Promoting Tobacco-Free School Policies Through a Statewide Media Campaign

Background:  Comprehensive, enforced tobacco-free school (TFS) policies lead to significant reductions in youth tobacco use. North Carolina is the first state in the United States to develop a statewide mass media campaign to promote the adoption of and compliance with TFS policies.
Methods:  In order to guide campaign development, researchers conducted a literature review as well as interviews with 45 TFS-policy experts, stakeholders, and North Carolina legislators. The experts included state and national TFS researchers and advocates, and the majority of stakeholders were North Carolina school administrators and personnel selected because of their personal knowledge of and experience with TFS policy. Interviewees provided information on messages they believed would be most salient to highlight in the media campaign and the best type of people to appear in ads.
Results:  Recommended themes included (1) a positive message about TFS becoming the norm in the state, (2) experiences of school districts that had successfully passed TFS policies, (3) the importance of adult role modeling, and (4) personal stories from youth about the importance of TFS policy. Recommended people to appear in ads included youth and adults with a personal connection to and experience with TFS policy. Using these recommended themes and people, the TFS media campaign began in the fall of 2006. In the 8 months following the campaign launch, 9 additional school districts adopted TFS policies, increasing the total from 78 to 87 (out of 115) by June 2007. In July 2007, the North Carolina legislature passed legislation mandating that all school districts adopt TFS policies by August 2008.
Conclusions:  Media campaigns can serve as part of a comprehensive strategy to advance TFS policies. Other states should consider these results in designing and evaluating a media campaign to promote adoption of and compliance with TFS policies.     

Passage of 100% tobacco-free school policies in 14 North Carolina school districts

Though comprehensive tobacco-free school policies constitute an important component of state tobacco control efforts, little research exists about their adoption process. In the past two years, efforts occurred in North Carolina to increase the number of school districts adopting 100% tobacco-free school policies. As part of the North Carolina Youth Empowerment Study (NC-YES), researchers developed a school tobacco policy interview guide to conduct interviews with 40 key people (e.g., school board member, principal, etc.) in each of 14 school districts that adopted a 100% tobacco-free school policy by the end of 2001. Results showed seven districts adopted their school policy in the past two years. Seven themes emerged: 1) Catalysts: Local adult and youth "champions" facilitated policy change; 2) Process of Adoption: Most school policies were adopted with an administrator or other adult initiating the change, but youth involvement increased in recent years; 3) Methods of Adoption: Advocates personalized health concerns by focusing on children and role modeling by adults; 4) Political Leadership: Governors of North Carolina, through letters to school districts and a policy summit, played an important role in stimulating policy change; 5) Barriers to Adoption: Concerns expressed before policy adoption, about teacher attrition or inability to enforce the policy, did not occur as feared; 6) Enforcement Issues: A key to policy enforcement involved being consistent, supportive, and firm; and 7) Economics of Tobacco Farming/Manufacturing: Though a local tobacco economy did little to influence policy adoption, districts that adopted policies were not located in counties with heavy tobacco production. Public health advocates may use this information to encourage school districts to adopt 100% tobacco-free school policies.     

Implementation of school policies to prevent youth tobacco use in Alabama

BACKGROUND: Public health professionals must monitor the effectiveness of school policies and programs to prevent youth initiation, promote quitting, and eliminate secondhand smoke. This analysis of school tobacco policies was preliminary to release of a state tobacco prevention and control plan for 2010‐2015. METHODS: University health educators collaborated with the state health agency to review policies of 33 school systems in 5 Metropolitan Statistical Areas and 9 public health areas. Authors developed a systematic approach of 8 steps useful to rate implementation of school tobacco control and prevention policies and discuss implications for health education program planning. RESULTS: Thirty school policies prohibited possession and use of tobacco by students, faculty and campus visitors, and 26 of 33 specified disciplinary measures following violations. Only 4 public education agencies included 3 of the 6 elements of a model tobacco prevention and control policy as suggested by the state public health agency. None featured all 6 elements. None specified establishing school‐community partnerships for tobacco prevention and control. CONCLUSIONS: Preparing smoke‐free youth requires implementing and evaluating tobacco education in grades K‐12 including use of model guidelines from federal agencies and professional organizations. Determining the focus of existing school tobacco policies is an initial step to encourage adoption of comprehensive policies to reduce youth use of tobacco. Youth health advocates may act together with school administrators and legislators to strengthen policies to be consistent with model guidelines for tobacco prevention and control.     

The North Carolina Youth Empowerment Study (NCYES): a participatory research study examining the impact of youth empowerment for tobacco use prevention.

This article describes the North Carolina Youth Empowerment Study (NC YES), a 3-year participatory evaluation of youth programs addressing tobacco use prevention. The study goals of NC YES were to (1) convene an advisory board comprised of lay youths and adults in a participatory research process, (2) document the characteristics of youth programs for tobacco use prevention and control in North Carolina, and (3) track the role of youth involvement in initiating and implementing 100% tobacco-free policies in local school districts. The NC YES Statewide Advisory Board helped guide the evaluation process, reviewed study protocols and data collection instruments, and helped interpret preliminary findings. Both quantitative and qualitative methods(e.g., telephone interviews and written questionnaires) were used to gather data from youth and adult leaders to achieve these aims. Lessons learned about the process of conducting participatory evaluation approaches and summary findings about the role of youths in policy advocacy efforts are presented.     

The Relationship Between School Policies and Youth Tobacco Use*

BACKGROUND: The school setting is frequently used both to educate youth about risks involved in tobacco use and to implement tobacco prevention and cessation programs. Given that school‐based programs have resulted in limited success, it is necessary to identify other setting‐level intervention strategies. School tobacco policies represent a type of universal intervention that might have some promise for preventing or reducing tobacco use. METHODS: Hierarchical linear modeling was used to assess whether school tobacco policies were related to observations of tobacco use and current smoking among 16,561 seventh through twelfth graders attending 40 middle and high schools in Illinois. RESULTS: Results indicated that the enforcement of school tobacco policies, but not the comprehensiveness of those policies, was associated with fewer observations of tobacco use by minors on school grounds as well as lower rates of current smoking among students. CONCLUSIONS: The school setting is a key system to impact youth tobacco use. Findings underscore the need to train school personnel to enforce school tobacco policy.     

A Framework for Mobilizing Communities to Advance Local Tobacco Control Policy: The Los Angeles County Experience

The Los Angeles County Tobacco Control and Prevention Program was significantly restructured in 2004 to improve capacity for local policy adoption. Restructuring included creating a fully staffed and trained policy unit; partnering with state-funded tobacco control organizations to provide high-quality, continuous technical assistance and training; implementing a highly structured policy adoption approach; expanding community capacity building; and establishing local coalitions to mobilize communities. Over the ensuing 6 years (2004–2010), 97 tobacco control policies were enacted in the county’s 88 cities and unincorporated area, including 79 that were attributable to the program. By comparison, only 15 policies were enacted from 1998 to 2003. Expanding policy adoption capacity through program restructuring may be achievable in other local jurisdictions.

KEY FINDINGS

• ▪From 2004 to 2010, 97 tobacco control policies were enacted in Los Angeles County’s 88 cities and unincorporated area, including 79 attributable to the program (only 15 policies were enacted from 1998 to 2003).
• ▪Increases in tobacco policy adoptions were attributed to the comprehensive restructuring efforts, including creating a Policy and Planning Unit, establishing key partnerships to provide technical assistance and training, extensive capacity building, use of policy organizing tools, and forming coalitions to mobilize communities.

Municipal-level tobacco control policies, such as indoor and outdoor smoking restrictions, play a vital role in local tobacco prevention and control efforts as well as in building grass roots support for state legislation.1 In 2004, the Los Angeles County Department of Public Health''s Tobacco Control and Prevention Program (TCPP) embarked on a comprehensive restructuring to focus its tobacco control efforts on local policy adoption in the county, a jurisdiction that has 88 cities and a large unincorporated area. We describe the elements of this transformation process and the lessons learned.     

Strength and comprehensiveness of district school wellness policies predict policy implementation at the school level

BACKGROUND: In 2006, all local education agencies in the United States participating in federal school meal programs were required to establish school wellness policies. This study documented the strength and comprehensiveness of 1 state's written district policies using a coding tool, and tested whether these traits predicted school‐level implementation and practices. METHODS: School wellness policies from 151 Connecticut districts were evaluated. School principal surveys were collected before and after the writing and expected implementation of wellness policies. Sociodemographic variables were assessed for each district, including enrollment, population density, political climate, racial composition, and socioeconomic status. Changes in school‐level policy implementation before and after the federal wellness policy mandate were compared across districts by wellness policy strength; policies were compared based on district‐level demographics. RESULTS: Statewide, more complete implementation of nutrition and physical activity policies at the school level was reported after adoption of written policies. Districts with stronger, more comprehensive policies were more successful in implementing them at the school level. Some sociodemographic characteristics predicted the strength of wellness policies. CONCLUSIONS: Written school wellness policies have the potential to promote significant improvements in the school environment. Future regulation of school wellness policies should focus on the importance of writing strong and comprehensive policies.     

Evaluating the Strength of School Tobacco Policies: The Development of a Practical Rating System

BACKGROUND: School tobacco control policies vary widely in their strength, extensiveness, and enforcement. Currently, no standardized method exists to assess the comprehensiveness of school tobacco policies. The purpose of this study was to develop a new practical rating system for school tobacco policies, assess its reliability, and present preliminary validation data.
METHODS: This study presents the systematic development of a rating system to assess the strength of school tobacco policies. Based on the empirical literature and the expertise of an advisory panel consisting of educational leaders and tobacco control advocates and practitioners, a "gold standard" school tobacco policy was developed and guided the content of the 40-point rating system. The 4 domains of the School Tobacco Policy Index were: Tobacco-free environment (14 points), Enforcement (12 points), Prevention and treatment services (6 points), and Policy organization (8 points).
RESULTS: The Index was pilot-tested using 95 Missouri public school district tobacco policies and proved to be highly reliable among coders. The evaluated policies varied greatly between school districts, with the lowest total policy score of φ and the highest score of 21. School district policy scores were significantly related to a number of county-level tobacco policy characteristics, including support for a tobacco excise tax increase.
CONCLUSIONS: The Index is a user-friendly, practical tool for tobacco control professionals and educators, providing them with the ability to easily evaluate their own school policies. Their evaluation efforts will be useful in strengthening existing policies and developing new comprehensive policies to protect the health of students, staff, administrators, and visitors.     

A review of school drug policies and their impact on youth substance use

Youth substance use is an important social and health problem in the United States, Australia and other Western nations. Schools are recognized as important sites for prevention efforts and school substance use policies are a key component of health promotion in schools. The first part of this paper reviews the known status of school policies on tobacco, alcohol and other illicit drugs in a number of Western countries and the existing evidence for the effectiveness of school drug policy in preventing drug use. The review shows that most schools in developed countries have substance use policies but that there is substantial variation in the comprehensiveness of these policies (i.e. the breadth of people, places and times of day that are explicitly subject to policy prohibitions), and the orientation of their enforcement (e.g. punitive versus remedial), both across and within schools. The few studies of policy impact focus solely on tobacco policy and provide preliminary evidence that more comprehensive and strictly enforced school policies are associated with less smoking. The second part of the paper introduces the International Youth Development Study, a new longitudinal research project aimed at comparing school policies and the developmental course of youth drug use in the United States, where drug policies are abstinence-based, with Australia, which has adopted a harm minimization approach to drug policy.     

Evaluation of Alabama public school wellness policies and state school mandate implementation

BACKGROUND: This study evaluated wellness policies created by Alabama public school districts and progress made in the implementation of Alabama State Department of Education (ALSDE) school food and nutrition mandates. METHODS: Wellness policies from Alabama public school districts were compared to minimum requirements under the Child Nutrition and Women, Infants, and Children (WIC) Reauthorization Act of 2004. Additionally, data were analyzed from a survey of school district superintendents regarding compliance with ALSDE mandates. Districts were graded based on the percentage of 7 components addressed in wellness policies, and on the percentage of ALSDE mandates implemented. RESULTS: The majority of school districts (71%) were in compliance with all federal wellness policy requirements. An average 6.4 components were addressed, for a mean score of 92%. Mean implementation of ALSDE mandates was 79%; only 7% of districts indicated implementing all of the mandates. No significant differences were found in federal wellness policy or ALSDE mandate compliance scores based on district type, enrollment, percentage of students eligible for free and reduced‐price meals, use of an environmental assessment survey, and use of wellness committee and a nutrition professional during policy development. CONCLUSIONS: The majority of Alabama school districts created school wellness policies with appropriate content. This does not, however, guarantee effective policies. School districts have not done as well implementing ALSDE mandates, demonstrating delay between policy creation and implementation. Future research is needed regarding progress the school districts make in the implementation of school health policy and on factors influencing that progress.     

Rating the Effectiveness of Local Tobacco Policies for Reducing Youth Smoking

Important questions remain regarding the effectiveness of local tobacco policies for preventing and reducing youth tobacco use and the relative importance of these policies. The aims of this paper are to: (1) compare policy effectiveness ratings provided by researchers and tobacco prevention specialists for individual local tobacco policies, and (2) develop and describe a systematic approach to score communities for locally-implemented tobacco policies. We reviewed municipal codes of 50 California communities to identify local tobacco regulations in five sub-domains. We then developed an instrument to rate the effectiveness of these policies and administered it to an expert panel of 40 tobacco researchers and specialists. We compared mean policy effectiveness ratings obtained from researchers and prevention specialists and used it to score the 50 communities. High inter-rater reliabilities obtained for each sub-domain indicated substantial agreement among the raters about relative policy effectiveness. Results showed that, although researchers and prevention specialists differed on the mean levels of policy ratings, their relative rank ordering of the effectiveness of policy sub-domains were very similar. While both researchers and prevention specialists viewed local outdoor clean air policies as least effective in preventing and reducing youth cigarette smoking, they rated tobacco sales policies and advertising and promotion as more effective than the other policies. Moreover, we found high correlations between community scores generated from researchers’ and prevention specialists’ ratings. This approach can be used to inform research on local policies and prevention efforts and help bridge the gap between research and practice.     

School wellness policies: perceptions, barriers, and needs among school leaders and wellness advocates

BACKGROUND: School wellness policies are a key component to the prevention of adolescent obesity. This national research study sought to understand the wellness environment in school districts across the country and to identify challenges districts face and needs they have in order to effectively implement, monitor, and evaluate school wellness policies. The study determined (1) perceptions, barriers, and opportunities regarding the development, implementation, and monitoring/evaluation of school wellness policies among school board members, state school boards association leaders, state public health nutrition directors, and school wellness advocates; (2) the readiness and capacity of survey groups to address nutrition and physical activity policies; (3) the extent to which survey groups collaborate; and (4) the acceptability of wellness tools. METHODS: In 2006, over 2900 individuals participated in online surveys, focus groups, and key informant interviews. School board members represented 1296 school districts across the nation. RESULTS: School board members expressed the highest level of confidence among all survey groups that their district has the capacity to develop, implement, and monitor/ evaluate the wellness policy. The disparities among groups are most notable with regard to perceptions of district capacity to monitor/evaluate the policy. School board members are interested in school wellness policy tools and trainings. CONCLUSIONS: There is an opportunity for state school boards associations, state public health nutrition directors, and school wellness advocates to build their own capacity to provide training and resources to districts on wellness issues, particularly physical education/activity, school-based wellness initiatives, and strategies for implementing and monitoring/evaluating wellness policies.     

Tobacco-free Schools In Minnesota

Since 1985, Minnesota schools have participated in an intensive, statewide effort to reduce tobacco use among adolescents through a variety of prevention efforts. This article describes the "Tobacco-Free Schools" project, one component of the effort that encourages school districts to adopt policies which prohibit tobacco use for students, staff, and visitors. Tobacco-free policies contribute to comfortable, healthy working and learning environments for students and staff. In addition, tobacco use prevention education is more likely to be effective when health education programs, adult models, and school policies offer the consistent message that tobacco use is unhealthy and unacceptable. From January 1987 to January 1988, the percentage of tobacco-free school districts in Minnesota increased from 3% to 43%, demonstrating that tobacco-free policies can have mass appeal to local schools and communities.     

The strength of school wellness policies: one state's experience

BACKGROUND: This study examines the results of federal legislation on the content and quality of policies written in 2005-2006 by Utah school districts (n = 30). METHODS: Policies were gathered by phone call requests to school districts or obtained on district Web pages. Content was compared to requirements outlined in the Child Nutrition Reauthorization Act (CNRA) of 2004 and recommendations made by a state coalition of health and education agencies. The strength of the language was assessed (mandate vs recommendation), and characteristics of school districts that adopted strong policies were identified. RESULTS: The majority of Utah school districts (78%) complied with the federal guidelines, and a variety of state recommended nutrition and physical activity policy statements were included. The strength of the language used in the policies revealed that districts were more likely to mandate items already required by other entities or well established in the district. School districts with high participation in free- and reduced-price programs had significantly more mandatory policies (mean = 9.2) versus low (mean = 7.1) and medium enrollment (mean = 4.7). Urban school districts were more likely to indicate mandatory competitive food policies than rural and suburban (mean = 2.3 vs 0.93, 0.83). There were no differences in policy language between school districts based on race or size. CONCLUSIONS: Compliance with the CNRA may be a positive step toward improving the school nutrition and physical activity environment, but it does not ensure a comprehensive or powerful policy. Schools and community partners must continue to work together to strengthen wellness policies and programs.     

The Colorado Tobacco-Free Schools and Communities Project

ABSTRACT: This article defends the appropriateness of tobacco-free school policies as an effective tool toward ensuring young people develop into healthy and intellectually strong adults, and demonstrates how such a policy can be introduced into a school district. Health education efforts to eliminate tobacco use are widely considered more effective when carried out in concert with school policies and adult role models offering the consistent message that tobacco use is unhealthy and unacceptable. Studies indicate students who attend schools with strict smoking policies are less likely to begin smoking than students who attend schools without such policies. Through research, support, and guidance, the Colorado Tobacco-Free Schools and Communities Project successfully has assisted almost half the 176 school districts in Colorado to adopt such policies.     

Middle school students' perceived access to cigarettes in Virginia

OBJECTIVE: To examine correlates of perceived access to cigarettes at home, school, and the store among youth. METHODS: Virginia middle school youth were surveyed before beginning tobacco prevention programs. Multivariate analyses examined household smoking, peer smoking, and perceived community tobacco use for their relationship to perceived access at home, school, and the store. RESULTS: Perceived access at home was associated with parent, sibling, and friend smoking. Perceived access at school and stores was associated with perceived peer and community smoking. CONCLUSIONS: Youth tobacco prevention programs should target the commercial and social sources of tobacco access to reduce experimentation, adoption, and addiction among youth.     

Association of the presence of state and district health education policies with school tobacco prevention program practices

BACKGROUND: Texas does not require health education or tobacco use prevention education (TUPE) in its middle schools. During planning for the Texas Tobacco Prevention Initiative, this baseline research was conducted to (1) describe tobacco prevention and control practices in middle schools prior to the pilot, (2) analyze implementation of a state law prohibiting tobacco use on campuses and at school events, and (3) identify how schools are influenced by district policies requiring health education. METHODS: Written surveys derived from the 2000 School Health Education Profile Tobacco Module developed by the Centers for Disease Control and Prevention were completed by principals and health coordinators at schools in districts requiring health education (n = 31) and schools without district requirements (n = 32). RESULTS: School tobacco policy familiarity and enforcement were consistently reported in response to a state law with rigorous recommendations prohibiting tobacco use. Significantly more activity in numerous components of TUPE was reported in schools in districts with a health education requirement. CONCLUSIONS: Results have implications for intervention programs planned in schools located in states seeking to develop or strengthen state laws, or in states without health education or specific health content requirements.     

Diffusion of an effective tobacco prevention program. Part I: Evaluation of the dissemination phase

As health promotion methods are proven effective, the diffusion and widespread implementation of successful programs can significantly reduce behaviors that pose risks to health within a targeted population. The Smart Choices Diffusion Project developed and evaluated a dissemination intervention program that targeted 128 school districts in east Texas. The project employed a theory-based model to disseminate information about a proven tobacco prevention program to opinion leaders in each district. These opinion leaders were asked to personally communicate the program information within their district using a videotape and printed materials, and advocate for program adoption. In addition to personal communication, a newsletter linked school districts. Opinion leaders in 52% of the districts showed the videotape, which modeled program adoption. A quasi-experimental design was used to evaluate the impact of the dissemination phase on teachers' and administrators' readiness to adopt a tobacco prevention program. Evaluation of the dissemination phase revealed no differences between the intervention and comparison districts in a district's readiness to adopt a tobacco prevention program. However, in intervention districts where school administrators viewed the videotape, the administrators were more likely to perceive the innovative program as having a relative advantage and to perceive their district's organizational and social environment as supportive of adopting the program.