Community Leadership Program Graduates Address Tobacco Use in High School Students in Appalachia

LEXINGTON, Ky. (Aug. 29, 2017) – Lifelong habits of tobacco use often begin during one’s teenage years. For Kentucky, this reality is particularly concerning, as the rate of tobacco use among Kentucky high school students is well above the national average — 35.8 percent compared with 20.2 percent. This includes all forms of tobacco, from cigarettes to vapes to chewing tobacco, though the rate of high school smoking in the Commonwealth is about double the national average (16.8 percent versus 8 percent).

Two recent graduates of the Community Leadership of Kentucky (CLIK) are hoping to address youth smoking through working with the public school systems in three Appalachian counties.

Sherrie Stidham, a former public school teacher turned health educator for the Kentucky River District and Perry County Health Departments, is hoping to spearhead the transition to 100 percent tobacco-free schools in Letcher and Perry counties. Only about 35 percent of Kentucky school districts are 100 percent tobacco-free, meaning no tobacco use of any kind by students, staff, or visitors.

In Rowan County, Ashley Gibson, a research coordinator at St. Claire Regional Medical Center, is working with Rowan County High School, which is in a tobacco-free school district, to develop an “alternative to punishment” wherein students caught with tobacco can participate in the Not on Tobacco program in place of half their punishment.

CLIK is a leadership development training program offered by the University of Kentucky Center of Excellence in Rural Health, the Kentucky Office of Rural Health and the Community Engagement and Research program of the UK Center for Clinical and Translational Science (CCTS). The Institute is designed to enhance capacity at the local level by assisting community leaders and organizations to reduce health disparities, leverage funding resources, and use data to improve services and programs. CLIK participants receive intensive training, a $2,500 grant to support their proposed projects, and ongoing technical assistance. Gibson and Stidham participated in the third CLIK cohort. 

Stidham spent nine years as an elementary and Head Start teacher before becoming a health educator with the Kentucky River District and Perry County Health Departments.

“I love this job. I can get into the community and help people change their lives,” she said. “I can still go into the school but I feel like I’m doing more. I felt like we weren’t getting this type of health education out there to the kids, and then they get on in age and make unhealthy decisions. You can’t just tell them not to do something without telling them why.”

Stidham is hoping to facilitate the transition to 100 percent tobacco-free schools in Letcher and Perry counties. While students are already prohibited from using tobacco on campus, the same isn’t true for staff and visitors, who have designated “smoking areas,” she said.  

The CLIK training helped Stidham refine and strengthen her project. As a result of CLIK, for example, she added a community survey component to gauge support for tobacco-free schools in each county. She will then take her case to the school boards of each county.

“Through CLIK I learned so much about the different ways I can improve my grant writing and talk to stakeholders. I learned how to plan out a big project bit by bit and inform my argument,” she said.

In conjunction with her proposal for tobacco-free school districts, Stidham will also offer to help the districts update their policies, develop ideas for enforcing the policy with staff, and lead tobacco cessation programs for each school, including Freedom from Smoking for adults and the Not on Tobacco program for students.

“We are out here trying to do everything we can to help kids learn and be successful,” she said. “But they also need to know how to stay healthy, and if we don’t help them learn that as well, they’re not going to live love enough to enjoy their success.”

If you live in Letcher or Perry County and are interested in answering a three-question community survey about tobacco-free schools, please contact Sherrie Stidham at (606) 436-2196.

In Rowan County, which has already adopted a tobacco-free policy, Ashley Gibson is working with Rowan County Senior High to offer tobacco-cessation programs in place of punishment for students caught with tobacco.

The project began as a conversation between Gibson and Brady Reynolds, Foundation for a Healthy Kentucky Endowed Chair in Rural Health Policy, co-director of the Institute for Rural Health Policy, and associate professor of behavioral science in the UK College of Medicine. The two are both members of the tobacco use subcommittee of the Gateway Wellness Coalition, a partnership of St. Claire Regional Medical Center, Morehead State University and the Gateway District Health Department to conduct an extensive community health needs assessment in four of the Gateway area counties (Bath, Menifee, Morgan and Rowan).

Reynolds, who lives in Morehead and maintains a research office there, had been approached by Ray Ginter, principal of Rowan County Senior High School, about developing a program to help students quit using tobacco.  

“Our attendance was negatively affected last year because of suspensions due to tobacco use,” Ginter said.  “We felt that is was a dual problem in that attendance was negatively impacted but it was often the same student. Therefore, that child may have developed a habit that suspension alone would not help.”

When Reynolds mentioned the potential project at a Gateway Wellness meeting, Gibson was considering applying for CLIK. She suggested to Reynolds that they work together, and that she facilitate the idea as her CLIK project.

“I can’t imagine a better candidate for the CLIK program,” Reynolds said of Gibson.

Gibson, three teachers from Rowan Senior High, two teachers from the Rowan alternative school, and two St. Claire Area Health Education Center staff members have now been trained to lead the Not on Tobacco (NOT) program, an eight-session course designed for young people. Students who are caught using tobacco on campus will have an “alternative to punishment” option to participate in NOT in place of half of their punishment, which is currently in-school suspension for the first two offenses and out-of-school suspension subsequently.

Because NOT is an after-school program, student participation requires parent/guardian involvement to arrange for transportation — a type of engagement that Ginter thinks could be beneficial.

“Both punishments take students out of class. Students can now choose counseling which will half the punishment,” Ginter said. “We feel that chronic users, those who don’t want to break the habit, need some type of incentive. By allowing counseling to account for half of the suspension, it puts parents in the decision process and the students are encouraged to attend rather than miss school.”

Reynolds is also contributing to the research component of the project.

“We talked with the school about the value of us collecting data from the kids who end up in this program — that collecting data is really going to help us know how effective what we’re doing is. Or, if it’s not effective, it could lead us to solutions about for to make things better.”

Gibson and Reynolds will monitor how many students choose and complete the NOT program, and the students will additionally have the option to participate in further research with Reynolds. If they choose to do so, they will visit Reynold’s Morehead research office to provide more information, including surveys and biomarkers about their tobacco use.

“In addition to knowing how many students use the NOT program, it would be helpful to know more, like if they’re heavy tobacco users and the most common products used — data to characterize the group and the issue, and also the effects of the program,” said Reynolds, who is conducting this research not towards any grant or funding of his own, but for the simple goal of helping his community. “For me this is a unique experience because we’re doing research but it’s not directed to scientific publication or getting a grant. It’s just about having an impact — getting info back to school and expanding the program.”

Gibson sees their alternative to punishment project as a potential model for other school districts, and hopes that their leadership will be as supportive as Ginter.  

“As more schools in the region go tobacco free, they’re going to need programs like this, and my hope is that we can be model,” she said. “And I just cannot say enough wonderful things about Dr. Ginter. He got substitutes for five of his teachers so they could attend the NOT training. He comes to meetings. He’s been a champion.”

For her, the CLIK program has provided not only enhanced capacity to help her community, but also a professional stepping stone and expanded network. Since graduating from CLIK, Gibson was hired in her current position as a research coordinator at St. Clare; the position is half-funded by the UK CCTS as a “field office” for community-engaged research.

“My experience with CLIK was fantastic. I enjoyed getting to know my fellow CLIK scholars and the communities they are working in. Learning about the programs they are developing, the health disparities they are addressing and their experiences in community engagement was a priceless experience,” she said. “And I was able to draw on my experiences with CLIK in my interview for the research coordinator position.”

For more information about CLIK, visit the program website.