How to use SHS as a weapon in the War On Tobacco? How to use youth to promote a political agenda? How to use taxpayers' money for political lobbying? What scum we have for enemies! Thanks go to Terry Gray for finding their book.

**********************************************************

Growing People: Building and Maintaining Coalitions for Tobacco Use
Prevention and Cessation

This guidebook was produced through a contract between
The Kentucky Cabinet for Health Services
and
The University of Kentucky
College of Nursing
Primary authors of the report are:
Carol A. Riker, RN, MSN
Associate Professor, University of Kentucky, College of Nursing
Ellen J. Hahn, DNS, RN
Associate Professor, University of Kentucky, College of Nursing
Lisa Greathouse, RN, BSN Leigh Ann Ford, MA
Amy Yoder, RN, MSN Allison Frederick, MS
Chizimuzo T. C. Okoli, RN, BSN Matthew E. Koger, MS
Seongkum Heo, RN, MSN, NCC Robert T. Rasnake, MA,
Graduate Students Christine Fann, MS
Gail O'Malley, RN, BSN, MSLIS Graduate Students
Information Coordinator University of Kentucky
Carol Donnelly, BA College of Education
Senior Research Associate
University of Kentucky Anna Allen-Edwards, MPA
College of Nursing Director,
Chandler Medical Center
Margaret A. Plymale, MSN, RN Minority Affairs
University of Kentucky
In collaboration with
Greg Lawther, MS
Former Chronic Disease Prevention and Control Branch Manager
Linda Dunne, BS
Tobacco Use Prevention and Cessation Program Manager
Kentucky Department for Public Health
February 2002
i
Acknowledgements
Special thanks to those who gave input as this guidebook was being
prepared:
Shana Allen, BS
Tobacco Prevention Coordinator
Jessamine County Health Department
Karen Baughman, RN
Tobacco Control Coordinator
Oldham County Health Department
J. C. Compton, BHS
Tobacco Prevention Coordinator
Jefferson County Health Department
Stephanie Creighton, MS, CHES
Tobacco Prevention Coordinator
Northern Kentucky Independent District Health Department
Robin Crosby, BS
Tobacco Prevention Coordinator
Christian County Health Department
Doris Gray
Tobacco Control Coordinator
Madison County Health Department
Kathleen R. Ginn, MBA
Public Health Administrator
Lewis County Health Department
Gina Jesse, RN, BSN
Tobacco Prevention Coordinator
North Central District Health Department
Mark Johnson, MSSW
Community Health Planner
Lexington-Fayette County Health Department
Anna Jones, RN, BSN
School Nurse
Lexington-Fayette County Health Department
Rebecca L. Judy, CHES
Healthy Start Program, Child Care Health Consultant
Tobacco Prevention Coordinator
Lincoln County Health Department
ii
Acknowledgements
(continued)
Stephanie Keelin, BS
Tobacco Prevention Coordinator
Green River District Health Department
Nancy Martin, RN, BSN
Tobacco Prevention Coordinator
Lexington-Fayette County Health Department
Melissa Moore, RN
Tobacco Prevention Coordinator
Mercer County Health Department
Veronica A. Nunley, MA, CPC
Manager, Tobacco Environmental Strategies Prevention Enhancement Site
ALERT Regional Prevention Center, Ashland, KY
Marilyn Peterson, RN, BSN
Core Health Educator
Lexington-Fayette County Health Department
Gerald Preston, BS, MA; Rank 1, School Administration
Tobacco Prevention Coordinator
Johnson County Health Department
Cyndi Steele, BS
Tobacco Prevention Coordinator
Bourbon County Health Department
Stephanie Uliana, BS
Tobacco Prevention Coordinator
Jefferson County Health Department
Stephanie Vogel, BS, MEd
Tobacco Prevention Coordinator
Northern Kentucky Independent District Health Department
Todd Warnick, MHA, CADC
Program Director, Tobacco Prevention and Cessation Program
Lexington-Fayette County Health Department
Denise J. Wooley, BS
Tobacco Prevention Coordinator
Purchase District Health Department iii
Support for this project was provided by state Master Settlement
Agreement (MSA) funds allocated to the Kentucky Department for Public
Health, 2000-2001.
Please direct requests for additional information to:
Carol A. Riker, RN, MSN OR Linda Dunne, BS
Associate Professor Tobacco Control Manager
University of Kentucky Kentucky Department for Public Health
College of Nursing Chronic Disease Control and Prevention
Lexington, Kentucky 275 E. Main St., HS1C – B
40536-0232 Frankfort, Kentucky 40621
(859) 323-6615 (502) 564-7996
iv
Table of Contents
Page
Introduction………………………………………………………………………... 1
Section 1: Recruiting a Broad-based Coalition………………………………….. 2
Grasstops vs Grassroots…………………………………………………….. 2
Different Kinds of Partners…………………………………….…………… 2
Recruiting Traditional Partners………………………………..……………. 3
Reaching Out to Credible Leaders …………………………………………..4
Recruiting Non-traditional Partners.…………………………………………6
Empowering Youth for Community Service in Tobacco Prevention ……….7
Case Study: Rural County…………………………………………..……… 13
Section 2: Coalition Structure, Leadership, and Conduct of
Meetings……….. 16
Coalition Structure…………………………………………………………. 16
Choosing an Effective Leader for Your Coalition…………………………. 17
True Partnerships: A Community Development Approach………………... 18
Planning Effective Meetings.…………………………………………….… 19
Conducting Effective Meetings………….………………………………… 20
Ground Rules………………………………………………………………. 21
Meeting Follow-up………………………………………………………… 21
Section 3: Motivating Coalition Members………………………………………. 23
Typical Timeline for Coalition Development ……………………………... 23
What Motivates People to be Active and Stay Active?……………………. 24
Support for the Coalition: Constant Care and Feeding…………………….. 25
Using Local Statistics to Build Awareness and Motivate Partners…………26
Motivating Through Knowledge and Skill Building………………………. 27
Section 4: Strategic Planning with Coalition Members…………………………29
Overview of the Planning Process…………………………………………. 29
Techniques for Collaborative Planning and Implementation ……………... 32
Section 5: Consensus Seeking and Conflict Management……………………… 37
Consensus vs. Majority Rule………………………………………………. 37
Leadership Skills for Consensus-building…………………………………. 37
Sources of Conflict………………………………………………………….40
Negotiation…………………………………………………………………. 41
v
Section 6: Achieving Visibility and Legitimacy………………………………… 44
Enlisting Key Supporters to Enhance Visibility…………………………… 44
Establishing Trust and Credibility in the Community……………………... 44
Member Training and Recognition to Support Legitimacy………………... 45
Assessment of the Current Image and Ways to Improve the Image……….. 45
Creating a Public Relations Plan……………………………………………45
Tailoring the Message for Specific Population Groups……………………. 46
Examples of Local Newspaper Articles……………………………………. 47
Section 7: Community Advocacy………………………………………………… 53
The Importance of Policy Development in Tobacco Prevention and
Cessation…………………………………………………………………... 53
Advocacy versus Lobbying: A Brief History……………………………… 53
Types of Policy…………………………………………………………….. 54
Laying the Groundwork for Advocacy…………………………………….. 54
Developing Relationships with Decision-Makers…………………………. 55
Developing an Advocacy Plan……………………………………………... 56
Creating Written Messages to Support Coalition Positions………………... 57
Defending Against Obstacles………………………………………………. 58
Section 8: Leveraging Resources for Coalition Work………………………….. 63
When is Funding Needed?…………………………………………………. 63
Grants and Contracts……………………………………………………….. 63
Dues………………………………………………………………………... 64
Private Sector Money………………………………………………………. 64
Foundations………………………………………………………………… 64
Fundraising………………………………………………………………… 64
Section 9: Celebrations and Rewards…………………………………………… 67
Fellowship, Solidarity, Affection, and Fun………………………………… 67
Accomplishment and Recognition…………………………………………. 67
Power and Growth…………………………………………………………. 68
vi
Introduction
Why a guidebook on coalition building for tobacco control? Given the
scope and complexity of tobacco-related problems in Kentucky, it is
critical to build capacity in our communities so that we can address
the issue from all perspectives. In fact, a coalition is defined as a
group of diverse partners who combine efforts and resources to
achieve a common goal that might be difficult for any one partner to
achieve alone. Coalitions have been used to address many difficult
issues because they help communities:
• Combine resources and reduce unnecessary overlap of efforts
• Find gaps in programs and services
• Grow and learn new methods to achieve smoke-free communities
• Improve communication among professional groups and with the public
• Find local solutions that work in a specific community
A coalition based on a community development approach has the
advantage of planning actions that will be the most effective in that
community. The community development approach is focused on community
strengths and emphasizes building capacity and local control. This
approach may seem different and perhaps a bit uncomfortable because
the role of the professional is that of resource, rather than key
decision-maker. The result of using the community development
approach is improved effectiveness, which is well worth the
discomfort that may arise from shared control. You will find the
resource role attractive as you learn how best to train and cultivate
passion and creativity in your coalition partners. When you witness a
highly successful activity tailored for a specific group in your
community, the time, work and restraint expended along the way will
be forgotten!
This guidebook has been developed for anyone interested in building
capacity at the community level. It provides:
• An understanding of how coalitions develop and grow; and
• Skills and strategies that can be used to recruit and train members
and sustain involvement over time.
It has been developed with a "lot of help from our friends."
Wonderful coordinators and partners in all parts of the Commonwealth
have given us input as the guidebook has been developed. Some input
may be woven throughout the text. You will see other contributions
in "Ideas from the Field" boxes emphasizing eliminating disparities,
creative coalition activities, and other unique approaches to tobacco
prevention and cessation.
1
Section 1: Recruiting a Broad-based Coalition
Grasstops vs Grassroots
Most of us are accustomed to working collaboratively with other
professionals and professional organizations in the community – in
a "Grasstops" coalition. Grasstops partners and their agencies often
find that they are working toward similar goals.
In order to be effective in tobacco use prevention and cessation, we
also must develop "Grassroots" coalitions that truly mirror the
community. Grassroots coalitions include a broader spectrum of
people - neighbors, townspeople, and non-traditional partners. Anyone
with a passion for the cause and a willingness to work on one of the
coalition activities can be included. Lexington-Fayette County Health
Department found a willing partner in an African-American church for
Operation Storefront, a campaign that assessed advertising in African-
American neighborhoods and compared it to advertising in other areas
of the city.
Different Kinds of Partners
It is not necessary for every partner to attend every coalition
meeting. Some participants would rather direct their time and energy
to a specific activity or group than be involved with overall
coalition planning. For example, a representative from a migrant
group may want to dedicate all of his or her time toward that group
and attend coalition meetings only for planning activities specific
to that group. Some partners would prefer to be involved only when
their specific expertise is involved. The Parks and Recreation
Director may want to attend meetings only when an activity is being
planned at one of the parks. School representatives may want to be
involved only when youth issues are addressed. There are many
different talents people offer1,2:
Activists: lead or serve on the committees that "get it all done!"
Communicators: get messages out to the rest of the coalition, to
decision-makers, or to the community
Nitty-gritty workers: love doing detail work such as stuffing
envelopes, making reminder calls, making the coffee, setting up the
room, and copying agendas and handouts
Helpers: those who wish to be involved in specific tasks
2
Be clear about your expectations as you recruit and remember to
include your part-timers in all communications and in your periodic
celebrations!
Ideas from the Field
Under Construction
Always keep in mind that coalition building is a `work in progress.'
Your efforts to build support will be ongoing. You may develop a list
of coalition members as well as a list of contacts available for
special projects. Both groups are equally important to your efforts.
Doris Gray
Madison County Health Department
Recruiting Traditional Partners
So how do you recruit traditional partners at the Grasstops level?
Networking is a key strategy. Use coalition organizers and health
partners to reach out to other leaders in the community. Consider
both social and professional contacts with an interest in tobacco
prevention/cessation issues or health; invite them to attend and to
bring others. Network as you conduct school and workplace policy
interviews. When you interview people who seem interested, invite
them to join the coalition as full or part-time members.
Ideas from the Field
Finding Your Friends
The most valuable and integral part of my newly formed tobacco
coalition would have to be my community partners. I have found that
the community agencies that have joined my coalition (American Cancer
Society, Kentucky Cancer Program, the Regional Prevention Center, the
school system) all have a great interest in the tobacco/cancer
epidemic. Many of the agencies listed work with people who have
suffered or are suffering from tobacco-related illnesses and can give
a first hand account of what we are up against. They have worked with
other coalitions similar to mine and have ideas that can carry over.
Lastly, they are very knowledgeable about tobacco and the illnesses
caused from tobacco. If I had one piece of advice for someone
starting a coalition, it would be to get to know your community
partners…they can be your best friends in a very (!) tough battle.
Shana Allen
Jessamine County Health Department
3
Traditional partners in the community include3:
Health care providers: Doctors, dentists, nurses, respiratory
therapists, physical and occupational therapists as well as
administrators and other personnel from hospitals, clinics, health
departments, home health agencies, nursing homes
Educators: Administrators, teachers, counselors, family resource and
youth services center personnel, and others from primary and
secondary education, college, and technical schools
Police and Fire Department personnel: Especially those involved with
prevention
Government officials and political figures and their staff: County
Judge Executive, Mayor, Council Members or Magistrates, and
candidates for political office
Media and others in the field of communications: Radio, newspaper,
and television contacts, including the newspaper's editorial board;
local sign and publishing companies
Business/Economic leaders: Business owners, bank officials, Chamber
of Commerce, associations of business leaders
Recreation personnel: Parks and recreation director, Y officials,
sport league personnel
Youth organizations: school-based, faith-based, community or
recreation-based groups
Faith community: Worship leaders, community service committees, youth
groups, congregations
Reaching out to Credible Leaders
At the Grasstops level, find ways to network with key decision-makers
and other credible leaders in your community. You may or may not
travel in the same social circles as community leaders, but someone
in your coalition does! Use those social contacts to introduce
yourself and take every opportunity to let community members know
what the coalition is doing. Professional connections can be used in
the same way.
4
Different aspects of coalition work will interest different community
leaders as noted below:
Business community
-Financial advantages of reducing secondhand smoke and promoting
cessation in the workplace
Educators
-School issues such as policy, cessation and curricula
-Financial benefit to the school of policies that keep students in
school
Medical community
-Preventing youth initiation
-Promoting cessation
-Reducing secondhand smoke in public places (especially as it impacts
asthmatics and other breathing impaired patients)
Parents, grandparents
-Preventing initiation
-Reducing exposure to secondhand smoke in homes and autos
If you cannot find an easy introduction to one of the decision-
makers, simply make an appointment to discuss coalition efforts. Take
another coalition partner with you for support. As noted so
eloquently below, take along your positive attitude and assume the
community leader will help your coalition!
Ideas from the Field
An Offer You Can't Refuse
As a tobacco prevention advocate you have to believe you will
succeed. You might approach every potential supporter with the
attitude, "I know you will want to help." After all, who can be
opposed to saving lives? We must keep tobacco prevention a public
health issue. It is not about politics, personal choice, or smoker's
rights. It is simply about saving people from death, disease, and
addiction.
Doris Gray
Madison County Health Department
5
Recruiting Non-traditional Partners
There are many ways to recruit a Grassroots coalition. Some may be as
simple as setting up display tables at groceries, churches,
libraries, local fairs or cultural celebrations, or other community
gathering places. Several local health departments have created
coalition display boards and brochures for this purpose. Fliers
describing coalition work and announcing meetings can be left at
laundromats, beauty shops or barber-shops, and some of the other
gathering places noted above. Community, neighborhood, or even block
meetings are other vehicles for recruitment.
Ideas from the Field
Working Within Small Social Groups in Neighborhoods and Churches
In my HIV/AIDS prevention work we sponsored "Safer Sex Parties" in
private homes for the African American community. I recruited hosts
by networking with health department workers and other contacts from
my community health work. Hosts then invited friends to their homes
for an educational session on the prevention of HIV/AIDS. The health
department provided $25 to the host or provided food for the event.
Guests at the parties then volunteered to host parties for other
social groups. Through these parties I conducted education for people
I never saw in any other venue; it was very effective. Word of mouth
worked so well that people are still calling the health department to
request these events long after the grant is over.
Another valuable way I've found to work at the grassroots level is to
partner with churches for health initiatives. The American Heart
Association is currently training church members to lead "healthy
heart" workshops for fellow church members. A group in Louisville is
training church folk to conduct physical fitness activities twice a
week at church and to do blood pressure screening.
Mark Johnson
Lexington-Fayette County Health Department
Networking provides one of the most valuable tools for reaching
disparate groups in your community. Who in your coalition or your own
personal/professional network knows someone in the community you want
to reach? Does a member's husband work on the production line or in
Human Resources at a local manufacturing plant? Do you have a member
who has a friend working in public housing? Does a member's faith
group reach out to the growing Latino/Hispanic Community?
If you can find no natural connections, reach out directly to the
community. Contact community, association, or religious leaders and
use them as key informants. Find out the formal or informal
associations that exist in that community. Remember that citizens
create groups to do work needed in their communities.4
6
Look for these or similar groups in any community:
Ethnic associations
Sports groups
Social cause groups
Support groups
Service groups
Artistic
organizations
Church/
faith groups
Interest groups
Some groups may not even have names. Researchers in a lower income
neighborhood found over 150 associations! When asked, neighbors may
tell you that the person who gets things done in their community is
the woman who organizes people to watch children in the streets. You
may find that a faith group transports elders or runs a food program
for the hungry. A loosely knit group may be creating a garden or a
mural at a public housing facility. "Soccer Moms" and car pools may
also be good groups to tap. People interested in health who are
already active in such associations will be great additions to your
coalition!
Empowering Youth for Community Service in Tobacco Prevention
Youth represent a tremendous resource in community work for tobacco
prevention and cessation. Youth are sometimes perceived as a problem,
yet they can accomplish goals in the community that adults might
spend years trying to accomplish. And the youth themselves will gain
in self-confidence from community work. The key is empowerment. If
community activities are determined and arranged for youth, no sense
of purpose and personal connection will be generated.5 If youth are
involved in selecting community needs they perceive as important,
they will participate in community action. Perhaps the greatest
benefit is that youth come away from meaningful community service
with an enhanced sense of control and a belief in their ability to
change their own lives.6 Community service builds youth empowerment
when it appeals to their maturity, provides social support, places
high expectations, provides opportunities to learn life skills, lets
youth assume responsibility, and gives them the opportunity to make
meaningful contributions to the community.5,6
7
Key elements of working effectively with youth include:
• Group-building
Conduct get acquainted exercises to help the group know each other
better (ice-breakers and energizers) and some group-building
exercises to help them build a good working relationship. A popular
exercise is "Bridge-Building,"7 where teams are chosen randomly to
build a bridge that can hold 3 bricks and allow a 12 pack of soda pop
to pass under it. The trick is that the bridge is to be built from
newspapers and masking tape! The group can talk during the 10-minute
planning time, but they may not touch the building materials! While
the group constructs the bridge (about 10 minutes), the members may
not talk to one another. Everyone will be surprised to know that this
task is actually possible. Discussion can bring to light many lessons
about how best to work together as a team.
• Training
Just like adult coalition partners, youth need training in tobacco-
related issues. They may need basic information about the effects of
tobacco use, reasons why people use tobacco, advertising techniques
that manipulate young people, and ways to avoid tobacco use. Youth
are motivated to action by information about tobacco industry
manipulation of the public and the harmfulness of secondhand smoke.
Training in how to respond to the media is a must including helping
them to formulate sound bites and to deliver them. Finally, like
their adult partners, youth need information on Best Practices so
that they can choose effective community activities.
• Investigation of community needs
Youth can be involved in conducting observations and interviews in
the community in order to identify the most pressing tobacco use
prevention and cessation needs.5 After training, they will be excited
to discover for themselves where and how tobacco is placed for sale
in stores, where youth report that they can buy, the kind of
advertising that is used, where people are allowed/not allowed to
smoke, and the attitudes of various community members toward tobacco
use. Youth often comment that they like this phase of investigating
and getting to know their community in new ways.5
• Planning for action and evaluation
Help youth plan by asking questions such as, "What issues concern you
personally and why?" "In what kind of community do you want to live?"
and "What do we hope to achieve/accomplish?"1 Another important
question for the group is, "What skills and strengths do you bring?
What would you like to contribute?"5 Ogden and Claus5 note that youth
appreciate the ownership of planning their own projects.
After ideas are gathered, consensus is reached, and goals are set,
assist youth in planning actions to reach their goals and simple ways
to determine whether goals were met. Kentucky Action uses a simple
form done in triplicate so that multiple copies are available for
follow-through and evaluation (see next page).
8
PROJECT S.T.A.R.T./ KENTUCKY ACTION
YOUTH ADVOCACY TRAINING
Local Team Planning Form
Group Name: ______________ Sponsor: ________________________
Please list the activities you have planned for your school or
community, along with
proposed date of each activity, the lead person for each activity and
some barriers
you might expect to encounter and overcome!
Activity
Proposed Dates
Lead Person
Anticipated Barriers
1.___________________________
Action Steps:
A.
B.
C.
D.
__________
1.
2.
3.
2.___________________________
Action Steps:
A.
B.
C.
D.
__________
1.
2.
3.
1.___________________________
Action Steps:
A.
B.
C.
D.
__________
1.
2.
3.
Note: Form used at Youth Advocacy Trainings held 2/24/01, Lexington,
KY & 11/10/01, Shepherdsville, KY.
• Action!
The most exciting element for youth will be the implementation of
their plans. In fact, Marilyn Peterson, RN, Core Health Educator at
the Lexington-Fayette County Health Department has been quoted as
saying that there should be no more than two weeks between planning
and implementation. Youth like to be active and involved! Provide non-
intrusive supervision for their activities and a supportive presence
they can call on when needed.
9
• Debriefing and evaluation8
After the activity, help the youth process by analyzing their plan of
action and how it worked out. Discussion of the events and the
dynamics of their success or failure can provide personal insight,
learning opportunities in community action, and fuel for next steps.
This phase should roll right into planning for next steps to be
implemented within a fairly short period of time.
• Recognition and dissemination of results
An essential element in community action is to spread the word about
the group's accomplishments and provide recognition for their
work.5,8 Recognition can be as simple as a pizza party with awards or
mementos from their work or as complex as stimulating media coverage
where youth are interviewed and showcased. In any event, the youth
should be encouraged to discuss their accomplishments and given
positive feedback for their hard work. The celebration, in any form,
will be a chance to reflect on what has been experienced and
accomplished.
Ideas from the Field
The Energy of Youth
I feel the key to working with youth is that they need to have fun
and feel ownership. I know I am being successful when I have more
kids show up every time we meet. The youth can be effective to open
doors for you that would otherwise not be available. If you are not
utilizing youth in your program you are missing a very valuable
resource.
Melissa Moore
Mercer County Health Department
10
Ideas from the Field
Y.A.C. (Youth Advisory Council)
In the Green River Health District, students from five counties
formed an active tobacco control youth advisory council. Youth were
recruited through Family Resource & Youth Services Center directors,
teachers, and guidance counselors, who first met as adult leaders.
Youth were then approached and agreed to:
• attend training sessions on developing and implementing the
projects.
• recruit other teens at their school to join them in implementing
one of the proposed project plans.
• designate an adult leader from each school to attend all meetings
and events.
• designate a teen chairperson at each school to lead the task force
and communicate with the Teen Advocacy Board.
• appoint teen members to promote events through various media
sources.
• Attend an end of the year meeting with all Y.A.C. members to present
1. problems and successes.
2. what action steps worked well and what could have been eliminated.
3. outcome results.
Y.A.C. worked hard on a smoke-free restaurant initiative that
achieved community awareness through a wide variety of media
(petition drive, recognition of smoke-free restaurants during half-
time at football games, a community forum, teen presentations to
professional clubs and local committees, local media coverage
including a live remote at the mall, and paid newpaper ads
recognizing smoke-free restaurants). Exciting next steps are already
planned.
Lessons learned included:
• Go to them – conduct trainings in each county.
• Poll school personnel about the best time of year for the
initiation of projects.
• Empower teens – give them choices.
• Offer teens incentives.
• Develop a positive working relationship with adult leaders.
• Hold weekly meetings in the evening to maintain communication.
• TEENS MAKE A DIFFERENCE!
Stephanie Keelin
Green River District Health Department
11
12
Case Study: Rural County
Look at your county data to determine how best to mirror the
community in your coalition. Take care to include groups
disproportionately affected by tobacco. Some fictional data is
presented from "Rural County" along with some thoughts about how to
connect with specific groups represented in the data.
Service Area
% Farm Pop.
1998
% Pop. Mfg.
1998
Poverty
Rate
1995
African
American
1998
His-panic
1998
Asian & Pacific
Islander
1998
Amer.
Indian
1998
% Smoking during Pregnancy 1999
Rural County
6.0
19.3
20.0
6.5%
1.5%
0.2%
0.1%
25.6
Kentucky
5.0
14.6
17.9
7.2%
0.7%
0.7%
0.1%
23.7
• Farming Population
Rural County has a slightly higher percentage of those who
work in farming than does the state. Look at the pounds of
burley produced to see whether you might encounter opposition
in your work from tobacco interests in the county. Regardless, keep
your focus on health, because farm families also need and want good
health. Farm associations are strong in rural communities and are a
good way to reach farm families. Expect that such associations will
not be able to embrace all the coalition efforts if Rural County
produces a substantial amount of tobacco. Work with such associations
without losing your focus on all aspects of tobacco prevention and
cessation (youth and adults) or getting sidetracked to their agenda.
• Manufacturing Population and the Poor
Consult the Cabinet for Economic Development's Economic
Profile for Rural County to determine which manufacturers
are located in your county and how many people are employed. Blue-
collar workers often smoke at higher rates than the rest of the adult
population so it would be helpful to get manufacturers and workers
involved in your coalition. Likewise, the poor are disproportionately
affected, and Rural County has a higher poverty rate than the state.
Assess Rural County to find ways to reach the poor; public housing is
a possibility and many may be tenant farmers who could be reached
through rural churches, schools, and other rural associations and
gathering places.
• Pregnant Women
Rural County shows a higher percentage of smoking during
pregnancy than does the state. Reach out to pregnant women
13
through obstetricians' offices, prenatal clinics, and WIC clinics.
Network with the health department, local clinics/hospitals, and
group obstetric practices to find the appropriate health care
providers.
• Ethnic Groups
Where are the African American and Latino/Hispanic
populations located in Rural County? You can reach out to
African Americans through their churches, which often are dedicated
to promoting health and involved in social justice issues. In urban
areas try African-American fraternal organizations, lodges, American
Legions, or social gathering places. If your Latino/Hispanic
community is primarily a migrant population, you may be able to work
collaboratively with local churches reaching out to them. As
mentioned earlier, self-defined communities have their own
associations, formal or informal, and they also may have cultural
celebrations through which you can make connections.
Ideas from the Field
Go to the People
In my experience, working with the Latino/Hispanic population is best
done when meeting them at places they are already gathering. Family
literacy programs in our rural area provide transportation for
parents and children to their facility. I have provided education to
mothers in this group about secondhand smoke and effects on their
children. This was new information to them and they were concerned
about protecting their children.
Gina Jesse
North Central District Health Department
Start networking and exploring parts of your community that you may
not know well. It will be an enlightening and inspiring experience!
Bring those interested in health into your coalition and watch the
whole community become involved in innovative ways to address the
tobacco epidemic.
Ideas from the Field
Keep Your Eye on the Prize
Coalition building requires passion from those who initiate the
coalition to address a specific topic. This passion must encompass
the topic and the desired outcomes of the coalition. The vision of
the process to achieve the outcomes must be kept clear. Coalition
building happens when people talk. You must talk to everyone about
the desired vision and outcome. You never know where you will find an
interested partner.
Cyndi E. Steele
Bourbon County Health Department
14
Footnotes
1. Americans for Nonsmokers' Rights. Clearing the Air. Berkeley,
Calif: Americans
for Nonsmokers' Rights; 1996.
2. Brahm BA, Griffiths ME. Mobilizing the community. Columbus, Ohio:
The Ohio
Center for Action on Coalition Development. The Ohio State
University; 1992.
Building Coalitions Series.
3. Anderson E, McFarlane J. Community as Partner: Theory and Practice
in Nursing.
Philadelphia, Pa: Lippincott; 2000.
4. Kretzmann JP, McKnight JL. Building Communities from the Inside
Out. Chicago,
Ill: ACTA Publications; 1993.
5. Ogden C & Claus J. Reflection as a natural element of service:
Service learning for
youth empowerment. Equity & Excellence in Education; 30:1; 72-80;
1997.
6. Florida Tobacco Control Clearinghouse. Youth empowerment and
health promotion.
Tobacco Control Research Report; #1; Florida Department of Health;
Office of
Tobacco Control; 1-11; July, 1999.
7. Shaffer CL. School-Community Team Training Participant Handbook.
Norman, Okla: Southwest Regional Center for Drug-free Schools and
Communities; 1992
8. Zoerink DA, Magafas AH, Pawelko KA. Empowering youth at risk
through
community service. Child & Youth Care Forum; 26:2; 127-138;1997.
15
Section 2: Coalition Structure, Leadership, and Conduct of Meetings
Coalition Structure
Coalition partners have several decisions to
make about coalition structure. One is
whether to form a freestanding coalition
or to become part of an existing coalition.
Tobacco prevention and cessation coalitions
have taken a variety of forms across Kentucky.
Some successfully use existing drug prevention
or health coalitions. Others start meeting
jointly with existing coalitions and then
separate completely or become a distinct
committee of the original coalition. This may be necessary because
the requirements of each group are too great to hold effective
meetings together. Occasionally, the existing coalition is not
supportive of the environmental strategies needed to achieve tobacco
use prevention and cessation goals.
District Health Departments must decide whether to have a district-
wide coalition or one in each county. Again, several models have been
effective. If distance or geography does not make travel from all
counties to a central location prohibitive, the district may
decide to save coalition development time and effort by building one
coalition for the district. This model is likely to be effective if
collaborative working relationships have already been developed in
the district to address other issues. Some districts find their
counties to be quite different in needs and working styles and have
developed coalitions that include multiple counties with similar
needs. For some districts, a coalition for each county has worked
best.
Coalition partners also face decisions about the inner workings of
the coalition.
• Should the coalition have officers and bylaws?
• If so, how specific should the bylaws be?
Many tobacco coalitions choose a chairperson and form committees.
Often the coalition and its committees operate by consensus. Some
coalitions have decided that their membership is too large or that
the goals of represented organizations are too complex and diverse to
operate the coalition without bylaws. The political struggles in some
communities also may dictate the need for structure. Coalitions may
start less formally and then adopt more structure if members see the
need for it. If a coalition shows a trend toward difficulty in
decision-making, bylaws may be helpful. Section 5 deals more
extensively with consensus-seeking and conflict management.
16
Ideas from the Field
To Join Forces or Act Independently?
Pros of using an existing coalition:
• No need to recruit a group of people
• Fewer meetings for community members who are on several
committees/coalitions
• Shared resources (example: Governor's Youth Substance Abuse
Prevention Initiative project pays for food at meetings)
• Easier to make sure activities are coordinated, with less
duplication of services
Cons of using an existing coalition:
• Time is short for your issues because business of other groups must
be addressed
• You are pulled into activities that may not be included in your
program goals (e.g., alcohol and other drugs)
• More talkers/decision makers and fewer doers may attend
• Harder to get volunteers to assist with your activities
Rebecca L. Judy
Lincoln County Health Department
Choosing an Effective Leader for Your Coalition
Should the Tobacco Prevention Coordinator automatically assume the
role of coalition Chairperson? While the coordinator should pull
together potential members for the first few meetings, it is not
always best for the Tobacco Prevention Coordinator to become
coalition Chairperson. If a good Chairperson can be selected from the
coalition membership, the Tobacco Prevention Coordinator can keep a
broad perspective and more effectively oversee all tobacco program
activities. Several coalitions have found skilled coalition
Chairpersons from local business and professional communities.
The Chairperson (or facilitator) is important because he or she lays
the groundwork for trust, sharing ideas, and formation of ongoing
relationships. A good facilitator teaches members to think in new
ways, conducts brainstorming sessions, fields questions and concerns,
discusses controversial issues thoroughly, involves quiet members,
and makes sure that all are aware of decisions. For the coalition to
function well, the facilitator helps the group work toward common
goals, shares leadership as appropriate, delegates, and helps all
members know their importance to the coalition.1,2
17
Find a coalition Chairperson with the following qualities:
• Constructive outlook
• Strong commitment
• Ability to listen and reflect
• Neutrality
• Awareness of what is not being said and how it can be stated
• Awareness of when to facilitate and when to participate
• Ability to seize the moment
• Good interpersonal communication skills2
True Partnerships: A Community Development Approach
In addition to determining the best structure and finding a good
leader, a coalition that wishes to design the most effective
approaches for tobacco use prevention and cessation uses a community
development approach. Such an approach differs from a traditional
community-based approach because it focuses on the strengths of the
local community, rather than on its problems and weaknesses. Using a
community development approach involves:
• Encouraging the community to define its problems and solutions.
• Building the community's capacity to respond to community needs.
• Enhancing community control.
• Using community professionals as resources rather than as decision-
makers.
In the community development approach, professionals support the
coalition by providing training in best practices, pointing coalition
partners toward resources, and helping grassroots coalition partners
develop leadership, public speaking, and media skills. Grassroots
partners provide expertise to Grasstops partners on how to reach out
to their populations and on adapting Best Practices with their
populations.
Ideas from the Field
Clone Yourself
As a tobacco prevention coordinator, two approaches have worked well
for me. One is to clone yourself. If you suddenly lost the
opportunity to perform your job, would your efforts and strategies in
tobacco continue? This leads to the second approach. Form
partnerships and seek support from the usual suspects, but be
creative in finding support, recruiting coalition members from
unlikely places. Some good prospects include public housing
directors, YMCA, medical equipment suppliers, Scouts, faith groups,
coaches, parents, and family resource directors.
Doris Gray
Madison County Health
18
Planning Effective Meetings
Effective meetings are also key ingredients for coalition success.
Plan ahead by including the following elements:
• Climate and environment
Plan for comfortable and familiar surroundings that are accessible
and
have sufficient space
Post coalition ground rules
Provide refreshments!
• Room arrangements
Arrange seating in a circle or around a table so members can see
each other
Provide sign-in sheets with space for name, address, phone, and e-
mail.
Arrange for a flip chart, easel, masking tape and places to hang
paper as the pages are filled.
Gather any audiovisual equipment needed.
• Content of the meeting3,4
Consider the goal(s) of the meeting.
Do your homework by reading and talking with people about each goal.
Decide who needs to be at the meeting in order to address each goal
and invite those people personally
Create a written agenda, with a time schedule.
• Enhancing Attendance
Have a regular meeting time so members know what to expect.
Send meeting reminders or call participants prior to the meeting
Share the agenda/main goals of the meeting as a part of the reminder
19
Sample Coalition Agenda
Johnson County Health Department
March 28, 2001: 12noon-1 pm
1. Refreshments and opportunity to meet other coalition members (10
minutes)
2. Introductions, announcements (5 minutes)
3. Overview of the Tobacco Prevention/Cessation Plan (10 minutes)
4. "Kick Butts" Day: Final plans (10 minutes)
5. Helping Teens Stop Using Tobacco (10 minutes)
• TEG-Intervening with those who do not want to stop using tobacco
• TAP-Helping teens stop using tobacco (for those who want to stop)
6. Open discussion from coalition members (10 minutes)
7. Adjourn
Gerald Preston
Johnson County Health Department
Conducting Effective Meetings
A good meeting facilitator understands the goals of the meeting (and
the organization), keeps the group on the agenda, includes everyone
in the meeting, and makes sure that decisions are made by consensus.
Here are some tips for conducting a good meeting3,4:
• Allocate time for socializing and refreshments
• Start and end the meeting on time. People will come to expect and
appreciate timeliness!
• Welcome everyone and make introductions.
• Review and reach agreement on the agenda, goals, and ground rules.
• Review tasks assigned at the last meeting.
• Recognize and celebrate accomplishments and successes.
• Encourage participation and avoid domination by one or two members.
• Stick to the agenda and bring closure to each item.
• Be flexible, but if a lengthy discussion seems necessary, ask the
group how they wish to handle this change in the timing of the agenda.
• Respect everyone's rights and opinions.
• Use open-ended questions and listen.
• Summarize what you hear.
• Use humor and avoid defensiveness.
• Assign tasks to specific members.
• Summarize the meeting and follow-up that will be needed.
• Thank the participants.
• Close the meeting.
20
Some extra tips for meeting success include watching the group's body
language, checking back with the group after you summarize, watching
your own speech and body language, and keeping your face to the
group, rather than to the easel or chalkboard. Be honest, use humor
and take a break when needed! Make sure meetings last no longer than
an hour and a half.
Ground Rules
Ground rules are guidelines for coalition operation and group
behavior. They are determined by the coalition, with each partner
having input. Ground rules help develop group norms and an
environment that feels comfortable, thereby enhancing the ability of
the coalition to work effectively. Be sure to post a copy of the
ground rules at each meeting so that partners can refer to them. Here
are some ground rules created to foster good working relationships in
all types of groups.
Sample Ground Rules
We agree to:
• Share information and learn from others
• Treat others the way they want to be treated
• Use no put-downs and avoid devaluing people in any way
• Give others a chance to speak, avoid interrupting, and listen as
they speak
• Correct misinformation about groups (our own and others)
• Treat each person as an individual, not as a member of a group
• Actively combat stereotyping
• Respect people's privacy and refrain from repeating personal
information
• Treat all ideas and emotions with respect
• Avoid blaming, accusations, and generalizations
• Agree to disagree without hurting others' feelings

Thanks to JIM at FORCES Tavern for this find.

I though it would be an interesting addition, showing how things at the "halls of higher learning" really are: biased and agenda driven, right from the start.

I see that mostly RN BSN's were authoring this fine piece of propaganda. Well, at least they could finally use all those goofy statistics classes they had to take, and it was not in VAIN....(sarc/off)

This is the kind of garabage that is really easy to get grants for, and that is exactly what paid for this propaganda- grant money.

And usually, these kinds of things are written by someone who already has an "interest", or agenda regarding said topic.

Bad mojo. They would have made wonderful assistants to stalin, though.

quote:

I see that mostly RN BSN's were authoring this fine piece of propaganda. Well, at least they could finally use all those goofy statistics classes they had to take, and it was not in VAIN....(sarc/off)

A former friend of mine went to nursing school. She used to be a really fun person until she started dating this guy who she is now married to and has several kids with. He is an aging wannabe 60s radical type and she converted to his Marxist ideology that all corporations (especially big bad tobacco) are conspiring to undermine public health and the environment. She thought the best way to fight back would be to become a nurse and work with "underserved and vulnerable populations" (favorite lefty buzzwords). Both nursing and teaching used to be well respected occupations (her hubby is a teacher - or "educator" as they like to be called), now as fewer qualified people choose to go into these fields, they have attracted many left wing kooks with a "lets change the world" agenda.

"He is an aging wannabe 60s radical type and she converted to his Marxist ideology that all corporations (especially big bad tobacco) are conspiring to undermine public health and the environment."


You got that right, Nick. And, weren't these same clowns "fighting against" all the "repression" of their parent's generation???



They turned out to be tyrants even stalin would have been proud to know. Rebels without a clue, indeed.

You have to look at nurses as union members trying to maintain their industry. They are solely dependant on the balance of the industry to keep food on their tables.

Currently they are no different that auto workers in my opinion. There were probably buggy workers in the same boat when cars were introduced.

Maybe if more nurses cared for patients and teachers taught a lot of this crap would go away. This country is top heavey in thinkers, not doers.

How many accountants talk about the value of keeping a good set of books in any relationship to anything except taxes.

In regard to Neo-Communists, I was watching a History Channel documentary on the Nixon Presidency earlier tonight.

When anti-war protests went into full swing, Nixon formed a team to find the Communist leaders within the U.S. who, in Nixon's mind, were undoubtedly behind the war protests.

Nixon's team found nothing.

Nixon was frustrated by this. So, Nixon formed a better team. Eventually, this "team" became the "The Plumbers" who conducted the Watergate break-in.

I found this interesting because it was consistent with what I'd posted here previously about "The New Communism"; Communism acts as a pattern of its own and it doesn't usually have specific people running around with a Communist Party ID card. Rather, the ideology, the pattern, in ways that we don't yet understand, walks around on its "own two feet" and expresses itself where it finds a path of least resistance.

This all gets a bit too philosophical, but suffice it to say that ideas, idealogies, are real things, as is evidenced simply by the fact that they keep popping up again and again. Communism looks like such a good idea on paper, that people keep drifting toward it as a solution to their problems.

Here is the best way I can describe Communism as a political system in a few short words.

You wear a blue shirt. I wear a green shirt. Rather than let us wear the color shirt we please, we all vote, as a group, on what color shirt is best. Green shirts win. Now, all people must wear green shirts because the group has agreed to them. Rather than letting one guy produce blue shirts and another guy produce blue shirts, we decide that only green shirts must be worn. Since private compeitition isn't necessary, the government, as a reflection of the greater will of the people, can simply produce the green shirts.

Now, because only green shirts are available at the government store for the Labor Day sales, rather than a variety of shirts, no one, or very few show up for the Labor Day sales. As a result, the economy begins to crumble.

People begin to complain, but we must sustain the system we've built. The complaints go on too long and the government suppresses the people who complain about the lack of variety in shirt colors. Shirt colors were decided by the people, in majority, and everyone agreed that we should agree with the majority for the good of all. The complaints, though, continue. This leads the government into the inevitable position that such dissenters must be imprisoned. The dissent still continues! The system, though, must prevail! Suppresion didn't work, imprisonment didn't work, so these people have to be silenced. They've commited a crime against the state.

Kill them.

Now, of course, you'll never reach the point of such dissent or having to kill people over shirt color because most people will, in fact, just get along and wear a green shirt rather than make trouble for themselves and their families. Why, after all, would someone lose everything they've worked for their entire life over the color of shirts?!?! Everyone can see how foolish they are!

If you complain to your friend, your friend says "Why do you complain? Why do you think so much? It's just a shirt. Who cares? Just get along. Life is easier. Be glad you have a shirt. The State has provided you with a shirt and that is all you really need! How selfish of you to complain against the color when it is against the good for all as it has been decided by the system! You'll be lucky if you're not reported!"

All of this seems very attractive to many, many people because they mistakenly believe that is is a solution to all problems. In fact, it invites ten problems for every problem it solves. People just keep bringing it up though, and they're not likely to ever stop.

http://speakeasyforum.com/eve/forums/a/tpc/f/8821083241/m/2401015581

http://www.mises.org/TRTS.htm

http://en.wikipedia.org/wiki/Friedrich_Hayek