2. 1
Table of Contents
Program Abstract.............................................................................................................................2
Program Narrative
Needs Statement..............................................................................................................................3
Introduction..........................................................................................................................3
Service Area.........................................................................................................................3
Priority Population...............................................................................................................4
Causal and Contributing Factors..........................................................................................5
Consequences of the Problem..............................................................................................7
Existing Resources and Assets.............................................................................................8
Barriers to Services............................................................................................................10
Community Engagement...................................................................................................11
Linking Needs to Proposed Program.................................................................................12
Goals and Objectives.....................................................................................................................14
Program Plan
Program Description..........................................................................................................16
Overall Strategy.................................................................................................................16
Recruitment........................................................................................................................18
Promotion...........................................................................................................................20
Program Availability and Accessibility.............................................................................20
Community Engagement...................................................................................................21
Partnerships and Collaboration..........................................................................................21
Cultural Competence.........................................................................................................22
Management and Staffing Plan
Key Personnel and Staffing Plan.......................................................................................24
Management Plan...............................................................................................................26
Quality Assurance Protocols..............................................................................................27
Logic Model...................................................................................................................................28
References......................................................................................................................................29
Budget
Line-Item............................................................................................................................33
Budget Justification...........................................................................................................32
Attachments
Attachment 1: Detailed Year 1 Work Plan........................................................................36
Attachment 2: Organizational Chart..................................................................................39
Attachment 3: Planning Team Bios...................................................................................40
3. 2
ABSTRACT
Philadelphia, Pennsylvania ranks the second highest in terms of mortality rates due to
CVD. Furthermore, the risk of CVD is doubled for those who have a history of smoking.
Philadelphia is afflicted with a 25% adult smoking prevalence rate, which is higher than the
national average of 17.3%. The 19121 area of Lower North Philadelphia has one of the highest
rates of smoking related deaths associated with heart disease. Although sales to youth have
decreased to 7.1%, the rate of smoking amongst adults continues to escalate.
SmokeBusters is a multi-strategic public health program focused on the secondary
prevention of CVD, which targets smoking as a risk factor amongst 25-44 year old low-and
middle-income African-American residents in the 19121 zip code. SmokeBusters targets this
particular underserved population because of the lack of access to quality smoking cessation
services. This program is designed to recruit and retain 45 individuals at a time by engaging
them in a series of 12-week educational sessions to strengthen behaviors associated with
smoking cessation. Through a partnership with SmokeFree Philly and an affiliation with corner
stores in the zip code, SmokeBusters will also provide smoking cessation aids such as nicotine
patches and nicotine gum, access to free support, and a 24-hour hotline. By the end of year one
SmokeBusters intends to decrease the risk for CVD for its participants by 50% through smoking
cessation.
4. 3
PROGRAM NARRATIVE
NEEDS STATEMENT
Introduction
Cardiovascular disease (CVD) has been the leading cause of death in the United States
since 1921. One of the greatest achievements in public health has been the decline of CVD by
60% since the 1950s, and yet one in three Americans still live with CVD (1). Among all of
Pennsylvania’s counties, Philadelphia ranks the second highest in terms of mortality rates due to
CVD (2).
Service Area
Philadelphia county alone accounts for 27% of all CVD related deaths in the state. With
Philadelphia having a premature CVD related death rate of 58.5 per 100,000, the burden is
particularly evident in people below the age of 65. When further broken down into districts
within the county, 3 out of the 18 planning districts bear most of the CVD death burden- West
Park, Lower North, and River Wards (3). The zip codes that are included are: 19151, 19131,
19121, 19122, 19125, 19134, and 19137.
Several risk factors predispose an individual to CVD. The modifiable factors are
hypertension, smoking, poor diet, and physical inactivity (World Health Foundation (WHF),
2015). Amongst those risk factors, smoking is Philadelphia’s greatest contributor of CVD risk.
Smoking has been shown to double the risk of CVD; this is more than the effect of alcohol, and
only second to diabetes (1). The prevalence rate of adult smoking in Philadelphia is 25%, which
is higher than the 17.3% national average. Also, the city ranks number one in smoking in large
cities in the US; these facts portray a need to focus on modifying this risk factor in the city (3).
5. 4
In an attempt to further narrow down which parts of the city are affected the most by
smoking related deaths, which include heart disease, a survey was conducted by the Philadelphia
Department of Public Health for their Community Health Assessment Report in May 2014. The
survey confirmed these 3 planning districts as being the most burdened- West, Lower North, and
River Wards (3). Of these 3 districts, Lower North and River Wards were also identified to have
the worst rates of CVD deaths in the city: 120.2 and 91.3 per 100,000, respectively. The zip
codes represented in these 2 regions are 19121, 19134, and 19137.
Priority Population: Low and Middle Income African-Americans
Income and educational level has a large impact on the rates of cardiovascular diseases.
Income below $15,000 a year increased the risk of CVD to 24% while income between $15,000
and $24,999 has a risk of 21%, versus the general rate of CVD regardless of income is only 12%
(1). To further compare, low-income adults in Pennsylvania are up to four times as likely as high
income adults to develop CVD, while the middle-income adults are almost twice as likely (1).
Education also has an important impact on CVD rates, with rates three times higher for people
with less than a high school degree than those with a college degree. However, it is important to
note that education level is directly correlated with income levels, and can be considered a
confounding factor in this case (1).
Another factor that is important to consider is the correlation between CVD and race.
CVD have been shown to disproportionately affect non-Hispanic Blacks; the premature CVD
mortality rate for Black non-Hispanics in 2012 was 88.5 per 100,000 which is much higher than
58.5 in the general population. In other words, Blacks have consistently higher rates of CVD
incidence and mortality than all other races (3). The same pattern is seen between smoking and
income level in Pennsylvania. Despite the tobacco tax, income levels are inversely proportional
6. 5
to smoking rates- both lower income and middle income have significantly higher rates of
smoking than higher income (14.9%) (1). When compared to other races, African-Americans
exhibit poor health outcomes when it comes to smoking and smoking deaths, where up to 26.7%
of African-American adults smoke and with the largest rate of smoking related deaths (322.2 per
100,00; Whites 245.1 per 100,000; Hispanics 115.5 per 100,000) (1). To further narrow down the
age group that is most burdened by cardiovascular deaths related to smoking in the US, trends
showed that the age group 25-44 ranked highest at 27.5% (4). However, in Pennsylvania, the rate
is highest in age group 18-24, 27.4% but the difference is by 0.1% and thus negligible (1).
Having carefully considered all the available data, it is clear that low to middle income
African-Americans particularly at age group 25-44 have the greatest burden for cardiovascular
deaths related to smoking when compared to other counterparts in the race and income categories
in Philadelphia. There is little effect of gender differences in CVD prevalence. This very narrow
target population is most condensed in the lower North District of Philadelphia, zip code 19121;
where 66% of the residents are African-American (3) and where poverty is listed as their worst
health indicator (Community Health Assessment, 2014). According to 2013 census data, 71%
make less than $30,000 a year, while the median income for Philadelphia County is $37,192.
Therefore, zip code 19121 in the Lower North district will be the target area.
Causal and Contributing Factors
The presence of smoking amongst individuals of low socioeconomic status (SES) results
in harmful health behaviors (5). The SES gradient in smoking – that is, the exponential growth of
cigarette smoking with people in low SES communities – has only continued regardless of a
decline in smoking prevalence in the general population (6). Furthermore, the impact of SES as a
casual and contributing factor on smoking is not limited to a single indicator; rather, multiple risk
7. 6
factors contribute to poor health outcomes over an individual’s life course. Such indicators
include the existence of social, behavioral, and environmental risk factors. The growing burden
of smoking-related diseases among racial/ethnic minority populations of low SES is of even
greater concern. Such disparities have been attributed to high smoking rates, low cessation rates,
and limited access to smoking cessation related programs in African-American (7). Data from
the CDC (8) reported a growing gap in smoking between college-educated adults and those
without a college education. This data is of critical relevance to the target population, because of
the overrepresentation of African-Americans of low SES and because of limited education, since
smoking results in unfavorable health outcomes (9).
It is evident that being of a lower SES results in an increased likelihood to engage in
smoking through complex pathways relating to social, behavioral, and environmental risk
factors. Furthermore, the presence of such risk factors among lower SES populations may be
increasing, and indicative of a lifelong impact of social and environmental stressors. Lifelong
stressors, such as financial insecurity and unemployment, are more common among those of
lower SES (5). Additionally, there is a strong association between smoking and poverty, as
roughly 29.2% of U.S. adults who are living in poverty smoke (10). Financial insecurity is
correlated with greater difficulty in smoking cessation and smoking relapse in the overall
population (11). Authors of a study on reducing social disparities in tobacco use suggest that
increased financial stress impacts how an individual chooses to cope with stress, which functions
as a causal and contributing behavioral factor (12). Thus, those of lower SES are more likely to
participate in cigarette smoking as a coping mechanism (12).
Being of low SES is only a contributing measure in relation to the aggregative effects of
behavioral factors and stressful environments that are the true predictors of smoking, which then
8. 7
increases the risk of CVD (9). In summary then, engaging in poor health behaviors has been
determined as being interrelated to being uneducated, of low SES, and being African-
American.
Also of note, Turner-Musa and Wilson (13) identified that among African-Americans,
recurrent stressful triggers, including educational and employment disparities, resulted in
increased likelihood of behavioral risks such as smoking. As specified by the United States
Surgeon General, African-Americans face challenges including access and availability of
smoking cessation programs and resources (14). These challenges are partly due to
environmental influences as opposed to simply being a result of individual “choice.” African-
Americans living in poor socioeconomic conditions have limited access to resources promoting
positive health behaviors.
Consequences of the Problem
According to the American Heart Association (15), smoking is not only linked to lung
cancer, but also smoking has been identified as a risk factor for heart disease (15). This risk
comes primarily from the inhalation of carbon monoxide and nicotine (15). The carbon
monoxide reduces the oxygen levels in red blood cells and increases the amount of cholesterol
that lines arteries, both of which lead to heart disease (15). Nicotine, the addictive chemical
found in cigarettes causes an increase in blood pressure and heart rate (15). In addition, the
nicotine constricts the arteries by narrowing them all while increasing the blood flow to the heart
(15). The combination of the narrowing and hardening of arteries, can lead to a heart attack (15).
These effects are not only found in smokers; those subjected to secondhand smoke are
also susceptible to the same risks (15). Studies have shown that the risk of developing heart
disease is 25-30% higher among people exposed to tobacco smoke at home or work, compared to
9. 8
those who are not exposed to second-hand smoke (15). Exposure to secondhand smoke now
causes more cardiovascular related deaths than lung cancer related deaths (16). A study included
in the Surgeon General’s report on The Health Consequences of Smoking showed that over the
last 50 years, there were 7,787,000 premature cardiovascular and metabolic disease related
deaths caused by smoking and exposure to secondhand smoke. (16). This total accounts for
almost 40% of all premature deaths caused by smoking and exposure to secondhand smoke
between 1965 and 2014 (16).
In addition to the health consequences of smoking, there is also a financial burden on the
country. Illnesses related to smoking cost the United States more than $300 billion a year and
this includes almost $170 million for medical care related costs for adults (17). According to the
American Cancer Society there is a $35 health-related cost to a smoker per pack of cigarettes
consumed (18). Cardiovascular disease costs more than smoking-related health costs.
Cardiovascular disease related costs were estimated to be $444 billion in 2010 (19). Both
cardiovascular disease and smoking-related health care costs are detrimental to the economy of
the United States and is only increasing the already stretched medical expenditure.
Existing Resources and Assets
The Lower North district of Philadelphia, with the zip code 19121, is located along the
Broad Street Line (BSL) of the Southeastern Pennsylvania Transportation Authority (SEPTA) on
one side and the Schuylkill River on the other. The nearest hospital to this area is St. Joseph’s
Hospital on 16th
and Girard Avenue. Additionally, there are three health clinics in the vicinity: the
Philadelphia District Health Center #5, Meade Family Health Center and Vaux Family Health
Center.
10. 9
The Philadelphia District Health Center is operated by the City of Philadelphia and the
center located in 19121 does not offer any services related to tobacco education nor smoking
cessation (20). Meade and Vaux Family Health Centers are part of Quality Community Health
Care Inc., (QCHC) and provide health education services for students enrolled at Meade and
Vaux Elementary schools, respectively (21). Although families of the children enrolled in the
specific schools cannot access the health education services, they are allowed to access general
health services (21).
Located next to the targeted zip code is the Health Behavior Research Clinic (HBRC).
This clinic offers smoking cessation and relapse prevention services in the Temple University
Area (22). The HBRC offers clinical services that focus on prevention and treatment of
behavioral health problems, such as smoking (22). The HBRC provides services primarily to
underserved populations such as those who are homeless, jobless, or are from a low-income
population (22).
Additionally, there are smoking cessation programs in the Philadelphia area at large.
These programs include the JeffQuit Smoking Cessation Program, and the Smoking Cessation
Program at the Paul F. Jr. Lung Center (28, 29). The most comprehensive and accessible
smoking cessation program in the city is SmokeFree Philly. SmokeFree Philly is part of the Get
Healthy Philly project, which is a component of the Philadelphia Department of Public Health’s
efforts to reduce smoking rates in Philadelphia. SmokeFree Philly offers free resources to aid in
smoking cessation, such as telephone coaching, face to face coaching and support, online, text
messaging, and 12-step coaching resources, nicotine patches, gum and lozenges (23).
Although there are smoking cessation services offered near the 19121 zip code, there are
none located in the immediate area. Residents of the 19121 zip code can access services from
11. 10
nearby neighborhoods via the BSL or other routes of public transportation, however this is a
barrier for smoking cessation.
Barriers to Services
SmokeFree Philly was established to provide guidance and resources to help people quit
smoking. One of the main goals of this program is to reduce the risk of cardiovascular disease
and other smoking related illnesses. Since the launch of Get Healthy Philly, there has been a 15%
reduction in smoking rates among adults in Philadelphia (25). SmokeFree Philly provides online
smoking cessation resources, community-based classes in Center City, and a 24/7 hotline that
serves all adults 18 years or older all over Pennsylvania (24). In communities like Lower North
Philadelphia, residents may not have access to the Internet or to the community-based class for
face-to-face support. Therefore, lack of easy access to direct smoking cessation services is a
barrier (26).
SmokeFree Philly does offer avenues to other smoking cessation programs in the city
such as JeffQuit Smoking Cessation Program and several others are located in areas of
Philadelphia. These programs are offered through private agencies that offer tailored drug
therapy plans, medication, and counseling & relapse prevention sessions (27, 28, 29). However
since these are private businesses, the clientele will have to pay for the services. Some health
insurances may cover it or clients would have to pay an out-of-pocket fee. For the majority of the
residents in the 19121 zip code who are of low-income, it is unlikely they would consider
looking to these centers for help due to the fact that they will typically have little left over for
food, education, unexpected financial hardships, and health care (30).
This suggests that expenses are arduous for low-income residents, and thus it would be
difficult to prioritize smoking cessation as something needful to them if they have to pay for it.
12. 11
This fact reinforces the need for a program that will provide services at little or no cost to the
inhabitants of the 19121 zip code.
Community Engagement
An important part of planning any research program is community engagement and the
first step in community engagement is to identify key stakeholders. Key stakeholders are parties
that will be affected by the implementation of the project, so it is imperative for them to be used
as a resource during this process. Engaging the stakeholders can enhance the program’s efficacy,
provide various opinions from the community members and partnerships, and be a supporting
factor in the evaluation (31).
In the target population, stakeholders will include health educators, churches, community
centers, residents, and local businesses so there will be a collaborative vision on how the
program can evolve within the 19121 zip code. In order to maximize the success of any
partnership within the community, it will be important to communicate to the stakeholders that
they will be active participants on an on-going basis from the beginning of the project
implementation until the dissemination phase.
Stakeholders are able to act as a liaison between the project managers and various
community members, recommend methodologies, provide detailed information about the target
population, and evaluate the programs to be developed. In order to make sure that the
stakeholders are aware of the planning procedures, town hall meetings should be held regularly
where information about the program is disseminated to the rest of the community.
There are several advantages of having the community engaged in the
program. Community stakeholders can provide a multitude of well-tailored solutions,
opportunities for networking amongst organizations, accessibility to an abundance of resources
13. 12
and information, and means of communication with hard-to-reach populations (31). It is
important that the issue the program is addressing be thoroughly discussed before the program is
implemented.
Stakeholders need to know the criteria used to determine the need for the program,
objectives, the prospective methods that will be used, and the sources of the data that will be
collected (31). Once the stakeholders are informed of these components in the town hall
meetings, they will be able to understand the framework and suggest on areas of improvement.
Cultural competency is also necessary in order to effectively engage with various
stakeholders. Program planners need to be aware of the traditions, values and norms in order to
have background knowledge on the framework regarding views on smoking in this
community. The reason why stakeholders are included in the evaluation process is because they
can properly analyze the results of the program from different perspectives and they are able to
assist in tailoring program initiatives specifically to their community (31).
Linking Needs to Proposed Program
In order to properly link the established needs in our target community with a proposed
program, it is important to reiterate the burden of CVD in the US and particularly in our target
population. In the nation at large, one in every 4 deaths is due to CVD (32) and Philadelphia
alone accounts for 27% of all CVD-related deaths in Pennsylvania, which is concentrated largely
in three planning districts. Two of these three districts are also affected with the largest rates of
smoking related deaths in the city (3). Smoking was selected as the risk factor of interest because
of its burden in Philadelphia. Of all the 10 largest cities in the nation Philadelphia ranks as the #1
city with the most adult smokers (3).
14. 13
Additionally, the African-American population has been identified as most affected by
smoking and CVD. Compared to Whites and Hispanics, African-Americans have a
disproportionately high rate of smoking related death (1). The need to hone in on addressing this
population cannot be overstated as they are also shown to be from lower SES, and poverty is
linked with smoking (10). Finally, of the two districts highlighted earlier, the 19121 zip code
particularly has 66% of African-Americans in their population, which sets them apart as those in
the most need (3).
It is therefore apparent, that African-Americans living in the 19121 zip code of
Philadelphia have an undeniably higher burden of cardiovascular disease due to smoking. Thus,
to improve the health status of that community, a well-planned and robustly funded health
program must be designed to address this very multi-faceted problem.
15. 14
GOALS & OBJECTIVES
Program Goal:
SmokeBusters will improve cardiovascular health by enhancing access to quality smoking
cessation services and conducting peer-led health education sessions.
Process Objective #1
By the three-month mark of our program, the program coordinator will have recruited 12
community members to serve as Peer Educators for the program (33, 34)
Process Objective #2
By the three-month mark of our program, the program coordinator will have used standardized
and pretesting training materials to train 6 community members to be Peer Educators who will
provide smoking cessation education to their fellow community members within the 19121 zip
code area (33, 34)
Process Objective #3
By year one of the program, the program coordinators will have incorporated smoking cessation
tools by providing nicotine patches and nicotine gum to 14 of the 47 corner stores (30%
participation rate) in the 19121 neighborhood (35).
Process Objective #4
By year one of the program, 6 Peer Educators will educate 75% of the 47 corner store owners on
the health benefits of smoking cessation with the use of cessation materials such as nicotine
patches and nicotine gum (36).
16. 15
Outcome Objective #1
By year one of the program, the marketing director will have distributed smoking cessation
marketing materials such as pamphlets and posters to 75% of the 47 grocery businesses in the
19121 zip code area.
Outcome Objective #2
By year one of the program, 6 Peer Educators will offer two 12-week long workshop sessions to
90 self-identified smokers in the target population of 25-44 year old low-income African-
Americans in the 19121 zip code who attend weekly night classes that teach participants about
the negative health effects of smoking and smoking cessation tools available to them.
Impact Objective:
As a direct result of program initiatives, SmokeBusters anticipates that 50% of program
participants will have sustained smoking cessation following 3 years of program completion.
17. 16
PROGRAM PLAN
Program Description
SmokeBusters is a public health program focused on the secondary prevention of
cardiovascular disease (CVD) by targeting smoking as a risk factor. The program targets
predisposing, enabling, and reinforcing factors via program interventions to improve the
cardiovascular health of adult African-Americans ages 25-44 years in the 19121 area of North
Philadelphia. In order to properly accomplish this goal, SmokeBusters will be aligning with the
results of a comprehensive needs assessment that was conducted; the needs assessment showed
that our target population lacked access to quality smoking cessation services. The program is
therefore designed with a multi-strategic approach to address this problem.
Overall Strategy
SmokeBusters will train 6 Peer Educators to serve as health education ambassadors for
the program (33, 34). The program will hold community capacity building and empowerment
sessions, which will be incorporated into a thorough educational curriculum (33,31). The
curriculum will be extensive in its topic coverage and it will be the responsibility of the Program
Director to develop the training materials for Peer Educators and program participants by the end
of July 2015; Peer Educator training will begin in September 2015. Peer Educators will be
effectively trained in disseminating the curriculum mentioned in Table 1 with the use of visual
aids (pamphlets, informational DVDs, handouts etc.). The visual aids will be obtained from the
American Heart Association and SmokeFree Philly. SmokeFree Philly is a smoking cessation
program of the Philadelphia Department of Public Health that is funded by the Center for
Disease Control and Prevention (24).
18. 17
Table 1 provides a simple outline of the 12-week educational sessions that will be hosted
by the SmokeBusters program. The opening sessions will provide background information on
CVD and its risk factors. Subsequently, sessions will be targeted to dispel commonly held myths
and address the contributing factors to smoking (33). Once both topics are introduced and a
clear link has been established between them, a discussion on the burden of smoking will follow.
These workshops will address behavior modification and intends on being supportive of the
participant’s pace of attaining smoking cessation. Additionally, in an attempt to address some of
the contributing factors to smoking, Peer Educators will also conduct demonstrations on stress
management to deter participants from smoking as a stress reliever (38). These participatory and
informational educational sessions will be held for the program participants: self-identified
smokers. These 12-week sessions will begin January 2016. In addition, optional ECGs will be
conducted as a visual tool for the program participant to assess CVD status and risk (38). The
overall curriculum for health education will cover the following topics (Table 1) in weekly
sessions for program participants and will be developed by the end of September 2015. The
curriculum has been adapted from the PRAISEDD study to be more specifically applicable to
our program and program participants (33).
SmokeBusters will also provide smoking cessation aids and emotional support through a
strategic partnership with SmokeFree Philly to obtain free smoking cessation aids and access to
free coaching and support and a 24-hour hotline (24). In addition, the program will form a
partnership with grocery and corner stores in the target area (40). Corner storeowners will be
engaged with program details and will also be encouraged to have smoking cessation materials
and aids available to consumers. SmokeBusters will obtain the materials from SmokeFree Philly
and distribute them to storeowners. SmokeFree Philly volunteers will be utilized to keep local
19. 18
businesses stocked with flyers and supplies. These strategies will address the enabling factor for
smoking of limited access to smoking cessation programs. The smoking cessation aids, such as
nicotine patches and nicotine gum will be available to community members in an effort to
alleviate the reinforcing factor, which is the addictive nature of nicotine.
Table 1: SmokeBusters Program Curriculum Breakdown
Weeks 1 & 2 Detailed Overview on CVD
Weeks 3 & 4 Busting the Myths of Smoking + General Overview on Ill-Effects of Smoking
Weeks 5 & 6 Link between Smoking and Risk of CVD
Weeks 7 & 8 Financial Implications of Smoking
Weeks 8 & 9 Stress as a Reinforcing Factor for Smoking Behavior with Physical Activity Demonstrations for
Stress Relief
Week 10 ECG Pictograms
Weeks 11 &
12
Smoking Cessation Tools – Availability in Community and Proper Use
Recruitment
The initial recruitment goal of SmokeBusters is to recruit community members who will
be trained as Peer Educators. The use of fellow community members as Peer Educators is to
enhance the uptake of the program by participants in the 19121 zip code. The Program Manager
is responsible for the recruitment of 6 Peer Educators by email announcements (Phila.gov
Department of Human Services, Indeed.com) as well as by flyers mailed by the United States
Postal Service. The program anticipates that increased community involvement will be
instrumental in capacity building and community empowerment to attain desired goals and
objectives. The Peer Educators must live in the same zip code, be non-smokers or previous
smokers who have quit for at least a year. Applicants will be strongly encouraged to contact the
20. 19
Program Manager with their application materials and the selected Peer Educators will be
contacted promptly via telephone and/or email.
Upon the conclusion of a comprehensive 3-month training of the Peer Educators, they
will be tasked with the responsibility to recruit program participants. The SmokeBusters program
is designed to recruit and retain 45 African-American individuals from the 19121 zip code in a
behavioral program designed to provide several strategies to strengthen participant behaviors
associated with smoking cessation. Recruitment criteria are as follows:
1) African-American Adults
2) Age range of 25 – 44years old
3) Current smokers- with history of any length of time
4) Individual currently resides in the 19121 zip code
Additionally, the program intends to target self-identified African-American smokers
with diverse experiences, attitudes, and knowledge concerning smoking. Flyers, posters,
pamphlets, and newsletters that are distributed by the Peer Educators and SmokeFree Philly
volunteers will include information that provides program description and contact information
for potential participants. After each selection process is complete per cohort, a group session
will be held 2 weeks prior to the start of sessions for participants to meet each other in a more
social setting.
On the week of the initiation of the first cohort, reminder phone calls will be made the
Tuesday before each weekly session and reminder phone calls will be made the morning of each
session to confirm program participation. If a participant is unavailable during weekly session,
SmokeBusters will attempt to reschedule the session through a phone recording or email
summary. In order to incentivize participants to successfully complete the program, at the
21. 20
beginning of each cohort, they will be entered into a raffle that will reward 2 lucky participants
with $200 and $100 supermarket gift card respectively for 100% attendance and for having met
all the requirements for successful completion of the program.
Promotion
Marketing materials in the form of flyers, posters, pamphlets and radio ads will be
developed by the Marketing Coordinator. These materials will be created by the end of August
2015 and distribution will occur twice a month, to ensure that corner and local community
locations such as churches and schools are stocked with information regarding the program and
available smoking cessation resources. In addition, at local community events, volunteers will set
up tables and engage the community by giving verbal presentations and handing out pamphlets
and flyers to promote program and smoking cessation tools.
Program Availability & Accessibility
The program will operate out of a centralized location the Columbia North YMCA,
located near major SEPTA routes (40). This will ensure the program is physically accessible to
program participants. The Columbia North YMCA is also wheelchair accessible. In addition, the
program office will be open three days a week from 2pm-8pm, and weekly classes will be held
on Tuesdays from 6pm-7pm. The scheduling caters to the target population who are most likely
to be working adults.
As a result of this partnership with YMCA, the SmokeBusters Program will also have
access to child care services that come with the facility (42). The program is aware that the target
population in the community is of child rearing age.
22. 21
Community Engagement
For our program, we will partner with Columbia North YMCA (42). This partner will
serve as our liaison to the community members. Both the YMCA and the Life Center serve a
large portion of our target population and thus we anticipate that the program will easily gain the
trust of the community members.
The Peer Educators will host informal visits at local gathering spots such as grocery
stores and popular corner stores to inform them of the program details. SmokeBusters will also
engage the community by hosting health fairs at community centers and churches in order to
provide information about the program. During these events, Peer Educators will hand out flyers
and newsletters to potential program participants and talk to community members about the
program development and how this change in their community will be beneficial to their lives.
Peer Educators will also post the flyers and newsletters on church and community center bulletin
boards throughout the 19121 zip code.
Before the program is initialized, the Program Manager will facilitate town hall meetings
to engage community stakeholders in the program development. During these meetings, the
community and program planners will discuss the needs of the target population, strategies on
engaging that population, the monitoring of behavior change, and the sustainability of
implemented changes in the community.
Partnerships and Collaboration
Once the stakeholders are engaged in the process, the Project Manager and Peer
Educators will be cultured in the 19121 zip code’s socioeconomic status, political makeup,
cultural values and norms, and demographic trends (31).
23. 22
SmokeBusters intends on forming meaningful partnerships with local organizations and
stakeholders to enhance the program and its services. SmokeBusters will partner with
SmokeFree Philly to provide volunteers for the lifespan of the program to assist with the
distribution of marketing materials to community members and local businesses. Additionally,
SmokeFree Philly will provide the program with smoking cessation marketing materials and
quitting aids like nicotine patches and nicotine gum to ensure that all the corner stores have
supplies at all times for community members to easily access. SmokeBusters will also partner
with the American Heart Association Philadelphia office to obtain educational materials related
to smoking and cardiovascular health. These materials will be made available during the sessions
and afterwards at the corner stores.
Finally, SmokeBusters will partner with Donnelly Distribution. This is a business that
operates within Philadelphia at large. The company states that they can accomplish total
distribution of marketing materials in any designated area (37). To this end, we have access to a
well-established resource within Philadelphia that will enable us to attain a thorough coverage of
businesses within the 19121 zip code.
Cultural Competence
The implementation of a successful smoking cessation program requires SmokeBusters to
understand and respect the culture of its target population: the African-Americans living within
the 19121 zip code. In order to provide optimal program services, SmokeBusters must
understand the target population’s culture and community norms to know how individuals will
respond to certain program demands. Cultural competency is an essential characteristic for any
Peer Educator or volunteer engaging with a cultural or community group of which they have
24. 23
limited experience working with. In a 2006 study by Frank Tesoriero, he asserts that cultural
differences attributed to contrasting worldviews can differ in meaning and as a result lead to
unique individual life experiences (33). It is imperative for SmokeBusters staff members and
volunteers to acknowledge and respect these differences and to integrate them into practice (33).
The program is incorporating this idea by ensuring that all the hired Peer Educators are
African-American community members that have a lived experience that is similar to the
program participants (33). During the course of the Peer Educator training, we will ask them to
educate the program participants on the social determinants of smoking related attitudes, norms,
and beliefs held by their fellow community members. Their input will then be incorporated into
the curriculum to ensure program efficacy and to achieve the program’s desired health outcome
in its target population.
Although the target population is solely African-American, it is essential for
SmokeBusters personnel to be cognizant of the astute variations within the target population
community in order to completely understand and respect the attitudes, values, and behaviors of
program participants. As discussed by Stanhope, Solomon, Pernell-Arnold, Sands, and Bourjolly
(2005), program contributors should expect that their ability to enact behavioral change is
dependent on their attainment of cultural competence (34).
In addition, it is critical to address the health literacy of program participants to ensure
that the development and delivery of SmokeBusters’ services are effective. In the research from
Berkman, Sheridan, Donahue, Halpern, and Crotty (2011), the authors explain how a deficiency
in health literacy has been linked to reduced use of preventive programs, specifically programs
designed at smoking cessation (24). To overcome potential deficits in communication,
SmokeBusters will incorporate a health literacy workshop into the Peer Educator training. This
25. 24
will ensure that in all communication with their fellow community members, they are not only
sensitive to the varying literacy levels but are also trained to effectively communicate with all
program participants, regardless of literacy level.
MANAGEMENT & STAFFING PLAN
Key Personnel & Staffing Plan
1) Program Manager: One program manager at 0.5FTE*
Qualifications: MPH degree and Certified Health Education Specialist.
Responsibilities:
a) Oversee the entire grant and serve as the liaison to the funding agency.
b) Hire all staff members and ensure that all hired staff members are fulfilling the
requirements of their roles.
c) Develop the curriculum materials during the first 3 months, pre-implementation.
d) Conduct training for the Peer Educators.
e) Ensure that the necessary progress reports are completed at the defined timelines.
* The Program Manager works 20 hours a week. We believe that the supporting staff, coupled
with the fact that the SmokeBusters program is one hour a week, makes the responsibilities
manageable at 20 hours.
2) Peer Educator: Six Peer Educators will be hired.
Qualifications:
a) Must have a bachelor’s degree in public health, social work or health education.
b) Must live in the 19121 zip code.
c) Must either be non-smokers or previous smokers who have quit over a year ago.
26. 25
Responsibilities:
a) Responsible for recruiting the program participants from the 19121 zip code.
b) Responsible for teaching the curriculum (after undergoing intensive training) by
conducting a once a week workshop in the local community center.
c) Responsible for administration of pre and post workshop surveys
d) Responsible for drafting the necessary summary reports per cohort.
Schedule & FTE: Each Peer Educator will be required to work 5 hours a week = 0.125FTE.
3) Marketing Coordinator: There will be 1 hired.
Qualifications:
a) Must live in the immediate community
b) Required to have at least a bachelor’s degree in marketing or a related field.
c) Possess strong communication skills as this position involves interfacing with people
at all times.
Responsibilities:
Responsible for handling all details of the partnerships with SmokeFree Philly as it relates to the
volunteers that will be given for the use of marketing the program.
a) Responsible for creating and managing the volunteer schedule and ensure they are
properly aligned with program goals.
b) Responsible for engaging the owners of the corner stores in the 19121 zip code to
convince them to keep stock of quitting aids.
c) Responsible for engaging Donnelly distribution - a sub-contracting company that will
be used for coverage of the community with marketing materials.
27. 26
d) Responsible for collating all reports relating to the amount of marketing materials and
quitting aids that are being distributed over the course of the grant.
Schedule & FTE: 10 hours a week = 0.25FTE
4) Quality Improvement Specialist: There will be 1 hired.
Qualifications: MPH degree with at least two years experience in a similar position
Responsibilities:
a) Responsible for developing all the pre-post tests for Peer Educators and participants.
b) Responsible for training the Peer Educators and marketing coordinator to accurately
do the data collection and entry.
c) Responsible for all data analysis.
d) Responsible for defining and reporting data summaries of all set benchmarks for
each program cohort.
e) As a result of ongoing data surveillance, bi-annual recommendations will be
expected of the Quality Improvement specialist that will ensure that program is
running according to initial goals and objectives.
Schedule & FTE: 5-hour workweek; which is equivalent to 0.125FTE.
Management Plan
The overall leader of the SmokeBusters Program is the Project Manager. All other key
personnel, the Quality Improvement Specialist, the Marketing Director and the Peer Educators
will be reporting directly to the Project Manager.
The Marketing Director will be overseeing all of the program’s marketing efforts, which
include the program and smoking cessation awareness marketing. SmokeFree Philly volunteers
will be reporting directly to the Marketing Director; one of the volunteers will be designated as a
28. 27
field coordinator during operations and coordinate with the Marketing Director. Additionally, all
correspondence with the program’s partner marketing firm -Donnelly Distribution will be led by
the Marketing Director.
Quality Assurance Protocols
In order to ensure proper Quality Assurance Protocols, it is the Program Manager’s
responsibility to ensure that the program’s goals and objectives are met. The Project Manager
will conduct monthly staff meetings with all key personnel to ensure continued alignment to the
program’s mission, goals and objectives.
Additionally, the Program Manager will work closely with the Quality Improvement
Specialist to develop evaluation guidelines and tools, to ensure the proper quality assurance
protocols are gathered and followed during the life course of the program. All key personnel will
be expected to submit quarterly progress reports detailing objective targets met, complications,
and future targets to the Quality Improvement Specialist.
The Program Manager will also work closely with SmokeFree Philly and Donnelly
Distribution to receive quarterly reports stating how many volunteers were assisting, and how
much marketing materials were donated and utilized, respectively, within the same quarterly
time frame. The Program Manager will compile these reports.
Finally, the Quality Improvement Specialist will analyze all quarterly data reports and
report trends and summaries to the Program Manager. At the conclusion of the quarterly
evaluations and results, a meeting will be scheduled by the Program Director and will require the
attendance of all Key Personnel and representatives from the Partner Organizations. The goal of
the quarterly gathering will be to keep all program parts aligned to the common goal of
promoting smoking cessation to reduce the CVD rates in the 19121 zip code.
29. 28
LOGIC MODEL for SmokeBusters Program
Program Goal: To reduce cardiovascular disease as a result of smoking in adult African-Americans ages 25-44 years in the 19121 zip
code.
Long-term Outcome/Impact: To reduce the incidence of CVD deaths due to smoking in the 19121 zip code of Philadelphia.
INPUTS STRATEGIES ACTIVITIES SHORT-TERM OUTCOMES INTERMEDIATE OUTCOMES
Staff:
Administrative
- Program Director
- Quality Improvement
Specialist
- Marketing Director
Teaching
- Peer Educators
Volunteers
- SmokeFree Philly
Money
Materials/Equipment
Technology
- Laptop, electronics,
cords, etc.
Educational materials
- Pamphlets, brochures,
etc.
Time
Peer Educator
Training
1. Program Manager will develop
training materials for Peer
Educators and Participants.
2. Program Manager will recruit &
train 6 Peer Educators using visual
aids and demonstrations in addition
to the curriculum.
By month 6, all Peer Educators
demonstrate competency from
training of knowledge and
demonstrations using a survey
(>=80% score).
At year 1, all Peer Educators
demonstrate sustained competency
(>=80% score) to reflect knowledge
retention from previous training.
Captured therein will be additional
questions about satisfaction with
program implementation, which will
be utilized for year 2 improvements.
Participatory
and
Informational
Education
session
1. Peer Educators will teach 12-week
curriculum to 45 program
participants for Smoking cessation
as a risk factor for CVD
By month 9 for Cohort 1 and month
12 for Cohort 2, 90 total participants
demonstrate competencies based on
surveys designed to capture
knowledge and attitude change as a
result of training and demonstrations
(>=75% score)
By year 1, 75% of program
participants complete an exit
qualitative survey capturing
perceived effectiveness of program
and intent to change behavior.
Community
Engagement
with Corner
store owners &
19121
community
members at
large
1. Program Manager & Marketing
Director will establish and maintain
relationships with 75% of Corner
store owners in the 19121
community
2. Marketing Director will obtain
smoking cessation aids from
SmokeFree Philly to be distributed
to 75% of the 19121 corner stores
At month 6, 75% of the corner
storeowners would have distribution
logs to show that 40% of the received
quitting aids have been given out
within the community.
By year 1, 75% of corner-store
owners would have distribution logs
to show that 80% of the received
quitting aids have been given out
within the community. The doubling
effect is expected by year 1 because
more marketing and educations
would have transpired in community.
3.Marketing Director will create a
marketing distribution plan with
Donnelly Distribution to ensure
marketing materials received from
SmokeFree Philly are distributed to
75% of the 19121 community
(schools, corner stores, grocery
stores, churches, YMCA).
By month 6, conduct 15 informal
observations with checklists of all
sites where marketing materials are
distributed to ensure marketing
materials are distributed to 75% of
sites
By year 1, conduct a community-
wide short quantitative survey
assessing marketing efforts of the
program. The results will inform out
marketing activities in Year 2. (35%
community participation anticipated)
30. 29
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38. Ussher, M. H., Taylor, A., & Faulkner, G. (2012). Exercise interventions for
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40. Philadelphia Department of Public Health. (n.d.). Walkable Access to Healthy
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Mallya, L. Colby, S. Solomon, A. Wagner, J. Aquilante, & . (Eds.). Retrieved
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Engagement Key
34. 33
BUDGET
LINE-ITEM BUDGET
SmokeBusters Budget
Salaries $84,400.00 Rewards $1,520.00
Program Manager 0.5 FTE $40,000.00
1st place
participation 2x$300 awards $600.00
Marketing Director 0.25 FTE $20,000.00
2nd place
participation 2x$200 awards $400.00
Quality Assurance Specialist 0.125 FTE $10,000.00
3rd place
participation 2x$100 awards $200.00
Peer Educators 0.125 FTE $14,400.00 1st place weight loss 2x$100 awards $200.00
2nd place weight
loss 2x$60 awards $120.00
Site $19,736.00
Stationary Supply $200/month*12 $2,400.00 Subcontractors $187.00
Equipment(computers,
furniture) $7,500.00
Donnelly
Distribution
Single
Commission $187.00
Program Materials (flyers,
posters) $1,000.00
Landline $25/month*12 $300.00 Other Expenses $2,820.00
Office Rent $20/sf/yr*400 $8,000.00 Food catering $210/session*12 $2,520.00
Utilities $1.34/sf/yr*400 $536.00
Snacks and
Beverages $75/month*12 $300.00
Other Indirect Costs $12,500.00
Security, payroll, insurance,
legal
10% of total
budget $12,500.00
Total Expenses $121,163.00
35. 34
BUDGET JUSTIFICATION
Salaries:
Program Manager (MPH; 0.5 FTE; $40,000 salary with no benefits) will be a Certified
Health Education Specialist who will be responsible for supervising the grant and present project
updates to funding agency. In addition, the Program Manager will hire all program required staff
members as well as develop culturally competent curriculum materials. Salary is based on
workload and qualifications required for position.
Marketing Director (0.25 FTE; $20,000 salary with no benefits) will have a bachelor’s
degree in marketing and be responsible for facilitating program objectives with community and
program participants.
Quality Assurance Specialist (MPH; 0.125 FTE; $10,000 salary with no benefits) will
have at least two years of experience in a similar position. This individual will be responsible for
the development of pre-post tests for Peer Educators and participants. In addition, the Quality
Assurance Specialist will collect and analyze program data as well as define and report data
summaries of all set benchmarks for each program cohort.
Peer Educators (0.125 FTE; $14,400 salary with no benefits) will be required to have a
bachelor’s degree in any health related field. These individuals will be responsible for the
recruitment of program participants as well as teaching curriculum during weekly program
workshops.
Site Costs:
Stationery supplies are given a per-month budget to ensure flexibility and proper stock of
supplies for SmokeBusters staff and program participants. One-time purchases account for 3
workstation all-in-one desktops for program heads (Dell Inspiron All-In-One listed a $600), an
36. 35
HP Officejet Pro X476dn printer/fax/scanner combo ($280), telephone sets ($55 each), and
appropriate furniture.
Finally, the office is expected to be 400 square feet to account for offices and meeting
zones, and average costs for rent and utilities per square foot in the 19121 area are derived
online.
Other Indirect Costs:
The fixed budget for other indirect costs is estimated to be 10.0% of the program budget,
which equates to $12,500. Indirect costs include security, payroll, insurance, and legal expenses.
Rewards:
Incentives and Rewards: an estimated cost of $1,520 has been designated to provide gift
cards and cash rewards as incentives to program participants. Rewards will play a major part in
maintaining program participation. SmokeBusters believes it is essential to recognize program
participants for their efforts and achievements in their commitment to the SmokeBusters’
initiative. Incentive cost based off leftover money after the cost of core programs were accounted
for.
Subcontractors:
Donnelly Distribution’s commission is $187 for the type and scale of service required,
according to a quote by a representative. Bulk printing services for the entire program have a
budget of $1,000, which can cover the cost of around 7,000 printable materials.
Other Expenses:
Food: The estimated costs of $2,820 will be designated for food and water during the
one-hour meetings. During weekly program sessions, participants will be provided healthy salads
and water supplied by Corner Bakery catering services.
37. 36
ATTACHMENTS
ATTACHMENT 1: DETAILED WORK PLAN
Table 2: Program Work Plan
Year 1
STRATEGY 1: PROGRAM DEVELOPMENT
Objective 1: By the three-month mark of our program, program coordinators will have recruited and used
standardized and pretesting training materials to train 6 community members as Peer Educators, to provide smoking
cessation education to their fellow community members within the 19121 zip code area.
KEY ACTION STEP
RESPONSIBLE
PARTY
TIMELINE
Jul
15
Aug
15
Sep
15
Oct
15
Nov
15
De
c
15
Ja
n
16
Fe
b
16
Ma
r
16
Ap
r
16
Ma
y
16
Ju
n
16
1.1 In January 2016, the
Quality Improve Manger
will be responsible for
administering pre-surveys
based on smoking baseline
information and pre-
intervention knowledge
testing. During this time,
official SmokeBusters
program activities will
begin. Peer Educators will
begin educating
participants in Cohort 1.
Quality
Improvement
Manager
X
1.2 SmokeBusters
operation will begin July 1,
2015 in order to provide
sufficient time for the
Program Director to recruit
programs Marketing
Director and to begin
developing training
materials for ensuing Peer
Educators. The program
will operate for a year until
June 30, 2016.
Program Director X
1.3 In September 2015,
Program Director will be
responsible for developing
curriculum for later
program participants
Program Director X
1.4 In August 2015,
recruited Marketing
Director will be responsible
for developing and
distributing marketing
materials.
Marketing Director X
1.5 In June 2016, the
Quality Improvement
Manager will have the
Quality
Improvement
Manager
X
38. 37
responsibility of posting
survey for evaluation of
program impact.
The community marketing
coordinator will have
distributed smoking
cessation marketing
materials such as
pamphlets and posters to
75% of the 56 grocery
businesses in the 19121 zip
code area by the end of the
first year of the program.
STRATEGY 2: RECRUITMENT
Objective 2: Program coordinators will have incorporated smoking cessation tools by providing access to nicotine
patches and nicotine gum to 14 of the 47 corner stores (30% participation rate) in 19121 neighborhoods by the first
year. Before the availability of these products, storeowners will be educated on the health benefits of nicotine patches
and gum.
KEY ACTION STEP
RESPONSIBLE
PARTY
TIMELINE
Jul
15
Au
g
15
Sep
15
Oct
15
N
o
v
1
5
De
c
15
Ja
n
16
Fe
b
16
Ma
r
16
Ap
r
16
Ma
y
16
Jun
16
1. In August 2015, the
Program Director will
begin recruiting Peer
Educators who reside in the
19121 zip code.
Program Director X
2. SmokeBusters operation
will begin July 1, 2015.
The Program Director will
be recruited during this
time to provide sufficient
time for the Program
Director to recruit
programs Marketing
Director and to begin
developing training
materials for ensuing Peer
Educators.
Program Director X
3. In September 2015, Peer
Educators will be
responsible for recruiting
paid interns/community
leaders from 19121 zip
code and to begin
educating the first cohort
participants with program
curriculum. By year end,
It is anticipated that by year
one of the program, Peer
Educators will have
educated 45 self-identified
smokers in the target
Peer Educators X
39. 38
population of 25-44 year
old low-income African-
Americans in the 19121 zip
code who attend weekly
night classes that teach
participants about the
negative health effects of
smoking and smoking
cessation tools available to
them.
4. In November, Peer
Educators will be
responsible for recruiting
program participants from
19121 zip code and to
begin educating second
cohort participants with
program curriculum.
Peer Educators X
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ATTACHMENT 3: PLANNING TEAM BIOS
Asha Dorsey, with a concentration in Epidemiology, brings to this group experience in
cardiovascular epidemiological research. These experiences have taught her how to collaborate
ideas with fellow researchers in the field. Her research experience aligns with the health problem
the program-planning group is focusing on: cardiovascular disease (CVD, and thus her
epidemiological insights will be valuable. Asha also possesses good listening skills and an ability
to properly identify problems. These strengths will serve the team by ensuring that team
dynamics work toward the SmokeBusters’ success.
Oluwatoyin (Toyin) Fadeyibi, with a concentration in Community Health and Prevention,
brings to this team her clinical background in pharmacy that will assist in framing the
cardiovascular health problem being addressed. She is also bringing to the project extensive
experience making presentations to small and large groups in a variety of settings. Additionally,
Toyin has been actively involved in non-profit organization leadership and thus has had ample
practice honing in her writing skills by drafting and editing a diverse array of professional
documents. Her focus, dedication and passion for purposeful, collaborative work is sure to
contribute positively to the success of this team project.
Philip Hall, with a concentration in Health Management and Policy, brings to this program
his background in the health sciences, which he treats not as a vocation, but rather a way of
thinking. Additionally, Phil has experience in clinical settings and in community service, which
have sharpened his interpersonal skills. His extensive research work makes him an asset in this
team, with sound writing and critical thinking skills. Phil’s diverse background also includes
finance, which will be utilized for SmokeBusters’ accounting and finance needs.
Yves Helou, with a concentration in Environmental Health, brings to SmokeBusters his
scientific background. His undergraduate degree in biology has left him with knowledge on what
is feasible and effective in addressing cardiovascular diseases. In addition, Yves has had
experience in research and data analysis, which will be very beneficial in ensuring that the needs
assessment and the program details are well grounded in evidence, and that the data sources are
reliable. His contribution to the team will ultimately be invaluable.
Bhavika Patel, with a concentration in Health Management and Policy, is a strong leader
with exceptional organizational qualities. A visionary, Bhavika has the ability to direct any team
in any situation towards goals and objectives set by the group. Bhavika is a team player with
successful experiences in-group settings, due to her strong interpersonal skills. Her strengths lie
in strategic thinking and program planning, which were an asset for the program-planning phase.
In addition, Bhavika’s professional portfolio boasts exemplary writing samples in public health
policy and advocacy, which will be utilized in writing up reports for SmokeBusters.
