2009. The survey data
also reveals a decline in the trend of college student (i.e. 18 to 25) smoking one or more
packs of cigarettes from 2002 till 2010. Although we do not have access to specific
county level data, we anticipate a higher smokeless tobacco use rate in the county due
to it being a rural population and the university being an agricultural based school
having a large percentage of students from rural communities where smokeless tobacco
usage is considered the norm in most cases.
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
Retail access in our community is very high; tobacco is sold right across the street from
high schools. Most teens could acquire tobacco if they wished to, in the rural areas store
owners do not I.D. teenagers because chewing tobacco or smoking is not seen as a
problem. Many college students work in gas stations where you can buy tobacco. An
eighteen or nineteen year old college student behind the counter is more likely to sell
tobacco to another young person without checking their identification. The availability
of e-cigarettes is a becoming an ever growing problem in Brazos County, especially
amongst the youth population. The fact that any one of any age can purchase this
product is a huge concern for the community. Although we do not currently have any
data that reflects this information, this is what our observation has been. We will work
to identify data that helps to provide a clearer picture to this topic.
B.
Enforcement
Although we do not currently have any data that reflects this information, this is what
our observation has been. It appears that our local law enforcement does not follow
through with citations for tobacco possession in most cases. The contributing variable
has been that there was really nothing for the judge to do with these adolescent
offenders as we have had no resources available for our adolescent population. We are
currently working on identifying potential programs that can serve as referral
opportunities for our local county judges an example being TYTAP. This alone would
help to change the mindset of the officers as they would know that something would
happen as a result of issuing a citation. In addition, educating officers on the obvious
progression of behavior will help them to realize that if some of these adolescents are
deterred from smoking because they face legal/financial ramification for being a minor
in possession, It’s possible to prevent that same young person from escalating to other
harmful behaviors. One of the important pieces to this will be making sure that once the
programs are available that it is communicated effectively to all local law enforcement
agencies, judges as well as juvenile probation officers. Ensuring that everyone is aware
of the programs that are available will help equip all parties with the knowledge of what
resources are available and add more “tools to their bag” hence allowing them to be
more effective at enforcement as it relates underage usage.
C.
Social Access
Cigarettes are the most traded item in the world. Because of this, it is one of the most
easily available items to obtain regardless of age. At any given time while in public, it is
likely that you will hear someone ask,” Does anyone have a cigarette”. The amazing
thing is that often, you see cigarettes being exchanges in this matter. What is alarming is
that no one has bothered to check the age of the person requesting a cigarette before it
is provided. This is common place and happens in a variety of environments. In addition
to the access one has just by asking, many stores locally have been caught selling
“loosies” (a single cigarette) at their stores even with the knowledge that it is illegal.
Doing this adds another access route for not only youth but adults who can’t afford an
entire pack but have enough money to purchase a single. The most common access
route for youth is the fact they know an adult who smokes or chews and can take a
cigarette or a minimal amount of chewing tobacco/ dip at any time without their
guardian even being aware. We have to increase education, and accountability. If
people are aware that if they provide tobacco to a minor that there will be legal
consequences, and if a retailer is selling to minors or selling single cigarettes that there
is a potential fine and additional legal consequences, they will be less likely to so easily
commit these acts. We have to make sure people are being held accountable for their
actions and ensure that as a community this information is communicated at such a
redundant level, that it generates a heightened awareness to ever member of the
county.
D.
Social Norms (Includes Perceived Risk)
Chewing tobacco and smoking are huge staples of the rural community. There are
country songs about Skoal rings and rodeos sponsored by Copenhagen. According to the
Center for Community Health Development and the Texas A&M Health Science Center
School of Rural Public Health “less than two percent of Brazos County residents
reported using other tobacco products, including chewing tobacco, snuff, or dip.” This
data may be skewed because the college students in town for the majority of the year
are not registered as having their address here and the surveys may not have included
an appropriate amount of them. Among some other sub-cultures smoking is more
prevalent. Most music events are almost always held in Bryan, a contributing factor for
this is the fact that Bryan does not have a smoke free ordinance in place in bars/clubs.
E.
Promotion
Cigarette ads on television and radio have been illegal since January 2, 1971 and
smokeless tobacco ads have been illegal since August 28, 1986. This being said, a main
unit of promotion among the industry to target youth is still the television. Movies and
TV shows have been glamorizing cigarette use for decades. The Motion Picture
Association of America did not address the issue until 2007; they may give a movie
glamorizing smoking a higher rating now. The internet is predominantly used by younger
people in our society and there are no current laws against cigarette advertising on the
web. However Google and Microsoft do not allow cigarette advertisements on their
networks. Racing has targeted many rural area children and car enthusiasts heavily as
well. From 1970 to 2003 the highest prize in racing was known as the Winston Cup and
among Formula 1 teams Kool, Skoal and Marlboro all sponsored teams until the mid2000s. Now however, both have outlawed tobacco sponsorship but the smaller racing
circuits have not followed in big brothers footsteps.
This leaves the rodeo as one of the largest advertising agents still in existence among big
tobacco companies. The US Smokeless Tobacco Company, and its brand Copenhagen, is
a major corporate sponsor of the Professional Bull Riders (PBR), the Profession Rodeo
Cowboy Association (PRCA) and most notably the National Intercollegiate Rodeo
Association (NIRA). The Texas A&M rodeo team appears annually in NIRA rodeos across
Texas and Louisiana and is a staple at the College National Finals Rodeo put on by the
NIRA. Texas A&M has had many national champions of these events and had an NIRA
event at the Bryan Expo Center in March, 2014. Smokeless tobacco targets youth in
these events because they are allowed to put patches on vests and helmets of riders as
well as banners and other product placement around the stadium that is caught on the
television camera. RJ Reynolds notably sponsored the Mesquite Rodeo in Dallas, Texas
where 20% of the attendees annually were 12 and younger. This statistic was based on
ticket sales because the rodeo offers discounts for fans under 12 years of age. Numbers
have recently been found that support that as high as 30% of rodeo attendees nationally
are under 18. This shows a tremendous amount of targeting and exposure to youth in
rural communities, like Brazos County.
F.
Pricing
As referred to in Part IV (i) of this narrative you can see that our state has a $1.41 excise
tax per pack of cigarettes sold. Brazos County does not tax the sale of tobacco any
further than the states excise tax; the same can be said of smokeless tobacco which is
taxed at the state level as $1.22 per ounce. The popularity of chewing tobacco in the
area due to the rurality of its inhabitants is expected but as referred to in Part V (d), the
numbers say 2% of residents identify themselves as using regularly. The pricing of
tobacco products can vary between a regular day in Brazos County and one of the 6-8
game day weekends where our population is increased by at least 50,000 for two or
three days. Many places raise alcohol and tobacco prices for those weekends knowing
that the demand will be higher. A few places in the county have been cited for selling
single cigarettes and there is a correlation between food stamp distribution and tobacco
retailer locations.
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.
a. Youth
The coalition currently has a very strong youth presence and overall involvement.
VKOT (Vikings Kicking Out Tobacco) is our local youth group based at Bryan High
school. This group is a school recognized organization and is an active group on
campus. The group was founded in late February and has grown to a membership of
50 plus students in a matter of 3 months. The student led group is a branch of the
Texas Say What movement. The student organizations presence on campus has been
very influential among their peers. VKOT held a Poster Campaign were they plastered
the campus of BHS with tobacco facts and statistics to help increase knowledge
amongst their fellow students. The club also held Tobacco Awareness week which
included various student activities promoting a smoke free life style. A pledge drive
was held and over 1200 students pledged to be Tobacco free! Anti- tobacco psa’s
were aired daily to help increase awareness and educate students of the dangers
associated with tobacco use. Due to the increased popularity of the club and the
overall movement, the club has been invited to give presentations to all incoming
freshman at orientation. We are working to establish similar youth groups at other
schools around the community.
b. Parents
The coalition has many members of the coalition who serve in dual capacities, as
representatives of various community organizations as well as that of a parent.
Because of this, we understand the importance of having parental support at every
level. We have utilized parents of VKOT members as volunteers to help with activities
within the community. The same parents have acknowledged the project’s success
and the impact it’s having on their children and their homes and families. We will
continue to recruit parents and make our presence known within the community to
further promote parental involvement and support.
c. Business community
We currently have several small communities represented on the coalition. We are
out in the community meeting with business owners in effort to recruit to the
coalition and promote the benefits of having a smoke free tobacco free workplace.
We have also provided signage to those businesses that had no signs in place
indicating that their business was a smoke free environment.
Although there have been some businesses who declined to speak with us, the
majority have been welcoming and anxious to express their support of the project by
displaying their smoke free environment signage. The coalition understands that in
order to reach our goal of making Brazos County Smoke free we will need the
support of as many business owners as possible.
d. Media
The coalition has representation from one of our local television media outlets KRHD
ABC 40/Telemundo. We currently have PSA’s being aired daily on this station.
Because of this relationship we were able to access an entirely different population
(Spanish speaking) with Telemundo. We have similar relationships with the other
major networks, KBTX and KAMU. The Eagle serves as the major news-paper in our
county and we utilize them regularly with press releases. We have also developed
contacts with our local theaters as they also have a large viewing audience and
provided additional opportunities to communicate with the residents of our
community. Overall, we have great working relationships with our local media outlets
and understand the importance of having and maintaining these relationships to
ensure that the work and activities that the coalition are involved in get the
necessary publicity to help promote the coalition and help spread awareness and aid
in increasing education in our county.
e. Schools
Bryan ISD and College Station serve as the major districts within Brazos County. In
addition to the two major districts, we have 10 private schools and 4 charter schools.
We have met with administrators at Bryan and College Station Districts and both
districts have expressed full support of the TPCC project and will allow us to teach
TNT at the middle schools and work to develop student groups at the high schools. In
addition, we have access to utilize other school facilities for various events. We have
met with the administrators at the largest private school in our area, St Joseph’s
Catholic school and have gained their full support of the TPCC project. We still have a
huge area of opportunity to engage and gain the support of the other private schools
and charter school population.
f.
Youth-serving organizations
As mentioned in Sec 2. (d), the coalition has an excellent relationship with several
youth serving community programs within Brazos County. We currently have one of
our youth group sponsors serving as the Supervisor of Operations at the local Boys
and Girls Club. Tobacco Education presentations are provided regularly at the Boys
and Girls Club of The Brazos Valley, Neal Recreation Center as well as the Lincoln
Recreation Center. We still have a huge opportunity to engage the local 4H clubs as
well as the Boy’s and Girl’s Scouts and other organization with a specific youth focus.
If we are able as a coalition to educate and create awareness with these
organizations, we will be able to have an impact on a larger population of youth and
gain valuable spokespersons to help promote the coalition’s message and ultimately
foster change and community norms.
g. Law enforcement agencies
The coalition has not gauged the readiness and support of our local law enforcement
agencies at this time. We know that all local law enforcement agencies declined to
participate in the Texas School Safety Center’s Tobacco Enforcement Program for the
upcoming year. We feel that this is a huge area of focus, if we can get these agencies
on board to participate in the program it would provide an increased level of
accountability to retailers as well as youth who are attempting to make these illegal
tobacco purchases. One of the major advantages from the law enforcement agencies
perspective would be the additional financial gains from the stings as they are
compensated for every sting that is completed. Holistically, we understand the
necessity of having support from the local authorities and will continue to work to
recruit members to the coalition and strive to gain in general their overall support of
the coalition.
h. Religious or fraternal groups
Texas is a part of the strongly socially conservative, Evangelical Protestant Bible Belt.
Connolly, Ceci (2003-01-21). Texas Teaches Abstinence, With Mixed Grades.
Washington Post. p. A01. Retrieved 2008-04-28.
In 2000, the religious demographics of Texas were:
Evangelical Protestant – 64.4%.(Baptist
Roman Catholic – 21.2%
Mainline Protestant – 8.1%
Orthodox – 0.1%
Hindu, Sikhs, Buddhists, Muslim, others; 2.0%
Unclaimed – 4.5%
"State Membership Report - Texas". Association of Religion Data Archives. Retrieved
2008-02-12.
We don’t have community level data to provide the specific religious breakdown at the
county level but expect that as a community we are consistent with the state level data.
The coalition has representation from several religious orientations. We understand
that having support from the faith based members of the county adds invaluable
resources as many faith based members are leaders within their respective
communities as well as the county as a whole. The faith based community’s views,
perspectives and opinions are considered heavily by our local elected governing
officials and heavily impact decisions at the county level.
i.
Healthcare professionals
As mentioned in sec 2, part (i), the coalition has representation from the Brazos
County Health Department and have their full support. Most health care providers
have been very welcoming in allowing us to come and discuss the E Tobacco Protocol
and provide any resources we can to allow them to better serve their clients who
battle with the addiction of tobacco. By the coalition providing Quitline information
as well as educational material to give their clients, we are helping to provide both
parties with the necessary resources needed to encourage and promote change. We
still have a huge opportunity to recruit other health care professionals to be a part of
the coalition and are actively working to recruit new members to ensure that we
have representation on the coalition. We feel that having participants of the coalition
as Health Care Providers will make it easier to promote the project as it adds
credibility and validity.
j.
State, local, tribal governments
The coalition has not gauged the readiness and support of our state, local or tribal
government at this time. We understand this is an area of opportunity as these
officials will be vital in the implementation and or revision of our local laws and
ordinances.
k. Other organizations interested in substance abuse prevention
The Coalition has a direct relationship with BVCASA, who serves as one of the areas
primary substance abuse prevention organizations. The coalition has the full support
of BVCASA’s staff and resources.
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.
We have gained a lot of invaluable information since the fruition of this project.
Holistically there is a lot of work that can be done by the coalition within the
community as a whole but we understand that if we are true to the data that has
been collected and will continue to collect, it will give us a great road map and help to
ultimately route us to a healthier smoke free community. Several issues have been
highlighted throughout this project that will be a major priority of the coalition. The
need to ensure that our pre-k –elementary aged population is receiving the necessary
prevention education and resiliency skill training is vital to position and empower
them to be able to make educated and informed decisions around tobacco use. We
feel that we have to make sure that they start receiving education as early as possible
as data shows that students are smoking as early as 4th and 5th grade. If we wait until
that time to try to address it, we will have failed them. Another area of concern is to
ensure that the lower economic area and population has access to as many resources
as possible. It is important that we equip our county with the education and
resources needed to help promote change, and that can only be done by making it
easily accessible. Our African American lung cancer incident rate for Brazos County is
87.6 per (100,000), the highest of any other ethnicity by nearly 30 people per
(100,000). This rate for the county is higher than that of the region, state and national
level. Although the Hispanic population’s number is substantially less, it still is higher
than that at the region, state and national level. In this same category, White
Americans in Brazos County rate have a lower rate than that at the regional, state and
national level. This is a great indicator that there is a huge opportunity to increase
knowledge and make more resources available to the minority population of the
county.
In addition, asthma prevalence in Brazos County surpasses state and nation
percentage values. For instance, the percent of adults with asthma in Brazos County is
15.80% (23,329 of 147,667 adults 18+). From BRFSS 2006-2010 estimates, Brazos
County is displaying a large percent of adults with asthma and at-risk of exposure to
tobacco smoke even compared to regional asthma estimates (Region 7 has 13.06% of
adults with asthma; 276,296 of 2,115,224 adults 18+).
The county issues and areas of opportunities that have been identified by the Brazos
County Tobacco Free Together Coalition all reflect and will address the 6 goals of the
coalition.
Goal 1: Prevent tobacco use among young people
Goal 2: Promote compliance and support adequate enforcement of federal, state and
local laws
Goal 3: Increase cessation among young people and adults
Goal 4: Eliminate exposure to secondhand smoke
Goal 5: Reduce Tobacco use among populations with the highest burden of tobaccorelated health disparities
Goal 6: Develop and maintain a statewide capacity for comprehensive tobacco
prevention and control.
Our plans to target our youth population in pre-K – elementary age, in addition to
providing TNT to the middle school population, will help to educate our students
before usage and increase cessation among those who have already began. We also
have Media campaigns in place for youth/adults. PSA’s are being aired at the local
theater on all screens with a specific age appropriate message dependent on the
rating of the film. We have youth focused PSA’s being aired on KRHD ABC 40 that air
during what have been identified as peak youth watching times. Additional PSA’s are
being aired to target current smokers providing Quitline information during peak
adult viewing hours. We are also excited to have PSA’s being aired on Telemundo
which will help reach the Spanish speaking population that often is left out due to a
language barrier.
Getting the support of our local law enforcement agencies including the campus
police departments will help ensure that the necessary enforcement is in place. As
mentioned earlier in this passage, the need to ensure that retailers and the
community are held accountable and the tobacco laws and regulations are being
closely adhered to. The coalition has identified areas in which more data is needed
and will work closely with PPRI to ensure that we are working to obtain at all levels.
One of the major opportunities is youth usage data. We currently do not have any
youth usage rates as our local high schools pulled out of the survey this year. We do
now have the full support of both districts and foresee having access to youth data in
the near future.
The Brazos County Tobacco Free Together Coalition is excited about all of the work
that lies ahead. We understand that this will be an ongoing process of recruiting, data
collection, data analysis as well as reevaluating and re strategizing and re prioritizing
the needs of the community.. We know that ultimately in order to make change in
the county we have to ensure that we are in tune with the needs and concerns of the
community. The coalition, with the help from TST, and the other resources that have
been provided by DSHS will work with the community to strive to make Brazos
County a healthy smoke free community.
Part VII – Logic Model
Patterns & Consequences
•Chewing
Tobacco
•oral health
•hygiene
Intervening Variables
•Few Ordinances
•Easy access
•Rural community
norms
Contributing Factors
•Easier access in
rural areas
•Parents and
College students
dip (role models)
•Not Ostracized
(no secondhand
damage)
perception of
low risk
Strategies
•Education of
Youth and Adults
•Enforcement of
Laws
•Compliance
Checks
•Media Campaign
Patterns &
Consequences
•Increased Hookah
usaage/Hookah bar
popularity
•More carcinogens
than cigarettes
due to longer
sessions
•Health problems
Patterns &
Consequences
•E-Cigarettes
•growing
populatrity
•Lack of data to
understand
extent of
consequences
Patterns &
Consequences
•Smoking
Cigarettes
•Health problems
•Secondhand
Smoke
•Lost
Productivitiy
•thirdhand
smoke
•ostracized
•illegal for youth
Intervening Variables
•Socializing tool
•seen as healthier
option (incorrectly)
•less offensive odor
•flavors
Intervening
Variables
•Socially accepted
due to less
offensive
secondhand
smoke
•lack of legislation
•attractive flavors
Intervening
Variables
•socially seen as
masculine or cool
•Not enough
enforcement/
mot viewed as a
high priority,(
have bigger
problems)
•easily accessible
Contributing Factors
•College ages, large
groups can
participate
•opposite sex not
put off by smell or
taste
•young people are
attracted by
assorted flavors
Contributing
Factors
•healthier option
than smoking
cigarettes
•allowed to use Ecigs many places
that smoking is
Contributing
Factors
•Rural
communities
•lack of tobacco
education/law
enforcement
•kids see college
students and
parents smoke
•younger people
are more easily
addicted
Strategies
•Education of Youth
and Adults
Strategies
•Education of
Youth and Adults
•Policy
Implementation
Strategies
•Education of
Youth and Adults
•Cessation classes
•Media Campaign
•Policy
enforcement
•Retailer
compliance
Checks