DEPARTMENT OF BUDGET & MANAGEMENT
LARRY HOGAN DAVID R. BRINKLEY Governor Secretary BOYDKRUTHERFORD MARC L. NICOLE Lieutenant Governor Deputy Secretary July 11, 2019
The Honorable Thomas V. Mike Miller, Jr. P1'esident of the Senate H-107 State House Annapolis MD 21401-1991
The Honorable Adrienne A. Jones Speaker of the House · H-10 I State House Annapolis MD 21401-1991
Dear President Miller and Speaker Jones:
Pursuant to Section 7-3 l 7(h)(2) of the State Finance and Procurement Article, we are forwarding reports on funds expended in the prior fiscal year from the Cigarette Restitution Fund and the related outcomes or public benefits, prepared by the Maryland Departmentof Health (MOH) and the Department of Agriculture.
A summary of fiscal year 2018 appropriations and expenditures (including encumbrances) follows. Please note that the expenditures represent State expenditures and not expenditures by the grantees. To the extent that the grantees do not spend grants, the funds may be returned to MOH as part of the grant reconciliation process conducted by the Department. That process is not complete until several months after the end of the State's fiscal year. Funds relating to unspent grants from prior fiscal years were recovered by MOH and transferred back to the Cigarette Restitution Fund in the amount of $2,611,462 (not reflected in the fiscal year 2018 activity shown below).
Crop Conversion L00A.12.10 Marketing and Development Appropriation: $4,773,000 Unobligated/Reverted: $(3,810,500) Expended/Encumbered: $962,500
L00A.12.13 Tobacco Transition Program Appropriation: $1,000,000 Unobligated/Reve1ted: $(12,500) Expended/Encumbered: $987,500
45 Calvert Street • Annapolis, MD 21401-1907 Tel: (410) 260-7041 •Fax: (4/0)974-2585 • Toll Free: I (800) 705-3493 • TTY Users: call via Ma,yland Relay · http://www.dbm.ma,ylandgov Cancer Prevention, Education, Screening, and Treatment M00F.03.04 Prevention and Disease Control Appropriation: $25,130,731 Unobligated/Reverted: $(2,278) Expended/Encumbered: $25,128,453
Tobacco Use Prevention and Cessation M00F.03.04 Prevention and Disease Control Appropriation: $7,705,016 Unobligated/Reve1ted: $(136,429) Expended/Encumbered: $7,568,587
Breast and Cervical Cancer M00F.03.04 Prevention and Disease Control Appropriation: $13,230,000 Expended/Encumbered: $13,230,000
Tobacco Enforcement M00F.03.04 Prevention and Disease Control Appropriation: $2,007,638 Unobligated/Reverted: $(51,431) Expended/Encumbered: $1,956,207
Drug Addiction M00L.0 1.02 Addiction Treatment and Prevention Services Appropriation: $21,452,828 Expended/Encumbered: $21,452,828
Medicaid M00Q.0 l .03 Medical Provider Reimbursement Appropriation: $61,770,000 Expended/Encumbered: $61,770,000
Education R00A.03.04 Aid to Non-public Schools Appropriation: $11,780,812 Unobligated/Reverted: $(344,790) Expended/Encumbered: $] 1,436,022 Legal Expenses CSIC.00.01 Legal Counsel and Advice Appropriation: $1,044,761 Unobligated/Reverted: $(4,956) Expended/Encumbered: $1,039,805
CS I C.00.14 Civil Litigation Division Appropriation: $485,429 Unobligated/Reverted: $(94,681) Expended/Encumbered: $390,748
If you have any further questions or concerns regarding this report, please contact me at 410-260-7041.
Sincerely,
David Brinkley Secretary
Enclosures MSAR 10412 MARYLAND DEPARTMENT OF HEALTH
CIGARETTE RESTITUTION FUND PROGRAM
FISCAL YEAR 2018 ANNUAL REPORT
FUND EXPENDITURES AND ACCOMPLISHMENTS
State Finance and Procurement Article, Section 7-317(h)(2) Chapter 58 of the Acts of 2015 (HB 67)
September 2018
MARYLAND Department of Health
Larry Hogan Boyd Rutherford Robert Neall Governor Lieutenant Governor Secretary (This Page Intentionally Left Blank) · LIST OF ACRONYMS
AHRQ Agency for Healthcare Research and Quality ALERT Alcohol Law Education Regulatory Trainings ASO Administrative Service Organization BCCDTP Breast and Cervical Cancer Diagnosis and Treatment Program BCCP Breast and Cervical Cancer Program BHA Behavioral Health Administration BRFSS Behavioral Risk Factor Surveillance Survey CCPC Center for Cancer Prevention and Control CDB Cancer Client Database CDC Centers for Disease Control and Prevention CPEST Cancer Prevention, Education, Screening and Treatment CRF Cigarette Restitution Fund EDB Education Database ESD Electronic smoking device FDA Food and Drug Administration FIT Fecal Immunochemical FMIS Financial Management Information System FQHC Federally qualified health center HIV Human Immunodeficiency Virus LGBTQ Lesbian, gay, bisexual, h·ansgender and queer LHD Local health department LRC Legal Resource Center for Public Health Policy MCR Maryland Cancer Registry MDH Maryland Department of Health MOTA Minority Outreach Technical Assistance NPCR National Program of Cancer Registries PATCH Pregnancy and Tobacco Cessation Help POST Point of Sale Toolkit RVR Retailer violation rate SAMHSA Substance Abuse and Mental Health Services Administration SFHG Smoke Free Holy Grounds Initiative UMGCCC University of Maryland Greenebaum Comprehensive Cancer Center UMMG University of Maryland Medical Group UMMS University of Maryland Medical System YRBSIYTS Youth Risk Behavior/Youth Tobacco Survey (This Page Intentionally Left Blank) CIGARETTE RESTITUTION FUND PROGRAM
FISCAL YEAR 2018 ANNUAL REPORT
Table of Contents
Section Page
I. Prevention and Health Promotion Administration - Cancer Control Programs and Tobacco Use Prevention Fiscal Reports - Cancer Control Programs and Tobacco Use Prevention 1 Managing-for-Results Reports - CatJcer Control Programs and Tobacco Use 5 Prevention Accomplishments - Cancer Control Programs 11 Accomplishments -Tobacco Use Prevention and Cessation Program 27 Accomplishments - Tobacco Enforcement 39 Counter-Marketing and Media -Tobacco Use Prevention 47
II. Behavioral Health Administration _Fiscal Report - Behavioral Health Administration 57 Accomplishments - Behavioral Health Administration 59
III. Medical Care Program - Medical Assistance Program Fiscal Report and Managing-for-Results Report - Medical Care Program 61
IV. Appendices -Tobacco Control Program Sample Media Appendix A - Maryland Tobacco Quitline Mass Media Promotions - 64 www.SmokingStopsHere.com Appendix B - Responsible Tobacco Retailer Campaign - · 66 www.NoTobaccoSalesToMinors.com Appendix C - Clean Indoor Air Act 10th Anniversary Campaign 69 Appendix D - The Vape Experiment - www.TheVapeExperiment.com 70 (This Page Intentionally Left Blank) FISCAL REPORTS
CANCER CONTROL PROGRAMS AND TOBACCO USE PREVENTION
I Maryland Depmtment of Health, Prevention and Health Promotion Administration Cigarette Restitution Fund Program Interim Fiscal Report - Fiscal Year 2018 (July I, 2017 - June 30, 2018)
1) Cancer Prevention, Education, Screening and Treatment Program
Components: A[l[ll"O[lriation Ex~enditures Obligations Unliguidated Administration 643,666 627,159 41,068 (24,561) Surveillance and Evaluation 1,249,468 1,125,668 108,360 15,440 Statewide Academic Health Center - Cancer Research 13,000,000 8,098,726 4,901,274 0 Local Public Health * 7,547,472 6,722,756 824,716 0 Baltimore City Public Health Grant * 2,446,000 1,439,513 1,006,487 0 Statewide Academic Health Center - Other 0 0 0 0 Cancer - Database Development 244,125 133,905 98,821 11,399 Total 25,130,731 18,147,727 6,980,726 2,278
Local Public Health Component - Distribution by Jurisdiction - CANCER
(Budget) Unreconciled Subdivision Available Expenditures Obligations Unliquidated Fundin Allegany 203,544 203,544 0 AnneAmndel 684,228 684,228 0 Baltimore Co. 1,083,489 1,083,489 0 Calvert 193,373 193,373 0 Caroline 141,032 141,032 0 Cairnll 290,107 290,107 0 Cecil 221,993 221,993 0 Charles 234,753 234,753 0 Dorchester 151,407 151,407 0 Frederick 318,467 318,467 0 Garrett 135,404 135,404 0 Harford 381,123 381,123 0 Howard 320,517 320,517 0 Kent 132,965 132,965 0 Montgomery 867,387 867,387 0 Prince George1s ** 824,716 0 824,716 0 Queen Anne's 157,177 157,177 0 St. Mary's 200,845 200,845 0 Somerset 135,877 135,877 0 Talbot 162,079 162,079 0 Washington 280,587 280,587 0 Wicomico 228,917 228,917 0 Worcester 197,485 197,485 0 Baltimore City * 2,446,000 1,439,513 1,006,487 0 TOTAL 9,993,472 8,162,269 1,831,203 0
* The budget and expenditure for Baltimore City are in the Baltimore City Public Health Grant. Baltimore City's budget of $2,446,000 adds to the Local Public Health distribution by jurisdiction of$7,547,472 to make a total of $9,993,472. ** Prince George's County no longer receives funds; the funds are allocated to Doctor's Community Hospital.
2 Maryland Department of Health, Prevention and Health Promotion Administration Cigarette Restitution Fund Program Interim Fiscal Report - Fiscal Year 2018 (July 1, 2017 - June 30, 2018) (Continued)
2) Tobacco Use Prevention and Cessation Program
Components Appropriation Expenditures Obligations Unliquidated Administration 267,345 175,100 26,466 65,779 Surveillance and Evaluation 1,022,142 701,421 314,767 5,954 Countermarketing and Media 0 0 0 0 Local Public Health 3,877,227 3,877,227 0 0 Tobacco Prevention and Cessation 216,478 182,970 33,508 0 CRF Enforcement 2,007,638 1,648,964 307,243 51,431 Statewide Public Health 2,321,824 1,077,545 1,179,582 64,696 Total 9,712,654 7,663,227 1,861,566 187,860
Local Public Health Component - Distribution by Jurisdiction - TOBACCO
(Budget) Unreconciled Subdivision Available Expenditures Obligations Unliquidated Fundin Allegany 123,969 123,969 0 0 Anne Arundel 245,943 245,943 0 0 Baltimore Co. 328,039 328,039 0 0 Calvert 126,670 126,670 0 0 Caroline 112,473 112,473 0 0 C_arroll 146,870 146,870 0 0 Cecil 131,503 131,503 0 0 Charles 147,148 147,148 0 0 Dorchester 109,808 I 09,808 0 0 Frederick 163,057 163,057 0 0 Gan-ett 111,138 111,138 0 0 Harford 179,321 179,321 0 0 Howard 155,191 155,191 0 0 Kent 105,755 105,755 0 0 Montgomery 237,792 237,792 0 0 Prince George1s 302,025 302,025 0 0 Queen Anne's 114,360 114,360 0 0 St. Mary's 131,936 131,936 0 0 Somerset 107,553 107,553 0 0 Talbot 110,461 110,461 0 0 Washington 150,338 150,338 0 0 Wicomico 134,438 I 34,438 0 0 Worcester 115,249 115,249 0 0 Baltimore City 286,190 286,190 0 0 Total 3,877,227 3,877,227 0 0
3 3) Breast and Cervical Cancer (Budget) Available Expenditures Obligations Unliquidated Fundin Breast and Cervical Cancer 13,230,000 12,ll7,042 1,112,958 0
Source: Financial reports of the State's Financial Management Information System (FMIS)
Definitions:
Budget: funds allocated to each component and distributed to each county.
Expenditures: items reflected in the State's FMIS.
Obligations: funds reflective of an executed signed agreement or contract.
Unliquidated: budget minus expenditures and obligations.
NOTE: Expenditures from all jurisdictions have not yet been reconciled.
4 MANAGING-FOR-RESULTS REPORTS
CANCER CONTROL PROGRAMS AND TOBACCO USE PREVENTION
5 M00F03.04 CIGARETTE RESTITUTION FUND - CANCER PREVENTION, EDUCATION, SCREENING AND TREATMENT PROGRAM - PREVENTION AND HEALTH PROMOTION ADMINISTRATION
PROGRAM DESCRIPTION
The Cancer Prevention, Education, Screening and Treatment (CPEST) Program was created under the Cigarette Restitution Fund (CRF) and seeks to reduce death and disability due to cancer in Maryland through implementation oflocal public health and statewide academic health center initiatives.
MISSION
The mission of the CPEST Program is to reduce the burden of cancer among Maryland residents through enhancement of cancer surveillance, implementation of community-based programs to prevent and/or detect and treat cancer early, enhancement of cancer research, and translation of cancer research into community-based clinical care.
VISION
The CPEST Program envisions a future in which all residents of Maryland can lead healthy, productive lives free from cancer or disability due to cancer.
KEY GOALS, OBJECTIVES, AND PERFORMANCE MEASURES
Goal 1. To reduce overall cancer mortality in Mmyland. Objective 1.1 By calendar year 2019, reduce overall cancer mortality to a rate of no more than 148.3 per 100,000 persons. (Age-adjusted to the 2000 U.S. standard population.)
CY2016 CY2017 CY2018 CY2019 Performance Measures Actual Actual Estimated Estimated Outcome: Overall cancer 111011ality rate 156.6 151.5 148.7 146.0
Goal 2. To reduce disparities in cancer mortality between ethnic minorities and whites. Objective 2.1 By calendar year 2019, reduce disparities in overall cancer mortality between blacks and whites to a rate of no more than 1.14. (Age-adjusted to the 2000 U.S. standard population.)
CY2016 CY2017 CY2018 CY2019 Performance Measures Actual Actual Estimated Estimated Outcome: Cancer death rate ratio between 1.15 1.11 1.11 1.10 blacks/whites
Goal 3. To reduce mortality due to each of the tm·geted cancers under the local public health component of the CRF program.
Objective 3.1 By calendar year 2019, reduce colorectal cancer mmiality to a rate ofno more than 13.2 per 100,000 persons in Mmyland. (Age-adjusted to the 2000 U.S. standard population.) 6 CY2016 CY2017 CY2018 CY2019 Performance Measnres Actnal Actual Estimated Estimated Ontcome: Colorectal cancer mmtality rate 14.2 13.7 13.4 13.2
Objective 3.2 By calendar year 2019, reduce breast cancer mortality to a rate of no more than 20.2 per I 00,000 persons in Matyland. (Age-adjusted to the 2000 U.S. standard population.)
CY2016 CY2017 CY2018 CY2019 Performance Measures Actual Actual Estimated Estimated Outcome: Breast cancer mmtality rate 21.3 21.6 21.3 20.9
7 M00F03.04 CIGARETTE RESTITUTION FUND - TOBACCO USE PREVENTION AND CESSATION PROGRAM - PREVENTION AND HEALTH PROMOTION ADMINISTRATION
PROGRAM DESCRIPTION The Tobacco Use Prevention and Cessation Program is a statutory program (Title 13, Subtitle 10 of the Health General) incorporating the best practice recommendations of the Centers for Disease Control and Prevention (CDC). The Program delivers comprehensive smoking cessation services to Maryland smokers seeking assistance in quitting smoking, and tobacco use prevention programs and counter marketing initiatives directed at Maryland youth and young adults. The Program is funded through the CRF.
The Program collects data on tobacco use in Maryland through the Youth Risk Behavior/Youth Tobacco Survey (YRBS/YTS) and the adult Behavioral Risk Factor Surveillance Survey (BRFSS). Both surveys collect county-level data on tobacco use and trends, including elech·onic smoking device (ESD) use.1 The Program uses the survey data to supp01i state and local program accountability measures, evaluation, program planning and development, as well as for the CRF legislative report. As directed by statute (Health General Article, Title 13, Subtitle 10), the Program conducted baseline surveys of youth and adult tobacco use in the year 2000.2 Thereafter, the Program has conducted youth surveys biennially, while the adult survey, which is coordinated through the Center for Chronic Disease Prevention and Control, is conducted annually.3 The Program completed the most recent cycle of youth surveys in Fall 2016, with data products released in November 2017. This data, along with 2016 adult survey data, was used in the 201 7 CRF Legislative report.4 The next cycle of youth surveys will be conducted in Fall 2018, and the data will be released in November 2019.
MISSION The m1ss10n of the Tobacco Use Prevention and Cessation Program is to reduce the use of tobacco products in Maryland, thereby reducing the burden of tobacco-related morbidity and mortality on the population. VISION The Tobacco Use Prevention and Cessation Program env1s10ns a future in which all residents of Maryland can lead healthy, productive lives free from disease and cancer caused by the use of tobacco.
KEY GOALS, OBJECTIVES, AND PERFORMANCE MEASURES5 Goal 1. To reduce the proportion of Maiyland youth and adults who currently smoke cigarettes.
Objective 1.1 By the end of calendar year 2020, reduce the prop01tion ofMaiy land middle and high school youth that cunently smoke cigarettes by 87.7% and
1 The term ESD includes products such as, e-cigarettes, vape pens, and vapes. 2 In years 2000-20 I 0, the YTS was not combined with the YRBS; the surveys were combined in 20 I 3 to streamline data collection in schools. 3 An enhanced adult survey with extensive questions about tobacco use is conducted during even calendar years. 4 "Maryland Department of Health. Monitoring Changing Tobacco Use Behaviors: 2000-2016." May 2018, Baltimore: Maryland Depa1t ment of Health, Prevention and Health Promotion Administration, Cancer and Chronic Disease Bureau, Center for Tobacco Prevention and Control, Retrieved I August 20 I 8.
CY2000 CY2016 CY2018 CY2020 Performance Measures Actual Actual Estimated Estimated Input: Percent of middle school students who 7.3% 1.3% 1.1% 0.9% currently smoke cigarettes
Input: Percent of high school students who 23.7% 8.2% 7.7% 7.2% currently smoke cigarettes Outcome: Cumulative percentage NIA -82.2% -84.9% -87.7% change from CY 2000 for middle school students Outcome: Cumulative percentage NIA -65.4% -67.5% -69.6% change from CY 2000 for high school students
Objective 1.2 By the end of calendar year 2019, reduce the proportion of Maryland adults that currently smoke cigarettes by 31.9% from the calendar year 2011 baseline rate.7
CY2011 CY2016 CY2017 CY2018 CY2019 Performance Measures Actual Actual Estimated Estimated Estimated Input: Percent of adults who currently smoke 19.1% 13.7% 13.5% 13.2% 13.0% cigarettes Outcome: Cumulative percentage change NIA -28.3% -29.3% -30.9% -31.9% from CY 2011
Goal 2. To reduce the prevalence of current smoking among minority populations.
Objective 2.1 By the end of calendar year 2019, reduce the propmtion of African-American adults who currently smoke cigarettes by 31.2% from the calendar year 2011 baseline rate.
CY2011 CY2016 CY2017 CY2018 CY2019 Performance Measures Actual Actual Estimated Estimated Estimated Input: Percent of African-American adults 18.9% 13.7% 13.5% 13.2% 13.0% who currently smoke cigarettes Outcome: Cumulative percentage change NIA -27.5% -28.6% -30.2% -31.2% from CY 2011
6 Maryland no longer limits data on youth tobacco use to those under the age of 18 years. Limiting the data to youth under 18 precluded comparison of Maryland data to data in other states, as they are typically categorized by school attended (i.e., middle or high school), without regard to the age of the student. Chapter 139 of the Acts of 2017 amended Md Ann Code Gen § 13-1003 so that data for all high school youth, not just underage youth, are included in these objectives. All high school data has been reanalyzed to reflect all high school youth. 7 Beginning in 2011, CDC enhanced its methodology for weighting estimates of adult risk behaviors, including tobacco use, through the Behavioral Risk Factor Surveillance System (BRFSS). As a result, BRFSS estimates for prior years, 2000~2010, cannot be compared to BRFSS estimates for 2011 or thereafter. A new baseline was established in 2011 for these objectives. 9 Objective 2.2 By the end of calendar year 2019, reduce the propottion of Hispanic adults who currently smoke cigarettes by 54.8% from the calendar year 2011 baseline rate.
CY2011 CY2016 CY2017 CY2018 CY2019 Performance Measures Actual Actual Estimated Estimated Estimated Input: Percent of Hispanic adults who 19.9% 10.2% 10.0% 9.5% 9.0% currently smoke cigarettes Outcome: Cumulative percentage change NIA -48.7% -49.7% -52.3% -54.8% from CY 201 I
10 ACCOMPLISHMENTS
CANCER CONTROL PROGRAMS
11 CIGARETTE RESTITUTION FUND PROGRAM
CANCER PREVENTION, EDUCATION, SCREENING AND TREATMENT PROGRAM (CPEST)
FISCAL YEAR 2018 ACCOMPLISHMENTS
LOCAL PUBLIC HEALTH COMPONENT
Overall
• In Fiscal Year 2018, funding was awarded to CPEST programs in each ofMaiyland's local jurisdictions, including 22 Local Health Departments (LHDs), one hospital in Prince George's County, and an academic health center and hospital located in Baltimore City. Each jurisdiction, excluding Baltimore City, received a base amount of$ I 00,000 with the remainder of its award based on the formula specified in the statute for the CRF Program. The Baltimore City programs (University of Maryland Medical Group and MedStar Health) were funded according to the budget allocation. The Baltimore City Health Department was funded to administer the Baltimore City Community Health Coalition.
• Community health cancer coalitions were implemented in 24 jurisdictions. Each coalition worked to increase participation of members that reflect the demographics of each jurisdiction, including representatives from minority, geographically diverse, and medically underserved populations in each respective jurisdiction, as well as various stakeholders who work with underserved populations. The majority of the community health coalitions met three or more times during the fiscal year. In Fiscal Year 2018, the passage of HB 747 (2017) updated Health General Article, § 13-1109 of the CRF statute to allow LHDs to utilize their existing community health cancer coalitions or to identify alternatives (e.g., local health improvement coalitions, wellness coalitions, combined LHD coalitions) to fulfill the prescribed duties.
• Comprehensive cancer plans addressing prevention, education, screening, and/or treatment for one or more of the targeted cancers were updated in 24 jurisdictions in Fiscal Year 2018: o 24 jurisdictions addressed colorectal cancer; o 12 jurisdictions addressed skin cancer; o 7 jurisdictions addressed breast cancer; o 7 jurisdictions addressed cervical cancer; o 6 jurisdictions addressed lung cancer; o 1 jurisdiction addressed prostate cancer; and o 1 jurisdiction addressed oral cancer.
• Contracts were entered into and/or renewed between the funded programs (LHDs, private vendors, academic health centers) and local medical providers (e.g. gastroenterologists, surgeons, radiologists, primaiy care physicians, hospitals, medical laboratories). These providers deliver clinical services for cancer screening, diagnosis, and treatment.
12 • CPEST programs continued to provide patient navigation services to assist insured clients in accessing cancer screening services. The objective of this service is to reduce disparities related to accessing screening services for all individuals, regardless of health insurance status. Patient navigation services were implemented by 24 CPEST programs for breast, cervical, and/or colorectal cancer screening. Individualized assistance was offered to clients to help them overcome barriers and facilitate timely access to cancer screening and diagnostic services, as well as to help them with initiation of treatment if needed.
• In Fiscal Year 2018, five CPEST programs (Baltimore County, Harford County, Allegany County, Kent County, and Calvert County) continued to participate in a pilot project to integrate the local CPEST and Breast and Cervical Cancer Program (BCCP) programs. CPEST and BCCP programs collaborated to integrate and streamline their programs' services. As a result of the pilot integration project, the BCCP and CPEST programs were able to increase referrals of clients and the overall number of clients served.
• In Fiscal Year 2018, 14 CPEST programs collaborated with their CRF Tobacco program counterparts to support tobacco cessation services as a means of cancer prevention. These programs include local health departments from Allegany, Anne Arundel, Caroline, Cecil, Charles, Frederick, Garrett, Harford, Montgomery, Queen Anne's, Somerset, and Wicomico, Doctors Community Hospital in Prince George's County and MedStar Health in Baltimore City. CPEST programs were able to support individual or group smoking cessation counseling, the provision of smoking cessation treatment aids, client referrals to tobacco cessation services and education, and the provision of tobacco cessation educational materials. As a result of the collaboration, 144 clients received smoking cessation treatment aids, 723 clients received group or individual counseling, and 656 clients were referred to the local CRF Tobacco smoking cessation program or the Maryland Quitline.
• In Fiscal Year 2018, six CPEST programs participated in a lung cancer screening pilot to assist uninsured and underinsured high-risk individuals access lung cancer screening services. The six CPEST programs were from Allegany, Baltimore, Cecil, Harford and Wicomico counties, and MedStar Health in Baltimore City. These programs also worked to increase public awareness of lung cancer and to recruit lung cancer screening clients.
Screening, Diagnosis, and Treatment
In Fiscal Year 2018, screening, diagnosis, and treatment data for the targeted cancers under the CRF-CPEST Program for LHDs, Baltimore City Local Public Health, and the statewide academic health center included the following:
All Cancers
o 3,152 screening tests were performed; o 2,691 persons received one or more cancer screenings; o 79% of those who received one or more cancer screenings were minorities; and o 65 individuals in the program who had received a diagnosis of cancer were either linked to care or provided treatment.
13 Colorectal Cancer
o 1,728 colorectal cancer screening procedures were performed, including: • 1,700 screening colonoscopies, in which 594 adenomatous polyps were found; • Four sigmoidoscopies, in which two polyps were found; • 14 fecal occult blood tests, one of which was found to be positive; and • Five double contrast barium enemas, one single contrast barium enema, and four virtual colonoscopies, in which no suspected cancer or cancer was diagnosed;
o 29 individuals in the program who received a diagnosis of colorectal cancer were either linked to care or provided with treatment funds;
o 261 individuals received patient navigation services guided through the health care system by a patient navigator, through the 23 programs, and completed at least one colorectal cancer screening procedure;
o 502 repmis ofbaniers to colorectal cancer screening were received from patient navigation individuals. The types of baniers and number reported are listed below: • Lack of medical resources - 126 • Transportation - 86 • Financial concerns - 39 • Language - 3 5 • Limited education - 28 • Lack of social support - 25 • Physical disabilities - 22 • Literacy - 20 • Scheduling conflicts with child/family care - 11 • Cultural attitudes/religious beliefs - 4 • Behavioral disabilities - 2 • Other barriers, such as assistance with scheduling and remembering appointments, not understanding how to navigate the healthcare system and how to use their insurance, anxiety, and health issues - 104 Oral Cancer
o 20 oral cancer screening exams were performed; and o No individuals in the program were diagnosed with oral cancer.
Skin Cancer
o 101 skin cancer screening exams were performed; and o 34 individuals in the program who had received a diagnosis of any type of skin cancer were either linked to care or provided treatment.
Breast Cancer
o 532 mammograms were performed; o 541 clinical breast examinations were performed; and
14 o Two individuals in the program were diagnosed with breast cancer and were either linked to care or provided treatment.
Cervical Cancer
o 230 Pap tests were performed; and o No individuals in the program were diagnosed with cervical cancer.
Smoking Cessation • Effective Fiscal Year 2018, three new smoking cessation performance measures were introduced to CRF-CPEST programs: • 723 cessation participants received group or individual counseling by CRF Cancer staff or with CRF Cancer funds; • 656 referrals were made to the CRF Tobacco smoking cessation program and/or Quitline by CRF Cancer staff or with CRF Cancer funds; and • 144 clients were provided smoking cessation aids (NRT, Chantix, Zyban, or gum) with CRF Cancer funds. o These performance measures were introduced in order to capture data that better reflect the impact of collaborative efforts between CRF Cancer and CRF Tobacco Cessation staff and the programs' commitment to the promotion of tobacco cessation and risk reduction for lung cancer.
Education and Outreach
• In Fiscal Year 2018, the education and outreach performance of CPEST programs were measured by the number of activities implemented and new individuals screened for cancer. These measures allow the programs to correlate their education and outreach activities to cancer screening outcomes. CPEST programs were also encouraged to focus on education and outreach strategies that would increase their effectiveness in linking individuals to cancer screenings.
• A total of 3,508 public education and targeted outreach activities were implemented for all cancers combined, resulting in 1,580 Maryland residents signing up for cancer screenings.
• CPEST programs implemented various public education and outreach activities in an effort to raise public awareness about cancer prevention and to link eligible individuals to cancer screening. These activities include targeted outreach at non-traditional and traditional venues, partnerships with providers and community stakeholders, and advertisements through large and small media platfmms:
o CPEST programs implemented targeted education and outreach activities in both traditional and non-traditional venues through brief interactions, group presentations, individual sessions, and dissemination of educational materials. Some traditional venues include physician offices, health clinics, local businesses, recreation centers, local libraries, and community health fairs. CPEST programs implemented culturally appropriate and targeted outreach encounters, provided small media ( e.g., flyers), and provided translated educational materials at non-traditional venues to recruit minority populations. These outreach encounters and the dissemination of materials took place at
15 locations frequented by minority populations, such as ethnic supermarkets and faith-based organizations.
o CPEST programs partnered with healthcare service delivery facilities such as federally qualified health centers (FQHCs), community health clinics, and other safety net clinics to implement outreach and educational activities. Programs conducted outreach at these facilities through meetings and presentations with providers and support staff, or by setting up information tables to provide direct education and recrnitment of clients in the waiting room. These partnerships have allowed programs to work directly with providers· and their staff on client education and referral to the program, screening navigation and process improvements.
o CPEST programs expanded their partnerships with local cormnunity health programs and initiatives that target similar underserved and minority populations. Partnerships include the local BCCPs, the local CRF Tobacco program, Minority Outreach Technical Assistance (MOTA) programs, the local Depmiment of Social Services, Human Immunodeficiency Vims (HN) client services and obesity and tobacco work groups. Some of these organizations were invited to patiicipate in the local community health coalitions to work on cancer sh·ategies.
o Media events were conducted to increase public awareness about cancer prevention and screening services. Several programs planned media events such as public service announcements (PSAs) on television and radio, television and radio talk show interviews, messages on public education channels, and articles in local newspapers. Programs also increased their education and outreach messaging through online and social media outlets, such as Facebook, Twitter, Instagram, and other websites.
• Examples of public education and outreach performed by the LHDs and the Baltimore City Public Health component included the following:
Allegany County The Allegany County CPEST program staff had a letter to the editor published in the local newspaper. The letter highlighted the impmiance of colorectal cancer screening along with information about the program's services. In response to the letter, the Allegany County Health Department Director of Cancer Programs was invited to an interview with Dave Norman, a local AM radio talk show host. The program's advertisement on the front page of the local newspaper resulted in inquiries from the general public.
Baltimore County Baltimore County's CPEST program conducted outreach to providers in their jmisdiction by disseminating information through mailings and e-mails, meetings at provider offices, and by consistently engaging with providers throughout the year. 55% of all new clients in Fiscal Year 2018 resulted from provider referrals. Pminer providers include Chase Brexton Health Services, the Esperanza Center, and Mission of Mercy.
Dorchester County The Dorchester County CPEST program partnered with various community health coalition partners to target underserved populations at non-traditional venues and 16 community sites. They disseminated English and Spanish educational information at low income housing complexes, senior housing facilities, shelters, minority churches, mental health facilities, and FQHCs. The program also partnered with their health department's HIV program to create a referral system, resulting in increased referrals to the CPEST program. During Colorectal Cancer Awareness month, the program's Case Manager was interviewed by WBOC TV 16 in their "DelmarvaLife" segment. The additional exposure led to enrollment of clients in the program.
Harford County Harford County's CPEST program partnered with various programs from their community health coalition, including their obesity and tobacco programs. Coalition members assisted with the distribution of CPEST cancer program information, while the CPEST program linked their clients to the other members' services. As a result, the CPEST program was able to reach more of their targeted minority and underserved populations. Throughout the year, the program focused on lower-income areas with large minority populations, such as Edgewood and Aberdeen, as well as rural and underserved areas in Darlington.
Howard County The Howard County Health Department implemented the CAREAPP in Fiscal Year 2018. CAREAPP is an electronic bi-directional refenal, coordinating, and tracking healthcare delivery system that identifies high-risk clients based on the social dete1minants of health (https://www.hccareapp.org/). This initiative will significantly impact clinical, education, outreach, and recruitment effotis to increase quality population-level screenings, and will increase referrals for insured individuals with baiTiers to care. Presently, there are 28 community partners, including Chase Brexton Health Services, Howard County General Hospital, Howard County Community College, Columbia Association, and various governmental and public service agencies such as the Regional Transpmtation Agency, Howard County Public Libraries, and the local food bank.
Baltimore City-MedStar Hospital MedStar Hospital's CPEST program in Baltimore City has built successful referral relationships with providers at various health service agencies that target underserved populations including Chase Brexton Health Services, Anne Arundel Community Clinic, St. Clare Medical Outreach, and Family Health Centers. The program reported that the majority of the clients learned of the program through their healthcare providers. In Fiscal Year 2018, 135 of the program's clients were physician referrals. MedStar also conducted a television interview during Colorectal Cancer Awareness month, which led to increased public inquiries about the program's cancer screening services.
Montgomery County The Montgomery County Health Department CPEST program collaborated with community-based safety net clinics to reach underserved populations. The program leveraged their collaboration with safety net clinics and area hospitals to provide trainings to healthcare providers and to address issues around cancer care and access to screening. The program and hospital staff also provided group and individual education sessions. As a result, the number of individuals screened via the program has increased by 39 .5% within the past year. The program has also expanded their marketing efforts through partnerships with local hospitals. 17 Washington County Washington County Health Department's CPEST program staff conducted presentations on program services and screening rec01mnendations at the local FQHC, Family Healthcare of Hagerstown. Program staff also reached out to provider offices at a local c01mnunity free clinic. As a result of their efforts, 29% of the program's clients are referrals from FQHC providers, and 53% from the community free clinic.
Wicomico County The Wicomico County Health Department's CPEST program established a strong relationship with their FQHC and was able to implement onsite recruitment in the waiting room. Program staff utilized the FQHC waiting areas to educate clients about cancer screening and program services, leading to successful onsite refe1rals.
Minority Outreach
• Each of the 24 jurisdictions planned specific activities that focused on ensuring that there was minority outreach within their communities. Examples of these types of services include:
Baltimore City - University of Maryland Medical Group The University of Maryland Medical Group (UMMG) Public Health CPEST program forged a strong partnership with the local FQHCs at Parkwest, Total Health Care, and Baltimore Medical System to navigate their minority and underserved patients for colorectal cancer screening. Many of these healthcare systems have patients who are unable to undergo cancer screenings due to various barriers. The UMMG CPEST program worked with these healthcare systems to develop workflows for identifying patients who have not completed recommended screening, conducted outreach to these patients, and provided linkage to screening. Patient navigation services were also provided to these patients to assist them with overcoming barriers to screening.
Harford County The Harford County Health Department CPEST program implemented education and outreach effo1is to increase its community engagement with Spanish speaking clients. The program worked with a translation company to update their materials and website information. Program staff distributed colorectal cancer prevention information in Spanish at Hispanic faith-based organizations and at local Hispanic community organization meetings to establish trnst and to reach clients in enviromnents where they are comfortable.
Kent County The Kent County Health Depatiment CPEST program continues to work with their MOTA vendor. The CPEST program's bilingual community health outreach worker and a bilingual outreach worker from a managed care program attended a MOTA event at a Hispanic church. The outreach workers were able to speak with the families in attendance, which led to several families accessing services through the health department for managed care assistance and cancer screenings.
18 Montgomery County The Montgomery County Health Department CPEST program implemented education and outreach activities that were culturally competent and language appropriate. Their health education materials were provided in various languages. The. CPEST program and its partners also applied a more direct outreach approach by venturing into barbershops, store fronts, apartment and senior community centers, churches, and metro stations.
Talbot County The Talbot County Health Department CPEST program implemented outreach and education efforts to recruit minority populations, and incorporated culturally appropriate materials to target Hispanic and African clients. By partnering with their BCCP, the CPEST program staff utilized a translator to provide cancer education sessions and materials in Spanish. The programs also worked together to assist Spanish speaking clients with cancer screening appointments. As a result, both programs were able to increase their enrollment of Hispanic clients.
STATEWIDE PUBLIC HEALTH COMPONENT
• Staff from the Maryland Depaiiment of Health (MDH) Center for Cancer Prevention and Control (CCPC) held monthly CPEST teleconferences throughout the fiscal year. Through these teleconferences, CPEST program participants from all 24 jurisdictions were able to receive relevant cancer screening updates, information on effective educational cancer messaging, and assistance with adminish·ative and budget requirements, and exchange information with their peers.
• CCPC staff conducted 16 site visits and quality assurance reviews of local CPEST programs in 15 jurisdictions. During these site visits, CCPC staff also provided guidance on educational and outreach strategies and technical assistance on clinical and case management processes. Additionally, administrative, billing, and program evaluation issues were discussed during these site visits.
• The following education and trainings activities were provided by CCPC:
o Webinar or conference call trainings were provided for CPEST program health educators, ouh·each workers, and clinical staff. The information provided in these training modules focused on clinical guidance, collaborating with CRF Tobacco programs, billing reimbursement, and client recruitment.
o Individualized technical assistance meetings and conference calls were provided to improve program performance for select CPEST programs. Conference call trainings covered multiple areas, including clinical and case management standards, quality assurance of clinical documentation, recall and recruitment eff01is targeting minorities and underserved target populations, and grant administrative and fiscal monitoring processes.
o Three regional sessions and one statewide training session were provided to local CPEST and Breast and Cervical Cancer Program staff, focusing on clinical and case management
19 updates. A statewide webinar provided local CPEST staff with updated colorectal cancer screening options.
SURVEILLANCE AND EVALUATION COMPONENT
• In Fiscal Year 2018, CCPC Surveillance and Evaluation staff continued to maintain and provide support for the Cancer Client Database (CDB) and Cancer Education Database (EDB) applications. The CDB and EDB are used by local CPEST programs to capture clinical and non clinical data about CRF-funded screening and patient navigation services. Various enhancements were made to the CDB and EDB during the year, including the addition of smoking cessation fields to the EDB data entry form, and the development of preliminary lung cancer data collection fonns for screening, post screening, and supplemental procedures.
o 21 LHDs, one statewide academic health center, and two private vendors used the CDB to enter data for individuals screened for colorectal, oral, or skin cancers. o 22 LHDs, one statewide academic health center, and two private vendors used the EDB to enter data on education and outreach activities implemented. o Nine staff from CRF-CPEST programs completed online EDB training. o 11 staff from CRF-CPEST programs, and two Department staff completed on-site CDB training at the Department. o CDB- and EDE-related trainings and updates were conducted, including: • Four quatterly "Introduction to the COB" training sessions; • Five statewide updates via CRF-CPEST teleconferences; and • Multiple technical assistance calls with CRF-CPEST programs.
• Quality assurance and reporting activities included:
o Quality assurance reviews of CDB and EDB data entered by all local CPEST programs were conducted and the results were shared with each program. o Various cancer repmts were disseminated to CPEST programs: • Quatterly Colorectal Cancer Benchmark Repmts; • Mid-year Performance Measures Rep01ts and Action Plans; • An annual Colonoscopy Feedback Report; and • Perfonnance Measures Sunnnary Reports.
• Data from the Cancer Screening and Tracking System (CaST) database used by CPEST programs targeting breast and cervical cancer screening, diagnosis, and/or treatment were analyzed by CCPC staff.
STATEWIDE ACADEMIC HEALTH CENTERS COMPONENT
Baltimore City Public Health Grant
• The Baltimore City Comprehensive Plan for Cancer Prevention, Education, Screening, and Treatment was developed and submitted to MOH for review and approval. UMMG, MedStar Health, and the Baltimore City Health Depattment were awarded grants for implementation of the Baltimore City Public Health Grant. UMMG focused on breast, cervical, and colorectal
20 cancer. MedStar Health focused on colorectal and lung cancer. The Baltimore City Health Department administered the Community Health Coalition, with active participation from UMMG and MedStar.
• The coalition met four times in Fiscal Year 2018: on October 19, 2017; December 11, 2017; February 5, 2018; and June 13, 2018. Additionally, a summit was held on September 27, 2017 to address colorectal cancer screening efforts in Baltimore City.
o September 27, 2017 Summit: The 80% by 2018 Summit was hosted by members of the Baltimore City Cancer Coalition. The Summit included an overview of the American Cancer Society's 80% by 2018 goals, an introduction to colorectal cancer training, a panel discussion of barriers and promoters to colonoscopies, an overview of Fecal Immunochemical Test (FIT) guidelines, and a call to action.
o October 19, 2017: During the October coalition meeting, members discussed cancer support groups in Baltimore City, FIT testing updates, training resources for colorectal cancer screening, joint efforts with the Tobacco Free Baltimore coalition, feedback and outcomes of the September 2017 summit, and partner updates.
o December 11, 2017: The coalition discussed the grants awarded by the Prevent Cancer Foundation to IO FQHCs in Baltimore City to provide FIT screenings in Baltimore City. The members also discussed the high prevalence rate of breast cancer in Baltimore City and cunent resources provided through various programs at Johns Hopkins, faith-based organizations, and survivor suppmi groups.
o February 5, 2018: The meeting was a combined tobacco and cancer coalition meeting. Coalition members' updates included information on upcoming American Lung Association trainings and events. A guest speaker discussed insurance coverage for tobacco cessation services. There was also discussion about structuring and scheduling combined meetings, as well as potential focus areas for upcoming meetings.
o June 13, 2018: During the last meeting of the fiscal year, the members discussed disparities in cancer mortality, focusing on prostate, lung, colorectal, and breast cancer disparities. The coalition also discussed their work plan for Fiscal Year 2019 to dete1mine focus areas. Discussions include increasing efforts to link individuals to tobacco cessation programs, adding cancer patient caregivers to the coalition, and addressing overall health issues of incarcerated clients. During this meeting, the coalition detennined that they will combine their cancer and tobacco coalition in Fiscal Year 2019.
• UMMG implemented 303 public education and targeted outreach activities for all cancers combined, resulting in 39 Maryland residents signing up for cancer screenings.
• UMMG screened 98 people for colorectal cancer, all of whom were screened with colonoscopies. Of those screened, 96 (98%) were racial or ethnic minorities, and 43 (44%) were patient navigation clients. One individual was diagnosed with colorectal cancer was either linked to care or provided treatment.
21 • UMMG screened 353 women for breast cancer with mammograms and clinical breast exams. Of the women screened, 336 (95%) were racial or ethnic minorities. One individual was diagnosed with breast cancer and as either linked to care or provided treatment.
• UMMG screened 135 women for cervical cancer. Of the women screened, 130 (96%) were racial or ethnic minorities. No individuals were diagnosed with cervical cancer.
• MedStar Health screened 240 clients for colorectal cancer, 236 of whom were screened with colonoscopies. Of the 240 screened, 218 (91 %) were racial or ethnic minorities, and 33 (14%) were patient navigation clients. One individual was diagnosed with colorectal cancer and was either linked to care or provided treatment.
Johns Hopkins Institutions Cancer Research Grant
• In Fiscal Year 2018, the Johns Hopkins Institutions were awarded $2,600,000.
• The Johns Hopkins Institutions awarded mini-grants in Fiscal Year 2018 including three for faculty recruitment, seven for faculty retention, and 23 for translational research. These 33 grants are listed below:
1. A pilot study to assess an educational intervention to address distress and quality of life related to financial burden in advanced lung cancer patients. 2. Novel individualized technology intervention for behavioral change among cancer survivors among a high risk group: Artificial intelligent solutions to increase physical activity. 3. Targeting M2-tumor associated macrophages (M2-TAMs) in prostate cancer. 4. Differential susceptibility of the female lung to genotoxic damage and to cigarette smoke. 5. Role of spermine oxidase-generated H2O2, DNA damage and epigenetic changes in inflammation/infection-associated carcinogenesis. 6. Preclinical evaluation of new vFLIP inhibitors to control HHV-8/KSHV. 7. Optimizing Bcl-2 inhibitor therapy for small cell lung cancer. 8. Identifying ba1Tiers to therapeutic clinical trial participation using clinical trial candidate data. 9. Examining gut micro-biota-mediated pathways in cancer etiology: A randomized controlled trial of metformin and weight loss in a biracial cohort of cancer survivors. I 0. Developing a point-of-care test for human papilloma (HPV) vaccination status. 11. Re-engineering the sensmy array of prostate to discover novel chemo-mechanical signaling node against cancer metastasis. 12. Effect oftranscatheter arterial chemoembolization and systemic therapy on the immune microenvironment in hepatocellular carcinoma (HCC). 13. Leveraging clinical somatic mutation profiling of malignancies with modern electronic health records to better characterize etiologic, prognostic, and therapeutic associations. 14. A potent rBCG as a therapeutic intervention for non-muscle invasive bladder cancer. 15. Characterizing sequences and functions ofLINE-1 endogenous mutagens. 16. Development, cultural adaptation and piloting of an avatar delivered smoking cessation intervention for low income smokers in Baltimore City.
22 17. Proteomic interrogation of the serum albumin adductome for discovery and characterization of airborne pollution carcinogen exposures. 18. Pharmacy-driven smoking cessation pilot program within a multidisciplinmy cancer clinic for thoracic malignancies. 19. COach2Quit: A novel mHealth smoking cessation application for cancer patients. 20. Individual characteristics and research decisions in cancer care at Johns Hopkins. 21. A novel screening strategy for adenocarcinoma of the cervix: The cervical cancer subtype on the rise in younger white women and older black women. 22. Estimating prevalences of liver fibrosis in those with and without risk factors for non alcoholic fatty liver disease, a contributor to the rapid rise in liver cancer in Maryland: Phase I - preparation. 23. Implementing an individualized risk prediction tool for men with prostate cancer: testing its impact on men with newly diagnosed cancer and expanding its capacity to men outside of Hopkins. 24. Electronic cigarettes as a pathway of exposure to toxic and carcinogenic metals. 25. Baltimore ambient particulate matter reprograms the immune system to facilitate tumor escape and progression. 26. Health experiences research on cancer-related fatigue among older adults. 27. Improving patient care and population health using patient-reported outcomes: developing a PRO core strategy. 28. Mechanistic model of absolute risk in cancer. 29. Early detection of lung cancer using circulating tumor DNA. 30. Cervical cancer disparities in the DC and Baltimore region and uncovering genomic differences by race. · 31. Metformin treatment or lifestyle intervention to improve health in overweight/obese cancer survivors. 32. Establishing the Community-based Participant Engagement and Translation (CPET) core: A developing core to facilitate intervention studies. 33. The East Baltimore household-based smoking cessation program.
• In Fiscal Year 2018, multiple audiences were educated about the findings of CRF investigators through various presentations. Findings were published in "Conquest" and can be viewed at http://www.hopkinsmedicine.org/news/publications/conguest/issues.
• In Fiscal Year 2018, CRF funds were leveraged and resulted in 146 new grants from outside funding sources.
University of Maryland Cancer Research Grant
• In Fiscal Year 2018, the University ofMmyland Greenebaum Comprehensive Cancer Center (UMGCCC) was awarded $10,400,000.
• UMGCCC continued to improve a Shared Services interactive research program structure designed to achieve bi-directional translational research. This structure brought together clinical and basic research investigators who worked together to assure rapid translation of research in the laboratory to the clinic by developing and supporting a series of shared resources which facilitated specialized research activities for all faculty.
23 • UMGCCC had several ongoing projects intended to translate research activity into clinical application for patient benefit. For example, cell tethering teclmology co-invented by Drs. Stuart Martin and Christopher Jewell was licensed by the University of Maryland to Cellth Systems, Inc. for the development of microfluidic devices to rapidly test patient tumor cells for metastatic potential and optimal drug response. • Shared Services include:
o Pathology Biorepository and Research Core Shared Service: This core provides banked tissues and blood specimens for genomics, proteomics, and other analyses for identification of new biomarkers and therapeutic targets while maintaining patient confidentiality. The core's main goal is to provide a constant flow of quality banked tissue and blood specimens to its researchers.
o Genomics Shared Service: This program is a comprehensive genomics resource facility that provides cytogenetic analysis, Sanger-based DNA sequencing, next-generation sequencing, genotyping, gene expression analysis by real-time polymerase chain reaction and microarray analysis in both a research and Clinical Laboratory Improvement Amendments-College of American Pathologists-accredited environment.
o Biostatistics Shared Service: This core promotes clinical and laboratory cancer investigations through the application of statistical methodology and bioinfonnatics to proposed and/or ongoing cancer research projects. The core service area serves as the central resource of statistical expertise for UMGCCC and is critical to meeting the goals of conducting and translating research into clinical applications.
o Flow Cytometry: This shared service provides supplies, including sheath fluid, necessary to operate the flow cytometers. It provides cell-sorting services, and access to novel inshumentation including imaging cytometers and spectral-cytometers.
o Translational Laboratory: This core service area was established for clinicians paiiicipating in early phase drug development clinical trials and for basic scientists that have an interest in assessing the clinical relevance of their own research topics.
o Structural Biology (X-ray Crystallography and Nuclear Magnetic Resonance): The Structural Biology Shared Service helps researchers use the unique information derived from macromolecular structures to understand the molecular basis of cancer-causing cellular defects and to design drugs that mitigate such defects.
o Imaging: The Imaging Shared Service provides a wide atTay of applications using state of-the-art imaging instruments, offers training and assistance in the use of the instruments, helps optimize data acquisition and analysis, and provides image processing and interpretation services. The applications include electron microscopy, confocal microscopy, and translational imaging services.
• As of June 30, 2018, there were 261 peer-reviewed articles authored and published by CRF supported UMGCCC investigators.
24 • As of June 30, 2018, 69 CRF-supported UMGCCC faculty members filed 228 federal, state, and private grant applications.
• 106 applications for clinical trials were submitted to the Clinical Research Committee, of which 99 cancer-related clinical trials were approved.
• Of the new clinical trials approved in Fiscal Year 2018, 63 were new University of Maryland cancer-based interventional treatment trials.
• During Fiscal Year 2018, a total of242 new patients entered into all clinical trials at UMGCCC - 60 (24.8%) were African-American, and 86 (35.5%) of all new patients were minorities.
Maryland Cancer Registry
• The Maryland Cancer Registry (MCR) submitted 2015 incidence data for evaluation and confidential feedback from the North American Association of Central Cancer Registries and received "gold" cetiification. The certification included review of the following areas: completeness of case ascetiainment, completeness of infmmation recorded, percentage of "death cetiificate only" cases, duplicate primary cases, passing edits, and timeliness.
• The MCR was recognized by the CDC National Program of Cancer Registries (NPCR) as a "Registry of Distinction." This achievement indicated that the MCR met the CDC NPCR National Data Completeness and Quality Standard. Of the 50 cancer registries supported by the CDC, the MCR was one of 23 that achieved this designation for the most recent data submission. Meeting these standards allows Maryland data to be included in the 2018 United States Cancer Statistics report and other analytic data sets.
• During Fiscal Year 2018, the MCR linked the MCR database with the BCCP database of cancer cases diagnosed from 2006-2015, resulting in a 100% case match across both files. The MCR links with the BCCP database annually to assist in case finding and as a requirement of funding for the MCR and the BCCP.
• MCR staff at the Department processed over 31 requests for release ofMCR data.
• MCR staff resolved over 3,268 unknown races through queries in the Motor Vehicle Administration's database for missing race information.
• In Fiscal Year 2018, a total of25 providers moved into full production as part of Meaningful Use and submitted actual Electronic Health Record (EHR) data from their practices to the MCR.
Breast and Cervical Cancer Diagnosis and Treatment Program
• The Breast and Cervical Cancer Diagnosis and Treatment Program (BCCDTP) was established in 1992 to provide breast and cervical cancer diagnostic and treatment services to uninsured or underinsured low-income Maryland residents.
25 • BCCDTP directly reimburses participating providers who provide covered services to BCCDTP participants. Covered services include but are not limited to: diagnostic mammograms and sonograms, surgical consultations, breast biopsies, colposcopies, cervical biopsies, surgery for cancer treatment and breast reconstruction, chemotherapy, radiation therapy, medications, durable medical equipment, home health services, physical therapy, and occupational therapy.
• For Fisca!Year 2018, the BCCDTP paid for services for 1,253 participants, and processed a total of 18,363 paid claims.
• BCCDTP funds were awarded to local Breast and Cervical Cancer Programs, which funded additional screening tests or diagnostic services in the local programs.
o 23 local programs received funds in Fiscal Year 2018.
o 2002 women received at least one screening test or diagnostic service: • 2002 women received a breast cancer service; and • No women received a cervical cancer service.
26 ACCOMPLISHMENTS TOBACCO USE PREVENTION AND CESSATION PROGRAM
27 CIGARETTE RESTITUTION FUND PROGRAM
TOBACCO USE PREVENTION AND CESSATION PROGRAM
FISCAL YEAR 2018 ACCOMPLISHMENTS
Background
Maryland's tobacco use prevention and cessation efforts have resulted in a decrease in the prevalence of tobacco use in both adults and youth. The prevalence of cigarette smoking in adults was 13.7% in 2016, down from 19 .1 % in 2011. High school youth tobacco use hit an all-time low of 14.4% in 2016, down from almost 27% in 2000. Youth initiation rates also decreased significantly from 18.0% in 2013 to 7.7% in 2016, and two-thirds of Maryland adults have never smoked.8
Despite this progress, more than 780,000 Maryland residents continue to smoke or use some fo1m of tobacco product.9 In addition, the skyrocketing populaiity of ESDs threatens to disrupt fmiher progress in youth tobacco prevention. In 2016, Maryland youth used ESDs more than any other tobacco product. It is widely repo1ted that fruit and candy flavors attract youth to ESDs. National data show that among ESD users ages 12 to 17, 85% rep01i using flavors such as mango and creme brulee. 10 Potential risks of ESD use during youth and adolescence include nicotine exposure and addiction that affects the developing brain; tespiratory damage from aerosolized chemicals such as solvents and flavorants; deterrence of quitting tobacco use; and dual use of ESDs and other tobacco products, which can impede quitting eff01is, increase addiction, and increase the dose of nicotine.
In 2018, the Food and Drug Administration (FDA) issued a request to ESD manufacturers to submit documents relating to their research and marketing practices to better understand youth use and product appeal, including whether certain product design feahires, ingredients, or specifications appeal to different age groups. The results have not been made public as of the writing of this report.
The Maryland Tobacco Use Prevention and Cessation Program implements a comprehensive statewide tobacco conh·ol program, based on the five core components outlined in the CDC's Best Practices f or Comprehensive Tobacco Control Programs (2014) : (1) State and Community Interventions; (2) Mass Reach Health Communication Interventions; (3) Cessation Interventions; (4) Surveillance and Evaluation; and (5) Infrash·ucture, Administration, and Management. 11 Accomplishments are discussed below by the CRF Tobacco Use Prevention and Cessation Program Component areas: Statewide Public Health, Local Public Health, and Surveillance and Evaluation.
8 "Maryland Department of Health. Monitoring Changing Tobacco Use Behaviors: 2000-2016" May 2018, Baltimore, Ma1y land Department of Health, Prevention and Health Promotion Administration, Cancer and Chronic Disease Bureau, Center for Tobacco Prevention and Control, Retrieved 2 1 August 2018.
• The Tobacco Use Prevention and Cessation Program (the Program) continued to provide funding for the Maryland Tobacco Quitline, 1-800-QUIT-NOW (Quitline), and provided support to over 7,800 callers during this reporting period. The Quitline has been an effective service for Marylanders since it launched in 2006, and has an established quit rate of 30%, while average quit rates without assistance such as the Quitline range from 4% to 7%. The Quitline continues to provide free telephonic tobacco cessation counseling 24 hours a day, 7 days a week to Marylanders 13 years of age and older. Residents 18 years of age and older can receive a free supply ofup to 12 weeks of Nicotine Replacement Therapy (a combination of patch, lozenge, and/or gum) while supplies last and budget allows, along with web and text support. Proactive counseling sessions include a combination of phone-, text-, and web-based services. The Quitline consistently demonstrates a stable reach across Maryland, including minority populations, uninsured callers, and Medicaid participants. Specialized multi-call and incentive programs for pregnant participants are included, as well as a specialized multi-call program for youth smokers (ages 13 to 17). Nearly 40% of callers to the Quitline self-reported being Medicaid participants in Fiscal Year 2018.
• The Program maintained the Pregnancy Rewards Program to encourage and supp01i pregnant smokers to use the Quitline. This incentive program offers rewards to women who are pregnant and up to six months postpartum who complete a series of calls with a Quit Coach. The Pregnancy Rewards Program initially required physician refetrnl, however this barrier was removed to encourage greater participation by those in need. Pregnant and postpartum women who call the Quitline receive $25 gift cards to Target in four installments, based on a total of 10 completed calls (maximum of $100 per patiicipant). The Program awarded 49 incentives during this fiscal year.
• The Program implemented the following health communication efforts with multiple CRF funding sources, as well as federal funds. The campaigns listed below are outlined in greater detail in this report under "Counter-Marketing and Media":
o Multiple campaigns promoting the Quitline; o Campaigns reaching those in vulnerable populations [e.g., Medicaid participants; individuals with behavioral health conditions including mental health and substance abuse disorders; pregnant women; and individuals who are lesbian, gay, bisexual, transgender and queer (LGBTQ)]; o Responsible Tobacco Retailer campaign; o Clean Indoor Air Act 10th Anniversary celebration (also known as "Clean Air Maryland"); and o The Vape Experiment campaign.
• The Program awarded a five-year media contract to Red House Communications (via competitive solicitation) in April 2017. Through the multi-year agreement, Red House is designing, developing, and. implementing health communication campaigns to further the goals of the Program. This fiscal year, Red House developed, tested, and executed a range of campaigns to reach Maryland's most vulnerable populations. Red House developed new campaigns, including "The Vape Experiment," and created promotional materials for the Clean
29 Indoor Air Act 10th Anniversary celebration. Red House also enhanced existing campaign materials and placed ads statewide for the Quitline and the Responsible Tobacco Retailer Initiative. Additional creative development began for a new campaign targeting the behavioral health population, their families, and providers who treat them. This campaign is slated to launch in Fiscal Year 2019.
• The Program supported the Maryland Resource Center for Quitting Use and Initiation of Tobacco (MDQuit), housed at the University of Maryland, Baltimore County. MDQuit provides statewide technical assistance and training to organizations and healthcare providers to share resources and best practices for tobacco cessation. MDQuit staff led training on the effectiveness of the Maryland Tobacco Quitline (Quitline); how best to use the Quitline in clinics; how to discuss tobacco cessation with patients; effective Quitline referral strategies; and an overview of phannacotherapy for tobacco cessation. MDQuit also continued to expand its Fax-to-Assist program, which makes it easier and more convenient for providers to refer clients to the Quitline. Additional accomplishments include: o 216 newly ce1tified and registered Fax-to-Assist providers; o 10 trainings for behavioral health providers throughout the state; and o 188 attendees at the 12 th Annual Best Practices Conference (see below).
• The Program, along with MDQuit, hosted the free 12 th Annual Best Practices Conference, "New and Innovative Practices and Treatments in Tobacco Cessation," on January 18, 2018 at Turf Valley Resort in Ellicott City, Maryland. Attendees included 188 providers and professionals from LHDs, healthcare organizations, MDH, Maryland Behavioral Health Administration (BHA), mental health and substance abuse agencies, colleges and universities, and faith-based organizations. Nationally recognized speakers led plenary sessions entitled, "Mindfulness-based Interventions for Alcohol, Nicotine, and Substance Use Disorders: Empirical Findings and Recent Adaptations" and "Using Technology to Reach and Engage Smokers in Tobacco Dependence Treatment." In addition, workshops explored mindfulness-based interventions for addictive behaviors as well as tobacco cessation for people with serious mental illness. Finally, awards for exception participation in the Fax-to-Assist Quitline referral program were presented.
• The Program supported the Legal Resource Center for Public Health Policy (LRC) housed at the University of Maryland Francis King Carey School of Law. The LRC provides technical assistance to community groups, employers, LHDs, residents, and agencies across Maryland on a variety of tobacco control topics. In Fiscal Year 2018, the LRC responded to 253 requests for technical assistance on: o Implementation of smoke-free multi-unit housing; o Implementation of smoke-free grounds; o Implications of ESD use and smoke-free policies; o Flavored tobacco products; o Tobacco sales to minors, including fmthcoming ESD sales restrictions effective October 1, 2018; and o Tobacco point-of-sale advertising and product placement in retail stores.
• The Program, along with the LRC, hosted a free, statewide tobacco control conference titled, "2018 Maryland Tobacco Control Conference, Navigating the Changing Landscape: The Future of Tobacco Control in Maryland." Then Deputy Secretary for Public Health Services, Howard 30 Haft, M.D., provided opening remarks followed by a plenary session on youth engagement by Gustavo -Torrez from The Campaign for Tobacco Free Kids. The conference offered seven . panel presentations, entitled: 1) Innovative Points of Entry and Apptoaches for Cessation; 2) Innovative Tobacco Policy; 3) Emerging Enforcement Issues; 4) Tobacco Prevention and Cessation Through the Health Equity Lens; 5) Vaping, Juuling, & Youth; 6) Substance Use: Intersection with Tobacco Law and Policy; and 7) FDA & Strategic Communications. Nationally recognized speakers included Kerry Cork, Kevin Schroth, Scott Hall, Desmond Jenson, Rod Lew, Juan Carlos Vega, Delmonte Jefferson, and Ilana Richman. Held on May 8, 2018 at the Sheraton Columbia Town Center in Columbia, Maryland, there were 131 attendees, including state and local health officials, local tobacco control coordinators, community health workers, law enforcement officers, and others.
• The Program supported the University of Maryland Baltimore, School of Medicine to implement an electronic referral (e-referral) program from the University of Maryland Medical System (UMMS) to the Quitline through patient health records. As of its system-wide implementation in December 2017, UMMS has electronically refen-ed 342 patients to the Quitline with 63 patients accepting services. UMMS continues to train providers on smoking cessation counseling and electronic referrals to the Quitline. Provider h·aining has been successful, with providers now utilizing smoking cessation materials for their patients without being prompted. UMMS plans to bring tobacco screening and smoking cessation services into their pregnancy programs to support expecting mothers and families, as well as women with mental health needs.
• The Program partnered with Johns Hopkins Hospital System to roll out the e-referral program to the Quitline through their entire hospital system. Johns Hopkins Hospital System has electronically referred 1,708 patients to the Quitline with over 400 patients accepting services.
• The Program supported the Orthopedic T1'auma Department at the University of Maryland, Baltimore with a research project on the effectiveness of tobacco cessation counseling, including referral to the Quitline, in inpatient hospital settings. Tobacco use has deleterious effects on fracture and broken bone outcomes. 12 During Fiscal Year 2018, the Orthopedic Trauma Department engaged 269 patients, with 197 completing all stages of follow-up. This project concluded on June 30, 2018. The final report for this project is due in September 2018.
• The Program maintained the following no-cost online trainings for healthcare providers:
o Helping Your Patients Quit: A Systems Approach to Tobacco Cessation. This webinar was developed by the Quitline's vendor, Optum, and can be accessed at: http://www.hcpoutreach.com/alr assets/Effective Tobacco Treatment Systems MDWe binar.mp4. o Treating Tobacco Use in Mmyland: Tools for Helping Your Patients Quit. This webinar features the "Ask, Advise, and Refer" methods for initiating tobacco cessation discussion, as well as pharmacology information. The training is available at: http://www.helppatientsquitmd.org and www.smokingstopshere.com/fax-to-assist/. · o An overview of the Quitline. The webinar describes how the Quitline operates; the effectiveness of the Quitline; a patient's experience using the Quitline; and how to set up and send e-referrals. The training is available at www.smokingstopshere.com ..
12 Let's Stop Now Trial, 18 August 2017, Retrieved 2 1 August 2018
o Allegany County's Cumberland Treatment Center, which provides substance use treatment services, added an additional group session to their treatment protocol to specifically focus on nicotine use prevention education during pregnancy. o Calvert County's Tri-County Youth Services Bureau adolescent behavioral health screening tool was modified to include a screening question about nicotine use. o Cecil County's Heritage Family Pregnancy and Family Health Center established a smoke-free campus. Additionally, nicotine use prevention education has been added to the Center's intake process. o Dorchester County's Eastern Shore Wellness Solutions established a screening process to ensure all program participants are asked about tobacco and nicotine. Tobacco users were referred to the LHD and/or Quitline.
LOCAL PUBLIC HEALTH COMPONENT
Local public health programs prioritize community engagement and mobilization in addressing tobacco control. Local programs encompass a diverse set of entities that reach across multiple sectors including voluntmy health agencies; civic, social, and recreational organizations; businesses, city and county governments; healthcare systems and providers; schools and universities; faith organizations; and organizations for racial and ethnic minority groups.
In this fiscal year, LHDs:
• Coordinated 24 local tobacco coalitions with a statewide membership of 536 people to ensure diverse representation and inclusive participation. The demographic composition of all the local coalitions was 33% African American, 4% Asian American, 56% Caucasian, 4% Hispanic/Latino, 1.3% Native American, and 1.7% other. These coalitions provide input on local tobacco control plans, assess local data trends, facilitate needs assessments, recruit community partners, support training and community outreach, and integrate tobacco control into other public health and healthcare settings.
• Provided training and technical assistance to funded organizations, and conununity partners to sustain tobacco control efforts, patticularly in the areas of ESD prevention and secondhand smoke exposure in homes.
• Funded 160 partner organizations ( community-based and faith-based organizations, behavioral health organizations, public school systems, colleges and universities, health 32 systems, day care centers, and the housing authority) to carry out youth tobacco use prevention, cessation, and other tobacco control activities.
• Worked with local public housing authorities to support the development of campus smoke free policies and to communicate the U.S. Department of Housing and Urban Development's mandate to·move all publicly-owned housing to a smoke-free environment effective July 30, 2018.
Community and School-Based
LHDs provide a wide range of staff-driven outreach, education, and awareness campaigns. LHDs also work with multiple organizations to increase local-level tobacco control capacity by training community organizations and school partners to carry out tobacco control activities and target high-risk populations. School-based activities include educating public, private, and alternative school students from pre-K through college; reaching youth through peer programs in schools; and educating school and daycare staff to support the goal of preventing the initiation of tobacco use among young people. In this fiscal year:
• 483 health communication campaigns were conducted.
• 644,174 individuals were reached through community engagement/outreach activities on a spectrum of tobacco use prevention and control strategies and programs in a variety of venues including LHDs, community outlets, and faith-based and grass-roots organizations.
• 200,903 individuals were reached through secondhand smoke prevention activities.
• 95,450 youth were reached through ESD prevention and awareness activities in a variety of community settings to address skyrocketing youth ESD use.
Some highlights of community-based local accomplishments include:
Baltimore County Funded 11 organizations to provide tobacco education including youth, faith-based, and other community groups. Those funded include Allie's Kidney Beans Foundation, Arbutus Volunteer Fire Department, Bnos Torah, Brick Bodies, Greater Baltimore Medical Center, Impact Baltimore, Ladies of Vision Charities, Pirchei Agudath Israel of Baltimore, Shiloh Baptist Church, St. Phillips Baptist Church, and Woodlawn Gwynn Oak Optimist Club. The community organizations educated 2,075 individuals.
Charles County Funded Lifestyles of Maryland, a major contractor for homeless services in Charles County. Lifestyles of Maryland provides tobacco education and cessation services to low-income populations by working collaboratively with government agencies, law enforcement, and trained volunteers, who go where the homeless live, including certain wooded areas and cars. Volunteers provided resources on secondhand smoke and agency services. From January through June 2018, Lifestyles of Maryland reached 6,745 people (2,459 youth and 4,286 adults).
33 Dorchester County Collaborated with Veterans Helping Veterans, which is a group of older veterans helping younger veterans to access resources to build their capacity for outreach to the veteran community. Two training sessions were conducted to educate the patinering veterans on tobacco cessation services, secondhand smoke prevention, and the emergence of ESD products. The veterans plan to launch a movement to end secondhand smoke in homes, which they have titled, "The War on Secondhand Smoke."
Frederick County Sponsored seven organizations to include tobacco prevention messages in programming and events. The organizations were provided with promotional materials, smoke-free signage, banners, and social media announcements to use during events. Sponsored organizations were the Frederick Center, The Frederick Keys, Celebrate Frederick, The Frederick National, Thurmont Little Leagues, and Downtown Frederick.
Kent County Funded Boy Scout Troop 130, Kent County Parks and Recreation, and Kent Family Center to engage youth in tobacco and nicotine use prevention activities, and to develop youth advocates to help guide future local policy development. Additionally, the Boy Scout troop conducted a tobacco-related park clean-up with youth at Wo1ion Park on May 8th and June 26th, 2018, filling large plastic bags with tobacco litter. Youth plan to have discussions with County Commissioners regarding their projects and the desire to make all county parks tobacco-free.
Partnered with the Kent County's Office of Emergency Services to incorporate tobacco and ESD awareness information into the new substance use addiction trailer. The trailer is designed to reflect a teenage bedroom and is utilized during a walk-through to raise awareness and educate parents about potential hiding places for substance use paraphernalia. The LHD was able to include ESD paraphernalia, prevention literature, and cessation service information as a paii of the ongoing walk-through exercise. As a result, 235 visiting parents were educated about the dangers of tobacco and nicotine products.
Washington County Conducted two training sessions on ESD products at the Bright Horizon Conference, which is the largest annual youth service organization conference in Washington County. This conference included representation from the County's Department of Social Services, the Mental Health Authority, Maryland Coalition of Families, Office of Consumer Advocates, Way Station, Brook Lane, Bester Community of Hope, and Hagerstown Community College. Forty-five individuals were in attendance.
Presented on the dangers of tobacco use, secondhand smoke, ESD products, and provided educational materials at the Western Maryland Counselors Conference on October 26, 2018. The Conference included 105 counselors from 42 public schools across Allegany, Garrett, Washington, and Frederick counties.
St. Mary's County Funded Tri-County Youth Services, Fidelity Chapter #60, and Great Mills High School Parent Teacher Association to educate school-aged youth about the dangers of tobacco and nicotine use,
34 as well as to organize a youth-led social media campaign entitled "Disconnected Youth." Over 4,000 youth were reached by these organizations.
Somerset County Funded Crisfield and Princess Anne Police Departments, as well as the Somerset County Sheriffs Department to work in partnership with local schools to engage youth in tobacco use prevention education, reducing exposure to secondhand smoke, and ESD prevention.
Smoking Cessation
To promote quitting among youth and young adults, and to eliminate exposure to secondhand tobacco smoke, LI-IDs provided free tobacco cessation assistance through on-site and LI-ID-led community cessation classes. LI-IDs also contracted with organizations and other trained providers. Services included behavioral modification smoking cessation classes, one-on-one counseling, and cessation advice in clinics and community settings. A variety of smoking cessation aids were offered to support quit attempts.
• 7,004 adults participated in smoking cessation services: o 96 pregnant women participated in smoking cessation services, and o 2,591 of the smoking cessation service pa1ticipants were behavioral health clients.
• 744 provider practices or hospitals were reached.
• 427 nurses and healthcare providers were trained on various smoking cessation models and clinical guidelines.
• 23 organizations were funded to provide cessation services.
• 3,630 refen-als were provided to the Quitline.
Some highlights of local cessation accomplishments include:
Anne Arundel County Funded a network of hospitals and healthcare centers across the county to ensure the public had convenient access to smoking cessation services and information. Funded centers were Anne Amndel Medical Center, Baltimore Washington Medical Center, Owensville Primary Care, Anne Amndel Community College Health Center, and Chase Brexton Medical Center.
Cecil County Developed a Health Promotion Referral Form to receive referrals from healthcare providers for tobacco cessation and other services. The LHD provides feedback and patient status rep01ts to the referring physician. By utilizing the Health Promotion Referral Form, providers have been able to fill identified gaps in follow-up, education, and tobacco cessation services for their patients.
St. Ma,y's County Through a paitnership with the St. Maiy's County Detention Center, the Tobacco Treatment Specialist conducts cessation classes onsite to help reduce contraband in the detention facility. 35 Imnates were incentivized to attend a tobacco cessation class with a five-day sentence reduction for attending all classes. During FY 2018, 18 imnates completed the class.
Youth Electronic Smoking Device Prevention Education Supported by LHDs
Baltimore County Funded 17 schools with grants to incorporate ESD prevention education in a variety of activities in schools and the community. A total of 7,788 youth were reached.
Charles County Funded the Young Researcher Community Project to work with the STEAM Onward Group, which developed an anti-ESD social media and print campaign to engage youth and counteract industry marketing strategies. Youth advocacy development is a central part of this initiative.
Cecil County Conducted an anti-ESD PSA targeting youth on 17 youth-friendly cable channels including Discovery, Music Television, Entertaimnent and Spmis Programming Networks, Nickelodeon, Animal Planet, Tru TV, Fox Sport 1, National Football League Network, Caiioon Network, Video Hits-One, and the Syfy Channel. View the PSA at https://www.d ropbox.com/s/ai5sid 1a57xo5i0/Dont %20Vape.mp4? dl=0.
Worcester County Offered an Alternative to Suspension Program, which includes tobacco prevention and cessation education, at Decatur High Schoo las an option for students who face suspension for violation of the school tobacco-use policy. A total of 43 students were refeITed and educated through the Alternative to Suspension Program.
Funded the Worcester County Youth Council to host peer leadership retreats at Camp Airnwhead in Lewes, Delaware for Students Against Destructive Decisions groups from middle and high schools. Workshops focused on tobacco and ESD prevention, in addition to alcohol and other drugs. A total of 91 youth were in attendance.
Policy Changes Supported by Local Health Departments
Wicomico County On August 28, 2017, the City Council amended Ordinance No. 2434, which prohibits smoking or vaping in, on, or within 25 feet of all public parks and publicly-owned property, including Salisbury City Park, Salisbmy Zoo, Salisbury Marina, and other public owned or leased and operated buildings and vehicles. This ordinance has the potential to protect over 30,000 residents of Salisbury, as well as thousands of visitors each year, from secondhand smoke exposme.
Worcester County On May 25, 2018, the LHD approved a tobacco-free campus policy, expanding its prohibition on tobacco use to include ESD use within the health depaiiment, as well as on outside prope1iy and grounds, including parking lots, state vehicles, and in private vehicles while on LHD grounds.
36 Faith-Based Interventions Supported by LHDs and Local CRF Programming
The Smoke Free Holy Grounds Initiative (SFHG), led by Bishop Larry Lee Thomas of the Empowering Believers Church of the Apostolic faith, is a state effort to involve LHDs and faith leaders in tobacco control and clean indoor air policies and practices. Over the past year, two counties implemented SFHG programs.
Somerset County On October 25, 2017, the local CRF Program hosted Apostle Larry Lee Thomas for a SFHG event. The goal was to engage church leaders in building awareness about the dangers of tobacco, ESDs, and secondhand smoke within their faith communities. Attendees heard discussions from MDH staff, Somerset County staff, local pastors, and Apostle Thomas on the importance on designating tobacco-free grounds. Four churches signed the Smoke Free Holy Ground covenant and received signage for their grounds.
Wicomico County On March 19, 2018, the LHD conducted a SFHG event targeting local pastoral leadership in collaboration with the Community Empowerment Center, a MOTA Organization, and Apostle Larry Lee Thomas. MDH staff, the Wicomico LHD, and Apostle Thomas encouraged pastoral leadership to adopt tobacco-free church ground policies. Eight churches signed the Smoke Free Holy Ground covenant and received signage for their grounds.
Enforcement
In Fiscal Year 2018, enforcement efforts were covered under a separate tobacco enforcement CRF line item; accomplishments can be found in the corresponding section of this report.
SURVEILLANCE AND EVALUATION COMPONENT
The surveillance and evaluation component monitors and documents key short-term, intermediate- and long-term program outcomes. Data can be used to inform program and policy direction, demonstrate program effectiveness, ensure accountability, and engage stakeholders. Highlights from surveillance and evaluation activities are detailed below:
• The Program received data from the 2016 Maryland YRBSNTS in November 2017. 13 These data were released to local health officers in April 2018, after county-level analyses were conducted. These data were also included in the 2017 CRF Biennial Tobacco Study Legislative Report, which highlights youth and adult tobacco use trends, as well as subgroup level analyses. 14 The next cycle of the YRBS/YTS will occur in Fall 2018 in 185 Maryland high schools and 183 Maryland middle schools. Data from this survey cycle is expected to be received in November 2019.
13 The YRBS/YTS combines the Maryland Youth Risk Behavior Survey and Maryland Youth Tobacco Survey, and is conducted biennially on even years. 14 "Maryland Department of Health. Monitoring Changing Tobacco Use Behaviors: 2000-2016." May 2018, Baltimore: Mmyland Department of Health, Prevention and Health Promotion Administration, Cancer and Chronic Disease Bureau, Center for Tobacco Prevention and Control, Retrieved I August 2018.
37 • The Program provided financial support and successfully collaborated with the Depmtment's Center for Chronic Disease Prevention and Control to enhance the capacity of the existing annual adult BRFSS.
• The Program successfully began a pilot of a new proprietary surveillance system, Point of Sale Toolkit (POST), developed by Counter Tools (https://md.countertools.org). Nine jurisdictions volunteered to be early adopters and have used POST in their enforcement efforts since January 2018. POST allows users to monitor tobacco retailer compliance with existing state and federal restrictions on the sale of tobacco products to persons less than 18 years of age. The system provides LHDs and law enforcement agencies with historical information as well as real-time data on individual retailer compliance. POST has an integrated mapping tool that allows stakeholders to find and display tobacco retail location data, such as school proximity to tobacco retail outlets. The mapping tool can also help stakeholders visualize how tobacco-related health disparities impact communities. For example, maps can be created that overlay tobacco retail density with area demographics such as race, ethnicity, educational attainment, percent of youth, income levels, and urban versus rural status. It is anticipated that this tool will help direct additional resources to areas with greater need.
• The Program contracted with the University of Baltimore, Schaefer Center for Public Policy (Schaefer Center) to conduct a comprehensive evaluation of the statewide Tobacco Use Prevention and Cessation Program. The Schaefer Center performed an extensive document review; conducted interviews and focus groups with Program partners and grantees, including LHDs; and drafted a report of preliminary findings. A strategic planning session is slated for Fall 2018. This session will actively involve pattners and grantees in creating the Program's new strategic plan.
38 ACCOMPLISHMENTS
TOBACCO ENFORCEMENT
39 CIGARETTE RESTITUTION FUND PROGRAM
TOBACCO ENFORCEMENT
FISCAL YEAR 2018 ACCOMPLISHMENTS
Background
As a condition of the Substance Abuse and Prevention Block Grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), the Maryland BHA must comply with the federal Synar Amendment, adopted in 1992. The Synar Amendment requires states to enact and enforce laws prohibiting the sale or distribution of tobacco products to minors. To comply with this amendment, BHA conducts annual, random, and unannounced inspections of tobacco retail outlets and vending machines to ensure adherence to Maryland's prohibition on the sale of tobacco products to minors. BHA then reports findings from the inspections to SAMHSA. States must maintain a retailer violation rate (RVR) of20% or less or be penalized by losing up to 40% of their block grant funds, which is over $13,500,000 for Maryland.
Maryland's RVR in Federal Fiscal Year 2014 was 24.1 %, exceeding the allowable threshold of 20%. SAMHSA offered the State an alternative penalty to the reduction in funding: the full SAMHSA funding would be maintained if the State allocated an additional $1,387,390 in new State funds for retailer education and enforcement activities in State Fiscal Year 2015. The RVR increased again in federal fiscal year 2015 to 31.4%, requiring another alternative penalty ofan additional $3,860,126 in State funds spent on retailer education and enforcement in State Fiscal Year 2016.
Due to coordinated enforcement and training efforts by MDH, the Comptroller, and LHDs, Maryland retailers have been back in compliance with the Synar Amendment since Federal Fiscal Year 2016, eliminating the requirement of penalty expenditures. The most recent completed RVR calculated for Federal Fiscal Year 2018 was 13.9%.
To sustain the success of statewide eff01is to reduce youth access to tobacco and to avoid costly penalties that could jeopardize state substance abuse treatment dollars, a Tobacco Enforcement line item was created in the CRF budget for approximately $2 million beginning in State Fiscal Year 2017. These dedicated funds are extremely important, as they allow MDH to maintain enforcement efforts, including the Responsible Tobacco Retailer Initiative. This comprehensive program works at the state and local levels to educate retailers on youth tobacco sales laws and to increase enforcement of these laws helping to keep the RVR below the 20% threshold.
Paiinerships between the Prevention and Health Promotion Administration, BHA, the Office of the Comptroller, LHDs, MDH leadership, statewide resource centers, community organizations, and the retail community assisted with the success of the Responsible Tobacco Retailer Initiative. Additionally, a contract with Red House Communications helped promote the Responsible Tobacco Retailer Initiative through media outlets statewide. Activities are outlined below.
40 State-Level
• Campaign Updates: The Program translated its online retail training module and quiz into nine additional languages that were identified by LHDs as prominent languages in their jurisdictions.
• Ad Placement: The Program executed a statewide health communications campaign with Red House Communications to place ads on in-store radio, transit, digital billboards, digital (mobile and web), and Gas Station TV mediums (see Counter-marketing and Media Section and Appendix B).
• Educational Materials: The Program developed a 2018 calendar (see Appendix B) to assist retailers at the cash register in verifying the age of customers purchasing tobacco products. Retailers specifically requested the updated calendar.
• Material Distribution: The Program mailed postcard mailers, educational materials, and ancillary items (window clings and 2018 calendars) to LHDs, MOTA community-based groups, and over 6,000 tobacco and ESD retailers. Additional materials were offered for free via an online order form and pdf download directly from the website: www.NoTobaccoSalesToMinors.com. An interactive online training module to assist retailers with complying with all youth tobacco sales laws and employee training was also offered through the website.
• Ongoing Technical Assistance and Training: The LRC provided ongoing technical assistance to the Department, LHDs, law enforcement, and additional partners on youth tobacco sales laws, how to properly enforce the laws and conduct compliance check inspections with retailers, and avenues for educating retailers and the community. In addition, the LRC hosted a series of webinars for local enforcement staff with tools and tips for conducting and documenting enforcement visits, and developed a toolkit for LHDs to describe the new civil monetary penalties for tobacco sales to minors under Health-General§ 24-307 (2017). 15
• Statewide Conference: The Program, along with the LRC, hosted a statewide tobacco control conference on May 8, 2018 (see Statewide Public Health Component above). The conference included dedicated tobacco enforcement sessions led by representatives from the Office of the Comptroller and LHDs, who presented on federal, state, and local laws restricting the sale of tobacco to minors, best practices to enforce these laws, lessons learned, and successful strategies in the field.
• Partnerships: The Department continued to partner with the Office of the Comptroller to increase enforcement efforts for retailers who violated youth tobacco sales laws on multiple occasions.
Local-Level
The Program allocated funds to all 24 LHDs to sustain enforcement effo1ts in Fiscal Year 2018. LHDs conducted compliance check inspections using underage youth, provided store-to-store education to tobacco retailers, funded non-governmental organizations to educate tobacco retailers, facilitated tobacco retailer trainings, contracted with law enforcement agencies to conduct tobacco sales
15 Univers ity of Maryland Legal Resource Center for Public Health Policy, "A Guide to Maty land Retail Tobacco Laws &-Local Enforcement Programs". Available at
• 6,494 tobacco sales compliance checks were conducted.
• 606 tobacco sales citations were issued.
• 345 tobacco sale outlets were referred to the Office of the Comptroller because of multiple affirmed violations for illegal sales of tobacco to youth.
• 16 non-governmental organizations (NGOs) were contracted to conduct vendor education and community education.
• 1,355 tobacco sales vendors were educated (face-to-face) on state tobacco sales laws byNGOs.
• 3,353 tobacco sales vendors were educated (face-to-face) on state tobacco sales laws by LHD staff.
• 68 leadership meetings were held with community partners, police agencies, local state's attorney community action agencies, and political leaders, with 1,598 attendees.
• 51 school-based collaborations that raised awareness about youth access to tobacco products and prevention were implemented, with 12,20 I attendees.
• 13 faith-based collaborations raised awareness in the faith community about tobacco use, youth access to tobacco products, and prevention through collaborative events, reaching 1,430 participants.
• 39 tobacco retailer group training sessions were conducted by LHD staff, with 883 attendees.
LHDs partnered with different enforcement entities, including Sheriff's Depmiments, Police Departments, Maryland State Police Barracks, and Departments of Liquor Control, to conduct tobacco compliance operations. Six LHDs have delegation authority and hire staff, or contractors, to conduct inspections.
Some highlights of local enforcement accomplishments include:
Allegany County Met with the local Chamber of Commerce to discuss reducing the sale of tobacco to minors. As a result, infonnational ads were placed in the Chamber's newsletters, and "No Tobacco Sales to Minors" window clings were sent to 560 Chamber of Commerce member businesses.
Cecil County Conducted three leadership meetings, with over 70 pmiicipants in attendance. Topics included the Synar Amendment, State and local Synar compliance rates, retailer education activities, education about tobacco/ENDS use among the youth in Cecil County, and the new POST software application being utilized by the State. 42 Charles County Collaborated with local agencies (Health Department, Social Services, School System, Public Library, and local churches) at a parent and teen summit where 82 attendees were educated on and had discussions about illegal sales of tobacco to minors.
Montgomery County Conducted monthly "Alcohol Law Education Regulatory Trainings (ALERT)" through the county's Department of Liquor Control. Over 25% ofretail outlets that sell tobacco products also sell alcohol and are required to attend the "ALERT" training prior to obtaining their license (and sometimes repeat it if there is a violation). A total of 470 participants attended the trainings.
Comptroller Referrals
Baltimore County According to State Synar reports, Baltimore County's non-compliance rate dropped from 40% in Federal Fiscal Year 2014 to 6% in Federal Fiscal Year 2018. Education on State and local laws regulating tobacco sales to minors was provided to 431 tobacco retailers. The County also conducted 1,376 compliance check inspections and issued 123 citations. Additionally, 314 referrals were made to the Office of the Comptroller for multiple violations. The Office of the Comptroller issued the following dispositions (some of which were for violations in the preceding year): • 216 warning/reprimands; • 27 license suspensions; • 6 received no action; and • 40 remain open.
Garrett County According to State Synar reports, Garrett County has successfully maintained a 0% non compliance rate between Federal Fiscal Years 2014 and 2018. Education on State and local laws regulating tobacco sales to minors was provided to 4 7 tobacco retailers. The County conducted 110 compliance check inspections and issued two citations. There was one referral to the Office of the Comptroller, and the case remains open.
Howard County According to State Synar reports, Howard County's non-compliance rate dropped from 20.6% in Federal Fiscal Year 2014 to 4.8% in Federal Fiscal Year 2018. Education on State laws regulating tobacco sales to minors was provided to 150 tobacco retailers. In addition, there were 250 compliance check inspections conducted and 27 citations issued. Nine outlets were referred to the Office of the Comptroller with the following dispositions: • 1 reprimand; • 2 warnings; • 2 suspensions; • I voided; • 2 open cases; and • 1 unlmown. 43 Talbot County According to State Synar reports, Talbot County's non-compliance rate dropped from 25% in Federal Fiscal Year 2014 to 0% in Federal Fiscal Year 2018. The County funded three NGOs to educate retailers on State and local laws. LHD staff and non-governmental organizations collectively conducted 164 store-to store tobacco education visits. The county also conducted 53 compliance check inspections. There were no citations issued in Fiscal Year 2018; however, three outlets were referred based on preceding year citations to the Office of the Comptroller with the following dispositions: • 1 dropped; • 1 received no action; and • 1 license suspension.
Community Partners Providing Tobacco Enforcement Edncation
The Program funded community partners in all 24 jurisdictions across the state to support tobacco retailer compliance through community and culturally appropriate vendor and community education. In Fiscal Year 2018, community partners conducted store-to-store visits to educate tobacco retailers about complying with State youth access laws; supported staff training; facilitated community meetings to raise awareness about youth access laws restricting the sale of tobacco and ESD products to minors; and supported grass root messaging campaigns aimed at changing social norms on tobacco use. Collectively, community partners conducted 2,656 store-to-store education visits and facilitated 15 community meetings on reducing youth access to tobacco products. Additionally, community paitners wrote local newspaper articles and one partner developed a T-shirt campaign to promote awareness about the prohibition of tobacco sales, including ESDs, to minors.
Highlighted local accomplishments include:
Asian American Center of Frederick County Completed 101 store-to-store tobacco sales education visits and hosted three community meetings in collaboration with the Neighborhood Advisory Council to promote store level compliance with youth access laws and to encourage community support for tobacco prevention. Community meeting pmticipants were encouraged to report retailers to the Asian American Center of Frederick County for follow-up education. At the same time, participants were encouraged to use positive reinforcement and compliment any retailer they witnessed asking for an ID before a tobacco product purchase.
Black Mental Health Alliance of Baltimore City Conducted 131 store-to-store tobacco sales education visits. The Black Mental Health Alliance of Baltimore City collaborated with Renaissance Academy High School students to sponsor a "No Smoking Skating Patty" to raise awareness among youth and adults about tobacco prevention, compliance with youth access laws, and to promote an atmosphere of prevention. They also launched a local T-shirt education campaign entitled, "Under 18, No Tobacco, No E0 Cigarettes. You Can't Sell, I Can't Buy," to galvanize community suppott for their efforts.
Brothers United Who Dare to Care, Inc. of Washington County Conducted 117 store-to-store tobacco sales education visits, and conducted two connnunity meetings entitled, "Lunch and Learn to Protect Kids from Tobacco." Meeting attendees included the Hagerstown Police Chief, the County Sheriff, a local church minister, and other community 44 members to gamer support for youth prevention and store-level compliance. Both meetings had the support of a Spanish interpreter. Brothers United Who Dare to Care, Inc. regularly publishes articles on tobacco retailer compliance in their "Speak Up Community News."
45 (This Page Intentionally Left Blank)
46 COUNTER-MARKETING AND MEDIA
TOBACCO USE PREVENTION
Chapter 58 of the Acts of 2015 (HB 67)
47 Background
Pursuant to Chapter 5 8 of the Acts of 2015 (HB 67), the Department can include a summary of the programmatic activities including the Counter-Marketing and Media Component as part of the annual expenditures and accomplishments report for the CRF required under Section 7-317 of the State Finance and Procurement Article.
Introduction
Approximately one-half of all long-term smokers will eventually die from their tobacco use, and in 2016, 25% of Maryland adult smokers reported a "fair/poor" health status-double the rate of their non 16 17 smoking peers. •
Maryland's direct healthcare expenditures for smokers exceed $2.7 billion annually. 18 Effmis promoting prevention and cessation are an essential, evidence-based approach for reducing the death and disease resulting from the use of tobacco products, especially to counter the roughly $26 million a day spent by the tobacco industry promoting and marketing its products. 19
Counter-marketing and media effmis are particularly important given today's shifting tobacco marketplace, caused by skyrocketing popularity of ESDs by youth. Data from the 2016 adult BRFSS and 2016 YRBSNTS show that while Maryland adults prefer cigarettes over other tobacco products, Maryland youth prefer ESDs, followed by small cigars and cigarillos. In 2016, approximately 13% of Maryland youth reported using ESDs, compared to just 3% of adults.20 It is widely reported that fmit and candy flavors are used to attract youth to ESDs.
Mass-reach health communication interventions are an essential program component for preventing the initiation of tobacco use, promoting and facilitating cessation, and shaping social norms related to tobacco use. The CDC recommends funding levels of $0.85 per capita per year for mass-reach health communication interventions in Maiyland, translating into $5 million annually devoted to these efforts.21 Effective mass-reach health communication intervention strategies at the state and local level include a variety of media, such as: television, radio, transit, billboard, print, digital, social media, and other advertising. The Community Preventive Services Task Force recommends mass-reach health communication interventions based on strong evidence of effectiveness for decreasing the prevalence of
16 U.S. Department of Health and Human Services, "The Health Consequences of Smoking - 50 Years of Progress: A Report of the Surgeon General," Printed with corrections January 2014, Atlanta, GA, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Retrieved 17 August 2018 Though the Tobacco Counter-Marketing and Media Component is no longer funded as a separate line item in the CRF budget, in Fiscal Year 2018, the Program continued to leverage federal prevention and cessation funding and campaigns, as well as CRF Statewide and Local Public Health dollars (through LHDs), to support these efforts. The Program promoted the Quitline; provided support to LHDs for . prevention and cessation efforts, particularly to populations disproportionately affected by tobacco use; and awarded a multi-year media contract with Red House Communications to design, develop, and implement additional health communication campaigns that support Program goals. Below is a summary of the counter-marketing and media interventions. Samples are in the Appendices. MEDIA FUNDED THROUGH STATEWIDE PUBLIC HEALTH COMPONENT Statewide Promotion of the Maryland Tobacco Quitline, 1-800-QUIT-NOW In State Fiscal Year 2018, the Program was able to leverage the CDC's National Tobacco Education Campaign, as well as television, transit, print, and digital media developed by the Program to promote the availability of the Quitline to Maryland residents. CDC's National Tobacco Education Campaign - Tips from Former Smokers The CDC's National Tobacco Education Campaign, Tips from Former Smokers (Tips), began in April 2018 and will continue through October 2018. The 25-week campaign featured non-actors candidly describing their devastating smoking-related health conditions ( e.g., chronic obstructive pulmonary disease, depression, and other health complications related to cigarette use). The campaign placements were purchased by the CDC, and were placed nationally on television, radio, billboards, magazines, newspapers, and online. The ads encouraged smokers to call the Quitline to receive access to quit support through state tobacco control programs. The large media placement of this national campaign in Maryland created a period of extended visibility and helped motivate Maryland tobacco users to call the Quitline. In the first week of the Tips Campaign, the number of registered participants increased 23% from the previous week. As the Tips campaign continues to run, it is anticipated that there will continue to be an increased number of calls and registered participants in Maryland. Once the campaign has ended, additional data can be provided on impact of call volume to the Quitline. Quitline Media Promotions During the media promotions from November 2017 to March 2018, there were 2,599 calls to the Quitline and 525 website submissions. During the media promotions in May and June 2018, there were 1,849 phone calls to the Quitiine and 320 website submissions. 22 The Community Preventive Services Task Force, "Tobacco Use and Secondhand Smoke Exposure: Mass-Reach Health Communication Interventions," Retrieved 17 August 20 18 o From December 25, 2017 to February 11, 2018, the Program aired existing "Real Marylander" TV testimonials (from Samantha, Jeffrey, Sheila, and Robin). These testimonials can be viewed at: http://smokingstopshere.com/media/. The testimonials were tagged with "Resolve to Quit" to coincide with New Year's resolutions. Testimonials ran on WJZ, which covers the Baltimore Metro area; WBOC, which provides coverage for Ocean City/Salisbury market area; and Comcast Cable (run from January 15, 2018 to February 11, 2018) covering Prince George's and Montgomery Counties. The testimonials ran on channels that included A&E, Bravo, BET, CNN, and others. There were 2,075 placements and over 10 million impressions were achieved. o From May 28, 2018 to June 25, 2018, the Program aired existing "Real Marylander" TV testimonials (Michael, Renee, and Stephen). These testimonials can be viewed at http://smokingstopshere.com/media/. The Center for Tobacco Prevention and Control Director, Dawn Berkowitz, was interviewed as part of the "B 'more Lifestyle" program, which aired June 7, 14, and 26 at 2:30 pm, and on "Midday Maryland," which aired on July 5 at 12:00 pm and 7:00 pm. There were 849 placements·and over 7 million impressions achieved. o From June 15, 2018 to June 30, 2018, the Program aired an educational PSA promoting the Quitline. The ads were distributed via wall mounted video flat screens with audio in 391 healthcare provider waiting rooms across the State. The PSA appeared along with other health and wellness information and localized physician messages. The spot aired approximately every 30-45 minutes during office hours, translating into an average of 16 times a day throughout a typical 8-hour office day. Over 780,000 impressions were achieved. o From June 11, 2018 to June 30, 2018, the Program aired a 30-second audio PSA promoting the Quitline in 237 retail locations such as Giant, Martin's, SuperValu, Shoppers, and Albe1isons chains. A total of 89,586 broadcasts ran, and over 4.3 million impressions were achieved. • Transit Mass-Reach Health Communication Interventions: o From December 18, 2017 to February 11, 2018, the Program placed the Quitline "Resolve to Quit" ads on transit mediums to raise awareness of the Quitline's free services available to Maryland residents. The ads were placed throughout Baltimore, and an estimated 34 million impressions were achieved. o From May 7, 2018 to June 17, 2018, the Program placed Quitline "Pregnancy" ads on transit mediums to raise awareness of the Quitline's free services available to Maryland residents. The ads were placed throughout Baltimore, Somerset, Wicomico, Worcester, Dorchester, Caroline, Talbot, and Harford Counties, with over 27 million impressions achieved. • Web and Digital Placemen.ts: The Program continued a strong web presence for the Quitline (at www.smokingstopshere.com), and 110,000 pieces of collateral were shipped from the electronic 50 ordering system in Fiscal Year 2018. Residents and healthcare providers can order and receive free materials (including brochures, wallet cards, and posters) directly from the Quitline to promote the availability of the Quitline and warn of the dangers of secondhand smoke. The Program also implemented the following novel approaches to reach more Maryland tobacco users, particularly those with substance abuse or mental health conditions, individuals identifying as LGBTQ, and racial and ethnic minorities, who experience a disproportionate burden.of tobacco-related diseases: o From November 13, 2017 to February 4, 2018, the Program placed Quitline ads on 413 digital touch screens or jukeboxes in bars and restaurants across Maryland. Ads had an interactive game component to engage patrons. These ads reach smokers at times when they may be vulnerable and experiencing cravings. Over 9 million impressions were achieved. o From November 13, 2017 to March 25, 2018, the Program placed web ads on Google AdWords promoting the Quitline and directing those who clicked on the ads to the Quitline website. Over 20,000 impressions were achieved. o From November 13, 2017 to March 25, 2018, the Program placed web ads on Google Video Network (Y ouTube) promoting the Quitline and directing those who clicked on the ads to the Quitline website. Over 77,000 impressions were achieved. o From December 25, 2017 to February 11, 2018, the Program placed web ads on WJZ.com promoting the Quitline and directing those who clicked on the ads to the Quitline website. Over 500,000 impressions were achieved. o From June 4, 2018 to June 24, 2018, the Program placed 225 Quitline ads statewide on Gas Station TV, and over 526,000 impressions were achieved. o On June 15, 2018 and June 24, 2018, the Program placed two geofilters on Snapchat to promote a smoke-free life during LGBTQ Pride celebrations in Baltimore City and Frederick. • In Baltimore City, the geofilter was used 370 times, resulting in 4,200 swipes and 19,000 impressions. ' • In Frederick, the geofilter was used 202 times, resulting in 1,265 swipes and 9,088 impressions. Health Communication Outreach to Targeted High-Risk Populations Pregnant Smokers Using federal and state funding, the Program executed two "Point of Care" marketing campaigns from November 13, 2017 through January 21, 2018, and May 14, 2018 through June 30, 2018 to reach pregnant women, post-partum women, and women of child-bearing age. Point of care madceting offers patients actionable information on key health conditions and lifestyle changes that directly influence the way they think about their health and encourages them to discuss condition-management with their physician. A pregnancy cessation incentive poster with "take-one displays" was placed in 93 locations in 51 OB/GYN, pediatric, and family practice offices throughout Maryland with a total of over 3 .3 million impressions achieved. Medicaid Pa1ticipants and Healthcare Providers Using federal and state funding, the Program executed two "Point of Care" marketing campaigns from November 13, 2017 through January 21 , 2018, and May 14, 2018 through June 30, 2018 to reach Maryland's Medicaid participants and the healthcare providers who serve them. The Quitline's Ready to Quit posters with "take-one displays" were placed in 124 doctors' offices and independent pharmacies who accept Medicaid throughout Maryland with a total of over 3.3 million impressions. Additional Statewide Health Communication Interventions Clean Indoor Air Act Anniversary Celebration In 2018, Maryland celebrated its 10th anniversary of the Clean Indoor Air Act, also known as Clean Air Maryland, which took effect Febrnary 1, 2008. Clean Air Maryland aims to preserve and improve the health, comfo1t, and environment of Maryland residents by limiting exposure to secondhand smoke. The law prohibits smoking in all indoor workplaces, including restaurants, bars, and clubs, as well as inside work vehicles. The Program is celebrating this milestone throughout the 2018 calendar year with billboards, outreach events, and press conferences. Starting May 14, 2018, the Program placed digital outdoor billboards and Jukebox advertisements. • Jukebox Ads: The Program placed 434 ads on digital touch screens or jukeboxes in bars and restaurants across Maryland. Ads included an interactive quiz component to engage patrons, as well as infmmation about quitting tobacco and the haims of nicotine. Over 6.7 million impressions were achieved. ■ Digital Outdoor Billboards: The Program utilized eight digital outdoor billboards across Cenh·al Maryland to celebrate 10 years of smoke-free restaurants and bars. Over 4 million impressions were achieved. The Vape Experiment Campaign Use of ESDs has skyrocketed in recent years, particularly among youth and young adults. There are many widely held misconceptions about ESDs, including that they do not contain nicotine (most in fact do) and that they emit harmless water vapor; however, ESDs emit an aerosol that can contain heavy metals such as nickel, lead and tin, and flavorings such as diacetyl, a chemical linked with serious lung disease.23 The Vape Experiment is a new ESD prevention campaign that aims to debunk common myths and misconceptions. The campaign is entirely digital and designed to reach youth and young adult audiences, with placement on mediums including Spotify, Xbox, Instagram, PulsePoint Native Adve1tising, Google Video (YouTube), and Jukebox. The ads feature a young adult who picks up a 23 Centers for Disease Prevention and Control, "About Electronic Cigarettes (E-Cigarettes)," August 30, 2018, The Program placed a majority of The Vape Experiment ads from June 13, 2018 through June 30, 2018, with ·some ad placements extended through September 30, 2018. • Jukebox Ads: The Program placed 85 ads on digital touch screens or jukeboxes in bars and restaurants across Maryland. Ads included an interactive quiz component to engage patrons. These ads were focused in establishments near colleges and universities, as well as vacation areas, such as Ocean City, to best reach the target population. Over 8 million impressions were achieved in its initial 60-day period. • Digital Ads: The Program placed ads on digital mediums including Xbox, Spotify, PulsePoint, Instagram, and Google Video. Over 6 million impressions were achieved in its initial 60-day period. . In Fiscal Year 2018, the Program received numerous requests for information on ESDs by school administrators, parent-teacher associations, and school nurses. In response, Program Director, Dawn Berkowitz delivered nine school-based ESD presentations and student assemblies. MEDIA FUNDED THROUGH LOCAL PUBLIC HEALTH COMPONENT For the past several years, LHDs have been engaging in a wide variety of counter-marketing and media activities with funding from the local public health component of the CRF Program. The various media and marketing campaigns developed by LHDs are intended to actively engage all Maryland residents in tobacco control discussions, prevention activities, including ESD prevention, cessation services, school based prevention programs, enforcement, policy measures, and dialogue concerning non-smoking. norms. Various print media campaigns conducted include: • Newspaper articles and inserts; • Direct mail campaigns; • News releases; • Brochures; • Billboards; • Bus shelter signs; • Highway signs; and • Placards and hanging signs. Other awareness campaigns were designed to market local programs and educate the public including: • Ads on local radio stations; . • Ads on local television and cable access channels; 53 • Ads at local movie theaters; • Oral presentations; • Web-based disseminations; • Text message blasts; • Online digital advertising; and • Electronic newsletters. Some jurisdictions used digital mediums to conduct media and marketing campaigns using electronic mailing lists and social networks such as Facebook, Twitter, Google, Pinterest, Instagram, Y ouTube, and mobile telephone apps. To maximize resources, some LHDs collaborated with neighboring health departments, City Councils, local Parks and Recreation Departments, the Board of Education, the Department of Social Services, and youth clubs and organizations. Local media and marketing campaigns were also tailored to reach target populations. These campaigns were developed in a culturally and linguistically sensitive manner. Targeted populations consisted of, but were not limited to, African Americans, Asian Americans, Hispanics and Latinos, Native Americans, medically underserved individuals, low-income individuals, uninsured individuals, LGBTQ individuals, and pregnant women. Below are some locations and organizations where direct marketing was targeted to reach ethnic and racial, vulnerable, and special populations: • Public housing authorities; • Churches and faith-based institutions; • Homeless shelters; • The Depatiment of Social Services; • Cultural organizations; • Malls; • Day care providers; • Mental health facilities; • Women, Infants, and Children (WIC) programs; • Hospitals and medical centers; and • Colleges and universities. LHDs enlisted members from their local tobacco coalitions, faith-based organizations, MOTA vendors, community patiners, schools, and state health department staff to develop tailored and sensitive media and marketing campaigns. All of the media and marketing approaches support the four goal areas of the CRF Program to: (1) prevent initiation of tobacco use, (2) eliminate harm from secondhand smoke, (3) suppmi cessation among adults, and (4) reduce tobacco-related health disparities. Media messages developed by LHDs were also targeted to youth-serving organizations such as the Boys and Girls Club, Students Against Destructive Decisions, the Police Athletic League, community centers, and youth leadership groups. Schools were targeted with poster displays, bulletin boards, videos, and printed materials. Social networks such as Facebook and Y ouTube have emerged as effective marketing and outreach tools to engage young people as well. 54 MEDIA FUNDED THROUGH CRF TOBACCO ENFORCEMENT Responsible Tobacco Retailer Campaign The Program designated state dollars to continue the Responsible Tobacco Retailer education campaign in Fiscal Year 2018. The campaign aims to reduce youth access to tobacco products and to renew the focus on retailer responsibility by educating retailers on the federal, state, and local laws prohibiting tobacco sales to minors (see Appendix B). Ads direct listeners and viewers to the campaign website, www.NoTobaccoSalesToMinors.com, where viewers can participate in an online retailer training module and quiz. From December 2017 to June 2018 there were 228 views of the retail training module and 112 views of the retailer quiz. Educational materials are also available for free to download and order from the website. This fiscal year, postcards, toolkits, and mini-packets containing 2018 calendars were sent to over 6,000 licensed tobacco retailers and vape shops in Maryland. Materials were also sent to all LHDs and community-based organization groups to assist with retailer educational visits. From April 2018 through June 2018: • Digital/Mobile Ads. The Program placed two ads on www.patch.com. Over 625,000 impressions were achieved. • Transit Ads. The Program placed 154 ads on Baltimore City/County buses, light rail panels, metro car interiors, and bus shelters. Ads were also placed on buses in Anne Arundel, Dorchester, Harford, Howard, Kent, Prince George, Queen Anne's, and Talbot Counties, as well as on buses in Ocean City and Annapolis. Over 42 million impressions were achieved. • Gas Station TV Ads. The Program placed ads on 299 Gas Station TV screens across the state. Over 815,000 impressions were achieved. • Digital Outdoor Billboards: The Program placed ads on eight digital outdoor billboards in Central Maryland along I-95, I-83, I-695 and I-295. Over 8.4 million impressions were achieved. • Radio Ads. The Program placed a 30-second radio ad at 237 grocery stores across the state on Public Service Network in-store radio. Next Steps In Fiscal Year 2019, the Program will continue its efforts to prevent tobacco initiation as well as to promote and facilitate cessation, with a special focus on reducing tobacco-related disparities, including disparities in rural parts of the state as well as among individuals identifying as LGBTQ. The Program will also continue to prioritize ESD education and awareness, through its digital/social media campaign, The Vape Experiment, and through other targeted outreach efforts. Additional ESD presentations within school systems are planned for Fiscal Year 2019, especially around the start of the new school year. Throughout 2018, the Program will continue to celebrate the Clean Indoor Air Act 10th Anniversary. These celebrations included a press conference on August 30, 2018 and a special event at the Maryland 55 State Fair. In addition, outreach materials and signage will be provided to restaurants and bars across the State to celebrate the smoke-free am1iversary. Program priority areas for health communication efforts include: • Continuing to leverage and promote the CDC "Tips from Former Smokers" campaigns, with ads airing in 2019. • Continuing to place and distribute Responsible Tobacco Retailer ads and materials. • Continuing to promote the Quitline to vulnerable populations. • Engaging populations dispropo1tionately affected by tobacco use, including LGBTQ individuals; those with behavioral health conditions; individuals emolled in Medicaid; and those of lower socioeconomic status, in addressing tobacco control efforts within their communities. • Promoting the Quitline to healthcare providers and encouraging them to discuss tobacco use cessation with their patients. • Continuing to paitner with Medicaid on the administrative match for Quitline services. This match provides Maryland with a 50% reimbursement of counseling costs for each Medicaid recipient who utilizes the Quitline. • Expanding smoke-free homes and smoke-free living initiatives. Effective July 30, 2018, the U.S. Depaitment of Housing and Urban Development required all federally-owned public housing to implement smoke-free policies.24 In Maryland, this means protections for more than 25,000 residents in local public housing agencies. 25 • Coordinating the 2018 Maryland YRBSNTS, as well as analyzing and disseminating the data products, once released. • Developing a new media campaign targeting individuals with behavioral health conditions. The new campaign is slated to launch in 2019. The Program will continue working with partners to promote and support the Quitline and other state and local initiatives, as well as to leverage resources from other Centers and programs within the Depaitment. Further, the Program will expand collaborations and partnerships to other state health depaitments, outside partners, and communities to sustain programming. 24 24 CFR Parts 965 and 966. 25 American Lung Association, "Ma1yland Families Living in Public Housing Now Protected from Second Hand Smoke Exposure," 30 July 201 8, Press Release, Retrieved 20 August 2018, BEHAVIORAL HEALTH ADMINISTRATION 57 Behavioral Health Administration Cigarette Restitution Fund Program Fiscal Report During Fiscal Year 2018, BHA administered $21,452,828 in CRF funds. These funds were appropriated in BHA's budget M00.L0I02-Behavioral Health Community Services to the Uninsured. The budget services provide funds for the enhancement and expansion of substance related disorder treatment and recovery services. Expenditures are based on claims submitted by providers that have been reviewed and approved for payment by the Administrative Service Organization (ASO). The goal of the ASO is to create a coordinated and seamless system to improve clinical outcomes, recovery, and resiliency for individuals served. As ofJune 30, 2018 Budget Expenditures Obligations Unobligated Treatment Services 21,452,828 21,452,828 Q Q 21,452,828 21,452,828 0 0 Statewide - Fee-For-Service As of June 30, 2018 Service Expenditures Ambulatory Services Outpatient Services 4,068,970 Intensive Outpatient Services 2,500,801 Opioid Maintenance Therapy 6,883,057 Subtotal- Ambulatory Services 13,452,828 Residential Services 8,000,000 TOTAL 21,452,828 NOTE - During FY 17 and FY 18, the Ambulatory and Residential Substance related disorder services transitioned from a direct jurisdictional grant system to a statewide fee for service system. Under the fee for service system, a payment for the service goes directly to the provider of the service. An ASO reviews the claims and manages the payments to the providers. 58 ACCOMPLISHMENTS BEHAVIORAL HEALTH ADMINISTRATION 59 CIGARETTE RESTITUTION FUND PROGRAM BEHAVIORAL HEALTH ADMINISTRATION FISCAL YEAR 2018 ACCOMPLISHMENTS Outcomes and Public Benefits: Fiscal Year 2018 Accomplishments During Fiscal Year 2018, CRF funds were used to support the following: Patients Served Ambulatory Services Outpatient Services (Level I) 10,22 I Intensive Outpatient Services (Level 2.1) 981 Opioid Maintenance Therapy (OMT) 4,207 Residential Services Residential Services (Level 3.3/3.5/3.7) 1,443 Managing-For-Results BHA does not establish MFRs according to funding streams (e.g., CRF). BHA awards funding to the jurisdictions by level of care ( type of certified service) through a combination of state, federal, and special funds. The applicable MFR performance measures address the agency goal to provide a comprehensive continuum of effective substance-related disorder treatment and recovery services with emphasis on access to treatment and retention in treatment. 60 FISCAL REPORT AND MANAGING-FOR-RESULTS REPORT MEDICAL CARE PROGRAM 61 CIGARETTE RESTITUTION FUND PROGRAM MEDICAL CARE PROGRAM PROVIDER REIMBURSEMENTS AND MANAGING-FOR-RESULTS Appropriation: $61,770,000 Expenditure: $61. 770,000 MOOQOl.00 MEDICAL CARE PROGRAMS ADMINISTRATION Objective 1.4 For Calendar Year 2020, reduce by 3 admissions the rate per thousand of asthma related avoidable hospital admissions among HealthChoice children ages 5-20 with asthma compared to CY 2017. Admissions are defined as "avoidable admissions" and are based on specifications from the Agency for Healthcare Research and Quality (AHRQ). The methodology for determining perfmmance reflects both AHRQ and the Healthcare Effectiveness Data and Infonnation Set (commonly known as HEDIS) specifications and recommendations. The denominator for this measure includes children enrolled for at least 320 days in a HealthChoice managed care organization during the calendar year and the previous calendar year. CY 2017 CY2018 CY 2019 CY2020 Performance Measures Actual Estimated Estimated Estimated Outcome: Rate per thousand of asthma-related avoidable admissions among 28 27 26 25 HealthChoice children ages 5-20 with asthma . Objective 2.4 For Calendar Year 2020, reduce the gap in access to ambulatory services between Caucasians and African-Americans in HealthChoice by 0.2 percentage points. CY 2017 CY2018 CY2019 CY2020 Performance Measures Actual Estimated Estimated Estimated Outcome: Percentage gap between ambulatory care access rate for Caucasians 3.7% 3.6% 3.6% 3.5% compared to the access rate for African-Americans Note: 90% of total HealthChoice enrollment is made up of African-Americans and Caucasians; therefore comparing access to ambulatmy services between these two populations is a good indicator of disparities in access to ambulatory services. 62 APPENDICES TOBACCO CONTROL PROGRAM SAMPLE MEDIA 63 Appendix A Maryland Tobacco Quitline Mass Media Promotions - www.SmokingStopsHere.com Quitline Ads: New Years Eve Ads lf,1.,,,.,. ·'>,,.))>~·)' I -~ "' / ~. {{)'' . Web Ad (GIF) ' Interior Bus Ad ,I Baltimore Metro Ad -64 Quitline Ads: Point of Care Marketing Maryland Tobacco Quitline's Print Materials: Wallet Cards and Brochures Maryland. d :t1kdi•ih1Mt•1N SmokingStopsH ere.com GI i 1 Nll',.-• t4- . -.. , _ . .... h i:.\.'» !!.D},j .'W START LIVING TOBACCO FREE. WE CAN HELP. h r-011'6-..::;.;. ,."'C.-:♦ o.. 1,- ... 1 ....~- It's free. It's confidential. It works. ·::.~:l"''Z:_...... ~;:- ·- ·... -·..--. ... ~ .... .,, 1- 800·7e64 -8669 SmokingSlopdh,ie• cQn) lo.kt nv.:mogee support. ·---..,.,,_.. _,.u'"-...- ,_,,_____ ,,...... ,., ___ _.... ·--·-...... Qullline services provid ed 24 hours a d ay. 7 days a week. ...,:._.. .. -::.··: M orylond O oportm ont o r Hoollh o l'ldMonl o 1Hygiono 1-877•777-6S3ol 1111'•1 --~----·-.. ~---- Marylnnd'O 11-&i •1¥Ut•l¼I SmokingSt opsHcre.com EMPIECE A VIVIR LIBRE OE HUMO . PODEMOS AYUOARLE. Es gratis. Es confidencial. Funciona. l-855·e3 35- 3569 SmokJngS•top 1He1e.com Menso;ee s d o texfo d oopoyo Se rvic l~s4~~;;~ 1:~i~'i~~1~~; ~~ :6~~~,~~~~onlb lc s Ooporlomonlo d e Solvd" H ig!vno Monl ol d er Morykind 1.e,;,,777,6S3<1 (H Y4'1 ttll~UO 0 :1,-..::E.::~ l .,._..,~_.,. I·~. -,_,..._,,:.:<---__ -~- --, __ -~~-.-· ...... __,, ... G ::.-: ....- -.~··--· ··' ~ ..._"':,..,::;-•·-- "'" 0 ::::::::.~:::::.., ___ ..... ,. .. -... -- . ✓-~--- ·-~:- 65 Appendix B Responsible Tobacco Retailer Campaign - www.NoTobaccoSalesToMinors.com Responsible Tobacco Retailer Transit Ads April-June 2018 IT'S THE LAW. ·-- 1B BrRCIWM IIJST AU IOtl1 MJTO, LO. J1IOII MJITIJI[ IJIIIJIK "ll. :2 _ UNDER 18? NDTOB ACCO. ~ Responsible Tobacco Retailer Campaign Ads: Patch.com caused flooding early Monday morning on laurel Patch = several streets in downtown Annapolis, according to nuthorities. At 7 n.rn., the Laurel, MD Local News Annapolis Office of Emergency Management reported that Dock Street and Newman Street Colvmbll @ :@Mfr§ M were closed due to high waters, and Flood Warning In Compromise Street was reduced to one lane of Effect For Multiple Maryland Counties, traffic. Cities byEl#.t:abf:lhJ.)nncy, P,m h Slaff I 51 mltlv1es,go IT'S THE LAW. NthS PG County 7-Day Forecast: Here's What ®~ @ To Expect ■ aal!U ~ .,_,.., byD.ln Taylor, P•tch Sraff I J hrs RETAILERS MUST ASK FOR PHOTO I.O. ago rt~ fl!OM EY£RYONEUNDER 27. ~ UNDER 187 NO TOBACCO. .Jl ,._ The office cautioned motorists to drive carefully "'"' 1O New Job Listings in the area. Around Bowle (Aprll 1SJ by O.ln fayfor, Patch Staff I 2 days o1go At about 7 a.m., the city's Police DcpartA snid that the flood waters were starting,., ' Provider of f lJ(> I ~t:! NaTobaccoSalesToMlnoruom rJ~'!: ,~,. 'l!' QUAKER ,,.._ 66 Responsible Tobacco Retailer Campaign Ads: Transit Ads Responsible Tobacco Retailer C,mipaign Ads: Digital Outdoor Ads 67 2018 Calendar for Tobacco Retailers Image below from a retail location ·a~ - m >pa~~ M - (Thia side fatu clerk ) JANUARY 2018 'S]d\fA ON '033\fOOl ON lBl HlONn FOR EVERY TOBACCO SALE: SMTWTFS Ask for photo ID from 123456 0 everyone under 27. 7 8 9 10 11 12 13 ~ Check to make sure all 14 15 16 17 18 19 20 2018 CALENDAR ////J V customers are at least 18. 21 22 23 24 25 26 27 a Refuse to sell tobacco 28 29 30 31 GG8• @ '-' to everyone under 18. If a customer is born after today's date in 2000, No Tobacco Salel 68 Appendix C Clean Indoor Air Act I 0th Anniversary Campaign Clean Indoor Air Act Anniversary Campaign Ads: Digital Ads n ~II AA J72-20 18/Ofi/25 I J: 1• 7: 11 I...., n., Quitline Pride Ads: Snape/tat Filters 69 Appendix D The Vape Exp eriment - www. The VapeExperimen t. com The Vape Experiment Campaign Digital Ads: Google Video (Youtube) The Vape Experiment Campaign Digital Ads: Instagram ~------·--·. Learn More Q O YI LH,mM.orc thevapeoxporiment Vapo is one big experiment. Don't be ,1 Jab rat. Learn more at th•vapt-txPOrimt nl VJJ)I 1, oot big Olptrtmflnl lhtwpMllJ)9rimtnt V•po is ono b19 «n pcnmt nl. Dol'l'I be a lab r~t. Lurn mote at Th eVapoE 1i:pc rim en I. com Don't be ,1 I.ab r.11t. Lea,n rna,o at Th0Vapl'Exi:,erirntt1t.c:om T,, 1.Va pebpo ri mtn I .com 111~ag1tWI\ thc 11apeexperimMt s onso,eo Thl.9 ls t,., t. ,.:~ Vape Experimen ::;' ...... r, .~ - You ar-a tbe ...... ~.,. ...· W' • test subject. LurnMo,, o a 17 QO~ thevapcoxporiment Vapc I, ooo bio e xperiment. lhtvapeuperlmMt Vape Is ono blO ellpt rimcnl. Don' t bo .> lab rJl. Learn mor~ at Don't be ., ltb rat. Ltorn more .i ThcV,1poExp orimont.tom ThoV,.1 po Exp trimII nl.com 70 ~ Home Channel You have 50.00 i:,)::1:' -,1 1,i! games r.1y b,lllh", : Acid On~ Brc)W\t' Mnv1t:•\ & Tl/ • •)•'.il; 'l /\I' 71 l4 Home Channel lY,XfHfnlt·rt,1111 ;> J8 PM 0 105 Mi1Cer Community Entertainment Store ~ 9.:, Resume Microsoft Edge Make someone's day New mes.sage from r· ,J #XboxEl Givf" an Xbox gift from th Xbox Live C j f~ l Uve ,;,tre,11n-:. and m ore ■ =Gohn ld for ~ 1 l4 Store Channel USXBl Entt,rf .J1n (i) 105 Get t.l>e r.c~ 'I' on vape. l llfH 110£0 Gt't th<> Wm9m.111 S!,trtPr r.id Join Gurne Pass for $1 (2) Deals f) Search El MC'mberships ~~ Use a code DC UNIVERSE 72 SMADC End of Year Report FY' 18 Southern Maryland Agricultural Development Commission (SMADC) October 2018 Of the Tri-County Council for Southern Maiyland (TCCSMD) END OF YEAR REPORT - FY'18 (SMADC Fiscal Year: July 1, 2017 -June 30, 2018) INTRODUCTION The purpose of the Southern Maiyland Agricultural Development Commission (SMADC) is to support farms and the future of agriculture in Southern Maryland. We are committed to expanding and promoting . a viable and profitable agricultural farming community in Southern Maryland, and while the primary focus is on the five southern counties of Anne Arundel, Calvert, Charles, Prince George's and St. Ma1y's, many of our initiatives do reach statewide. SMADC provides vision, support, grants, and marketing and promotion to area farmers. As new farm economies are being formed, SMADC helps to streamline regulations and reduce obstacles. At SMADC, we are assisting farmers in creating a profitable farming future and educating the public on the importance of local fa1ms to our overall economy. To achieve that goal, we are committed to helping connect local farmers to their consumers, as well as to protecting area farmland through l?cal land preservation. SMADC has completed the disbursement of tobacco buyout funds to all buyout participants, developed a regional strategic plan for diversification, and continues to provide agricultural grants, training, and funding for land preservation as it is available. We have worked to increase the awareness of farm products available to regional consumers, while enhancing farmers' profitability. We created a farm equipment rental program to increas·e accessibility of equipment to farmers and developed a Maryland FarmLINK program to foster new and beginning farmers and raise awareness of available farmland for sale or lease in the state. Our efforts in streamlining regulations have helped farms to add value to their products by extending the life of farm foods through on-farm processing, meat and dairy processing, and more. Simultaneously, SMADC launched promotional campaigns to the public to ale1i consumers and buyers to the availability of Southern Maryland's diverse farm foods, innovative on-fa1m services, and "legacy" programs. SMADC looks forward to continuing our work to provide the resources and infrastructure needed for market-driven farms to thrive and be profitable, to expand the region's overall agricultural economic development, to preserve Southern Ma1yland farmland, to connect consumers to their farmers, and to assure the long-term viability of the regional agricultural economy in Southern Maryland. To aid in the continuance of this mission, SMADC will be releasing its updated Strategic Plan in FY' 19. SMADC End of Year Report FY' 18 The SMADC staff is a dedicated and driven group of individuals who are passionate about furthering SMADC's mission. In pursuit of that mission, staff has collaborated with the following agricultural groups across the state to host and/or attend meetings and events in FY' 18: • College of Southern Matyland • Eastern Shore Land Conservancy • F3 Tech Accelerator Program • Future Harvest - Chesapeake Alliance for Sustainable Agriculture (PH CASA) • Grow & Fortify • Maryland Agricultural and Resourced-Based Industty Development Corp. (MARBIDCO) • Matyland Agricultural Education Foundation • Maryland Department of Agriculture • Maryland Department of Commerce • Ma1yland Department of Natural Resomces • Maryland Farm Bureau • Maryland Pork Producers • Maryland Soybean Board • Patuxent Environmental & Aquatic Research Laboratory (PEARL) • Rural Matyland Council • Southern Mmyland Economic Development Offices • Southern Maryland Soil Conservation Districts • University of Maryland Extension (UME) • University of Maryland's Institute of Applied Agriculture SMADC HIRES NEW STAFF 2018 brought the addition of more talented and dedicated staff to SMADC, and SMADC couldn't manage or offer all of our programs without them. Karyn Owens - Ka1yn first joined SMADC in 2015 as an Intern, while a student at the College of Agricultme and Natural Resources (AGNR) at the University of Maryland, obtaining a degree in Plant Sciences. Once graduated, Kmynjoined SMADC again in December 2016 as a permanent part-time employee to assist with Commission meetings; as well as SMADC workshops and events. Now Katyn is a permanent full-time addition as of December 2017 as SMADC's Program Specialist, managing Ma1yland FannLINK and a number of other programs. She is a current fellow in LEAD Maryland Class X and participated in the Future Harvest CASA's Beginning Fatmer Training Program in 2016. 2 SMADC End of Year Report FY' 18 Craig Sewell - Craig joined SMADC in January, 2018 as the new Livestock and Marketing Specialist for Southern Matyland Meats, a marketing program created to suppott the region's livestock producers. He is the former owner of A Cooks Cafe, which for 15 years has been at the forefront of the 'Buy Local' movement in Annapolis as one of the first restaurants in the area to source locally raised products and develop a conduit for customers to buy local produce and meats through the restaurant's CSA and Market Basket program. A graduate of Harvard University with a BA in economics, his professional career has focused on his passion for local agriculture and the sustainability of local business. He served as founding president of the Annapolis Sustainable Business Alliance ( a group of independent, local businesses with a mission to supporting locally owned businesses) and as Executive Director of both the National Trade and National Utility Locating Contractors Associations and is a Master Gardener. Jean Burke - Jean joined SMADC in early April, 2018 as the new part-time Grant Coordinator, to assist in identifying viable funding opportunities including federal, state, foundation and local grants. She comes to us with about ten years of freelance writing and grant writing experience. Prior to that, Jean was the Theater Manager at the College of Southern Maryland. She is a graduate of St. Mary's College of Maryland with a BA in Art History. SMADC APPOINTS NEW CHAIRMAN, EDDIE BOWLING Eddie Bowling was nominated the SMADC Chairman effective April ·1, 2018. He is a member of the board as the Charles County farmer seat, a 4-year term. He also served as Chair of SMADC's Southern Maryland Meats Steering Committee. Now retired from a career with the USDA, Eddie is cmrently a full-time farmer in Charles County and has brought valuable insight to SMADC over the years through his involvement with the local fanning community, including the Charles County Farm Bureau. He is also enthusiastic to engage more youth and new farmers in livestock production and helped to launch the Southern Maryland Meats Junior Livestock program. Eddie owns and operates River Creek Farm where he raises Angus beef and sells his meats to consumers. MEAT CENTER Feedback from public forums and surveys, particularly during FY' 15, identified a meat processing facility as the top priority for the region. · The objective of the TCCSMD. and SMADC board is to create a Request for Proposal (RFP) that allows a public-private partnership to develop, manage and operate a meat processing facility located within the five counties of Southern Maiyland (under current structural organization the TCCSMD and SMADC cannot hold title to prope1ty). The meat processing facility is intended to provide a suite of multi-species meat processing services adhering to USDA ce1tification (slaughter, cut, process and wrap). Ideally, a single award will be made to an entity which can provide all of the services through sub-contractors and a lease or purchase of property. The contract to be awarded will be for a term of up to 9 years. 3 SMADC End of Year Report FY' 18 In FY' 16, SMADC set aside funds to support the development/consh·uction of the meat processing facility. Ma1yland Agricultural Resource-Based Indushy Development Corporation (MARBIDCO) agreed to assist with the financial component of the RFP development and administer SMADC funds through a low-interest loan which may be converted to a grant, conditional upon certain benchmarks being achieved. The total maximum amount available is $1 million, of which $500,000 is available as a loan which can be converted to a grant and the remaining $500,000 is available as a loan only. The RFP was issued on November 28, 2016 on eMaryland Market Place and promoted statewide through media press-releases, paid advertisements and SMADC social media platforms. No proposals were received by the due date, January 27, 2017. SMADC and TCCSMD subsequently appointed a committee to review the RFP and address issues that may have inhibited potential bidders. A revised RFP was issued on September 27, 2017. The proposal invited innovative solutions and portions of the process to take place in more than one location/facility. In addition to press releases and local media ale1ts, the RFP announcement was sent to over 13 national meat/cattlemen's/butchers' associations, plus national meat and processing publications and established Maryland meat processing plants. Only one bid was received by the deadline of February 8, 2018 which was subsequently rejected by the Review Committee, as the bid did not meet minimum qualifications or demonstrate maste1y of the subject matter. In the interim, members of the Amish community in St. Mary's county confirmed their intention to build a slaughter facility which they plan to be USDA certified and in operation by the Fall of 2018. Town Hall Meetings: In the Spring of 2018, the Southern Maryland Meats program of SMADC hosted two Town Hall Meetings to inform livestock producers on the outcome of the RFP and engage the stakeholder community in the 'meat center' project going forward. At the meetings, SMADC discussed the potential offered by the Amish slaughter facility and also options for livestock producers to fonn a cooperative venture to own and operate a regionally located slaughter and/or finer meats processing center, with the rationale to meet the specific needs of the region's producers and reinforce the SMM brand identity in PLEASE JOIN US FOR A the market place. Plans are in development to initiate small s;Gl:~l":'"'"~"~. . _,: group committees to investigate options and develop a 'F_,,,,_..";r,'- ;-~ feasibility study. ~.,.,..-r: ··.~•G - :· ... .·• ...... ·._a: . 0 ·.-~ ' ·I• .. Highlights: nd Town Hall Meeting • 2 RFP launched September 27, 2017 for All Meat Produce;·s in • 2 Town Hall Meetings engage over 40 producers Southern 1\tlarylancl Thursday, Mc1rch 22nd from S to 7pm al the SMr:ro t\ uditorium Discuss next steps for meat proc(>ssing in the region www .somd meal processing. t.>ve nt b rite.com 4 SMADC End of Year Report FY' 18 SOUTHERN MARYLAND AGRICULTURAL DEVELOPMENT PROGRAMS: PROVIDING FARMERS RESOURCES TO BE PROFITABLE Regional Agriculture Projects {RAP) This initiative was conceived by SMADC to further its mission to support farms and farmers in order to sustain the future of agriculture in Southern Matyland. All five Southern Maryland counties collaborated with their county Farm Bureaus, Soil Conservation Districts and Economic Development/county governments, to identify much needed enhancements for their agricultural communities. Every county will provide matching funds to their projects for a total regional investment of $980,000. Projects and partnerships offer potential to boost economic viability for all types of farming enterprise and strengthen cross-county relationships. Awards - Four projects were awarded totaling $J00,000. Projects ( expected to begin in 2018 and completed within three years) address specific issues or needs expressed by the counties, include: • The restoration of an historic dairy barn in Anne Arundel County for agriculture education programs and meeting space • An online infrastructure and content management system for Calvert County to provide opportunity for all producers to have a presence on the internet • A soil health demonstration project for Prince George's County to help educate the farming community on best management practices that improve soil health • A new enclosed farmers market building for St. Mary's County that provides utility services to allow the expanded sale of refrigerated value-added products. Charles County is supporting the St. Mary's County market project with their share ofRAP funds as the market offers opportunity for vendors/jarmsfrom both counties. 5 SMADC End of Year Report FY'IS Pictured on previous page from Left to Right - Dec. 2017 Group Presentation All Counties: Kim Rush-Lynch, Agriculture Marketing Consultant, Prince George's County University ofMmyland Extension Steve Darcy, District Manager, Prince George's County Soil Conservation District Lisa Barge, Agi·icultural Marketing & Development Manager, Anne Arundel Economic Development Co,poration Shelby Watson-Hampton, Director, SMADC Donna Sasscer, Manager Agriculture & Seafood, St. Mary's County Government Senator 'Mac' Middleton, Board Member SMADC, Senator Charles County Eddie Bowling, Board member, SMADC Willie Goddard, Board member, SMADC Martin Proulx, Agriculture Specialist, Charles County Economic Development Jennifer Pettko, Agricultural Marketing Specialist, Calvert County Economic Development Yates Clagett, Chairman, SMADC Southern Maryland Agricultural Farmer Mini-Grant Program The Farmer Mini-Grant Program is open to applicants age 16 and older, residing and farming in Anne Arundel, Calvert, Charles, Prince George's or St. Mary's counties. Grant awards will be made up to $2,000 per applicant, as a one-to-one match and can be used for a variety of projects. The Mini-Grant program designed to assist new and beginning farmers with small start-up projects and assist existing farmers looking to diversify or expand a ctment agriculture project. Projects must be completed within one year. In FY'18, SMADC offered two rounds of mini-grants. A total of 24 grants were awarded totaling $37,815. • 804 Cattle Company ($2,000) - Cattle Corrals in Prince George's County • Anderson's Farm ($1,660) -Heritage Sheep Fencing & Egg Production in St. Maiy's County • Jacob Bowen ($200) - Livestock Scale in Calvert County • Bowling Farm ($1,875)-Livestock Fencing in Charles County • Dicot Farm ($2,000) - Scaling Up Salad Greens Productions in Charles County • Fields of Valor Farm ($940) - Hoop Honse in Prince George's County • Floating Lotus Farmstand ($1,575) - Season Extension with Hoop Houses in Anne Atundel County • David Wood of Forrest Hall Farm ($1,000)-Addition of Hoop House in St. J\.llaiy's County • Kayla Griffith of Griffith Family Produce ($250) - Family Produce Revitalization: Marketing in Anne Arundel County • Heart Barn Farms ($2,000) - Perimeter Fence in Anne Arundel County • Hereonthere Farm ($715) - Deer Exclusion Fencing in Prince George's County • Holiday Memories Farm, LLC ($2,000) - Pick Your Own Blueberries in Anne Arundel County • Honey Cove Farm ($2,000) - Cattle Al Equipment in Calvert County • Horsmon Farm ($2,000) - Hay Accumagrapple Project in Calvert County • Indian Summers Farm ($2,000) - Perimeter Fence in Charles County • Loblolly Farm ($1,000)-Transplant Nursery in Charles County • March Meadows ($2,000) - Goat Fencing in St. Mary's County • Matthew Mudd ($2,000)- Livestock Fencing and Waterline in Charles County • Owl's Nest Farm ($1,600) - Rainwater Catclnnent System for winter high tunnel production in Prince George's County 6 SMADC End of Year Report FY' 18 • Pale Blue Dot Farm ($2,000) - Enhanced Food Safety and Product Marketability Through Installation of a Farm Cooler in Prince George's County • Terra Alta Farm ($2,000) - Cattle establishment in St. Mary's County • Tobacco Barn Distillery ($1,000)- Whiskey Mash Dewatering System in St. Mary's County • Trossbach Produce ($2,000) - High Tunnel Greenhouse for vegetable production in St. Ma1y's County • Wyoming Farm ($2,000) - Orchard Establishment in Prince George's County Featured below are examples of funded projects: Owl's Nest Farm - Rainwater Catchment System for winter high tunnel production in Prince George's County Owl's Nest Farm is a diversified vegetable farm on four acres in Prince George's County, just twenty miles from Washington, D.C. Established in 2016, the farm is Certified Naturally Grown and they currently sell their products through a CSA, Farmer's Market, and Restaurants. They applied for the SMADC Agricultural Mini-Grant in July 2017 to build a rainwater catchment system for their high tunnel to ensure reliable water access during the winter months. This allows the farm to expand and continue to meet the demand for fresh, local produce to restaurant customers as well as stabilize cash flow by adding income during December and January. The total cost of the project (including construction labor, hardware, lumber, and misc. supplies) was just over $3,000. The rainwater catchment system was designed and constructed by Earth-Bound Building, Farm and Forestty based out of Cambridge on the Eastern Shore. The project is already having a significant impact on the business by allowing them to maintain strong relationships with key contacts. "With fi·esh greens as the anchor, we 're already thinldng about how we might expand winter sales in 2018. For example, this year, we harvested and stored root crops like watermelon.radishes and hakurei turnips to sell to restaurants in addition to the greens and in 2018, we 're planning to expand production ofthese root crops that we can harvest and store throughout the winter," said Liz Whitehurst, owner and operator of Owl's Nest Farm; she added, "Ifwe can continue to increase winter income, we may be able to offer winter hours to our seasonal staff, which will help with employee management and turnover. " 7 SMADC End of Year Report FY' 18 Trnssbach Produce - High Tunnel Greenhouse for vegetable production in St. Mary's County Trossbach Produce is a family-owned and operated farm located just north of Point Lookout State Park in St. Maty's County. The fann sells peaches and berries as well as a variety of fresh vegetables, jams, and baked goods. As Trossbach Produce transitions from one generation to the next, they applied for the SMADC Agricultural Mini-Grant in July 2017 to supp01t the conshllction of a 4,080 square foot high tunnel to extend their growing season and to better facilitate current and future market needs. This allows the farm to start growing crops earlier, such as tomatoes, and diversify to build a larger customer base. The total cost of the project (including high tunnel kit, lumber, hardware, and labor) was just over $12,000. The Nahtral Resources Conservation Service's EQIP program provided funds in addition to SMADC additional matching funds. 804 Cattle Company - Cattle Corrals in Prince George's County 804 applied for the SMADC Agricultural Mini-Grant in July 2017 to facilitate building a corral and chute system on their 33-acre fmm. The purpose of the corrals and chute system allows them to effectively and safely handle their cattle in order to perfo1m preventative care, wean calves, perform pregnancy and health examinations and to a1tificially inseminate. 804 was awarded the grant in September 2017 and has already completed the project. They repo1ted that having the corral and chute system allowed them to administer vaccinations and deworm cattle in accordance with Beef Quality Assurance (BQA) standards. 8 SMADC End of Year Report FY'18 During Fall, all their cows, steers and calves were dewonned, vaccinated and given a mineral injection which would not have been possible without a functioning corral and chute system. All their non pregnant animals had their estrous cycles synched and were artificially inseminated during November, and will be checked the first week of December. During calves were weaned using the corrals and a process called "fence-line weaning", which greatly decreases the amount of stress for the calf and dam as it allows them to see each other and touch noses but prevents nursing. The total cost of the project (panels, gates and accessories for the corrals) was $5,359.80 ( does not include cost of chute or palpation cage). 804 applied for, and received, $2,000 in funding from SMADC. 804 provided the remainder in matching funds. Equity Incentive Matching Fund A joint partnership with MARBIDCO designed to incentivize loan requests from Southern Maryland farmers and to help them meet certain down-payment (equity) requirements, in order to help improve the credit quality of their applications. Each established MARBIDCO program has its own eligibility criteria and application/approval process. Southern Maryland applicants simply follow the regular application process, and meet the rigors ofMARBIDCO's underwriting criteria for each loan program. In FY' 18 four applicants used this program. The four applicants were approved for $20,000 each, toward MARBIDCO' s Maryland Resource-Based Induslly Financing Fund Loan (MRBIFF) Program. Each applicant purchased fa1ms for agricnltural use. $80,000 has been utilized for this program. Southern Maryland Revolving Loan Fund A loan program was designed by MARBIDCO exclusively for Southern Maryland applicants to assist with purchases and upgrades. Under this program, only the activities of agriculmral businesses located in the five Southern Maryland counties are eligible for farm business financing. Loan amounts may range between $10,000 to $20,000, with no collateral security pledge required. Only the personal guarantees of all the borrowers will be needed. MARBIDCO administers the loan program on behalf of SMADC. B01rnwers that pay on time will receive approximately 20-25% loan forgiveness at the end of the loan term. Loan funds may be requested for the following types of projects: • Purchase livestock and/or enhance existing herds and flocks. • Incubate the production of small fruits and hops and increase acreage by existing small fruit/hops growers. • Upgrade for the safe growing, harvesting, packing and holding of produce in line with Good Agricultural Practices (GAP). • Shellfish Aquaculture foundation development. In FY'lS, three applicants were approved for loans for fencing (two) and aquaculture (one). To date, $58,000 has been utilized for this program. 9 SMADC End of Year Report FY' 18 SMADC Scholarships SMADC recognizes the importance of educational and networking opportunities for farmers and for young adults (high school and above) that promote and support agriculture, stimulate interest in careers in agriculture and grow a new generation of farmers. To address this need, SMADC offers both sponsorships and scholarships to residents in Southern Matyland. In FY' 18, three students received scholarships totaling $3,225. Additionally, to complement the college level courses offered in Southern Maryland through the University of Maryland's Institute of Applied Agriculture (IAA), the SMADC board approved scholarships. Eight students received scholarships totaling $6,500 for the SMADC IAA partnership classes. The scholarships helped to attract students to this new educational opportunity in Southern Maryland. (See 'Education and Workshops' for a detailed summa,y). SMADC Sponsorships SMADC continues to support workshops, conferences and continuing education opportunities for farmers. In FY'18, we sponsored nine events (listed below) for a total of $4,560. • 20 I 7 Southern Ma1yland Crops Conference & Dinner (UM Extension) $100 • 2018 Farm Succession Workshop (UMO's Dept. of Ag. & Resource Economics) $375 • 2018 So. Md. Vegetable & Frnit Production Meeting (UMD) $85 • 2018 Maryland 4-H Horse Jamboree (UM Extension) $1,000 • The Matyland (Ag) Day Livestock Show, Block & Bridle Club ofUMD $150 • 20th Anniversary Gala, LEAD MD Class X $1,000 • Bounty of the County (Fa1m to Table event), Charles Co. Chamber of Commerce $1,000 • Agricultural Marketing Professionals (AMPs) Tour in October 2018 $500 • 2018 Maryland Commodity Classic (MD Grain Producers) $350 SOUTHERN MARYLAND MEAT INDUSTRY Southern Maryland Meats (SMM) During the last 8 years, SMADC has undertaken the challenge of building the local meat industry. The Southern Maryland Meats marketing program was developed in response to high consumer demand for local, farm-raised meats. The program provides education, marketing suppmi and infrastructure for livestock producers and others exploting the opportunity to diversify with livestock production. Producers may take advantage of the value-added potential for profit offered by SMM trailers and rental farm equipment provided by SMADC grants. Cumulative trailer use since the inception of the Southern Maryland Meats (SMM) program in 2010 demonstrates the industty is solidly established and continues to grow annually. 10 SMADC End of Year Report FY' 18 Southern Maryland Meats - Freezer Trailers In 2011, SMADC provided funds to SMADC Freezer Trailers - Estimated Retail Value of St. Mary's and Prince Cargo & Total Pounds Transported George's county Farm $559,164.00 . Bureaus to purchase $473,745 two freezer trailers to transport farmers' meat $395,920 products from USDA $364,698 processing plants to the $306,820 farms for sale. In $243,000 FY'15, funds were approved for a third trailer for Calvert $112,000 102,084 l 68,760 81,517 51,658 ss,1s3 I 62,540~ ! County Farm Bureau. 25,000 I I All three trailers are I l I ' I ! I I available to rent by any ■ Southern Maryland -FY'12 FY'13 FY'14 FY'15 FY'16 FY'17 FY'18 meat producer. In ■ lbs Transported - Retail Value FY'l6, Prince George's and St. Mary's counties received funding to purchase new trailers. Both counties auctioned their old trailers; sale proceeds were returned to SMADC to establish a trailer and display case maintenance fund. In FY'18, a combined total of 102,084 lbs of processed meat was transported with an estimated retail value of$559,164.00 (an increase of25% from FY'17). Promotion and Marketing A program priority is to build awareness for SMM meats. The "Southern Ma,yland Meats" brand and logo (co-created by SMADC and producers) assures transparency and product authenticity to consumers. Participating farms' raising practices are 'juried' to assure the quality and integrity of the SMM brand is maintained. In FY'18, the SMM logo was updated to conform to the new SMADC logo/marketing identity. New SMM Marketing and Livestock Specialist- In the Fall of 2017, the Southern Maryland Meats Steering Committee determined that the SMM required a dedicated full time staff to administer the program, re-direct goals and develop initiatives to enhance outreach and revitalize program effectiveness in line with stakeholder needs. A new Marketing and Livestock Specialist, Craig Sewell, was appointed in Januaiy 2018. Key tasks will be increased marketing efforts to re-inforce brand recognition for SMM producers, promotion of individual farms, explore options for value-added meat processing, the establishment of a locally situated slaughter facility, and the development of SMM branded meat products. In FY' 18, the SMM specialist conducted a full review and ripdate of all SMM participants and met individually with current and pending SMM members to assess needs going forward. In FY'18, 40 producers confirmed active participation in the program (4 new in FY'18) and an addition 7 are pending approval in FY'19. Town Hall Meetings - SMM coordinated two Town Hall Meetings in the Spring of 2018 to engage regional livestock producers in the on-going research and development of a Southern Maryland-based slaughter/process facility. The first meeting, on March 22, provided a forum to discuss.meat processing options and other concerns impacting the livestock community including mitigating transpo1tation costs, quality assurance/branding, fine meat processing and traceability issues. Over 40 producers attended. 11 SMADC End of Year Report FY' 18 The second meeting on April 16, focused on potential consolidation of livestock at a centralized location fos transportation to an existing slaughter facility and the return/delive1y of cut and wrapped aged product as well as value-added commodities back to the centralized location. In attendance were representatives of existing slaughter/process facilities to discuss potential for a regionally located value-added processing facility to make products such as sausages, charcuterie, beefjerky and hotdogs. Over 30 attended. Slaughter Facility Regulatory Assistance - SMADC staff provide assistance to So.MD livestock producers requesting marketing and regulatory guidance (licensing and pennits). Members of the St. Mmy's county Amish · community requested assistance with the development of Standard Operating P1;ocedures (SOPs) and USDA inspection specifications for a slaughter facility; cmrently under construction. Staff is facilitating communications with state USDA/FSIS and local inspection agencies and assisting the development ofHACCP, SOP and facility plans, similar to help provided to the Clover Hill Cheese Daily. SMM Social Media and Website-The SMM website is the main public p01tal for the SMM program providing consumers with clear information about the raising, processing and labelling standards of the brand, and listings of brand participants and venues (stores, markets, farm stands and butcher shops) where SMM products are sold. The website also features marketing and processing resources for producers including downloadable promotional materials, regional rental equipment inventories, regulato1y guides and tutorials. In FY' 19 the website will be redesigned to enhance promotion of individual SMM farms and broaden consumer outreach. The SMM website averages 1,800 unique visits a month. The SMM Facebook page offers an additional conduit for retail partners and producers to connect directly with consumers and 'post' availability of product for sale, upcoming events and other updates. Education Livestock Enhancement Project - Five livestock workshops (3 Small Ruminant, 2 Beef) were developed during FY' 18, funded in pmt by a grant awarded by the Rural Maryland Prosperity Investment Fund Grant (RMPJF) program. The goal of the workshops is to enhance the livestock genetic base in Southern Maryland in order to help meet the increased demand from consumers for high quality meat products. University of Mmyland Extension educators partnered with SMADC to assist with the presentation of the workshops. 107 producers/farmers participated in at least one or more (total of 5) workshops. (See 'Education and Workshops' for detailed summary). SMM Junior Promotion - In FY' 17, SMM launched the Junior Promotion program. The Junior Program seeks to inform a new generation of young/beginning farmers about SMM program livestock quality and raising standards, and ultimately grow pmticipation in the SMM program. Participants received free promotional materials, including a stall card and t-shirt, to promote their animals during the fall fair livestock auctions. At the conclusion of the promotion and successful sale of their animals, applicants submitted a one-page essay about raising and selling their livestock to program standards. Successful program completers received an award of $100 to help finance on-going livestock projects and a ce1tificate signed by SMM Chairman and the SMADC Director. 15 youth participated in the SMM Junior Program in FY'l7 . A total of $1,500.00 was awarded. 12 SMADC End of Year Report FY' 18 In FY '18, the SMADC board approved funding to continue the SMM Junior Promotiqn. 32 youth signed up for the program in the Spring of 2018 and will complete their projects in the fall. (22 new participants in FY'l8/19). "At first glance the Southern Maryland Meats program seemed like just another project that anyone could join. But through research I found out it was much more. My interest peaked when I found out excellent care standards for all livestock where enforced to participate. Being an avid showman, I want to make sure my animals and my products are top quality and knowing that this program followed my ethics I was quick to sign up. Another reason I was determined to join was to better my ties to the agricultural community so I may continue to learn from and even teach others about the benefits ofraising quality animals and products, ensuring a brightfi1turefor all generations to come." - Savannah Bell-Bussler, SMM Jr. Member. "TJ" ll'e/a11d- FY'17118 Jr. Pro111otio11 Highlights: • 40 producers participate in SMM Program (4 new in FY'l8, 7 pending for FY'19). • 15 successful SMM Jr. Promotion completers in FY' 17/ 18 - $1,500 total funds awarded • 32 youth sign up for FY' 18/19 SMM Junior Promotion (22 new) • 102,084 lbs processed meat transported by SMM Trailers/estimated retail value $559,164.00 (25% increase in FY' 18). • 5 SMM workshops attract 107 producers. REGULATORY ASSISTANCE/ SMADC OMBUDSMAN SMADC's regional and statewide programs strive to create economic opportunities for farmers and provide the research and resources for existing and new farm entrepreneurs to be successful. SMADC works cooperatively with farms and state and local agencies to facilitate a vital regulatory information conduit for the farming community by providing workshops for regulato1y updates, staff expertise and support for ongoing record keeping, process reviews; and license applications as needed. How SMADC Helps -An ever growing inventory of value-added on-fatm products (fermented foods, dairy, acidified, meats, etc.) coupled with innovative on-farm agritourism activities are dramatically changing the profile of farming; health and permit inspectors struggle to interpret current guidance and regulation to accommodate new agri-business models. As a result, SMADC staff is frequently sought out regionally and statewide as a knowledgeable resource to help producers navigate the complex regulatory requirements of multiple federal, state and local agencies (FDA, USDA, FSIS, DHMH, SHA) which · oversee food production and farm enterprise. 13 SMADC End of Year Report FY' 18 The Food Safety Modernization Act (FSMA), has intensified regulatory On-Farm DHMH Meats License oversight for food production, as focus Number of Farms Assisted shifts to heightened preventative controls. As anticipated, almost all 51 58 farming enterprises are affected by the new regulations. SMADC places great importance on continuing training for SMADC staff in food safety protocols __.,_Cumulative Total to enhance SMADC's ability to Number of Farms Assisted provide informed ongoing regulatory assistance to regional value-added farm enterprises engaged in value added production. FV'12 FV'13 FV'14 FV'15 FV'16 FV'17 FV'18 Additionally, SMADC provides assistance to farms experiencing zoning, permit and other land use issues as they expand their revenue options with on-farm activities and services (agritourism). SMADC capitalizes on its knowledge in regulations and partnerships with state and local organizations to leverage positive outcomes. SMADC's online tools, tutorials and template resources continue to provide easily accessible (local and state) regulato1y compliance guidelines for Acidified Foods and DHMH On-Farm Processor/Meats License applications; both tutorials are endorsed by Maryland DHMH and remain top visited pages on the SMADC website. Examples of SMADC regulatory outreach in FY'18 include: • Slaughter Facility - Staff is assisting Westham slaughter facility with the development of Standard Operating Procedures, HACCP plans, facility construction protocols and other mandated regulatory requirements for USDA inspection. • Butcher Shop - Staff is assisting Knott Family Farm with USDA re-certification of an on-farm butcher shop/meat processing facility. • Value-added Food Processing - SMADC staff with State DHMH coordinated annual on-farm Acidified Foods processor reviews (4 farms). One new recipe for tomato salsa (Fisher Faim, Mechanicsville) registered with DHMH Office of Food Protection. • On-Farm Processor Meats License - 7 new on-farm processor meat licenses facilitated. • Dairy SO P's and Approvals - Staff is assisting Clover Hill cheese daily with the development of Standard Operating Procedures for a new 2,000 sq. ft production room expansion. 7 cheese recipes/SOP's approved in joint meetings with Division of Milk Control. • Food Safety Workshop - SMADC with Center for Milk and Dairy Product Safety and State DHMH coordinated a Food Safety Training Workshop for Clover Hill cheese daily. Attendees participated in food safety demonstrations and presentations including identification and prevention of production area bio-hazards and worker hygiene protocols. Highlights FY'18: • 4 on-farm acidified foods - DHMH annual process reviews facilitated. • 7 new on-farm processor meat licenses facilitated. • 2 meat processing facilities SOP/HACCP plans in development • I dairy food safety workshop facilitated. 14 SMADC End of Year Report FY' 18 SMADC MARKETING AND OUTREACH Commencing in FY' 17 the key elements of So. Mmyland, So Good program were absorbed into SMADC's new marketing strategy and corporate identity templates. In FY' 18, all program literature, guides, websites and social media platforms now conform to the new marketing guidelines. Outreach and marketing efforts (newsletters, social media, biogs and forums) in combination with grant opportunities, workshops, tutorials, utilization of staff expertise and other SMADC resources have actively engaged and benefitted over 280 Southern Maryland farms. (59 new farms/ag. businesses in FY'18). SMADC Guides SMADC guides are available to view or download at SMADC.com. Initial publications/print runs are distributed free to the general public (while stocks last) at regional libraries, welcome centers and participating farms and businesses by request. 2017/18 Farms for the Holidays Guide - The newly designed full color mini-brochure Farms for the Holidays showcases 71 (22 new in FY' 18) Southern Maryland farms, wineries and other agriculture-related businesses offering farm products, tastings, tours, events and more for the holidays. Regional stores and restaurants that source from local farms and watermen are also featured. 5,000 guides printed and distributed in FY'18. 2018 Farmers Market Guide - In FY' 18 the Farmers' Market guide was redesigned and updated in line with the new SMADC logo/corporate identity. The guide features 32 Southern Ma1yland markets and 10 additional markets in Metro DC and Virginia that host Southern MD farm vendors. Listings include Southern Maryland markets by county with days/hours of operation, market locations and addresses, websites, market contact information, plus a regional market locater map. 7,500 guides printed and distributed in FY'18. Southern Maryland Trails - A powerful economic development tool for the region, the online guide celebrates everything handmade, homegrown and locally harvested in Southern Maryland including local farms, art galleries and studios, wineries, lodgings, natural areas, restaurants that serve locally grown food and natural areas and parks that highlight the region's heritage and beauty. Southern Maryland Historic Horse Trail & Equine Guide - One of a network of self-guided trails in development around the state with the suppo1t of the Maryland Horse Industty Board, the online Southern Maryland Historic Horse Trail encompasses Calvert, Charles, Prince George's and St. Mary's counties and highlights documented equine-related sites and educational oppo1tunities in the region that are part of a state-wide historical archive of the role of horses in Ma1yland's history. SMADC's Southern Maryland Equine Guide, lists 63 local stables, horse farms and other equine resomces in the five southern counties. Southern Maryland Oyster Trail In the Spring of 2018, SMADC adopted the Southern Maryland Oyster Trail, formerly developed and administered by Morgan State University and PEARL Oyster Lab in conjunction with St. Mary's and Calvert County Economic and Tow-ism Depa1tments. SMADC plans to update and expand the Southern Maryland Oyster Trail website and companion brochure beyond the two counties currently showcased, to be fully inclusive and representative of Southern Maryland's oyster 15 SMADC End of Year Report FY' 18 industry. The guide will also feature affiliated regional businesses such as restaurants, museums, oyster research organizations and other associations and institutions com1ected with oyster production in Southern Maryland. SMADC expects to relaunch this Trail in the Spring of 2019. Maryland Farm and Harvest SMADC sponsored the popular Maryland Public Television show "Farm and Harvest". SMADC's 15 second spot (delivered to over 60,000 households) will air at the beginning or end of each episode ofMPT's Season 6 Fann and Harvest Series. The visuals, in combination with audio script, emphasize SMADC's suppmt for farms and for providing consumers with the resources they need to find farm products: "The Southern Maryland Agricultural Development Commission supports farms and the future of agriculture - with marketing programs, grant opportunities and education for/armers, as well as guides, and events to connect consumers with local farms. Learn more at SMADC.com." SMADC News and Social Media Platforms The SMADC News and Subscription portal at SMADC.com invites the agricultural community and general public to engage in SMADC's direction and outreach with suggestions, tips, comments, or ideas to assist in the development of SMADC's programs, resources and support. SMADC Facebook - SMADC's Facebook page/account is designed to be an interactive interface for the farming community and further enhance engagement with consumers. SMADC's Facebook account registered 1,559 followers (537 new) in FY'18. SMADC Instagram Account - SMADC created an Instagram account to connect with farms in a SUPPORTING FARMS . EMPOWERING CONSUMERS more dynamic and pictorial way and, in particular, to further engage smadc.com the younger members of the farming community. The trending social media 'app' provides a photo-sharing option and instant graphic news feed for mobile devices, which is popular with new and begi_nning farmers. To see SMADC on Instagram search: @southern_ma,yland_ag. 705 Instagram followers (53 new posts) in FY'18. SMADC Twitter Account - SMADC utilizes Twitter as an additional infmmation conduit for specific subject updates and to alert/broadcast quickly 'calls to action' and other info1mation of importance and/or of general interest to regional farm businesses. 704 Twitter Followers with a total of 30,922 Tweet Impressions registered in FY'18. 16 SMADC End of Year Report FY' 18 SMADC's "Farm Focus" Online Newsletter - SMADC's monthly newsletter features information on SMADC, featured farms, recipes, ag news, upcoming events, and more. The newsletter is intended to be informational for board members, farmers, ag. organizations, and interested consumers. The newsletter is available on the SMADC website and social media channels. Consumers and farmers can read the editions and subscribe by email on www.smadc.com, under "What's Southem M.lrybntl Ai rlcoltu~I Dtvt lopm«ntCommis~lon, Mil~ Edition, 1011 New". 527 individual subscribers registered in FY'18. 0 ® 0 0 SMADC Websites In FY' 18 SMADC/TCC migrated all web platforms to a new IT Management and Server. In transfer, cumulative analytics data collection was suspended for most SMADC hosted websites (SMADC.com, SOMDTrails.com, Southernmarylandmeats.com, Maryland FarmLINK.com, Somdhorsetrails.smadc.com). In FY'18, Buylocalchallenge.com was updated and redesigned; Southernmarylandmeats.com is currently undergoing reconstrnction. In order to establish the approximate FY' 18 web activity for SMADC.com the total 'unique visit's over a 3-year period (FY' 15 - 17), were averaged to achieve monthly estimated totals. SMADC data collection will be resumed as each website is updated and/or reconstrncted. In previous year end reports SMADC measured using the total number of visits, not accounting for multiple visits by individuals. SMADC Guest Speakers SMADC continues to seek and maintain vital connections with stakeholders and with other organizations, educational institutions and businesses that interact with the regional farming community. Guest speakers are invited to present at the monthly SMADC board meetings. 13 speakers (representing 12 organizations) presented in FY'18: • Amber DeMarr - Morgan State University Patuxent Environmental and Aquatic Reasearch (PEARL) • Pat Hudson - Trne Oyster Restoration Initiative (TORI) • Bob Parkinson - Moonstrnck.Oysters, LLC • Chris Seubert - University of Maryland Extension • Mark Powell - Ma1yland Dept. of Agriculture • Robert Hahn, Jackie Miller - End Hunger in Calvert/Chesapeake Church • Eric Steenstra - Vote Hemp • Josh Hastings, Rob Etgen - Eastern Shore Land Conservancy (ESLC) • Robert McCord - Maryland Department Dept. of Planning • Julie Oberg - Maryland Dept. of Agriculture • Wendi Peters - Sma1t Growth • Cindy Beuche1t, Doug Hill - Southern Mmyland Meats Steering Committee • Saul Kinter, James Fotouhi - DC_Water Highlights FY'18: • 281 farms ( 59 new in FY' 18), listed throughout all SMADC websites, guides and contacts. • 32 So. MD and 10 additional regional markets listed 2018/19 Farmers' Market Guide • 71 agricultural businesses (22 new) listed - 2017/18 Farms for the Holiday's Guide in FY' 18. • SMADC adopts Southern Maryland Oyster Trail • SMADC website averages over 3,000 unique visitors per month • 1,559 (537 new) followers - SMADC's Facebook account in FY' 18. 17 SMADC End of Year Report FY' 18 MARYLAND BUY LOCAL CHALLENGE SMADC created the Buy Local Challenge (BLC) in 2007 to educate the public about the benefits of supporting local farms with the goal to incentivize and increase purchases of Maryland farm foods year-round. Tlu·ough promotions like the BLC, public awareness and preference for locally raised/produced products has increased demand for locally sourced foods and has incentivized distributors, food service directors and large groce1y chains to connect with local growers. Buy Local Challenge Week Take the Pledge Promotion - This year marks the 11 th anniversary of the BLC first conceived by SMADC as a regional promotion and subsequently endorsed by the state and is now jointly promoted statewide in partnership with Maryland Depaitment of Agriculture. BLC Media Campaign - The BLC campaign is self-propelling (borne out by the activity on Facebook, Instagram, Twitter and the BLC website) as more consumers connect with "the Challenge" and are incentivized to create their own BLC week events and commit to the challenge annually. Advertisements drive consumers to the BLC website to 'take the pledge' to buy local and discover state wide resources on where to buy Ma1ylaµ.d grown farm products. Throughout the BLC week, the Governor's Office, MDA, SMADC, numerous independent media (ABC News, Capital Gazette, CBS, Baltimore Sun and others), county agencies, local townships and governments promoted the BLC on social media and on their websites. To incentivize pledging and gauge response to the BLC, the general public were also invited to share their BLC experiences for a chance to win prizes by registering their BLC pledge to 'eat local', or by posting photos of their 'buy local' shopping spree to Facebook or Instagram. Winners received a choice of SMADC T-shirts or insulated shopping bags. 10 winners were randomly selected, from close to 300 entries. During the campaign, the BLC Facebook page registered 'lifetime post total impressions' of over 17,000 and 840 Twitter Followers. The BLC website registered 2,539 users (from May 9 - July 31 ), of which over 1,371 were new users. SMADC suppo1ted the BLC with digital advertisements geo-targeted to Southern Maryland. The WashingtonPost.com adve1tisement employed content and behavioral targeting across all platforms (desktop, mobile and pads). Ads were delivered to an audience of over 879,000 consumers. 18 SMADC End of Year Report FY' 18 Buy Local Challenge Website Redesigned - In June 2018, SMADC debuted the re-designed BLC website, www.buylocalchallenge.com. A fresh new look dominates the pages with user-friendly navigation tools to help consumers find statewide resources for Maryland farm products, enter BLC contests, take the BLC pledge, and more. Why Is ii important to buy/eat locally grown foods? The Governor's Buy Local Cookout - SMADC staff ~-:a...:i~ ■ .:a.'.:l.ilr'II paiticipated in Governor Larry Hogan's 'Buy Local Cookout', ~ SLO'N•ROAST...■D.. GOAT TACOS • which traditionally kicks off Maryland's Buy Local Challenge ~ VUlHl,.... tfC0117f~Oll>"1 ,::~·· Week. Held at Government House in Annapolis, the 'invitation i:· - only event' was attended by over 500 statewide agriculture representatives; business owners, organizations and institutions throughout the food industry, store buyers and restauranteurs. Teams of local chefs and producers were invited to submit . '. ; . . ,: . original recipes that highlight the diversity of Maryland ·1 . ~~:• ~ ' . products. Recipes are paired with Maryland produced beer, ,I · rA . .• ,t ·"' I ' \a:'. - ~ wine or distilled spirits. The Southern Ma1yland Meats Program submitted one recipe (of 16 featured) which was prepared with meat raised by Southern Maryland Meats producers and vegetables provided by regional farms. The SMADC team booth later appeared in the Governor's Twitter Feed. A total of 5 Southern Maryland farms/producers featured in recipe selections. Buy Local Challenge Celebration Event In FY' 17, SMADC marked the 10th Anniversary of the BLC with a celebration of farms and food promotional event featuring Maryland farm products at Robin Hill Farm and Vineyards in Prince George's County. The Buy Local Challenge Celebration Event was enthusiastically received by farms and consumers, and as a result the SMADC board voted to continue the "BLC Celebration" as an annual recun'ing event to be held on a rotating basis at agritourism venues in the 5 Southern Maryland counties. Eligible agritourism venues were invited to submit proposals to host the 2nd annual Celebration. Proposals were reviewed by the SMADC Board. Greenstreet Gardens in Anne Arundel County, was selected as the host site for the 2018 Celebration. 19 SMADC End of Year Report FY' 18 The BLC Celebration evening event was set up farmers' market style with 45 vendors offering tastings and.sales of Maryland grown and produced products (meats, produce, dairy and value-added) as well as wineries, br.eweries, distilleries, local artisans and crafters and representatives of agricultural organizations. Food trucks catered the event and featured at least one locally sourced product in their menus. The admission fee included an insulated shopping bag to keep purchases fresh, musical entertainment, carriage rides, various fun activities for children and the Maryland Agricultural Education Foundation trailer. Over 600 people attended, (177 tickets were sold at the door). Event VIP's - Governor Hogan addressed attendees and presented host Ray Greenstreet and SMADC Director Shelby Watson-Hampton with the 'Governor's Citation' acknowledging "The increasingly popular and important Southern Ma,yland Buy Local Challenge Celebration. " An Executive Citation was presented on behalf of Anne Arundel County Executive Steven R. Schuh. Also in attendance were Agriculture Secretary Bartenfelder and Deputy Secretary Oberg. Event Sponsors - The Celebration was sponsoi·ed in part by 10 organizations including, MARBIDCO, Anne Arundel Waterman's Association, Rural Maryland Council, Maryland Agricultural Education Foundation, Maryland Fann Bureau, Arnndel Ag, Reilly Benefits, Sandy Spring Banlc, Grow and Fortify, and the Maryland Depa1tment of Agriculture. Sponsors received 50 specially designed 'Buy Local' tote bag giveaways (featuring sponsor logos) as an 'appreciation bonus'. Highlights: • 60,000 SMADC/BLC fliers distributed statewide. • Governor Hogan and Agriculture Secretary endorse BLC Week. • 600 attend the SMADC/BLC Event. • 45 farm vendors featured at SMADC/Event. • 10 BLC SMADC/Event Sponsors • Numerous independent articles, press notices, TV, radio and SMADC ads, Social Media platforms reached a combined audience over 1 million people. 20 SMADC End of Year Report FY'l8 FARM EQUIPMENT RENTAL PROGRAM SMADC continues to fund and support a regional farm equipment rental program in the region. Through the years, SMADC has invited agricultural entities to identify farm equipment needs to be shared and rented by farmers across Southern Maryland. Funds have been made available to purchase the equipment. In addition to popular pieces of equipment, priority was placed on equipment that promoted long-term environmental benefit to the Chesapeake Bay and/or supported new farm initiatives. The equipment is managed by local agricultural entities. Rental fees are expected to cover routine · maintenance and other costs of the program, such as insurance. The equipment is listed on the "Fanner Resources" page of the SMADC website, and on the websites of the managing entities. Highlights FY'l8: • In FY'l8, the St. Mary's Farm Bureau Board of Directors made the decision not to manage the rental equipment program and transferred ownership to the Homegrown Farm Market, LLC, which stepped forward to take on the equipment and rental program. "The Homegrown Farm Market, LLC, believes this equipment should continue to be made available to the farmers ofthe Southern Ma,ylandfarming community." The market board confirmed they will manage the equipment for as long as is needed, as well as provide education and outreach to encourage more farmers to take advantage of the rental program. • The SMADC Board approved funds for new equipment purchases. At the end of the fiscal year, a notice to agricultural entities was made inviting them to make requests. SMADC Staff will report on the new equipment in the FY 2019 report. • To date, 36 pieces of equipment are in inventory and are available for farmers to rent across the region. • 1,610 acres positively impacted by conservation tillage across the five counties. LAND PRESERVATION AND STEWARDSHIP AGRICULTURAL LAND PRESERVATION The land preservation component of the Tobacco Buyout should not be understated. While the buyout of individual farmers radically changed the culture of agriculture in the five-county region, investment in land preservation has made a significant impact on the region's agricultural industry. Land preservation efforts have slowed the development of prime agricultnral land, helped to stabilize farming operations and foster renewed enthusiasm for agriculture in Southern Maryland. Land preservation is a high priority for SMADC, as Southern Maryland has been one of the fastest growing areas in the state. The average age of the tobacco farmer is now well into their 70's. These funds assure that farmland will persist not just for today, but for farmers and food production into the futnre. 21 SMADC End of Year Report FY'18 Highlights FY'IS - SMADC funds: • 635 acres ( 4 fanns) directly preserved in four counties ( I 'Anne Arnndel, I Charles, I Prince George's and I St. Mary's). • Resulting in 17,631 cumulative acres over the 16 years of program funding. SMADC funds, plus leveraged County and State program funds: • 40,357 acres (357 farms) cumulatively preserved in the five counties. • SMADC funds represent approximately 44% of acres preserved with leveraged County and State programs. FOOD, FARMS AND COMMUNITIES SOUTHERN MARYLAND FARMERS' MARKETS Fanners' markets continue to be popular for a number ofreasons: more informed consumers, desire to suppo1t the local growers and the economy, and want to know where their food comes from. Markets can also be a means to boosting income for fmmers. SMADC Support SMADC assists farmers' markets in the five counties through education, promotion, advice for start-up, and acting as a conduit of information about regulations and other pertinent information. SMADC provides promotional assistance grants, ranging from $500 - $2,000, directly to farmers' markets where the maj01ity offann vendors are from Southern Maryland. Since 2003, over $290,300 has been awarded to eligible farmers' markets for promotion. In 2017, gross revenue from these farmers' markets was approximately $3.3 million, from 232 Southern Maryland vendors. Over the years that SMADC has worked with markets, a cumulative estimate of over $34 million has been earned through the markets; which amounts to a $64 million impact on the local economy, as fanns and their employees reinvest their earnings in the community. For a relatively small amount of SMADC grant funds, the overall return on investment in the farmers' markets has been significant. Year Market impact Total So.Md. SMADCMkt. (Previous Total Revenue with multiplier* Vendors Vendors Grant Market Markets (1.86) Yem) 2003 - 117 1655 222 156,250 15,687,450 29,178,657 2010 2011 19 239 217 25,000 2,312,498 4,301,246 2012 16 291 252 22,450 2,667,252 4,961,089 2013 17 353 314 22,650 2,647,760 4,924,834 2014 14 279 266 16,500 2,460,386 4,576,318 2015 11 288 266 16,500 2,583,000 4,804,380 2016 11 273 243 17,500 3,129,770 5,821,372 2017 11 341 232 13,500 3,195,440 5,943,518 TOTAL 290,350 34,684,556 64,511,414 22 SMADC End of Year Report FY' 18 EDUCATION AND WORKSHOPS For FY' 18, the State budgeted General Funds for the Regional Cc;mncil potiion of the Rural Maryland Prosperity Investment Fund Grant (RMPIF) program. Each regional council, (Tri-County Council of Southern Maryland is considered a regional council of which SMADC is a division) is eligible to receive funding for rural regional planning and development assistance. The SMADC was awarded a RMPIF grant for $80,000 in early September 2017; SMADC matched the grant with $38,765. Additionally, SMADC was awarded $30,000 from the USDA Specialty Crop Block Grant to offer a new series of workshops - Ready to Take Root: Getting Started with Small Fruits and Hops. A total of 12 educational workshops/classes were funded in part by the RMPIF program. 20 SMADC sponsored/funded workshops engaged a total of 216 individuals in FY'18. Livestock Enhancement Workshops Five livestock workshops (3 Small Ruminant, 2 Beef) were developed during FY' 18 in partnership with University of Maryland Extension educators. The goal of the workshops is to enhance the livestock genetic ba.se in Southern Ma1yland in order to help meet the increased demand from consumers for high quality meat products and increase potential for profit for livestock farms. Three sessions for Sheep and Goat producers provided for the needs of experienced and beginner producers (including Southern Maryland Meats Junior members) as well as those exploring opportunity for meat production. Two Beef producer workshops were developed to incentivize enhanced genetic selection for increased productivity and improved meat quality. "Thanks so much for putting together today's workshop. I found it informative and entertaining so it kept my interest. I've been to a number ofthese things over the years - my family raised tobacco, Christmas trees and now sheep - and they are not always so professionally run. Nutrition and More - focused on the nutrient requirements, the evaluation of nutritive quality of feeds tuff and hay quality, balancing rations, and use of body condition scoring to evaluate flock status and nutrition programs. 26 farmers/producers attended. Lambing and Kidding- featured preparation, nutrition and care of ewes/does through gestation to birthing, aftercare of newborn lambs/kids, health issues, appropriate facilities and related equipment. Life-size animal models were used to guide participants through normal and difficult births. 53 farmers/producers attended. Marketing Sheep and Goats - addressed options for marketing animals and associated value-added products and hands on market readiness training. A panel session led by experienced producers explored the logistics and legalities of on-farm processing regulations, marketing, labelling and sales. 18 farmers/producers attended. 23 SMADC End of Year Report FY'l8. Beef Producer's Genetics, Estrus Synchro and Artificial Insemination (AI) - presented education for increased pregnancy success rates and quality meat production, as well as AI practice sessions using a dissected reproductive tract, chute-side protocols and hands-on body condition scoring demonstrations. Farmers elected to join a synchronized 'group' breeding season and benefit from Al semen/services from a leading genetic company. Producers were reimbursed for semen, arm service, hormone costs and other expenses up to $500 per producer. To further incentivize participation in the AI implementation, a full refund of the workshop registration fee ($100) applied to farmers completing the breeding series. "I want to let you know that Racheal Slattery (UME stajj) came to ourfarm today to assist us with the AI ofour black Angus cows. Everything went brilliantly and we look forward to seeing the results. Thanks again for putting 011 the class." -Boothe Farm. 21 producers attended the workshop. 7 producers completed the full AI course. A total of 84 beef cattle were professionally inseminated with the producer's choice of sire/bull. Beef Short Course - SMADC co-opted with an existing UME beef program to meet the needs of the broader regional beef producers ( experienced, beginners and those exploring potential for beef production). The two-day course featured presentations, networking and field tours at two St. Mary's county farms. Topics included economics of production, EPD's (Expected Progeny Differences), nutrition, nutrient management and pasture development. Field tours focused on facilities, herd health and management, grazing, pasture management, evaluating market readiness and value-added marketing. "The beefproducer's course you just put 011 was very informative and helpfitl to me, it was excellent. " - Donohue Downs Farm. 13 farmers/producers attended. Small Fruits and Hops Market Enhancement Workshops ..... ;-~~ .; • •• • ~ If#. r. • Five workshops were developed in partnership with University of Maryland Extension (UME) to encourage the increase of entrepreneurial activity, and assist in the retention of valuable farm land for productive use by present and future generations. The 'Ready to Take Root: Getting Started with Small Fruit' series explored different production styles and techniques as well as research and marketing for various fruit crops specific to Southern Maryland's growing region, including blueberries and ~ ,~}.\!~:• : .\. i;i brambles, hops, strawbenies, and alternative and niche small I .. ,. ~! - ' • ~:,- ' .. fruit. A portion of the RMPIF grant funds were also used to supp01t variety h·ials at the University of Maryland's Upper GB!!!S: Marlboro Research Station. This research will help UME to determine suitable small ftuit varieties and growing practices best suited for the Southern Maryland region. An advanced workshop series is in development for spring 2019. In addition to RMPIF, this initiative is also funded by the USDA Specialty Crop Block Grant. "The presenters and staffhave done an amazing job with the series. They are an asset to the ag community." - Workshop participant. 61 individuals participated (inclusive of 14 unique small businesses/farm operations). Blueberries and Brambles - topics included indusby and marketing overview, site preparation, soil testing and nematology, bramble/bluebeny variety suitability, establishment and trellising methods, bird predation control. 32 farmers/producers attended. Hops - presentations featured industry overview and market status, site selection and soil preparation, h·ellis design, hop varieties, establishment, harvest and processing, weed and pest management. 35 farmers/producers attended. 24 SMADC End of Year Report FY' 18 Strawberries - topics featured industry overview and marketing opportunities, site preparation including testing and identification of soil borne disease and pest management. Selection/suitability of varieties and establishment for plasticulture and matted row production. 11 farmers/producers attended. Alternative and Niche Small Fruit - included production techniques and marketing opportunities for Aronia, Beach Plum, Cherry, Ground Cherry, Goldenbeny, Table Grapes, Figs and Hardy Kiwi. 12 farmers/producers attended. Marketing Small Fruits - the series concluded with a workshop focused on marketing small fruits. Topics addressed diversified marketing strategies including online marketing tools/options, marketing and business development planning. Post workshop surveys targeted key areas of concern which will be addressed one on one specific to the producer's knowledge and variety of fiuit/hops to be marketed. 11 farmers/producers attended. Expanding Access to Agriculture Education In partnership with the University of Maryland's Institute of Applied Agriculture (IAA), SMADC Application Due Date Extended to Jan 161!>, 20181 offered two classes in Southern Maryland online and Apply by visiting laa.umd.edu through monthly in-person classes held in Southern Maryland. INAG 205: Analyzing Alternative INSTITUTE V F Agricultural Enterprises and JNAG 132: Agricultural APPLIED AGIUC Ur:ruRE Leadership and Communications. The goal of the Eon, college credits In agriculture from the University of Maryl and remotely In Southam Maryland, during Spring 20181 classes is to provide access to college level agriculture Th• 6ou1hem Mtryl• ndAgrtcultural Oovtlopment CommJu lon (SMAOCI andtl'i• Unlvtnity of Mtryltnd'a lr,t liluta of APPlltd Agrt,ulture (IAAI are bringing two education to Southern Matyland farmers in order to hybrid coursH to Southtrn Ma,ytand In Spring 2018: expand general exposure to a wide variety of career and • INAG205:AnalyzlngAlt•matlv• Ent•rprf111 • JNAG132: Agricultural Lead•11hlp •ndT,amworlt business opportunities in agriculture, and to assist in E"'oll In one o, both of lhtH course, 10 Hm college c,edl11 toward• c,,t1nca1, ! lnAppHt d Agrlcultute or• bachtlor'a degra• at the Unlvenlty of Maryland. developing leaders in Southern Maryland's agriculture community. SMADC used matching funds to offer scholarships for students from Southern Maryland who enrolled in the Fall classes to assist with tuition costs. A po1tion of the RMPIF grant funds will be used to create a free 'lending library' of books in all areas of agriculture to be housed at the SMADC offices. "As a graduating senior at the University ofMmyland during the spring 2018 semester, I've taken many classes through various colleges. In my opinion, the classes offered through the Institute ofApplied Agriculture (IAA), including the two offered by SMADC, are some ofthe most beneficial." - Workshop participant. "This course was different because I got to meet other agriculturally-minded individuals from Southern Maryland. This is a huge benefit because most ofus will likely remain in the area for a long time and having those connections could be important in the future, both as friends and colleagues." - Workshop participant. A total of 9 students enrolled. Pork Producers Workshop The Maryland Pork Producers Association held an informational session presentation covering advertising, market development and on-farm research. 7 local producers attended. 25 SMADC End of Year Report FY'18 American Planning Association Conference SMADC paiticipated in the presentation hosted at Serenity Farms with Farming 4 Hunger. The presentation reviewed the role that planning has played in preserving farm land and the many ways that planning needs to support agriculture to allow for expansion of farming practices as well as protect the safety and welfare of the public as new farm business models continue to evolve. Approximately 45 individuals attended. Get the Job Done - Farm Labor Workshop Speakers from the Maryland Department of Labor covered what's involved in hiring skilled labor for farms with the H-2A and H-2B programs. Topics included application for foreign labor, visas, housing and transpmtation, work hours, wage rates and record-keeping. 18 farmers attended. Food Products and Agritourism Law and Liability Workshop Workshop attendees heard from representatives from insurance companies, UME legal specialist and the Maryland Farmers' Market Association on how to manage legal and insurance risks on their fam1s including sales of farm made foods, hosting farm events and agritourism related activities (weddings, wineries) and more. Two experienced agritourism farms shared their insights. Topics also included insurance for off-farm events such as festivals and liability issues for farmers' markets. 22 farmers/producers attended. Farm Succession Workshop SMADC and the Maiyland Farm Bureau jointly sponsored the workshop presented by The Department of Agricultural and Resource Economics, University of Matyland Extension, The Agriculture Law Education Initiative, the Maryland Department of Agriculture, and Nationwide Insurance. As the farm succession process can be challenging, due to differing family opinions on the future of the farm and other factors, the workshop focused on the succession process, including communication tactics, business planning, estate planning and tax basics. Participants heard from legal, insurance and other experts on what is needed to develop a robust farm succession plan and prepare the next generation to keep the famling operation successful. 12 families attended. Dig It! An Introduction to Farming in Southern Maryland Workshop SMADC held a free workshop for those that are completely new to fanning, or considering farming. The workshop was designed to give participants an inventory of the tools and must-have resources AN IIITRODUCTION TO FARMING IN SOUTHERN MARYLAND to begin their farming journey from the ground up. Attendees heard from beginning farmers who have recently started their farm operations. Representatives and literature from various agricultural support and funding agencies were at the workshop to meet with participants - University of Maryland Extension, Farm Service Agency, Maryland Department of Agriculture and Soil Conservation District. 35 attended. 26 SMADC End of Year Report FY' 18 Common Market Meeting SMADC facilitated a meeting with area farmers who are interested in learning how to sell their produce through a distributor. Attendees learned how to prepare their produce business to become wholesale ready. The Common Market Mid-Atlantic is a mission-driven distributor of sustainable, local farm foods connection with institutions and communities from over 200 producers in Pennsylvania, New Jersey, New York, Delaware, Maryland, and Virginia. 9 farmers/producers attended (4 via WebEX). Southern Maryland Invitational Livestock Expo SMADC has sponsored the SMILE show for 13 consecutive years. The SMADC board places great importance on providing support for educational and networking opportunties for farm and community youth to stimulate interest in agricultural careers aµd incentivize a new generation of farmers. The SMILE livestock show offers a unique combination of education, competition and fun for youth (ages 6 - 21 years) involved in raising livestock and provides an opportunity for them to meet and socialize with i:...----=---...... ------·....i·· regional youth involved in farming. The SMILE Novice Class engaged 10 participants (6 and 7 years old). SMILE's informal show format has attracted· hundreds of kids from all over Southern Maryland to compete with their animals in fitting and showmanship and breed competitions for beef and dairy cows, pigs, sheep, goats, rabbits and guinea pigs. Rabbit and Cavy classes offer urban youth and others who may not have the land and facilities to raise large livestock. The show also includes special presentations, organized games, and group activities. A total of 111 youth.participated in FY'18, representing 5 counties (Anne Arundel, Calvert, Charles, St. Mary's, Montgomery, Queen Anne's and Talbot). 394 animals were shown. "We want kids to learn and enjoy themselves at the same time. The show ring is informal and the judges 11 take the time to give advice and plenty ofencouragement. - Jay Farrell, SMILE Chairman Highlights: • 12 RMPIF/SMADC funded workshops • 8 SMADC sponsored workshops • SMADC sponsored/funded workshops engaged a total of 216 individuals • 111 youth participated in SMILE Livestock Expo 27 SMADC End of Year Report FY' 18 MARYLAND FARMLINK The Maryland FannLINK program and website is designed to help farmers locate farmland for lease and purchase, featuring an interactive Farm Forum for members to exchange ag-related information, find mentors and business partners, find equipment for rent, workshops and educational opportunities happening around the state. The website also hosts a ~, '""' = -~ 'Property Exchange' that provides a two-fold service approach: helping land owners keep their farmland in production and helping farmers (many young and beginning fatmers) find fannland for sale or lease. Over 35 new farm properties were listed for sale or lease on the FarmLINK website in FY'l8. Visits to the FarmLINK website increased during FY'l8, attracting 350 new members. FarmLINK maintains a current calendar of upcoming workshops, events, and other edncational opportunities around the state, averaging 20-30 listings at any time. FannLINK also maintains an 'Everything Ag' page on the website that provides additional resources snch as where to rent equipment around the state, soil mapping infonnation and gnides and tutorials for farmers and realtors selling farmland. The FarmLINK "Weekly Roundup" newsletter was delivered by email to 2,400 subscribers; the newsletter features new listings, posts, and upcoming workshops and events posted to the FarmLINK website. The Matyland FarmLINK program is a benchmark model for others around the state and SMADC is happy to continue to share information and resources, and to partner with other organizations. New Initiatives-In Spring of 2018, SMADC explored a joint venture with the Eastern Shore Land Conservancy to expand the FannLINK Property Exchange and Mentor "\ (/;_ASTERN SHORE Match program. The initiative was approved by the L\V ~AND CONSERV~~- commission in June of 2018 and SMADC looks forward to working with ESLC to further Maryland FarmLINK's reach across the state. SMADC was also approved for additional grant funding for FY' 19 through the Rural Maryland Prosperity Investment Fund (RMPIF) to support a complete redesign of the Mmyland FarmLINK website and creation of new marketing materials. MENTOR MATCH: TRAINING FOR BEGINNING FARMERS A major component ofFarmLINK is the Mentor Match program which pairs experienced farmers (mentors) with new or transitioning farm owners/operators (mentees) for one-on-one training, advice and interaction. The program also hosts workshops, farm tours and educational meetings based on the needs of the mentees. 28 SMADC End of Year Report FY' 18 During FY'l8, there were a total of four mentees in the Mentor Match Program. Mentors have specific experience with Southern Maryland climate/soils, where to locate resources and farm supplies, and pest and disease issues specific to the region. Mentors conimented that they have been able to provide guidance primarily on proper equipment, planting schedules and varieties for those starting or diversifying their operations. A mentee from Anne Arundel County said this about her mentor during the program, "Thank you again for pairing me up ·with Dicot Farm. [visited their farm again on Friday and stayedfor an awesome dinner. Their high tunnel tomatoes are well underway right now and it was really great seeing their system in person. " Mentor Match is currently only offered to residents of Southern Ma1yland. Subsequent to the Mentor Match no longer being offered state-wide in 2016, Future Harvest CASA expanded their Beginning Farmer Training program to offer Level 3 training in 2017, which expanded Mentor Match again to be a state-wide program. SMADC believes it is a worthwhile program and is enthusiastic that regional partners are able to continue this important resource to farmers state-wide. SM;ADC also hosted a 'Dig It! Introduction to Farming in Southern Maryland' workshop in February of 2018 that was open to the public and mentees in both Mentor Match programs. The free workshop was designed to give participants an invento1y of the tools and must-have resources to begin their fanning journey. 35 attended, including several FarmLINK mentees. Highlights: • New Partnership with Eastern Shore Land Conservancy launched • Approved FY' 19 funding through the Rural Maiyland Prosperity Investment Fund • Over 350 new members signed-up for the FarmLINK website and the "Weekly Roundup" • 52 Ma1yland Farm.LINK "Weekly Roundup" newsletters delivered to 2,400 subscribers • 13 blog posts published • 4 Mentor/Match farm enterprises facilitated • 1 workshop for the Mentor Match program hosted • 35 new/beginning farmers engaged - FarmLINK "Dig It" Introduction to Farming Workshop 29. SMADC End of Year Report FY' 18 SOUTHERN MARYLAND AGRICULTURAL DEVELOPMENT COMMISSION Southern Maryland Regional Agricultural Strategy 2012-2020 MEASURING FOR RESULTS FY' 18 GOAL 1: THRIVING, MARKET-DRIVEN FARMS THAT HAVE THE RESOURCES TO BE PROFITABLE Resources for Profitability Southern Maryland Meats (SMM): • 102,084 lbs processed meat transported estimated retail value $559, I 64. • 40 producers participate in SMM ( 4 new in FY' 18). • 32 youth sign up for FY'18/19 SMM Junior Promotion. (21 new) • 5 SMM workshops attract 107 producers. Value Added Agriculture: • 7 new on-farm processor meat licenses facilitated. • 4 on-farm acidified foods annual process reviews facilitated. • 2 meat slaughter/process facilities SOP/HACCP plans in development • 1 dairy food safety workshop facilitated. Maryland Buy Local Challenge (BLC): • 60,000 SMADC/BLC fliers distributed statewide. • 600 attend the SMADC/BLC Event. • 45 fann vendors featured at SMADC/Event. • SMADC Social Media platforms and ADs reached a combined audience over 1 million people. GOAL 2: FARMLAND PRESERVATION AND ENVIRONMENTAL STEWARDSHIP Increased acres under farmland preservation Agricultural Land Preservation: • Four farms totaling 635 acres have been directly preserved by the program in four counties of Southern Maryland in FY' 18, resulting in 17,631 acres cumulative over the 16 years of program funding (with only SMADC program funds). • 357 farms containing 40,357 acres have been cumulatively preserved in Southern Maryland (SMADC and leveraged funds by the counties). Farm Share Equipment: • In FY' 18, 1,610 acres positively impacted by conservation tillage across the five counties. • 36 pieces of equipment are in invento1y and available for farmers to rent across the region. 30 SMADC End of Year Report FY' 18 GOAL 3: A FUTURE WHERE PROFITABLE FARMS PLAY AN INTEGRAL ROLE IN OUR COMMUNITY (FARMS, FOOD, COMMUNITY) Enhanced awareness of the beneficial role farms provide Measurement: Track the number ofchildren that participate in SMILE SMILE: • 111 youth participated from 7 counties (Anne Arnndel, Calvert, Charles, St. Ma1y's, Montgomery, Queen Anne and Talbot). Increase the number of new farmer enterprises • 4 Mentor/Match farm ente1prises facilitated in FY' 18 • 7 new on-farm processor meat licenses facilitated. • 71 agricultural businesses (5 new in FY'l8) listed in 2017/18 Farms or the Holidays Guide. • 281 farms including equine/horse businesses (59 new in FY'18) engaged through SMADC websites, guides, p1:ograms, promotions and services. Maiyland FarmLINK: • Over 350 new members signed-up for the FarmLJNK website and Weekly Roundup newsletter. • 2,400 subscribers receive FarmLJNK "Weekly Roundup" newsletters. • 4 Mentor/Match farm enterprises facilitated. • 35 new/beginning farmers engaged- FarmLJNK "Dig It" Introduction to Farming Workshop For more information regarding this program, please contact: Southern Ma1yland Agricultural Development Commission P.O. Box 745, Hughesville, MD, 20637 Telephone: 301-274-1922 xl [email protected] www.smadc.com SMADC Staff: Shelby Watson-Hampton, Director Craig Sewell, Livestock & Marketing Specialist Cia Morey, Administrator Susan McQuilkin, Marketing Executive Karyn Owens, Food Programs Coordinator Jean Burke, Grant Coordinator 31