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Forming community coalitions: “Smoking Stinks”
  1. Jenny DesVaux Oakes
  1. Sierra Health Services, Inc., PO Box 15645, Las Vegas, Nevada 89114-5645, USA;jennypr{at}

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I am pleased to have the opportunity to present my company’s efforts to address the problem of smoking among young people, and to share with you what can be accomplished through a collaborative effort between public and private sector agencies and organisations. National statistics are beyond what we might call alarming. Approximately 25% of American adults smoke. We spend $50 billion each year on healthcare costs that are associated with smoking-related illness. Many of the advertising campaigns of the tobacco companies have been targeting our children and, unfortunately, many of our children have responded. Smoking among young people is a very significant health hazard which, if unchecked, promises future physical, emotional, and financial misery. As President Clinton said, “Tomorrow, 3000 children will start smoking and 1000 will die as a result.” We know that we must address this major health problem head on—we know that treatment is not the only answer—prevention is clearly the key.

Before I tell you about the coalition in southern Nevada, I should like to give you just a brief “snapshot” of our company and our community. Sierra Health Services, Inc., which is headquartered in Las Vegas, Nevada, consists of 19 subsidiary companies. We are publicly traded and licensed to do business in 44 states and the District of Columbia. We are the largest provider of health care and health insurance in the state of Nevada. Our health maintenance organisation (HMO), Health Plan of Nevada (HPN), is the largest HMO in Nevada with 160 000 members. Most of our members live in southern Nevada.

Southern Nevada has approximately 1.2 million residents out of Nevada’s approximately two million residents. We have a robust economy with a core industry of tourism, but we are rapidly diversifying our economic base. With approximately 5000 new residents moving into southern Nevada each month, and a projection of two million residents by 2010, we are the fastest growing area in the entire United States and have been for a number of years. This tremendous growth, which is fuelled in large part by the expansion of our tourism industry, has had a major impact on infrastructure, public services, education, and of course, health care—public and private. Many of these new residents are uneducated, have few job skills and hold low paying service jobs such as maids, porters, and kitchen staff. We know that the more education they have, the less likely they are to smoke. Nevada has the highest percentage of residents who smoke in the country. Nevada women have among the highest lung cancer rates in America.

In 1997, Sierra Health Services became the first and only national recipient of the Smith Kline Beecham Health Care Partnership Award. It recognised the company for creating innovative partnerships to solve community problems. The award involved an unrestricted $50 000 grant to the Sierra Community Healthcare Foundation. We felt it most appropriate to use the grant to form another partnership to address a major healthcare issue. Although $50 000 is certainly a very generous grant, we knew that it was going to take resources of a number of other partners to maximise our dollars and to have the ability to be as effective as possible. We created a committee to determine the best focus of such a partnership.

The “Smoking Stinks” coalition

On the way to our corporate offices, many of us drive by a local high school on a daily basis. We have noticed many of the kids, just off the school grounds, smoking in groups. It is a very disturbing scene, seen in most communities. We did some research to find out what, specifically, was being done to address the problem of young people smoking in Nevada. We learned that 66% of young people in Clark County had tried smoking, and 33% reported smoking within the past 30 days. The Centers for Disease Control and Prevention (CDC) estimates that in Nevada, nearly 100 000 young people are projected to begin smoking before age 18, with a projected 31 000 premature deaths, resulting in $372 million in healthcare expenses to our state. We also learned that, although the school districts and the American Cancer Society have some substance abuse prevention activities and assistance, there was not a formal, community-wide programme to try and prevent young people from starting to smoke—in the state with the highest percentage of smokers in the nation. We knew we had the right issue.

Health Plan of Nevada made a commitment for additional funding and support. We also called our friends, business associates, and our partners with whom we worked in other community initiatives, and we formed what later came to be known as the “Smoking Stinks” coalition. We all know that putting together the right collaborators is key to the success of any partnership.

The response and the support that we received when we approached different partners to invite them to participate was absolutely incredible. The coalition members include: Health Plan of Nevada; the Sierra Community Healthcare Foundation; the Nevada Tobacco Prevention Coalition, which is an arm of the American Cancer Society; the Clark County School District; KVBC Channel 3 which is the local NBC affiliate; KXTE Extreme Radio and KLUC The Hit Music Station, two radio stations whose target audiences are adolescents and teenagers; and Merica Dickerson Advertising and Public Relations Agency.

Our advertising agency created a logo (figure) that would be direct, that would strike a chord with the young, and that would not come across as “sterile” and, as they say, “uncool”. We also knew our message had to appeal to children and that it could not be too clinical; as we all know, kids think they are going to live forever. Most importantly, our message had to be consistent with the way young people really think and behave, and not be a “turnoff”.

The mission of the “Smoking Stinks” coalition is: to prevent southern Nevada’s youth from starting to smoke through innovative educational programmes, to promote public awareness campaigns and community events, and to serve as a community resource for smoking prevention information.


With that, we were ready to begin our real work. We decided that the first step was obviously a public awareness campaign. We realised that although we should like to think of ourselves as “cool” and “hip”—and that is probably not the right terminology these days—that we are actually light years away from being “hip”. With the help of the school district, we created a student advisory committee to review several concepts for radio and television public service announcements (“spots”), which our advertising agency partner developed as part of their commitment.

We settled on a concept called “What were you thinking?” We then approached the school district’s Las Vegas Academy of Performing Arts and International Studies for the talent for our spots. We found that aspiring student actors were more than happy to donate their time and were pleased to be a part of that message. The copywriter donated his time as well to serve as the main character in the spots, a daytime talkshow host. Our television partner produced the spots and our radio partners produced the public service announcements on radio.

We began airing the six spots during times appropriate to our target audiences. With the savings we were able to make in production costs, we were able to commit much of our budget to buy airtime that was significantly discounted by the stations.

We worked through the summer months with the school district. We developed innovative, approved activities designed to meet tobacco prevention curriculum guidelines as set forth by the district. We planned a day-long “Smoking Stinks” in-service programme to present those activities to middle school and physical education teachers. We formed a curriculum committee, which was made up of HPN, the Sierra Health Education and Wellness Department, the American Cancer Society, the Clark County School District, the University of Nevada School of Medicine and Cooperative Extension Division, and the Clark County Health District. The result of this work was the “Smoking Stinks” activity guide which is now in use in the Clark County School District’s middle school health classes.


The day-long, in-service programme included approximately 50 middle school health and physical education teachers. It took place in autumn 1997 and was designed to open educators’ eyes to Nevada’s ugly statistics regarding tobacco use in the young, and to present teaching techniques and lesson plans through the activity guide. The results of our evaluation forms were very positive and we are currently surveying the teachers again to determine how the activities and lesson plans are working in the actual classrooms.

During the week of 17 November 1997, we sponsored a number of activities in the high schools and middle schools in connection with “Great American Smokeout Day.” During that week, more than 9000 students signed “Chain Of Life” forms which signified their commitment to lead smoke-free lives.

Throughout the entire programme thus far, public relations activities have played a significant role in spreading the message that “Smoking Stinks.”


We are still running the television and radio spots. We are taking our message to young people at health fairs and special events and in the schools. We are planning the next phase of the programme, and we are looking for additional funding to expand the programme. We do feel that we have made great strides in the short life of the programme. We have sent the important message, to which kids can relate, regarding all of the ugly aspects of smoking—from how it can affect your looks, to how it can make you smell, to how it can affect your physical performance, to how it can threaten your life. In its largest and truest sense, as we all know, it is a message about the possible difference between life and death. It is certainly a message we must continue to deliver.

I think the success of this programme thus far serves as testimony to what can be accomplished through a community-wide coalition of dedicated partners who work together to address an important community health issue. We at Health Plan of Nevada and the Sierra Community Healthcare Foundation are very pleased to have been the driving force behind this coalition.


I should like to acknowledge one of Sierra’s health educators who was the driving force behind the activity guide and teacher in-service, Bonnie Buzick.