A Statewide Movement to Promote the Adoption of Tobacco‐Free School Policies*

BACKGROUND: Since most tobacco users become addicted to nicotine as teenagers, prevention efforts for youth remain central to comprehensive prevention programs. National and state efforts that encourage adoption and enforcement of comprehensive tobacco‐free school (TFS) policies can lead to significant reductions of youth tobacco use. In 2003, North Carolina (NC) Health and Wellness Trust Fund grantees began to focus statewide on the adoption of and compliance with TFS policies in NC schools. This study examined 46 NC districts that passed TFS policies between 2003 and early August of 2005 to see what factors were important in policy passage in order to support the continued promotion of TFS policy adoption across the state. METHODS: Detailed interviews were conducted with 118 key informants who were intimately involved with passage of their school districts’ TFS policies, and results were coded and analyzed for common themes. RESULTS: The study found several strategies key to adoption of TFS policies: effective leadership from organizations and individuals in positions of influence, grassroots organizing from community coalitions and youth groups, and communication strategies that optimally position policy adoption and compliance. CONCLUSION: States that have not yet achieved TFS policy adoption can focus on leadership development, grassroots organizing, and improved communication to advance their advocacy efforts.     

Funding of North Carolina tobacco control programs through the Master Settlement Agreement

Changing political and economic forces in 1 tobacco-dependent state, North Carolina, demonstrate how the interplay between these forces and public health priorities has shaped current allocation of Master Settlement Agreement funds. Allocation patterns demonstrate lawmakers' changing priorities in response to changes in the economic climate; some of the agreement's funds targeted to tobacco farmers appear to reflect objectives favored by tobacco manufacturers. Funds earmarked for health have underfunded youth tobacco prevention and tobacco control initiatives, and spending for tobacco farmers in North Carolina has not lived up to the rhetoric that accompanied the original agreement. We discuss the implications of these findings for future partnerships between public health advocates and workers as well as tobacco control strategies.     

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.     

Tobacco industry youth smoking prevention programs: protecting the industry and hurting tobacco control

OBJECTIVES: This report describes the history, true goals, and effects of tobacco industry-sponsored youth smoking prevention programs. METHODS: We analyzed previously-secret tobacco industry documents. RESULTS: The industry started these programs in the 1980s to forestall legislation that would restrict industry activities. Industry programs portray smoking as an adult choice and fail to discuss how tobacco advertising promotes smoking or the health dangers of smoking. The industry has used these programs to fight taxes, clean-indoor-air laws, and marketing restrictions worldwide. There is no evidence that these programs decrease smoking among youths. CONCLUSIONS: Tobacco industry youth programs do more harm than good for tobacco control. The tobacco industry should not be allowed to run or directly fund youth smoking prevention programs.     

Applying community-based participatory research principles to the development of a smoking-cessation program for American Indian teens: "telling our story".

Community-based participatory research provides communities and researchers with opportunities to develop interventions that are effective as well as acceptable and culturally competent. The present project responds to the voices of the North Carolina American Indian (AI) community and the desire for their youth to recognize tobacco addiction and commercial cigarette smoking as debilitating to their health and future. Seven community-based participatory principles led to the AI adaptation of the Not On Tobacco teen-smoking-cessation program and fostered sound research and meaningful results among an historically exploited population. Success was attributed to values-driven, community-based principles that (a) assured recognition of a community-driven need, (b) built on strengths of the tribes, (c) nurtured partnerships in all project phases, (d) integrated the community's cultural knowledge, (e) produced mutually beneficial tools/products, (f) built capacity through co-learning and empowerment, (g) used an iterative process of development, and (h) shared findings/ knowledge with all partners.     

Ethnic disparities in youth access to tobacco: California statewide results, 1999-2003

The authors examined the role of youth ethnicity in youth access to tobacco with large, random samples of stores and large samples of ethnically diverse youths for the first time. From 1999 through 2003, White, Black, Latino, and Asian youths made 3,361 cigarette purchase attempts (approximately 700 per year) statewide. Analyses revealed that Black youths had significantly higher access than other youths and that access rates for Black and Asian (but not Latino or White) youths exceeded the Synar-mandated < or = 20%. Clerks who failed to demand youth proof of age identification (ID) sold 95% of the tobacco that youths received and sold significantly more often to minorities and to girls, whereas clerks who demanded youth ID sold equally infrequently to all youths. These findings highlight significant ethnic disparities in youth access to tobacco and imply that those might be eliminated by policies and interventions that increase clerk demands for youth ID.     

Planning for the North Carolina healthy homes initiative

Substandard housing conditions have been linked to widespread childhood environmental health ailments, including two of the leading causes of childhood morbidity: lead poisoning and asthma. In 2009, the United States Surgeon General called for action around healthy homes. Improving home health environments can alleviate the cycle of childhood morbidity and mortality. The North Carolina (NC) Department of Environment and Natural Resources Children's Environmental Health Branch is working to build capacity at the State level to expand the childhood lead poisoning prevention program to respond to additional in-home environmental health issues. To achieve this objective, North Carolina must consider recommendations for assessment, management, and evaluation. This paper will situate healthy homes on the national public health agenda; discuss ways that healthy homes programs address children's environmental health disparities; introduce the NC Healthy Homes Initiative; explore current healthy housing efforts in North Carolina through an examination of the Guilford County Healthy Homes Initiative; and provide recommendations for the NC Healthy Homes Initiative to address children's environmental health disparities.     

Attempts to undermine tobacco control: tobacco industry "youth smoking prevention" programs to undermine meaningful tobacco control in Latin America

We sought to understand how the tobacco industry uses "youth smoking prevention" programs in Latin America. We analyzed tobacco industry documents, so-called "social reports," media reports, and material provided by Latin American public health advocates. Since the early 1990s, multinational tobacco companies have promoted "youth smoking prevention" programs as part of their "Corporate Social Responsibility" campaigns. The companies also partnered with third-party allies in Latin America, most notably nonprofit educational organizations and education and health ministries. Even though there is no evidence that these programs reduce smoking among youths, they have met the industry's goal of portraying the companies as concerned corporate citizens and undermining effective tobacco control interventions that are required by the World Health Organization Framework Convention on Tobacco Control.     

Culturally Grounded Prevention for Minority Youth Populations: A Systematic Review of the Literature

Contemporary prevention science has focused on the application of cultural adaptations of evidence-based prevention programs for minority youth populations. Far less is known about culturally grounded methods that are intended to organically develop prevention programs within specific populations and communities. This article systematically reviews recent literature on culturally grounded interventions used to prevent health disparities in ethnic minority youth populations. In this review, we assessed 31 peer-reviewed articles published in 2003 or later that fit inclusionary criteria pertaining to the development and evaluation of culturally grounded prevention programs. The evaluated studies indicated different approaches toward cultural grounding, as well as specific populations, geographic regions, and health issues that have been targeted. Specifically, the findings indicated that most of the studies focused on the development and evaluation of culturally grounded HIV/STI and substance abuse prevention programs for Mexican–American, African American, and American Indian/Alaska Native youth residing in the South or Southwestern US. These studies largely relied on community-based participatory or qualitative research methods to develop programs from the “ground up.” This review has implications for the development of future culturally grounded and culturally adapted prevention programs targeting underserved minority youth populations and geographic regions. Specifically, it identifies populations and regions where culturally grounded prevention efforts are underdeveloped or non-existent, providing some scientific direction for the future development of these types of programs.     

Tobacco use among students aged 13-15 years--Kurdistan Region, Iraq, 2005

Tobacco use is one of the major preventable causes of premature death and disease in the world. The Global Youth Tobacco Survey (GYTS), part of the Global Tobacco Surveillance System initiated by the World Health Organization (WHO), CDC, and the Canadian Public Health Association, was developed to monitor tobacco use, attitudes about tobacco, and exposure to secondhand smoke among youths and has been conducted in 140 countries. This report presents findings from the GYTS conducted in the Kurdistan region of Iraq (i.e., Irbil, as-Sulaymaniyah, and Dahuk governorates) in 2005, which revealed that one in 10 students currently smoked cigarettes or used other tobacco products. Boys (21%) were statistically significantly more likely than girls (2.1%) to smoke cigarettes, but no significant difference was observed between boys and girls in their use of other tobacco products. Public health authorities in the Kurdistan Region of Iraq can use the baseline information from the GYTS to design and implement tobacco-control programs to reduce youth smoking.     

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.     

Longitudinal Outcomes of an Alcohol Abuse Prevention Program for Urban Adolescents

PurposeThis randomized clinical trial examined longitudinal outcomes from an alcohol abuse prevention program aimed at urban youths.MethodsStudy participants were an ethnically and racially heterogeneous sample of early adolescents, recruited from community-based agencies in greater New York City and its environs. Once they assented to study participation and gained parental permission, youths were divided into three arms: youth intervention delivered by CD-ROM (CD), the same youth intervention plus parent intervention (CD_P), and control. Once all youths completed baseline measures, those in CD and CD_P arms received a computerized 10-session alcohol abuse prevention program. Parents of youths in the CD_P arm received supplemental materials to support and strengthen their children's learning. All youths completed postintervention and annual follow-up measures, and CD- and CD_P-arm participants received annual booster intervention sessions.ResultsSeven years following postintervention testing and relative to control-arm youths, youths in CD and CD_P arms reported less alcohol use, cigarette use, binge drinking, and peer pressure to drink; fewer drinking friends; greater refusal of alcohol use opportunities; and lower intentions to drink. No differences were observed between CD and CD_P arms.ConclusionsStudy findings lend support to the potential of computerized, skills-based prevention programs to help urban youth reduce their risks for underage drinking.     

Getting to social action: the Youth Empowerment Strategies (YES!) project

This article describes the social action component of the Youth Empowerment Strategies (YES!) project funded by the Centers for Disease Control and Prevention through its community-based prevention research (CBPR) initiative. YES! is designed to promote problem-solving skills, social action, and civic participation among underserved elementary and middle school youth. The after-school program focuses on identifying and building youths' capacities and strengths as a means of ultimately decreasing rates of alcohol, tobacco, and other drug use and other risky behaviors. The article discusses the conceptual models of risk and intervention and factors contributing to successful social action work, including group dynamics, intragroup leadership, facilitator skills, and school-community contexts. Attention is focused on how the nature of the projects themselves played a key role in determining the likelihood of experiencing success. Implications and recommendations for other youth-focused empowerment education projects are discussed, including the effective use of Photovoice in such projects.     

Predictors of Alcohol Use Among Rural Adolescents

There is increasing evidence that alcohol use is becoming more common during childhood and early adolescence. However, little is known about alcohol use among rural youths. This article reports a study of alcohol use among 367 fifth-grade students in two rural South Carolina school districts. More than one third (n = 131) of the fifth graders reported having used alcohol. Of these, 34 percent (n = 44) reported drinking during the previous month; 8 percent had been intoxicated during the previous two months; and 54 percent reported drinking in the home with or without parental approval. Logistic regression analysis was used to determine the predictors of alcohol use by fifth graders. The results indicated that gender (OR = 2.82), mother's alcohol use (OR = 1.86), father's alcohol use (OR = 2.13), and smoking (OR = 8.30) were significantly associated with alcohol use. The findings suggest that prevention programs address cigarette smoking and drinking behaviors of parents to reduce alcohol use and the acquisition of other health compromising behavior by youths. Early intervention approaches must go beyond the schools and target families as well as community populations.     

Perceived risks and benefits of alcohol,cigarette, and drug use among urban low-income African-American early adolescents.

Perceptions about drugs and the social environment may be important influences on cigarette, alcohol and drug use, yet little is known regarding the perspective of early adolescent boys and girls, especially among minority urban youths. Among 351 African-American low-income urban youth, 9 through 15 years of age, completing a community-based computerized questionnaire, 25% acknowledged alcohol, cigarette, and/or illicit drug use in the past 6 months; 19% expected to use one of those substances in the next 6 months. Family exposure to drugs increased the likelihood that youths expected to use drugs by factors of 4.5 (boys) and 2.5 (girls). Other factors (feelings about drugs, community drug use, long-term expectations) distinguished users from nonusers or had different associations with use in boys and girls. Gender-specific perceptions about drugs may have the potential to be modified in drug and substance use prevention programs.     

Guidelines for School Health Programs to Prevent Tobacco Use and Addiction

ABSTRACT: Tobacco use is the leading cause of preventable death in the U.S. Most daily smokers (82%) began smoking before age 18, and more than 3,000 young persons begin smoking each day. School programs designed to prevent tobacco use could become one of the most effective strategies available to reduce U.S. tobacco use. The following guidelines summarize school-based strategies most likely to be effective in preventing tobacco use among youth. They were developed by CDC in collaboration with experts from 29 national, federal, and voluntary agencies and with other leading tobacco-use prevention authorities to help school personnel implement effective tobacco-use prevention programs. These guidelines are based on an in-depth review of research, theory, and current practice in school-based tobacco-use prevention. The guidelines recommend that all schools: a) develop and enforce a school policy on tobacco use, b) provide instruction about the short-term and long-term negative physiologic and social consequences of tobacco use, social influences on tobacco use, peer norms regarding tobacco use, and refusal skills, c) provide K-12 tobacco-use prevention education, d) provide program-specific training for teachers, e) involve parents or families in support of school-based programs to prevent tobacco use, f) support cessation efforts among students and all school staff who use tobacco, and g) assess the tobacco-use prevention program at regular intervals. (J Sch Health. 1994; 64(9): 353–360)     

Smokeless tobacco use by youth in the U.S

Oral snuff and chewing tobacco, commonly referred to as smokeless tobacco, are being used by many adolescent and young adult males, and no indication exists that use by this group is declining. Users are at risk for oral cancer, noncancerous oral pathology such as leukoplakias, and addiction. Information about patterns of smokeless tobacco use and motivations of users may help planners develop and implement interventions. Variables include the importance of peer and family influences, social image, knowledge of harmful effects, regional differences, use of other substances, and addiction. Due to the addictive nature of smokeless tobacco, older youth may need cessation programs. Health educators are encouraged to include smokeless tobacco in their tobacco use prevention programs and to develop and implement comprehensive tobacco interventions appropriate for their youth population.     

The development of a technical assistance system for residential treatment programs

Using a technical assistance model, the authors developed a University-based program to facilitate staff development among direct care personnel in a network of community-based residential treatment programs serving emotionally disturbed children and adolescents in North Carolina. The process used and the results are described, followed by the implications of this program for child and youth services professionals.The project described in this paper is supported by the North Carolina Department of Human Resources utilizing Title XX funds. The authors are associated with the University of North Carolina School of Education's Division of Special Education, Peabody Hall 037 A, Chapel Hill, North Carolina 27514.