Using a Collaborative Approach to Tobacco Control Efforts in Marginalized Communities

ObjectiveTo examine community engagement as a means to strengthentobacco-related policies and programs use in marginalizedpopulations.IntroductionAlthough significant progress has been made in tobacco control inthe United States (US) over the past 50 years, more than 15% of thepopulation currently use tobacco products.1Tobacco use continuesto be the leading cause of preventable death, contributing to over480,000 deaths and about $300 billion in economic costs each year.To achieve theHealthy People 2020(HP2020) objective of 12%national adult smoking rate by 2020, it is important to focus ourtobacco control efforts on surveillance and addressing disparitiesin tobacco use prevalence and tobacco-induced diseases acrossdifferent subpopulations and geographic areas.2Utah reportedthe lowest prevalence rate (9.7% in 2014), while rates as high as28% were identified in central Appalachia. Modern epidemiologyis limited in its ability to explain patterns of tobacco use andtobacco-related interventions and policies in these highly prevalent,marginalized environments. Therefore, a combination of quantitativeand community-based participatory research (CBPR), as proposedin Public Health 3.0, will expand the scope and reach to addressall factors of tobacco use, including cross-sector collaboration andmulti-level actions.3This study aimed to comprehensively investigatecounties in the Northeast Tennessee region where tobacco useprevalence is disproportionately highest, and to identify regionaland culturally specific evidence-based practices for tobacco control.Additionally, the study examined how these practices can be scaledup to address similar high tobacco use and disadvantaged populationselsewhere in the US and worldwide.MethodsGrounded by the CBPR framework, a mixed-methods approachtriangulated multiple sources of data using a three-prong assemblageofProtection,Prevention, andCessation, to develop tobaccocontrol recommendations and goals as part of a Population HealthImprovement Plan for Tennessee. Information gained from healthcouncil discussions, focus groups, interviews, and stakeholdermeetings were combined with quantitative analyses of secondarydata from Tennessee Department of Health, school-based surveys,and qualitative analyses conducted for descriptive and inferentialstatistics. All discussions and interviews involving 222 individualsfrom 91 organizations were recorded and organized using NVivo10, thematically coded using grounded theory, and analyzed usingdescriptive statistics. The results utilized aggregated themes generatedfrom the data.ResultsTobacco use in the Northeast Tennessee region comprises cigarettesmoking and smokeless tobacco, with increasing uptake of electroniccigarettes across all age groups. Among others, culture of tobaccouse and cultivation was identified as the most salient factor fortobacco use. Reducing tobacco use requires a foundation built oninformatics, community engagement, and a model for sustainablefunding to support infrastructure and program interventions. Whilestate and national policies and programs have received less attentionin this region, several effective community-based policies andprograms to prevent tobacco use were identified, including incentiveprograms such as Baby and Me, voluntary smoke-free campuspolicies by businesses and colleges, 100% screening programs byhospitals, and nicotine-free employee population. Overall, a total of25 recommendations were identified, with 14 aimed at protection,four at prevention, and seven at cessation. These recommendationsculminated into five overarching goals:Protectthe population fromtobacco and secondhand smoke exposure through policy enforcementand implementation and counter-marketing;Preventinitiation oftobacco use with comprehensive youth-focused programs that increaseknowledge and awareness;Expandaccess to cessation resources andtreatment, especially in high risk populations;Fostercollaborationand partnership; andMonitordata for evaluation and validity.ConclusionsThis is one of the few comprehensive attempts to address the socialdynamics of tobacco use and identify population and geographicpolicies and programs in highly prevalent communities. Amongthe myriad issues identified, the expansion of surveillance data toinform tobacco policy and culturally-tailored tobacco policies andprograms are essential to reduce tobacco use in population subgroups.Combining CBPR with actionable data can spur innovations inlocal efforts, highlight social determinants of health, and contributeto evidence-based policy. While the results of this study primarilyprovide in-depth descriptions of central Appalachia’s tobacco-relatedrisks and their perceptions of and reactions to tobacco preventionintervention, the policies and programs identified through the processmay be more readily adopted and scaled-up to address the disparitiesin tobacco use and tobacco-induced diseases, particularly pertainingto low-income, disadvantaged, and hard-to-reach populations.

Dynamic Traditions

This book examines the dynamism of Appalachian dance traditions and the creativity involved in their evolution. Focusing on six dance communities—three in Eastern Kentucky, one in Northeast Tennessee, and two in Southwest Virginia—the book documents the experience of dancing as people have enjoyed it, or continue to enjoy it. It shows that dance traditions are never static; they constantly shift and change over the course of decades. Like all customs, they are characterized by “flexibility of substance” or continued evolution. Characteristics are retained, discarded, or altered according to adherence to precedents. This is evident in old time square dancing and footwork dancing, both of which have waxed and waned in popularity from decade to decade in all six communities. This book also explores the dance communities' divergent responses to social change, including industrialization, as well as the use of dance for community development.

Afterword

This book has explored what has given life and meaning to old time dancing in six communities in Eastern Kentucky, Northeast Tennessee, and Southwest Virginia in the late twentieth and early twenty-first centuries. Through interviews, it has identified a variety of circumstances responsible for the appearance of dancing in these dance communities, and the ways that residents of each community experienced and responded to industrialization and other societal changes. It has also examined how decisions made by individuals and groups shaped dancing and how decision making was affected by factors such as culture and cultural exchange. Finally, it has discussed the decline and revival of old time dancing in the six communities as well as change and continuity as evidence of the power of local tradition in the Appalachian region. The book concludes with an afterword, which expresses the hope that all six stories will stimulate thinking and exploration and pave the way for future projects on American dance traditions.

Old Time Dancing in Northeast Tennessee

This chapter examines the impact of social and economic changes on old time dancing in Northeast Tennessee in the twentieth century, using the Beechwood Family Music Center in Fall Branch as a focal point of discussion. It begins with a background on Beechwood, one of several places in the Northeast Tennessee–Southwest Virginia valley where old time dancing took place in the late 1980s and early 1990s. It then considers how how rural values and industrialization converged in early-twentieth-century Northeast Tennessee, along with its effects on local dance traditions. It also explores the marketing of square dancing as part and parcel of the rural image produced by the barn dances and by recordings of “hillbilly” music; the emergence of modern western square dancing and wagon training in Northeast Tennessee; and folk revival and festivals. The chapter concludes with an overview of the evolution of dance forms and styles as well as dance music at Beechwood, along with the revival of traditional Appalachian square dancing and clogging in Northeast Tennessee.

The Answer Is Yes

Objective: The study assesses the impact of dual enrollment participation on remediation and completion for traditional first time, full-time freshmen at a community college in Northeast Tennessee. Method: This study began with the full population of 1,232 students who enrolled between 2008 and 2012 at a community college in northeast Tennessee the fall semester after finishing high school. The population was required to have American College Testing (ACT) scores, completely fill out the Free Application for Federal Student Aid (FAFSA), enroll full-time as a degree-seeking student, and complete the first fall semester. Propensity score matching was utilized to eliminate self-selection bias and enable parametric comparisons using optimal matching of dual enrollment participants and non-participants while controlling for a range of covariates. Results: The analyses showed that community college students who participated in dual enrollment were (a) 9% or nearly 3.4 times less likely to take remediation, (b) 26% or nearly 2.5 times more likely to graduate in 2 years, and (c) 28% or nearly 1.5 times more likely to graduate in 3 years. Contributions: This study contributes to the literature showing that dual enrollment reduces remediation rates and assists in timely completions for community college students. Policy recommendations are to increase equitable participation, normalize dual enrollment for students academically able to do college coursework, align state terminology with the nation, and improve data for future research.