Transcript of Episode 5: Great Texas Smokeout

with host David Richards [DR] and guests William Carter [WC] and Robin Ray [RR]  
Listen to the audio

[DR] This week on the Healthy Communities Podcast we’re going to talk about tobacco use and the harms of secondhand smoke with William Carter and Robin Ray of the Wichita County Public Health District. We’ll see why you don’t want to mess with Texas.

[DR] Welcome to the Learning Network’s Healthy Communities Podcast; I am your host, David Richards from APHA. This is Episode 5: Great Texas Smokeout.


[WC] Sure, absolutely. I’m Will Carter. I’m a lead project and health educator here at the Health District. My background is actually in the military and that’s actually what got me involved in public health. I joined when I was very young, still unsure of what I wanted to do with my life and through the military I learned to appreciate the value of health and people. I learned a lot in the field of nutrition and physical activity helping people prepare for their fitness tests or anything they can do in the realm of nutrition to control a chronic disease. I was fortunate that when I left the military there was an opening for a health educator at the Health District for a job very similar to the job I was doing in the military. That brought me to where I am today. Robin?

[RR] I’m Robin Ray. My background is in public education. I taught public school for 16 years, but in my youth I was a premed major and I never really got far away from that love of medicine and when I went to change careers, I found an opening here at the Health District in health education and it was right up my alley and that’s how I started here. I’m not the program manager for Tobacco Prevention and Control. 

[DR] What did you teach?

[RR] I taught all subjects except for science. 

[DR] For what age group?

[RR] When I first started, I taught fourth graders and then went all the way up to twelfth graders. My Last ten years, I was teaching ninth, tenth, eleventh and twelfth. 

[DR] Let’s talk about the public health issues in Wichita Falls. But first, can you describe what Wichita Falls is like? What are the people like? What’s the community like? 

[WC] Sure. We’re a mid-sized city around 100,000 for Wichita and 130,000 for Wichita County. Wichita Falls is the principle city in the seat of the county government. The thing that I love about this place is that you can drive anywhere in about 15 minutes. Traffic is never an issue. [RR] Except one day a year. [WC] One day a year, yeah. People are very friendly. Their also very tied to their traditions and the culture here is also very strong. We’re the biggest thing between the Dallas metropolitan area, which everyone knows about, and Oklahoma City, to our north. From a health perspective, we do a lot of business with the local surrounding counties. We are the medical center. We have a trauma center here. We have a birthing center here, so for the entire lifespan for the surrounding counties, everyone comes here for their health care. We’re also a military community. The military is the number one employer in the area and is very involved in our community initiatives. They are on several of our coalitions involved in health. Anything to add Robin?

[RR] Our area is kind of rural. Wichita Falls is the largest in about a 16 county radius. It tends to be slow to change. It tends to be really tied to tradition here. 

[DR] Let’s talk about that. You both mentioned that your community is tied to this tradition. How do you change behavior? How do you change the culture, if you’re so tied to this tradition?

[RR] I look at it this way. There are three P’s that help us change the culture here: policy, pricing and promotion. That of course is promoting the health benefits of this or that behavior.

[WC] Honestly, I think that’s the million dollar question. If we had an answer to that, then most of us would be out of business. It is a problem. [RR] It’s not insurmountable. [WC] It’s not insurmountable at all, but it does take time and it does take patience. On a national level, we’ve come a long way on a relatively short period of time in about 50 years to about a 50 percent drop in tobacco usage rate down to where we are now. It’s lower in our communities, our partly rural type communities. It takes a little longer, especially for us. We have to realize that it’s going to take time. It may not even happen in our lifetime. Hopefully it does, but we have to be just what Robin said, patient, persistent and we need policies. We’re going to get there, but we have to be patient. It’s a marathon. 

[DR] Let’s turn to that. Let’s get into tobacco use as a problem. What percent of the population are smokers and how does that effect secondhand smokers?

[WC] Well right now it’s about 20 percent according to the county health rankings for Wichita County, which is very high considering that the Texas average is around 14 percent.

[DR] Why do you think that is?

[RR] Partly, it’s the lifestyle. In this part of the country, populous can be very individualistic and they view smoking as a right. They feel like the antismoking messaging would be violating their right to dictate their behavior. They would push back against that. We also have this concept in the rural setting that tobacco use is viewed as almost a right as passage, a door to adulthood. 

[DR] Does the crop grow in Northern Texas?
[RR] It does not. [DR] Okay, I was wondering if it was part of the economy.

[DR] What are the health effects of tobacco?

[WC] Wow, where to start? Lung cancer, throat cancer, infant sudden death syndrome, low birth rate, what else Robin? [RR] COPD (chronic obstructive pulmonary disease), high blood pressure. I could go on and on. The top three most common deaths in our county can be related to tobacco. 

[DR] What does the average Wichita Falls community member think? What answer would they give?

[WC] You know, that’s a great question. Going back to what Robin said previously concerning the belief in individual rights. You’ll actually have a few nonsmokers that would advocate on behalf of smokers because they see it as an individual right. Even though we have a great percentage of nonsmokers, it’s a little bit different perception when it comes to a smoke free community. What do you think Robin?

[RR] I agree completely. As far as health effects, they kind of see themselves as immune. It’s that situation where they understand in a general way that tobacco use has detrimental effects on health, but it’s one of those, “it’s not going to happen to me king of things.” 

[WC] And going back to that cultural aspect, just like in some communities, having a beer with your kid when they reach a certain age is something you look forward to. The same is true here with tobacco as well. It’s that engrained in the culture. It’s that important part in the life of this area. 

[DR] Well then that’s interesting because Wichita County has two of the strongest smoke free ordinances in the state of Texas that protects over 90 percent. Can you explain that? How was that passed?      

[RR] It took quite a long time to get it passed. Originally, we started working on the passage of tobacco ordinances in the 90s and it’s been on and on. The first one that passed provided for separate areas for smokers and nonsmokers in businesses. Today, we have a comprehensive smoke free ordinance that covers Wichita Falls and Burkburnett. They are quite strong. The Wichita Falls ordinance covers hotels and motels, bars and restaurants. Public places are covered by both those ordinances including parks. Wichita Falls even includes public events as well. [WC] It also includes e-cigarettes as well. [RR] Yeah, e-cigarettes are included in both of those ordinances as well for Burkburnett and Wichita Falls. 

[DR] That’s interesting that you brought up e-cigarettes, has that become more popular?

[RR] Yes. We have seen some growth in the use of e-cigarettes among the youth in particular from data from our youth tobacco survey. We have tried to address that issue by discussing e-cigarettes and what might be included in the liquid, but of course without any enforcement of the FDA requirements at this time, it’s very difficult for us to make any real statements. Also, we don’t have the background of data that we have on actual tobacco as opposed to e-cigarettes. Right now, our best option is to demonstrate to everyone that they’re still playing with fire.          

[DR] I really want to talk about that secondhand smoke and your projects in particular. What are you seeing in children affected by secondhand smoke?

[WC] Too many kids are exposed. This came to light from the Youth Tobacco Survey that we’ve been doing here for the past couple of years. Robin’s program, TCPP, has been working hard on cessation programs and education for the public, helping people when they’re drafting worksite policies stuff like that nature. This is just one aspect of the problem in the area is that we haven’t been able to focus on yet and thankfully through the Healthiest Cities & Counties Challenge that small infusion of funds gave us an opportunity to do just that. As I reported in our proposal, 35.6 percent of county middle and high school students reported riding in a car with someone who was smoking and 28 percent live with someone who smokes in the house. We have a very high percentage of kids exposed to secondhand smoke. 

[DR] For something in private places, in terms of someone’s car or home, how do you regulate that?

[RR] It’s extremely challenging. We do actually have a Texas state law that prohibits foster parents from exposing foster children to smoke in the home and in vehicles. But how do you enforce that? 

[WC] Enforcement is a big part of the problem. Going back to that issue of individual rights that belief that tobacco use is covered on the individual rights that kind of trumps, in this part of the country, health. They see it as their right, their personal space and our ordinances; the one’s we just talked about recently are still pretty new like three to four years old. For a lot of people, the wound is still pretty fresh. 

[RR] In this area, it can be all about the timing. We’re attempting to educate, educate and educate. With this particular campaign, the secondhand smoke in cars campaign, the imagery for it actually grew out of my program from in schools in the area. It was a collaborative effort among officials, department of transportation, to all come together to create this concept that secondhand smoke kills with a child wearing a snorkel in order to breathe inside the car.  

[DR] That’s being targeted to the students or the parents? 

[RR] That is actually being put out for the whole population. It appeals to the children because they can relate to that feeling of needing a snorkel to breathe or some kind of assistance to breathe when they’re trapped in an enclosed space with somebody smoking, but it also targets those parents and other adults who are exposing those children to that secondhand smoke. If nothing else, it makes them think about what they’re doing to the child. 

[DR] Has that been effective in its messaging? It sounds more punitive than incentive-based. What kind of reactions does it draw? 

[RR] We’ve been getting a lot of good feedback from it.

[WC] Yeah, and something we’re getting ready to do next month is focus groups to get other reactions. That way we can collect more data on the effects. I know you mentioned punitive. The thing that I like about this campaign is that we offer a resource. We had a coalition meeting recently and one of the members of the coalition is a mother who still smokes. We were asking about we’re embarking on another educational opportunity for the secondhand smoking in vehicles initiative, “What would be a good way to approach this?” She said, “Look, I’m a parent, I’m a smoker. I know that it’s dangerous. I know that it’s dangerous for my kid.” She said what would appeal to her is resources. She said, “I know it’s bad, but tell me how I can quit? Tell me where the resources are.” In this campaign, of course, at the end, we put the resources how you can quit whether it’s joining a fresh start program or a quick line a resource to actually help you. The goal isn’t to make it punitive; it is exactly what Robin said, “awareness” and to educate the public on the dangers and hopefully, within time, we want health to trump individual rights. 

[DR] In terms of the children, are they being admitted more for asthma-related issue or are you seeing more respiratory illnesses within children?

[WC] I can answer your question this way. I don’t know those numbers exactly, but I can tell you that out of 242 counties in the state of Texas that report to the county health rankings on the criteria health behaviors we’re 241. Our behaviors are directly impacting our health and tobacco is a big part of that. 

[DR] Let’s try to move this a little bit more positive. Who are your champions? Who has really shined?

[WC] Robin is my champion because she runs the tobacco control coalition, and through Robin, we have amassed a wide, diverse group of people. I’ll let her talk to you about the folks we have with us. 

[RR] We have members now who are in our coalition who are from every community sector. Some of our strongest champions are the schools and veteran’s associations both for mental and behavioral health. Communities and schools have been awesome. [WC] Also, organizations that work specifically with drugs and education on drug awareness in schools like Serenity House, the local university, SMU, law enforcement. It’s such a well-represented group. They’re so passionate. Like I said earlier, we went to a meeting recently and it’s a good composition of people that are working the work. Despite all the negative things we talked about before, for me, I’m excited because I see what Wichita County and Wichita Falls can become. I see the change occurring. Just a few years ago, it was the norm to go into a bar or restaurant and see people smoking. Now it’s becoming the norm. Now for people moving into the area, this is all they know, which is fantastic. That’s part of that cultural change. It takes a combination, it’s a multi-faceted approach and this coalition is a representation of that. It’s a representation of our community. They’re helping us advance a smoke-free initiative, which has taken time, but it’s wonderful to see. [RR] And our youth members. [WC] We haven’t event talked about our youth! 

[RR] They have been really instrumental in getting out there and talking to the public and pushing the agenda. They want to see an ordinance that prohibits tobacco use in vehicles with minor children in the car. [WC] They’re not shy at all. They helped advocate for smoke-free cars at public events, in their communities, in their schools. They are fantastic!

[DR] This has been a lot of fun and really great to learn about your projects. What are some of the greatest lessons that you’ve learned so far? 

[WC] Going back to what I said before about being so close to the finish line. Tobacco rates have fallen quite a bit, but we still have a little ways to go. It’s not the time to be complacent. We have to be patient, persistent and we have to persevere. It’s going to take some time. We’ve had two very strong ordinances passed recently. Right now, we’re not at the end game. We’re at stage one when it comes to smoke-free cars. Right now we’re at the education phase; educating the public and giving them the information, even our elected officials so then they can make informed decisions in the years to come. How about you Robin?

[RR] Well, you know, educate, educate, initiate. [WC] There you go!                                                                 


[DR] That’s the show this week! The show was produced by David Richards. Thank you to my guests William Carter and Robin Ray, and thank you all for listening. I’ll see you next time.