This grant proposal seeks funding for a program to reduce smoking and smoking-related deaths in Gallatin County, Kentucky. According to data, smoking rates and lung cancer deaths are higher in Gallatin County than statewide averages. The proposal outlines a series of evidence-based interventions targeting adolescents and adults, including educational sessions addressing media influences, stress management, and social influences on smoking. The goal is to reduce adult smoking rates by 30% and the number of households with smokers by 50% by 2020 to ultimately lower lung cancer mortality in the county. A needs assessment provides background on the county's demographics, health indicators, and behavioral and environmental factors related to tobacco use.

1. Gallatin County Healthy Lungs Program
Kaylon Peck
HEA 480W
Grant Proposal

2. Needs Assessment
Phase 1: Social Assessment:
Gallatin County, Kentucky was established in 1798 as Kentucky’s 33rd county. Its county
seat is Warsaw Located on the banks of the Ohio River; Gallatin is a part of the “Golden
Triangle,” of Cincinnati, Louisville and Lexington and covers 101.23 in land area in square
miles, (2010 US Census). According to the county website (2014), Gallatin County has been
proclaimed the Racecar Capital of the State, with the attraction of the Kentucky Speedway and
Bluegrass Motorsports Park. Also, with the Ohio River being located right next door, water
sports and boating is a popular attraction.
According to the U.S Census Bureau (2010), with a total population of 8,589, Gallatin
County shows little diversity with a majority of the county population being white (94%), 1.3%
African American, 0.1% American Indian and Alaska Native, and 0.2% being of the Asian race.
The male and female population is very close. This consists of a population of a male population
of 50.2% and a female population of 49.8%. Of the population ages 18 to 24 years, 28.9% had
less than a high school degree and 43% had a high school degree, while only 7.4% had a
bachelor’s degree or higher. In the population ages 24 or older, 13.4% didn’t earn a degree from
high school, 18.7% had some college, but no degree, and 6.8% had at least a bachelor’s degree.
The U.S census gave a poverty rate for the population 25 years and over for whom poverty status
is determined by educational attainment level (2010). Residents with less than a high school
diploma were 32.5% considered in poverty and only 2% with a bachelor’s degree had poverty
status. The median household income is estimated at $43,860. Overall, 19.5% of the population
lives below the poverty level while 80.5% live either right at or above the poverty level.

3. Phase 2: Epidemiological Assessment:
A. Health Assessment:
According to the Center for Disease Control (2014), cigarette smoking causes more than
480,000 deaths every year in the US. Smokers have an increased chance of developing
cardiovascular disease, respiratory disease, and cancer.
Smoking can have an impact on someone’s quality of life. When a person begins to
smoke, damage to the body is happening right away. Of lung and bronchus cancer in Gallatin
County, the death rate is 98 deaths per 100,000 populations. Compared to Kentucky’s 75 cancer
deaths per 100,000 populations, Gallatin County is higher. In 2011, the Kentucky Cancer
Registry had reported 18 total cases of lung and bronchus cancer out of the 8,547 population at
risk throughout Gallatin County. (Kentucky Cancer Rates, 2010)
B. Behavioral/Environmental Assessment:
County Health Rankings & Roadmaps (2014) reported 45% of adults smoke >=100
cigarettes or are currently smoking. The Institute for Health Metrics and Evaluation (IHME)
analyzed a performance of all 3,143 US counties for smoking prevalence. The smoking
prevalence of females in Gallatin County had a value of 27.9% and national rank of 2,902. The
males on the other hand had a value of 31.9% and a national rank of 2,939. (IHME, 2013)
Although it may be a personal decision to start smoking or continue to smoke, the
environment around may influence your decision. A study at Dartmouth College found that
children who had at least one parent who smoked were four times more likely to buy cigarettes
versus the children who grew up in a household that was smoke free. According to the Healthline
website, there are environmental "triggers" that can cause an individual to smoke. These

4. behaviors began by casually smoking at parties when drinking alcohol. (Rufener, B. 2012)
The behavioral target is smoking. The environmental target is prevalence of households
in which adults smoke.
Phase 3: Educational & Ecological Assessment:
With smoking being the actual behavior that contributes to lung cancer, cardiovascular
disease, and other types of diseases, there are other contributing factors that can play a role in
beginning the smoking habit. Teens may start to smoke because they think they will look cool,
adults may smoke as a stress reliever; others may smoke because it helps to control their weight
or they enjoy smoking for the pleasure of it. However, the pressure to start smoking is
everywhere, especially in the media. (Health Literacy, Why People Smoke)
One specific type of contributing factor that may lead one to start smoking would be the
media advertises smoking everywhere. The tobacco industry spends billions of dollars every year
to make smoking look cool and safe. Two out of three box office hit movies include smoking in
them (American Cancer Society, 2014). The media usually targets adolescent populations, young
adult and college-aged populations, and in established smokers (The Society of Behavioral
Medicine, 2013).
Environmental factors for smoking are everywhere as well. Those who you are around
have the biggest influence on whether an individual picks up the smoking habit or not.
Regarding peer influences, reviews showed a strong association between friends’ smoking and
adolescent smoking. Adolescents with smoking friends are more likely to smoke than those with
only non-smoking friends. Also, children who had both parents who smoked were three times as
likely to smoke themselves. (Leonardi-Bee, Jere, Britton, 2011)

5. The targeted contributing factors in this case for individuals who smoke would be the
media advertising cigarettes and making them look glamorous, growing up in a household where
everyone smoked or having peers who smoked, and lastly stress on the individual.
Goals and Objectives
Goal: To reduce the number of premature deaths from smoking in Gallatin County residents.
Outcome Objective: By 2020, reduce the number of lung cancer deaths in the residents of
Gallatin County by 20%.
Behavioral Objective: By 2020, reduce the number of adult smokers by 30% in residents of
Gallatin County.
Environmental Objective: Reduce the number of households that contain adult smokers by
50% by the year 2016.
Learning Objective 1: Within one year, all middle school aged students will be able to spot 3
different techniques the media uses to advertise smoking.
Learning Objective 2: By the end of session 2, participants will learn 5 techniques on how to
cope with stress.
Learning Objective 3: By the end of session 3, participants will have an increased awareness of
family/friends influences on smoking.
Learning Objective 4: By end of session 3, participants will have an understanding of any
questions they may have on harmful effects of smoking.
Process Objective 1: By the end of 2015, participants will be able to recognize their own
intentions of wanting to smoke and be able to resist temptations.
Process Objective 2: At the end of session 2, students will be able to implement 4 healthy ways
to relieve stress without smoking.
Process Objective 3: At the end of session 1, participants will be able to combat 3 strategies that
will keep them from becoming irritable from withdrawals.
Process Objective 4: At the end of the 6 week program, participants will be able to list 5 harmful
chemicals in tobacco.
Implementation Plan

6. Phase 4: Intervention Alignment:
The first type of evidence-based intervention is known as Project EX. This intervention is
a school-based smoking-cessation clinic program for adolescents that stress motivation, coping
skills, and personal commitment. Project EX uses engaging and motivating activities such as
games and yoga to reduce or stop smoking among adolescents and teach self-control, anger
management, mood management, and goal-setting techniques. Adolescents are provided with
accurate information about the social, emotional, environmental, and physiological consequences
of tobacco use. (NREPP, Project EX, 2006) The two main outcomes for this intervention are
tobacco use and Motivation to quit tobacco use.
This type of intervention would be a great intervention for reducing the number of adult
smokers because eventually the adolescents who are currently smoking will grow into adult
smokers. Therefore, ending adolescent smokers and motivate them to not smoke again will be a
good way to reduce adult smokers in the future.
Since the media plays a huge role in the tobacco industry, another type of intervention
that deals with the media would be Media Ready. Media Ready is a media literacy education
program for children ages 6 to 17 years old. The goal of the program is to prevent or delay the
onset of tobacco use as well as alcohol by encouraging healthy beliefs and attitudes about
abstaining from these products. It also helps by enhancing the ability to apply critical thinking
skills in interpreting media messages. The objectives pertaining to tobacco are asking their
intentions to use tobacco. Because the media does play a big part in contributing to tobacco
users, educating the youth on how to spot these messages will hopefully keep them from falling
under their spell and reframe from buying into their product. (NREPP, Media Ready, 2010)

7. Template A: ActivityDescription
Activity title Questionnaire
Activity description (2-3 sentences describing what will
be done)
A questionnaire to examine the unique influences of media-related cognitions on adolescents’
currents substance use and intentions to use substances in the future, controlling for parental
and peer influences.
Learning/resource objective addressed by this
activity
Within one year, all middle schoolaged students will be able to spot 3 different techniques the
media uses to advertise smoking.
Target population 6-12 (Childhood) 13-17 (Adolescent),Male/Female, All Ethnic groups
Start and end date(s) of the activity 10 45-minute lessons
Location(s) of the activity School
List of staff and stakeholders/partners and their roles
in the activity
Health Educator
List of resources needed to complete the activity Questionnaires
Activity title “your cigarettes may be stressing you out”
Activity description (2-3 sentences describing what will
be done)
This activity is a talk show event.“Guests” include an ex-smoker, psychologist,and a
physician. Guests discuss how tobacco use actually increases, rather than decreases,stress.
Youth learn healthy ways (skills) to cope with stress.Also,they practice the “healthy
breathing” novel-type activity. They are instructed how smoking hurts one's breathing, and are
provided with exercises on healthy breathing.
Learning/resource objective addressed by this
activity
By the end of session 2, participants will learn 5 techniques on how to cope with stress.
Target population 13-17 (Adolescent) 18-25 (Young adult), Male/Female, All Ethnic groups

8. Start and end date(s) of the activity Session 2 held in a 2 week period
Location(s) of the activity Schools
List of staff and stakeholders/partners and their roles
in the activity
Ex-smoker, psychologist,physician
List of resources needed to complete the activity Statistics info, graphs,chairs, desk, overhead projector to showdemonstrations
Activity title “family and friends confront smokers about their habit”
Activity description (2-3 sentences describing what will
be done)
Session 1 imparts the ground rules for the clinic and discusses reasons forusing and quitting
tobacco.Also the talk show“family and friends confront smokers about their habit” is
completed. The smoker talks about being nagged, whereas the family expresses their worries
and how the smoker has become more irritable after becoming a smoker.
Learning/resource objective addressed by this
activity
By the end of session 3, participants will have an increased awareness of family/friends
influences on smoking.
Target population 13-17 (Adolescent) 18-25 (Young adult), Male/Female, All Ethnic groups
Start and end date(s) of the activity Session 1 held in a 2 week period
Location(s) of the activity Schools
List of staff and stakeholders/partners and their roles
in the activity
Family Members, Health educator
List of resources needed to complete the activity Bring items that may calm a smoker down when they become irritable, Family photos
Activity title “Is smoking on the menu?”
Activity description (2-3 sentences describing what will
be done)
Discusses the harmful substances in tobacco and how it can injure one's body. Youth also play
the game “is smoking on the menu.” Students create a menu of possible categories and order
questions regarding the dangers of passive smoke as a group competition.

9. Learning/resource objective addressed by this
activity
By end of session 3, participants will have an understanding of any questions they may have on
harmful effects of smoking.
Target population 13-17 (Adolescent) 18-25 (Young adult), Male/Female, All Ethnic groups
Start and end date(s) of the activity Session 3 held in a 2 week period
Location(s) of the activity Schools
List of staff and stakeholders/partners and their roles
in the activity
Heath Educator, group of student smokers,
List of resources needed to complete the activity Menus,tables set up like at a restaurant,board with questions answered on it

10. Template B: Expense Sheet
EXPENSE SHEET
Category Amount
Salaries $40,000.00
SUBTOTAL PERSONNEL$40,000.00
Teacher's manual with audio CD $360.00
Student workbook $35 for 5 $175.00
Student surveys Free
1-day, on-site training, $1,100-$1,300 for up to 25 participants $32,500.00
Teacher certification test $25 each $50.00
Limited phone and email consultation Free
Pre- and posttest outcome assessment instruments Free
Implementation design and monitoring consultation $175 per hour $1,050.00
Evaluation services consultation $175 per hour $1,050.00
SUBTOTAL OPERATING EXPENSES $35,185.00
TOTAL EXPENSES (PERSONNEL + OPERATING) $75,185.00
OPERATING EXPENSES (Non-staff costs of implementing programs)
PERSONNEL (include salary and fringe benefits in the amount)

11. Template C:Logic Model
→ → → →
→
INPUTS
-Supervisors
-Staff to conduct
training
-School systems
-money
ACTIVITIES
-Questionnaire
-“your cigarettes
may be stressing
you out”
- “family and
friends confront
smokers about
their habit”
-“is smoking on
the menu”
OUTPUTS
-An anonymous
questionnaire was
administered to
students regarding
the media
-Held spin-off of
talk show event
-Held an
intervention
involving the
family
SHORT-TERM
OUTCOMES
-increase awareness
in the advertising
techniques to
glamorize smoking
- increase participants
understanding on
families views of
smoking
-increase participants
knowledge on
harmful effects of
smoking
-decrease stress levels
in participants
LONG-TERM
OUTCOMES
-Reduce number
of premature
deaths
-Lung Cancer
INTERMEDIATE
OUTCOMES
-reduce the
number of adult
smokers
-Reduce the
number of
households that
have adult
smokers
Context or Conditions: Insert key points from the needs assessment:
- Cigarette smoking causes more than 480,000 deaths every year in the U.S.
-Smokers have an increased chance of developing cardiovascular disease, respiratory disease, and cancer.
-Of lung and bronchus cancer in Gallatin County, the death rate is 98 per 100,000 populations.
-In 2011, 18 total cases of lung and bronchus cancer out of 8,547 populations at risk throughout Gallatin
County.
Gallatin County Healthy Lungs Program
Goal: To reduce the number of premature deaths from smoking in Gallatin County residents.

12. Template D:Timeline
Project Start Date: February 9, 2015
Project End Date: March 23, 2015
Tasks Year 1
MONTHS
J F M A M J J A S O N D
X X
Your cigarettes may be stressing
you out X X
“family and friends confront
smokers about their habit” X X
“is smoking on the menu” X X

13. References:
Age-Adjusted Cancer Mortality Rates by in, - . (2010). Cancer-Rates.info. Retrieved Sep 22,
2014, from http://cancer-rates.info/ky/
"American FactFinder - Community Facts." American FactFinder - Community Facts. N.p., 22
July 2014. Web. 22 Sept. 2014.
County Health Rankings & Roadmaps. (2014, January 1). Retrieved September 23,
2014,http://www.countyhealthrankings.org/app/kentucky/2014/measure/factors/9/ map
Health Effects of Cigarette Smoking. Centers for Disease Control & Prevention. (2014,
February 6). Retrieved September 23, 2014.
Hiemstra M, Kleinjan M, van Schayck OCP, Engels RCME, Otten R (2014) Environmental
Smoking and Smoking Onset in Adolescence: The Role of Dopamine-Related Genes. A
Findings from Two Longitudinal Studies. PLoS ONE 9(1): e86497.
doi:10.1371/journal.pone.0086497
Kentucky Institute of Medicine. The Health of Kentucky: A County Assessment. Lexington, KY;
2007. Authors' analysis of data from Kentucky State Police Crime in Kentucky annual
reports (1999-2003).
Leonardi-Bee J, Jere ML, Britton J (2011) Exposure to parental and sibling smoking and
the risk of smoking uptake in childhood and adolescence: a systematic review and meta-
analysis. Thorax 66:847–856.
Rufener, B. (2012, February 24). Quitting Smoking and Your Environment. Retrieved October
23, 2014.
Shadel, W., Martino, S., Setodji, C., & Scharf, D. (2013). Exposure to Pro-smoking Media in
College Students: Does Type of Media Channel Differentially Contribute to Smoking
Risk?. Annals Of Behavioral Medicine, 45(3), 387-392. doi:10.1007/s12160-012-9461-7
"Why Do People Start Smoking?" American Cancer Society. N.p., n.d. Web. 22 Sept. 2014.