# Presentation: 521619

## Youth Tobacco Prevention Policies and Programs in Schools and Communities

- Youth Tobacco Prevention Policies and Programs in Schools and Communities

## Center for the Application ofPrevention Technologies

- Center for the Application ofPrevention Technologies

- 763-427-5310 or 800-782-1878

## Regional Map

## Central CAPT Region

## CAPT Mission Statement

- 	To bring research to practice by assisting state/jurisdictions and community-based organizations in the application of the latest research-based knowledge to their substance abuse prevention programs, practices, and policies.

## CAPT Core Prevention Services

- Repackage, transfer, and replicate science-based prevention _program models_.
- Customize, repackage, and transfer scientifically defensible prevention _best practices_.
- Customize, repackage, and transfer scientifically defensible prevention _promising approaches_.

## Comprehensive Response to Youth Tobacco Use

- Prevention - prevent youth from starting to use.
- Cessation - identify, persuade and help youth and staff who use tobacco to quit
- Environment - provide a smoke-free environment for students, staff and visitors

## Integrates Three Approaches

- Student Services/Assistance
- Tobacco Diversion/Alternatives to School Suspension
- Tobacco Prevention/Education

## Workshop Objectives

- Frame tobacco use as a health issue;
- Identify key components of an effective policy;
- Create effective consequences.

## Workshops Objectives (cont’d)

- Integrate tobacco-use violations into student services/assistance;
- Assess all referrals to student services/assistance;
- Provide training for all school staff;

## Workshops Objectives (cont’d)

- Establish relationships with community-based programs and services.
- Develop K-12 classroom prevention programs.
- Evaluate school policies and programs.

## Project Background

- “The Tobacco-Free School 		  Policies: Best Practices”
- Identify effective tobacco-free school and enforcement strategies
- Disseminate “Best Practices” to school and community groups

## Project Background	(cont’d)

- Student Assistance Program Review
- Program review to integrate tobacco use/violation into student assistance process
- Staff training to identify and refer tobacco use violations

## Project Background (cont’d)

- “The Tobacco Diversion and 		Alternatives to School 			Suspension”
- Identify community diversions and alternatives to school suspension programs
- Disseminate information to school and community groups

## Methodology

- Advisory Committee
- Literature Review
- Review of Random Sample of Tobacco-Free Policies
- Key Informant Interviews
- Informal Interviews
- Responses to Preliminary Findings
- Think Tank
- Workshop Participant Feedback

## Student Services/Assistance Program Issues

- The appropriate role of student assistance teams in handling youth tobacco use, and
- What to do with students once they are referred to student assistance teams

## Frame the issue of student tobacco use as primarily a health concern.Discipline plus Health

## Primary GoalTOBACCO-FREE STUDENTSnot just tobacco-free buildings and grounds.

## Smoking and Public Health

- Single most preventable cause of death.
- More people will die from tobacco-related deaths than from alcohol, drugs, firearms, motor vehicle crashes and HIV/AIDS combined.
- Ninety percent of adults started before age eighteen.
- It is estimated that one-third will eventually die from tobacco-related illnesses

## Frequent Smokers and Non-SmokersAny substance Use in Past 30 Days2001 Minnesota Student Survey12th Grade Students

## Benefits of Tobacco-Free Policy

- Establish non-smoking as the norm.
- Reinforce and support existing prevention efforts.
- Contribute to a healthy working and learning environment for students and staff.
- Contribute to reduced smoking rates by employees and a subsequent reduction in health problems and economic costs.
- Identify tobacco violators and provide early intervention with at-risk behavior.

## Role of Community

## Policy Development and Revision Components

- A clear rationale for the policy focusing on reducing health risks related to tobacco.
- Prohibitions against the use of tobacco products.
- Prohibitions against tobacco advertising or tobacco promotion and advertising on school property and school-sponsored events or publications.

## Policy Development and Revision Components (cont’d)

- Classroom education programs for students.
- Clear procedures for communicating the policy to those affected by it including students, staff, parents and visitors.
- Consistent and equitable enforcement of the policy.
- Smoking cessation programs for students and staff who wish to quit smoking.

## Key Findings

- All schools are tobacco-free by law.
- Policy implementation and enforcement varies widely and is inconsistent.

## Key Findings (cont’d)

- A variety of consequences are administered for violation of tobacco-free school policies.

## Examples of Punitive Consequences

- Verbal or written warning/reprimand
- Fines
- In-school suspension
- Out-of-school suspension
- Alternative to school suspension
- Community service

## Examples of Punitive Consequences (cont’d)

- Clean up of environment
- Written assignments
- Education classes
- Suspension from athletics and other co-curricular activities
- Expulsion from athletics and other co-curricular activities

## Examples of Punitive Consequences (cont’d)

- Alternative education
- Police notification
- Revocation of parking privileges
- Referral to administrator
- A combination of more than one of the above

## Effective Consequences

- If perceived to be too lenient, offer little deterrence.
- If perceived to be too severe, will not be enforced consistently.

## Examples of Health Consequences

- Referral to student assistance program/team
- Notify parent/care provider
- Meeting between parent/care provider and school personnel
- Required attendance in tobacco education/diversion program
- Required enrollment in tobacco cessation program

## Three Factors Related to Effective Consequences

- Certainty
- Severity
- Celerity

## Key Findings

- Tobacco use violations are not referred to pre-assessment teams or student assistance program staff in most schools.

## Beyond Diversion/Alternatives to Suspension:  A Comprehensive Community Response to Youth Tobacco Use

## A Model for Matching Student Needs with School & Community Resources

- A
- A response which focuses on information or education which the student needs to change behavior.

- B
- A response which focuses on life skills, social competencies or social support which the student needs to change behavior.

- C
- A response which provides some sort of low structured program of treatment or remediation.

- D
- A response which provides a highly structured program of treatment or remediation.

- ASSESSME
- NT

- low

- high

- low

- low

- high

- high

- 1.             2.

-       Social         Developmental
-     Support          Competency

- 1.  Includes family and peer support as well as involvement in groups such as church/synagogue, sport teams or activities.
- 2.  Includes age appropriate behaviors and skills.

- Problem Severity

## Training

- Student Services/Assistance Process
- All school staff
- Student services/assistance staff
- Peer Leaders
- Classroom Prevention/Education
- Teachers
- Peer Leaders

## Role of School Staff

- Observe and Identify
- Document Behavior
- Share Concern
- Refer Student if Appropriate
- Provide Ongoing Support

## Behavior of Concern

- 	Specific, observable behavior that concerns you.

## See It, Say It  -  6 Steps

- I Care
- I See
- I Feel
- LISTEN
- I Want
- I Will

## Key Findings

- Community involvement in policy implementation is infrequent and limited to police and public health.

## Cooperative Relationships

- Cooperation with community-based diversion programs can provide students with the information, skills, and support needed to avoid further tobacco use.
- Cooperation with other community agencies and health plans can provide cessation resources.

## Tobacco Diversion/Alternatives to School Supervision

- 	Programs designed to offer young people who have violated a tobacco-use law or school tobacco-use policy an incentive to participate in an educational program that can lead to a positive behavioral health change.

## Diversion Program Goals

- Provide an incentive for a positive alternative to the young person who has used tobacco illegally or violated school tobacco use policy.
- Provide young people with current information on tobacco use and its consequences.
- Prepare young people to reduce or quit using tobacco.
- Provide access to tobacco cessation assistance.

## Diversion Program Components

- A tobacco education class or series of classes
- A connection to cessation assistance

## Diversion Program Class Content

- Assess reasons for smoking.
- Learn about the addiction process.
- Learn about the legal and health consequences of tobacco use.
- Examine advertising/marketing schemes; Industry strategies; motives.

## Diversion Program Class Content (cont’d)

- Develop skills, i.e., stress and anger management, refusal, etc.
- Become familiar with education strategies - how to reduce or quit.
- Learn about resources for cessation and be connected to other comprehensive community resources.
- Develop a plan of action for behavior change.

## Tobacco Education Structure

- Integrate youth as part of the class or peer educator, connection with own age quitters.
- Involve parents.
- Conduct evaluation and gather feedback from class.
- Provide follow-up.

## Beyond Diversion/Alternatives to Suspension:  A Comprehensive Community Response to Youth Tobacco Use

## Key Elements of the Effective Community Diversion Programs

- Clear city/county ordinance with effective consequences.
- Law enforcement consistently tickets and refers violators to class.
- Communication with school personnel.

## Key Elements of the Effective Community Diversion Programs (cont’d)

- Judges support citations and diversion.
- Frequently scheduled diversion classes.
- Follow-up.

## Key Elements of the Effective Community Diversions Programs (cont’d)

- Training for staff conducting classes.
- Availability of cessation.
- Follow-up (aftercare).

## Key Findings

- Many school staff and students report a desire to stop smoking and would like help to quit.

## Examples of Youth Cessation Programs

- Self-help print materials.
- Brief interventions by health care providers.
- Two- or three-hour education classes.

## Examples of Youth Cessation Programs (cont’d)

- Six- to eight-session classes.
- Group support.
- Nicotine replacement therapy.
- Social support.

## Examples of Youth Cessation Programs (cont’d)

- Skills training/problem solving.
- Hypnosis.
- Acupuncture.
- Inpatient treatment.
- Stress management.
- Combination of 1-12 above.

## Implementing School Cessation Programs

- During the school day
- Study period
- Lunch hour
- Rotate during regular class hours
- Refer to community based programs

## Obstacles to Effective Diversion/ Alternatives to School Suspension

- A culture or norm that exists that tobacco is simply not a significant problem.
- A lack of follow-through by judges and the court system which reduces program effectiveness.
- A lack of integrating science-based principles in the design of education classes.

## Obstacles to Effective Diversion/ Alternatives to School Suspension (cont’d)

- Difficulty in getting youth motivated to participate in class activities.
- Fines and other consequences are sometimes not severe enough to encourage participation in the classes.
- Inconsistency among community partners.
- Not making an effort to connect with families.

## Obstacles to Effective Diversion/ Alternatives to School Suspension (cont’d)

- Some parents are not supportive because of their own tobacco use and others simply do not view tobacco use as a significant problem.
- There is a lack of referral resources for cessation and a simple referral process.
- There is a lack of training for people conducting the classes that includes the art of teaching/learning.

## Obstacles to Effective Diversion/ Alternatives to School Suspension

- There is a lack of clarity or communications on how health care, social service and, parent and self-referrals can be simplified.
- The title “diversion” needs to be changed to something more appealing.
- If the program becomes school-dominated, then it becomes “school’s” problem/responsibility rather than a community problem/ responsibility.

## Key Findings

- While most schools offer classroom-based tobacco-use prevention programs, there appears to be limited coordination of instruction across grade levels and few examples of documented scope and sequence of instruction.

## Multiple Efforts

- Prevention strategies showing greatest promise of effectiveness focus on change at multiple levels:
- Individuals
- Family
- School
- Communities

## Multiple Efforts (cont’d)

- The expected impact of any single prevention program is likely to be limited and difficult to isolate.
- Classroom-based prevention, in 	isolation from other prevention 	approaches, has been consistently demonstrated to have limited impact.

## Social Influences Model

- 	School classroom prevention programs appear to be most effective if based on the social influences model for primary prevention.  Elements of this model include:

## Elements of the Social Influences Model

- Short-term consequences,
- Reasons for using and not using,
- Accurate information about peer norms,
- Influence of advertising,
- Resistance skills,
- Effects of substance use in community,
- Public commitment to refrain from use.

## Common Attributes of Effective Approaches

- Interactivity
- Cultural relevance
- Intensity and duration
- Credibility of presenter:
- Peers
- Cross-age mentors
- Message:
- Accuracy
- Relevance

## Shifting Focus

- School/community policies and laws should be reviewed regularly and updated when appropriate.
- Environmental approaches to prevention are demonstrating a reduction in certain alcohol, tobacco, and other drug-related behavior and problems.

## Workshop Objectives

- Frame tobacco use as a health issue;
- Identify key components of an effective policy;
- Create effective consequences;

## Workshop Objectives (cont’d)

- Integrate tobacco-use violations into student assistance;
- Assess all referrals to student services/assistance;
- Provide training for all school staff;

## Workshop Objectives (cont’d)

- Establish relationships with community-based programs and services;
- Develop K-12 classroom prevention programs;
- Evaluate school policies and programs.

## Youth Tobacco Prevention Policies and Programs in Schools and Communities

- Youth Tobacco Prevention Policies and Programs in Schools and Communities