Youth

Engagement

in Tobacco Prevention and Control
Acknowledgements

This guide was produced for the Centers for Disease Control and Prevention by the Center for Public 

Health Systems Science at the Brown School at Washington University in St. Louis. 

Primary contributors:

Stephanie Andersen, Laura Brossart, Douglas Luke, Erin Foster, Isaiah Zoschke, Elyse Vesser, Amy Endrizal, 

Rebecca Ballard, Sarah Moreland-Russell

Input was provided by:

Brian Armour, Trish La Chica, Michon Mabry, Tim Poor, Daniel Saggese, Karla S. Sneegas, Gustavo Torrez, Michael 

Tynan, Kimberlee Homer Vagadori, Renee Wright

Input for the case studies was provided by:

Mark R. Kaser, Indiana Teen Institute

Miranda Spitznagle, Indiana Department of Health, Tobacco Prevention & Cessation Commission

Eoana Sturges, Vermont Tobacco Control Program

Rachel Williams, Mt. Ascutney Prevention Partnership

Cindy Hayford, Deerfield Valley Community Partnership

Sandra Brauer, Enosburg Falls Junior/Senior School

Amy Brewer, Franklin Grand Isle Tobacco Prevention Coalition

Other Contributions: 

Photograph on page 4 courtesy of Catalyst

Photographs on page 6, 20, and 30 courtesy of Truth Initiative

Photographs on page 7 and 18 courtesy of Youth Leadership Institute

Photographs on page 11 and 13 courtesy of Virginia Y Street

Photograph on page 15 courtesy of Pennsylvania TRU

Photographs on page 19 and 21 courtesy of Tobacco Free Florida

Photograph on page 24 courtesy of The 84
Table of Contents

Guide to the Reader .......................................................................................... 1

Making the Case .............................................................................................. 2

Brief History ................................................................................................... 3

How to .......................................................................................................... 4

 What Is Youth Engagement in Tobacco Prevention and Control? .................... 4

The Importance of Youth Engagement .................................................. 5

How Should Programs Engage Youth? .................................................. 7

 What Should Youth Be Working On? ..................................11

Creating Tobacco-Free Environments ...................................................11

Increasing the Price of Tobacco Products ...............................................12

Reducing Tobacco Industry Influence at the Point of Sale ..........................14

Communicating the Dangers of Youth Tobacco Use .................................17

Building Community Awareness ........................................................22

Monitoring and Enforcing Tobacco Control Policies ..................................24

 Implementing Youth Engagement Efforts ......................................26

Preparing to Engage Youth ...............................................................26

Developing an Action Plan ...............................................................27

Involving Youth in Reducing Disparities ................................................29

Evaluating Youth Engagement ..........................................................31

Sustaining Youth Engagement ..........................................................32

Providing Support ...........................................................................................35

Case Studies ..................................................................................................36

Case for Investment .........................................................................................40

Resources .....................................................................................................42

References ....................................................................................................48
Youth Engagement

GUIDE TO THE READER

Purpose

The Center for Public Health Systems Science at 

Washington University in St. Louis is developing a 

set of user guides funded by the Centers for Disease 

Control and Prevention (contract 200-2015-87568) 

for the Best Practices for Comprehensive Tobacco 

Control Programs—2014 (Best Practices 2014), an 

evidence-based tool to help states plan and establish 

comprehensive tobacco control programs. In the user 

guides, tobacco refers to manufactured, commercial 

tobacco products. 

The purpose of the user guides is to help tobacco 

control staff and partners implement evidence-based 

best practices by translating research into practical 

guidance. The guides focus on strategies (e.g., programs 

and interventions) that have shown strong or promising 

evidence of effectiveness. Recommendations in 

this guide are appropriate for programs interested 

in engaging youth. Implementation of these 

recommended practices is at the discretion of each state 

or community, according to its needs and goals.

Content

Best Practices 2014 recommends that states focus 

on four goals, including preventing initiation and 

promoting quitting among youth and young adults.1

The 2012 Surgeon General’s Report, Preventing Tobacco 

Use among Youth and Young Adults, defines youth as 

people ages 12–17.2

 The youth perspective is critical to 

tobacco prevention and control because most people 

start smoking cigarettes before age 18.3

 The tobacco 

industry also continues to use advertising strategies 

that appeal to youth to recruit the next generation of 

smokers.2

 Youth involvement can lead to important 

environmental and social norm changes and reduce 

pro-tobacco influences. This guide gives program 

managers information on how to engage youth as a part 

of a comprehensive tobacco control program. 

Links to More Information

Italicized, bolded blue text in the guide indicates a link to 

an external resource or a page within the guide itself with 

more information. Website addresses for blue resources 

are also included in the Resources section.

Organization

8 Making the Case: a brief overview of why it is 

important for tobacco control programs to involve 

youth

8 Brief History: how tobacco prevention and 

control efforts have shifted from youth education to 

youth engagement

8 How to: strategies to involve youth in tobacco 

prevention and control efforts

8 Providing Support: how programs can support 

efforts to engage youth

8 In Action: real-world examples of how programs 

have worked with youth to advance tobacco 

control goals

8 Case for Investment: information that can 

be used to inform the development of youth 

engagement efforts

8 Resources: publications, toolkits, and websites to 

help in planning efforts

Best Practices for Comprehensive 

Tobacco Control Programs–20141

Best Practices 2014 is an evidence-based 

guide to help states plan, establish, and 

evaluate comprehensive tobacco prevention 

and control programs. The report offers 

recommendations and evidence for five 

essential components of effective programs:

• State and community interventions 

• Mass-reach health communication 

interventions

• Cessation interventions

• Surveillance and evaluation 

• Infrastructure, administration, and 

management

l 1
Making the Case for Youth Engagement 

After years of steady declines in youth tobacco use, the number of students using tobacco products has sharply 

increased, coinciding with the emergence of e-cigarettes.4

 In 2018, e-cigarettes were the most commonly used 

tobacco product among middle and high school students.4 Despite claims that their tactics are aimed at adult 

smokers, tobacco companies continue to use themes and packaging that appeal to youth and promote their 

products in places visited by young people.2 Because we cannot end the tobacco epidemic without preventing 

initiation among young people, it is critical that programs engage youth in tobacco control efforts.2 Youth can 

be powerful allies to help communicate the impact of tobacco use on young people, implement effective tobacco 

control strategies, and shift social norms around tobacco use in their communities. Youth are essential partners for 

an effective, comprehensive tobacco control program because they:

8 Project a powerful voice

Youth can use their credibility with peers and the public to educate the community about how to reduce protobacco influences and shift social norms around tobacco use.5

8 Expose tobacco industry tactics

Young people can be effective partners in exposing the tobacco industry’s manipulative tactics to recruit youth 

as replacement smokers.6

8 Offer energy and enthusiasm

Youth bring energy to activities and events that can increase awareness and advance tobacco control goals.7

8 Provide generational insight 

Youth can offer important insights about their peers. Involving youth helps programs design effective tobacco 

control strategies that respond to youth’s actual experiences.8

8 Bring new perspectives and innovative ideas Young people naturally challenge the traditional attitudes that may limit how adults think and act. They can add 

innovation and creativity to any program, making it more attractive to other youth and community leaders.9

Their novel ideas for tobacco control strategies can help push efforts forward.9

8 Mobilize their peers 

Youth can play a vital role in reaching other youth.10 They can mobilize their peers for activities, strengthening 

and expanding tobacco control efforts.5

8 Become the next generation of tobacco control leaders

Offering leadership opportunities encourages youth to stay involved in tobacco control over the long term.10

Some young people may continue this work by devoting their careers to building healthier communities.8

Youth Engagement l 2

MAKING THE CASE
BRIEF HISTORY

From Education to 

Engagement

Youth engagement in tobacco control efforts has evolved 

over the past few decades, both in the types of activities 

and in the quality of youth involvement (see Figure 1

below). While the most effective method for involving 

youth has not always been clear, the need to involve 

youth in tobacco control programs is established.2

From the release of the 1964 Surgeon General’s Report, 

Smoking and Health, through the early 1980s, health 

education was the primary youth tobacco control 

intervention.11,12 This strategy was based on the idea 

that young people simply needed access to the right 

information so they could make the right decision and 

avoid using tobacco.11

In the 1980s, programs recognized that youth were not 

influenced by statistics but by their social environment 

(e.g., peers, family, and media).12 Delivering classroombased life skills training and teaching youth to refuse 

offers of tobacco replaced pure education as the 

primary interventions.12 However, while public health 

acknowledged the need to involve youth, the importance 

of integrating youth as partners was not yet realized.

The Florida truth® campaign radically changed this 

trend. Released in the late 1990s, this provocative 

advertising campaign exposed the tobacco industry’s 

deceptive marketing tactics and highlighted the 

importance of involving youth in tobacco control 

efforts.13 For the first time, youth were seen as 

important partners in developing solutions to combat 

the tobacco industry.

Funds from the 1998 Master Settlement Agreement 

partly went to form the American Legacy Foundation 

(now the Truth Initiative), which launched the national 

truth® campaign using the same strategies as the 

Florida campaign.14 Legacy also funded local youthled tobacco control efforts in 19 states through Youth 

Empowerment Grants.15 Activities funded by Legacy, 

along with many state programs, further highlighted 

the importance of partnering with youth and helped to 

expand youth engagement initiatives.15

Today, youth engagement is an important part of a 

coordinated tobacco control strategy.16 Many states 

and localities have involved youth in tobacco control 

efforts in some way.14 Young people work diligently on 

behalf of their communities to help prevent and reduce 

tobacco use. Youth have helped inform the public about 

the dangers of secondhand smoke, the influence of 

the tobacco industry in stores, and the importance of 

increasing the sales age to 21.17-19

Recent developments in youth engagement include 

the use of social media to recruit and organize around 

tobacco control strategies, making it easier to reach a 

broad audience, and an expanded focus on all tobacco 

products.20 As youth use of other tobacco products 

has increased, youth engagement efforts have begun to 

address these products.

Figure 1. Youth Engagement Continuum and Timeline

Youth Engagement l 3
HOW TO

What Is Youth 

Engagement in 

Tobacco Prevention and 

Control? 

Youth engagement is the involvement of young people 

in decision making to create positive social change.21

Youth engagement efforts give young people the ability 

and authority to make decisions that improve the policy 

environment, change social norms, and reduce tobacco 

initiation and use in their communities. 

Minnesota youth hold march in St. Paul to thank legislators for passing a clean indoor air policy Source: Andy Berndt - Catalyst

Youth engagement is more than youth participation 

in program activities or events (see Figure 3 on page 

9).22 It is characterized by ongoing, frequent, and 

meaningful opportunities for youth to contribute to 

tobacco control efforts.23 When youth are engaged, 

they work as full partners with adults, with equal 

responsibility to plan and implement strategies carried 

out by the program. The contributions of youth and 

adults are equally valued, and their interactions 

are based on mutual 

respect.24 Young 

people add diverse 

perspectives that help 

achieve better results 

than if youth or adults 

work separately to 

advance tobacco 

control goals.24

Youth are defined as 

people ages 12–17.2

 The 

age of youth involved 

with a program may 

vary based on the 

communities served by 

the program and the 

program’s goals. Older 

youth such as high 

school students can be 

especially helpful for 

more complex, longterm projects.25 Middle school youth may have more 

free time to take part in activities.25

Programs work best when they take a comprehensive 

approach to tobacco prevention and control.27

Successful programs involve youth in population-level 

strategies based on strong science, such as creating 

tobacco-free environments and communicating the 

dangers of tobacco use.27

Characteristics of Youth 

Engagement26

Youth are engaged when:

• They are respected and trusted

• They are involved as both teachers 

and students

• Their opinions and ideas are valued

• They help make decisions

• They see change as a result of their 

contributions

Youth Engagement l 4
The Importance of Youth Engagement

Young people are important to tobacco control efforts. 

The tobacco industry knows that exposure to tobacco 

advertising causes young people to start smoking, and 

most people start smoking cigarettes before the age of 

18.2,3 The industry’s own internal documents make it 

clear that companies see youth as an important source 

of “replacement smokers.”2 Despite some restrictions 

on marketing targeted to youth, tobacco companies 

continue to create advertising that appeals to youth, 

using themes such as independence and a sense of 

belonging.2

 Tobacco companies also design products 

and packaging to attract youth and promote their 

products in places frequently visited by young people.2

When young people learn they are being manipulated 

by the tobacco industry, they want to take a stand and 

get involved in tobacco control.28

Trends in Youth Tobacco Use

Despite recent declines in youth cigarette smoking, 

young people have increasingly turned to other tobacco 

products.29 From 2011 to 2018, current e-cigarette use 

among U.S. high school students increased by more 

than 1000% while other tobacco use declined, as shown 

in Figure 2 below.4

 E-cigarettes are now the most 

commonly used tobacco product among both middle 

and high school students.29 Involving young people in 

developing relevant, effective strategies is critical to 

counter these alarming trends.

Figure 2. Youth Tobacco Use among High School Students from 2011 to 2018

Adapted from: Gentzke et al.4

*Cigarettes, cigars, pipes, bidis, kreteks, and/or dissolvable tobacco †Chewing tobacco, dip, snuff, snus, and/or dissolvable tobacco

Notes: Dotted lines show changes in how e-cigarettes are measured. Data collected before 2013 may not be comparable to new estimates.

Benefits of Involving Youth

Young people offer fresh perspectives.7 They 

understand the resources and needs of their 

communities and are not afraid to try new 

approaches.7,30 Their input can expand the reach of 

strategies and improve their acceptance by youth.30,31

Youth can also add energy to efforts with their 

enthusiasm and creativity.30

Young people who are given opportunities to contribute 

to positive public health outcomes can also benefit their 

communities through continued civic engagement. 

They may help build tobacco-free communities as 

youth and later as adults.8

 

Youth Engagement l 5

HOW TO
Youth E-cigarette Use 

Electronic cigarettes (e-cigarettes) 

are the most commonly used 

tobacco product among youth.29

Growth in e-cigarette use has risen 

alarmingly fast: from 2017 to 2018, 

use increased by 78% among high 

school students and 48% among 

middle school students.32 Youth use 

e-cigarettes for a variety of reasons, 

including flavors and social exposure.33 However, any youth use of e-cigarettes is unsafe; e-cigarettes can 

contain harmful ingredients, including nicotine.34 Nicotine exposure during adolescence can lead to 

addiction and can harm the developing brain.34 Youth e-cigarette use is also strongly associated with the 

use of other tobacco products, including cigarettes.34 

Since its introduction to the U.S. market in 2015, the e-cigarette brand JUUL has become increasingly 

popular.35 Shaped like a USB flash drive, this product is easier to conceal and use discreetly in places like 

classrooms and bathrooms.36 Despite being marketed as a faster way to deliver nicotine, many youth 

users (63%) are unaware that all JUUL products contain nicotine.37

In 2016, the FDA began regulating e-cigarettes. State programs can also play an important role in 

preventing e-cigarette initiation and promoting cessation in youth by taking the following steps: 

• Educating youth on nicotine in e-cigarettes and the dangers of using them

• Informing parents of the risks of youth e-cigarette use and how to talk with their children about 

e-cigarettes

• Reaching out to doctors on how and why to talk about e-cigarette use with young patients 

• Teaching school staff how to recognize e-cigarette use and providing resources to share with students

• Involving youth in the creation of messages and educational materials to ensure they are relevant 

to young people

• Monitoring and enforcing existing population-level strategies, such as the inclusion of e-cigarettes 

in smoke-free indoor air laws, prohibitions on sale of flavored e-cigarettes, and increases in the 

minimum legal sales age for tobacco products to 21

Learn more about educating parents, teachers, and health care providers about pod-based e-cigarettes 

in the CDC tip sheet, E-cigarettes Shaped like USB Flash Drives: Information for Parents, Educators, 

and Health Care Providers. For health care professionals, the Surgeon General resource, Health Care 

Professionals: Educate Your Young Patients about the Risks of E-cigarettes, offers helpful guidance 

and education. Recommendations for parents are available in the Surgeon General tip sheet, Talk with 

Your Teen about E-cigarettes. For information to share with youth about e-cigarettes, see the CDC 

presentation, Know the Risks: A Youth Guide to E-cigarettes.

Screenshot from the truth® “Puppets” campaign Source: Truth Initiative

Youth Engagement l 6

HOW TO
Involving youth can also:

• Increase adults’ commitment to 

tobacco control9,21

• Build public support for tobacco 

control efforts5

• Enhance the credibility of tobacco 

control programs5,7

• Add unique skills, such as digital and 

social media expertise30

• Make programs more appealing to 

potential funders7,38

Youth, in turn, benefit from engaging 

in tobacco control. Youth engagement 

programs build youth self-confidence, 

knowledge, and skills such as leadership, 

problem solving, and public speaking.9,39

Youth also learn that their voices matter 

and that they can achieve their goals.9

Youth engagement connects youth to their 

communities and creates a sense of belonging.9

 Some 

evidence has also shown that involvement in youth 

engagement programs can change how youth view 

tobacco and can reduce youth tobacco use.40,41 

Youth leaders from the Tobacco Use Reduction Force (TURF) make their voices heard at San Mateo 

City Hall Source: Youth Leadership Institute How Youth Help Advance Tobacco Control Strategies

How Youth Help Advance Tobacco Control 

Strategies

Young people are essential partners for implementing 

tobacco control strategies. They can add a vital 

perspective when learning about a community’s 

tobacco use patterns, access to tobacco products, and 

support for tobacco control.8

 They are also passionate, 

effective communicators who can speak with 

community members, local businesses, and decision 

makers about the importance of tobacco control 

efforts.25 Youth also learn and work in places covered 

by tobacco control policies. They can help monitor 

new policies and ensure they are enforced. Programs 

that involve youth quickly find that their creativity and 

enthusiasm generate innovative approaches.9

Recent efforts to include youth have shown the important 

role they play in achieving program goals. For example, 

youth in Boston gathered letters of support from 

community organizations, spoke with store owners, 

and met with the city’s Board of Health about removing 

tobacco products from pharmacies.18 These strategies 

would later be used by youth and partners in over 160 

other Massachusetts communities.42 Youth have also 

impacted federal efforts. For example, the U.S. Food & 

Drug Administration (FDA) used survey data gathered 

by Virginia youth to conclude that the availability of 

dissolvable tobacco products (i.e., products that melt in 

the mouth) could increase tobacco use.17

How Should Programs Engage Youth? 

Young people may join tobacco control efforts for many 

of the same reasons adults do. Some have experienced 

the negative effects of secondhand smoke exposure, 

some have family members who have died from tobaccorelated diseases, and others are themselves victims of 

diseases caused by tobacco use.43 Whatever the reason for 

their passion, it is important that young people are not 

overlooked as valuable partners in tobacco control and 

other public health issues. Before engaging youth, it is 

important for program staff to first develop a recruitment 

strategy and clearly define youth and adult roles.

Finding, Recruiting, and Preparing Youth 

Successful efforts to involve youth begin with careful 

consideration of how best to reach young people, how 

they should be involved, and what training will help 

Youth Engagement l 7

HOW TO
them make a real contribution.31 Involving youth who 

already work with the program in planning efforts can 

help staff select the best recruitment strategies.30

Young people themselves are often the best recruiters; 

they can share their positive experiences with peers 

and encourage them to get involved.30 School staff can 

also help programs reach out to students.10 In other 

instances, a trusted parent or teacher can be an effective 

recruiter, but this strategy should complement peer-topeer recruiting and broader community outreach by 

staff.25 To engage these partners in youth recruitment, 

programs can:25

• Give youth members examples of how their 

peers can get involved

• Build relationships with many school staff, such 

as coaches and counselors

• Highlight the connection between tobacco 

control and class projects

• Offer resources to schools in return for their 

help recruiting youth

• Attend parent group meetings to share successes 

and the benefits of youth involvement

• Invite parents to attend youth events

Young people lead busy lives and are often already 

engaged with other causes important to them.23

Programs that give youth something they value will 

be more likely to engage them in activities. Some 

youth may be motivated by small incentives, food, or 

the opportunity to spend time with friends.44 Others 

may want the chance to add to their résumé or build 

experience for college applications.45 Educating youth 

about the tobacco industry’s tactics and the program’s 

past successes may encourage youth to join efforts to 

make a difference in their communities.46

Following up quickly with concrete ways to get involved 

can ensure youth act on their initial interest.25 Reaching 

out through many channels, including email, text, 

letter, in person, and on social media, can also help 

engage potential new members.25 Logistical challenges 

may keep even the most interested youth from joining 

tobacco control efforts. Offering transportation to 

and from meetings and holding meetings at times and 

places that are convenient to youth can reduce barriers 

to involvement.47

Where to Find Youth

Successful recruitment strategies involve 

going where youth naturally gather.9,25 Groups 

working in tobacco control tend to recruit 

through the following avenues: 

• Existing youth groups such as Future 

Farmers of America and the Future 

Business Leaders of America48

• Schools (e.g., forming partnerships 

with school staff and recruiting 

students at lunch tables)29

• Social media sites such as Facebook 

and Twitter25

• Community events such as concerts, 

rallies, and festivals49

• Community and faith-based 

organizations serving youth49

• Youth hangouts such as parks and 

arcades50

• Word of mouth, especially from peers51 

Offering trainings can also encourage youth to get 

involved and helps prepare them to be effective leaders.30

Programs can train youth on the following topics:41

• Health consequences of tobacco use

• Tobacco control strategies

• Public speaking skills

• Teamwork

• Action planning

• Media literacy

It can be challenging to continually offer relevant and 

up-to-date trainings to new youth members.52 Taking 

Down Tobacco is a free online youth training program 

developed by Campaign for Tobacco-Free Kids. It offers 

self-paced, interactive courses that can be taken online 

or in person.53 During the training, youth learn about the 

toll of tobacco use and the tobacco industry’s tactics.53

Youth can also complete the advanced Core 4 trainings to 

build additional skills in creating community change:52,53

Youth Engagement l 8

HOW TO
• Messaging Matters, developing effective messages

that resonate with the community

• Mastering the Media, working with media outlets

• Informing Decision Makers, sharing personal stories

with community leaders

• Activities that Kick Butts, planning effective events

and activities

The program also offers a train-the-trainer course 

that teaches youth how to deliver the training to other 

youth in their community. 

Defining Complementary Youth and Adult Roles 

Clearly defining youth and adult roles is important to 

maintain a successful program where young people have 

a voice.7,39 Both youth and adults add unique perspectives 

and skill sets. The challenge is having enough adult input 

so that efforts are organized and intentional, yet enough 

youth contribution so that young people are engaged, 

challenged, and dedicated to the cause. 

Figure 3. What is the Difference between Youth Participation and Youth Engagement?

Source: Adapted from Center for the Study of Social Policy30 

Youth Roles

As a group, young people bring energy, idealism, and 

new ideas to tobacco control. As individuals, they have 

varying interests and talents. While some young people 

may choose to be organizers, others may want to act as 

representatives at board meetings or share messages on 

social media. Youth can serve in the following roles:

• Researchers, collecting information about tobacco

control issues and analyzing findings23

• Planners, helping choose strategies23

• Organizers, bringing together community

members in support of tobacco control goals23

• Educators, informing the public and decision

makers about the importance of tobacco control14

• Informants, sharing feedback on program

materials and strategies through focus groups,

surveys, and interviews54

• Evaluators, assessing progress toward goals23

• Specialists, providing expertise in areas such as

social media or technology23

Youth Engagement l 9

HOW TO
The capacity of the program to engage youth and 

internal program support for involving youth 

determine which roles youth will fill.31 Programs can 

assess their readiness to involve youth by using the 

self-assessment tool included in the California Youth 

Advocacy Network’s Regional Youth Engagement 

Workshops Summary Report. The assessment 

encourages users to think critically about their 

organization’s readiness to work with youth, what 

barriers might exist, and potential partners for youth 

engagement efforts. 

Adult Roles

Adults encourage youth engagement by creating 

a supportive environment in which young people 

can make meaningful contributions. By focusing on 

relationship building, an effective adult collaborator can 

help organize and mobilize a group of interested young 

people. Adults can support youth engagement by:

• Guiding youth in planning strategies55

• Helping youth set priorities by offering choices 

and time for reflection55

• Handling day-today logistical and 

administrative 

tasks, such 

as organizing 

transportation8

• Organizing 

training 

opportunities56

The appropriate level of 

involvement for adult 

advisors may depend 

on the age of young 

people working with the 

program. Adults working 

with younger youth (ages 

12–14) may take on more 

of the initial planning 

and then allow youth to 

choose which strategies 

to pursue.57

Characteristics of Adult 

Advisors58

The most effective adult collaborators: 

• Relate well to youth

• Care about young people

• Are flexible and thrive in creative, 

sometimes chaotic environments

• Are comfortable talking about tough 

issues

• Are well informed about tobacco 

control issues 

Youth Engagement l 10

HOW TO
What Should Youth Be 

Working On?

Comprehensive approaches to change community 

environments and social norms about tobacco use work 

best to reduce youth tobacco use and prevent youth 

initiation.1

 Effective efforts are based on strong science 

and typically focus on:2,59

• Raising awareness about the importance of 

tobacco-free environments

• Educating about the impact of tobacco product 

prices

• Reducing tobacco industry influence in retail 

stores

• Communicating the dangers of youth tobacco 

use and secondhand smoke exposure

• Building community awareness of tobacco 

control efforts

• Monitoring and enforcing tobacco control 

policies

Creating Tobacco-Free Environments

Youth are especially vulnerable to secondhand 

smoke exposure.60 The lungs are still growing 

during childhood and adolescence.60 Exposure to 

secondhand smoke during this critical time is linked 

to ear infections, asthma, and poorer lung function.60

Despite this risk, youth experience more secondhand 

smoke exposure than adults.60

Tobacco-free environments protect youth who visit 

tobacco-free places as employees, customers, and 

students. Comprehensive smoke-free laws also prevent 

youth initiation, reduce smoking among youth and 

young adults, and make it easier for young tobacco 

users to quit smoking.2,61 By decreasing smoking among 

adult role models, these policies emphasize that tobacco 

use is not acceptable for youth or adults.3

The number of states and communities with smokefree laws has increased rapidly in recent years.3

Comprehensive smoke-free laws are often implemented 

in places that affect young people, including schools 

and college campuses, parks, vehicles, and multi-unit 

housing.3

 Many families also choose to adopt tobaccofree rules in their homes.2

Many states and communities are addressing the recent 

increase in youth use of e-cigarettes by including these 

products in comprehensive smoke-free laws.62 The 

aerosol produced by e-cigarettes is not harmless.34 It 

can contain harmful and potentially harmful chemicals, 

including nicotine.34 Exposure to nicotine during 

adolescence can cause addiction and harm to youths’ 

developing brains.34 Because e-cigarettes often resemble 

cigarettes, including them in comprehensive smokefree laws can also simplify policy enforcement and help 

communities maintain smoke-free norms.34

Involving Youth in Tobacco-Free Strategies

Young people’s energy and enthusiasm for tobacco-free 

strategies can help bring attention to the importance of 

protecting youth from exposure to secondhand smoke 

and e-cigarette aerosol. Their credibility with adults 

and other youth can also help engage the community in 

adopting comprehensive smoke-free laws. For instance, 

when youth conduct community assessments, they 

may be able to get responses from other youth who are 

reluctant to talk to adults about tobacco use.63

Virginia youth posted informational signs to increase awareness of tobaccofree school policies Source: Virginia Foundation for Healthy Youth

Youth Engagement l 11

HOW TO
Lobbying Restrictions with 

Federal Funding

When tobacco control programs 

communicate with decision makers, it 

is critical that they understand special 

restrictions on programs that receive federal 

funding. While educating and raising 

public awareness about issues are important 

activities of a tobacco control program, 

lobbying efforts are not permitted.64

Prohibited activities that are considered 

lobbying include directly communicating 

with decision makers about pending 

legislation or encouraging their constituents 

to ask them to support a specific bill.64 It is 

important for programs to ensure that youth 

activities comply with all requirements. For 

more information about which activities 

are allowed, read the CDC resource, Antilobbying Restrictions for CDC Grantees.

Assessing Tobacco-Free Environments

Youth interested in working on tobacco-free strategies 

can begin by assessing the community environment.14

Youth can interview community members, conduct 

surveys, and record observations.14 They can also gather 

information on the community’s current policies, 

attitudes toward tobacco use, tobacco-related behaviors, 

and available cessation resources.14,65 Assessments can 

answer questions such as: 

• Does the community have any comprehensive 

smoke-free laws, and are they enforced?66

• Do existing policies prohibit all tobacco 

products, including e-cigarettes?14

• Can policies be strengthened or updated?67

• What percentage of community members use 

tobacco products?66

• Do community members support 

comprehensive smoke-free laws?66

• Are effective cessation resources available, and 

are these services used?65

Raising Awareness about Tobacco-Free Strategies

Youth can call attention to tobacco control issues by 

raising awareness about tobacco’s impact on health 

in their communities. They can educate the public on 

the burden of tobacco use and the impact of tobacco 

control strategies by writing letters to the editor and 

giving presentations at community meetings.68

Other ways youth can increase awareness include:

• Organizing tobacco litter cleanups14

• Talking to community members about the 

importance of comprehensive smoke-free laws14 

• Holding smoke-free pledge events where 

community members commit to make their 

homes and vehicles smoke-free69

• Educating landlords and residents on the 

benefits of smoke-free housing70

• Encouraging local businesses to go tobacco free14

After implementing tobacco-free strategies, it is 

critical that program staff and youth communicate 

the changes so that community members are aware of 

new policies.71 Youth can post signs in locations where 

tobacco use is prohibited, send letters or postcards to 

those affected, post about the changes on social media, 

and alert local news media.65,71 Since comprehensive 

smoke-free laws can make quitting tobacco easier, staff 

and youth can also educate the community on available 

cessation resources.72

Increasing the Price of Tobacco 

Products

Increasing the price of tobacco products is one of 

the most effective ways to reduce tobacco use and 

prevent initiation.1,2,73 Increasing cigarette prices 

by 10% decreases adult consumption by 3%–5%.2,74

Youth consumption is even more responsive to price 

increases, declining by two to three times as much as 

adult consumption.2 Minority youth may be even more 

sensitive to price increases.75,76

Youth Engagement l 12

HOW TO
To increase the price of tobacco products, youth can 

work to change store practices on accepting rebates, 

discounts, and coupons. Young people who are exposed 

to tobacco coupons are more likely to have tried 

cigarettes and are at greater risk of smoking cigarettes in 

the future.77,78 Learn more about pricing strategies in the 

resource, Pricing Policy: A Tobacco Control Guide. 

A CLOSER LOOK: Virginia Youth Help Schools Go Tobacco Free

Since 2004 the youth engagement program of the Virginia Foundation for Healthy Youth, known as Y 

Street, has trained more than 8,500 youth to be agents of change in their communities. Each year, a 

dedicated group of these youth, called Y-Sters, become members of the Y Street Leadership Team. Kit

Harmon, a senior at Fauquier High School in Warrenton, Virginia, is one of the leadership team members

who works toward Y Street’s goal of creating a healthier Virginia.

Kit said, “The Y-Sters at my school 

work hard to make sure students 

have the best opportunity to be 

healthy.” Through her work with 

an earlier Y Street campaign, 24/7, 

Kit became determined to help her 

public school become a tobaccoand e-cigarette-free campus.

First, Kit met with school officials, 

including principals and the 

assistant superintendent. After 

securing their support, she met 

with her county school board to 

describe the resources that the 24/7

campaign provides, including signs 

and a free toolkit to help schools 

implement, communicate, and 

enforce comprehensive tobaccofree campuses. In 2018, the school board adopted a comprehensive tobacco- and e-cigarette-free policy. 

Between 2015 and 2018, Y Street youth working on the 24/7 campaign statewide completed 110 principal 

meetings and helped 16 public school divisions become tobacco-free, covering 98,197 students.

Youth can take the following steps to help their schools become tobacco- and e-cigarette free:

• Meet with school-level officials such as principals and superintendents for initial buy-in.

• Attend school board meetings and communicate how the youth program can support tobaccofree schools in the community.

• Provide resources to help schools implement and enforce tobacco-free campuses.

Y Street Leadership Team members and Fauquier County school board officials pose 

after becoming creating a tobacco- and e-cigarette-free environment. Source: 

Virginia Foundation for Healthy Youth 

Involving Youth in Pricing Strategies

Many young people see tobacco prices and discounts 

advertised on their way to school or in stores where 

they shop.2 They can help tobacco control efforts 

by documenting what they see and sharing their 

experience with community members. When young 

Youth Engagement l 13

HOW TO
people speak out about how pricing affects youth 

tobacco use, they help make the case for strategies to 

increase the price of tobacco products. 

Documenting Tobacco Prices and Discounts 

Youth interested in gathering pricing information 

can start by planning a route that is safe, walkable, 

and located near school crosswalks or bus routes.79

Working in small groups of four to six people, they 

can take photographs or videos of tobacco prices 

and promotions along the route. They can also look 

for signs with tobacco product branding or ads on 

functional items like gas pumps.79

Strategies like Photovoice can help young people 

capture what they see. Photovoice combines 

photography and personal narratives to better 

understand and educate others about social issues. 

Program staff can support Photovoice activities by:80

• Providing cameras for youth

• Training youth in basic photography techniques

• Educating youth about safety while in the 

community taking pictures

• Leading discussions about what issues the photos 

depict and what can be done about them

• Helping youth plan to share their photos by 

hosting exhibits, displaying them at public 

events, sending postcards or videos to 

community decision makers, or sharing photos 

on social media

Learn more about using Photovoice in the 

Community Tool Box resource, Implementing 

Photovoice in Your Community.

Raising Awareness of Industry Pricing Strategies

Youth can raise awareness about tobacco pricing issues 

by educating the community on how the tobacco 

industry’s pricing strategies attract youth. For example, 

in 2011, Tobacco-Free Providence launched the Sweet 

Deceit education campaign in Providence, Rhode 

Island. Youth and adults surveyed over 1,200 residents 

about their knowledge of tobacco pricing strategies.81

The surveys also created opportunities to talk about the 

problem of price discounts on tobacco products. Survey 

results helped show decision makers that most people 

supported raising prices, and Providence become 

the first city in the U.S. to ban tobacco product price 

discounts and coupon redemption.81

To raise awareness about pricing issues, youth can:

• Survey community members about their 

knowledge of tobacco product pricing issues and 

support for raising prices80

• Educate community members and decision 

makers about the industry’s pricing strategies, 

such as coupons and multipack discounts81

• Share information about the dangers of cheap 

tobacco products and youth tobacco use81

• Inform decision makers about the importance of 

precise definitions to avoid loopholes that allow 

some products to be taxed at lower rates82

Reducing Tobacco Industry Influence at 

the Point of Sale

Since the 1998 Master Settlement Agreement, 

tobacco product advertising targeting youth has 

been increasingly restricted. Today, youth primarily 

see tobacco ads and promotions in retail stores. The 

tobacco industry spends nearly $1 million per hour to 

advertise and promote tobacco products at the point 

of sale.83 These ads often feature colorful packaging 

that resembles candy or are placed at youth eye level 

Youth Engagement l 14

HOW TO
near the soda and candy aisles.2

 These industry tactics 

work; retail advertising and promotion cause youth to 

start using tobacco products and progress to regular 

use.2 Strategies to reduce youth exposure to tobacco 

advertising are important to prevent initiation and 

prevent relapse among youth who quit tobacco. 

A CLOSER LOOK: Youth Work to Raise the Age to Buy Tobacco in Cities 

Nationwide

Increasing the legal age to buy 

tobacco products to 21 is becoming 

a popular strategy to reduce youth 

tobacco use. As of September 2019, 

the Tobacco 21 movement included 

over 500 localities and 18 states: 

Arkansas, California, Connecticut, 

Delaware, Hawaii, Illinois, Maine, 

Maryland, Massachusetts, New 

Jersey, New York, Ohio, Oregon, 

Texas, Utah, Vermont, Virginia and 

Washington.88 The goal of Tobacco 

21 policies is to reduce social 

sources of tobacco by making it 

more difficult for younger teens 

to get tobacco products from 

young adult friends and relatives, 

the main way that underage users 

get tobacco products.89 Research suggests that raising the age to buy tobacco products to 21 will delay 

or prevent youth initiation, with the greatest impact among teens ages 15–17.89 The results of Tobacco 

21 policies have been dramatic: in Needham, Massachusetts, the first town to adopt Tobacco 21, youth 

smoking prevalence decreased by nearly 50 percent in just five years.90

Around the country, youth have been important partners in adopting Tobacco 21. In Hawaii, youth made 

Tobacco 21 the focus of their 2015 Kick Butts Day rally and shared their message on social media with 

the hashtag #RaisetheAgeHI.

19 On June 19, 2015, Hawaii became the first state to adopt Tobacco 21. 

Pennsylvania youth show their support for raising the age to buy tobacco to 21 

Source: Pennsylvania TRU 

As young people’s tobacco use patterns change, retail 

strategies become increasingly important. In 2014, 

e-cigarettes became the most popular tobacco product 

among middle and high school students.84 Students 

report seeing e-cigarette advertising most often in retail 

stores.85 Like other tobacco products, e-cigarettes are 

often placed near products that appeal to youth, such 

as candy and slushie machines.86 Youth e-cigarette 

use is also strongly associated with use of other 

tobacco products, including cigarettes.34 Easy access to 

e-cigarettes threatens to make tobacco use acceptable 

once again. 

Programs can pursue a variety of retail strategies, 

including:87

• Reducing or restricting the number, location, 

density, and types of tobacco retailers (e.g.,

limiting tobacco retailers near schools or 

banning tobacco product sales in pharmacies)

• Restricting point-of-sale advertising (e.g., 

banning advertising near schools or places 

youth visit)

Youth Engagement l 15

HOW TO
• Restricting product placement (e.g., banning 

self-service displays)

• Increasing the minimum sales age for tobacco 

products to 21

• Banning flavored tobacco product sales

• Implementing similar strategies for e-cigarettes 

(e.g., setting a minimum sales age for 

e-cigarettes or limiting e-cigarette sales near 

places youth visit)

Learn more about potential strategies in the resource, 

Point-of-Sale Strategies: A Tobacco Control Guide.

Involving Youth in Point-of-Sale Strategies

Involving youth in retail efforts helps reveal advertising 

tactics aimed at young people and expose differences 

in tobacco advertising across communities. Youth 

involvement also helps programs develop relevant and 

effective policies. Youth can:

• Conduct store assessments and walking 

tobacco audits

• Map tobacco retailers

• Survey the community about tobacco control 

issues

• Share the results of their activities with 

community members

Conducting Store Assessments

Store assessments, sometimes called store audits or 

store observations, assess interior and exterior tobacco 

product advertising and availability, price, placement, 

and promotions.91 This information helps programs and 

partners stay up to date on the constantly changing retail 

environment, select strategies, and determine if strategies 

are successful. Store assessments are also a way to involve 

youth and keep them engaged over time.92

Program staff can encourage youth involvement in store 

assessments by educating them about the importance 

of surveying tobacco retailers. Sharing examples of 

successful youth involvement can help generate interest.92

For example, nearly 300 youth helped conduct more than 

7,000 store assessments across California that led to store 

makeovers and the adoption of local policies.93

Staff can also give youth store lists and assessment tools 

like the Standardized Tobacco Assessment for Retail 

Settings (STARS).94 The 20-item tool takes about 10 

minutes to complete online or on paper. STARS does not 

require special training and has been used by youth and 

adults. After completing the assessment, programs can 

use the STARS Policy Crosswalk to select strategies.

By 2015, 31 states had used or were planning to use 

STARS.95 Programs can also combine STARS with other 

assessments to gather more information. For example, 

the Oregon tobacco control program added questions 

about food, alcohol, lottery, and energy drinks sold 

in stores, and Vermont added questions about access 

to fresh fruits and vegetables.96 Researchers have also 

adapted the tool to assess other aspects of the tobacco 

retail environment. The vSTARS tool was released 

in 2016 to assess vape shops (i.e., retailers that sell 

e-cigarettes).97 More information and training materials 

for all of the STARS tools are available on the Counter 

Tobacco website.

Safety is a top priority when involving youth in store 

assessments. Program staff can ensure a safe and fun 

experience by obtaining parental consent, coordinating 

transportation, sending youth in pairs, and providing 

adult supervision.98 Youth may also need training on 

how to collect data and talk with store employees. After 

data have been collected, staff can bring youth together 

to discuss the results and decide what action they 

want to take next. Learn more about how to conduct 

store assessments in the Preventing Chronic Disease

article, How to Conduct Store Observations of Tobacco 

Marketing and Products. 

Mapping Tobacco Retailers

Maps can tell powerful stories about tobacco advertising 

in communities. Young people can help create maps 

that show how many tobacco retailers are located in a 

specific area or how close they are to schools, parks, or 

other places that youth visit. Maps can also demonstrate 

the potential impact of retail strategies. For example, 

mapping places that sell tobacco products can show how 

access to tobacco could be reduced by prohibiting sales 

in certain retailers, such as pharmacies.99

To create a map, youth can start by choosing a 

geographic area to focus on, such as their neighborhood 

or the streets around their school. State tobacco control 

Youth Engagement l 16

HOW TO
programs can help youth get the latest information on 

which stores sell tobacco products, often available in state 

or local licensing lists. Youth can then use Geographic 

Information Systems software or free programs like 

Google’s My Maps to create maps and add other 

information like the locations of schools or parks.

Sharing Results 

When young people present information about tobacco 

advertising in their communities, adults listen. Youth 

can present store assessment reports, photos and videos 

of tobacco advertising, retailer maps, and community 

survey results. Inviting community leaders to take part 

in activities can leave a lasting impression. For instance, 

youth in New York City asked decision makers to join 

them on walking tobacco audits to see tobacco advertising 

that youth are exposed to every day. The “Take a Walk in 

Our Shoes” tours got people talking about how easily New 

York City’s youth can access tobacco products.100

Youth can also submit fact-based comments that share 

new scientific findings or experiences from the field 

when new tobacco regulations are proposed.101 In 2012, 

youth from Virginia’s Y Street presented information 

about the appeal of dissolvable tobacco products 

to the FDA’s Tobacco Products Scientific Advisory 

Committee. Dissolvable products, such as lozenges, 

strips, or sticks, melt in the mouth and do not require 

spitting tobacco waste.102 Y Street conducted over 8,000 

surveys, finding that teens thought the products were 

actually candy, mints, or gum and would be interested 

in trying them based on their packaging.103 FDA 

acknowledged that the Y Street testimony helped them 

conclude that dissolvable products may increase the 

number of tobacco product users.17

Youth can also extend the reach of retail activities 

by taking photos and videos during their events and 

sharing on social media. For instance, New York City 

youth shared videos of the walking tours on Facebook, 

YouTube, and Twitter and with community leaders.100

Inviting press to cover events can also help generate 

news coverage of youth efforts. 

Examples of tobacco placement shown in the STARS Pocket Guide used 

to complete store assessments 

Communicating the Dangers of Youth 

Tobacco Use 

Although federal regulations and court rulings 

have placed limits on tobacco product advertising, 

youth are still exposed to tobacco marketing in 

their communities, online, and in movies and video 

games.1

 The tobacco industry has also turned to other 

marketing strategies, such as in-store ads, direct mail, 

and digital marketing, to work around advertising 

restrictions.2 Youth exposed to tobacco advertising 

and promotion are more likely to try and continue to 

use tobacco.2 Communications strategies are critical to 

counter the influence of pro-tobacco media.104

Communications campaigns share messages about the 

dangers of tobacco use and secondhand smoke exposure. 

When part of a comprehensive program, campaigns 

prevent youth initiation, reduce youth tobacco use, and 

Youth Engagement l 17

HOW TO
increase cessation.1,2 They can also shift social norms 

around tobacco use and increase acceptance of tobacco 

control strategies.3

 Learn more about communications 

strategies in the CDC Best Practices User Guide: Health 

Communications in Tobacco Prevention and Control.

A CLOSER LOOK: San Francisco Youth Reduce Tobacco Retailer Density

In 2009, the Youth Leadership 

Institute, with funding from the 

San Francisco Department of 

Health, brought together a group 

of young people to explore tobacco 

control issues in the city. They 

called themselves the Tobacco 

Use Reduction Force (TURF) 

and began mapping the locations 

of tobacco retailers across the 

city. TURF was alarmed to find 

that stores selling tobacco were 

concentrated in neighborhoods 

with the lowest incomes, large 

minority populations, and close 

proximity to schools.105 With 

this information, they created 

recommendations to reduce the number of tobacco retailers.

To strengthen their recommendations, youth observed stores in different neighborhoods.105 TURF 

updated their original map with new data and recommended limiting tobacco retailers near schools. 

They also worked to build a broad coalition of support. TURF youth met with businesses that sold 

tobacco to discuss their concerns, surveyed community members about their support for limits on 

tobacco retailers, and formed an advisory board of community leaders.105 TURF also created videos and 

garnered news coverage in magazines and on the radio to educate the public and decision makers on 

reducing tobacco retailer density.106

The youth’s determination and willingness to learn from past failures paid off. In January 2015, the 

San Francisco Board of Supervisors unanimously passed a law to cap the number of retailers in each 

district, limit the number of stores in a single block, and restrict retailers from locating near schools. 

Supervisor Eric Mar credited the youth’s research and door-to-door education efforts for the proposal’s 

success.107 The policy is expected to eventually reduce tobacco retailers in San Francisco by 50%, but 

immediate effects are already evident. Within the first year, the number of licensed tobacco retailers 

decreased by 8%.105 

TURF’s logo

Involving Youth in Communications Campaigns

Although communications campaigns often involve 

specialized staff such as public relations specialists 

and media buyers, youth are also important partners. 

They can offer unique insight on the messages and 

Youth Engagement l 18

HOW TO
themes that will resonate best with youth. Youth also 

have credibility with community members, the news 

media, and their peers. They can use this influence 

to generate media coverage about tobacco control 

issues and efforts, share campaign messages on social 

media, and reduce exposure to tobacco products in 

movies and video games. Media literacy training can 

help youth better understand how tobacco advertising 

impacts viewers. 

Pretesting Messages and Materials

Input from youth is important to ensure that campaign 

messages resonate with youth audiences. Youth can help 

pretest campaign messages and ads, an important step 

in ad development during which a focus group or panel 

helps determine if messages will be effective. Youth can 

share their opinions on the following topics:111

• What messages they take away

• What parts of the ad they like

• What parts of the ad they do not like or find 

confusing

• Whether the ad is believable

• Whether the ad is relevant to their lives

• Whether the ad motivates them to change

Reducing Youth Access to Candy-Flavored Tobacco Products

Many tobacco products, 

including e-cigarettes, come in 

a variety of sweet flavors that 

appeal to youth and may play 

a role in youth initiation.108 In 

2014, more than 80% of youth 

reported that the first tobacco 

product they ever used was 

flavored, and more than 

65% cited flavors as a major 

reason for using tobacco 

products.108 The FDA recently 

proposed restrictions to limit 

youth access to flavored tobacco products in stores and online.109 Youth are also taking action in their local 

communities. In Florida, Students Working Against Tobacco (SWAT) raised awareness about the dangers of 

candy-flavored tobacco products. As of 2014, all 67 Florida counties had passed resolutions urging tobacco 

retailers to restrict the sale and marketing of flavored products.91 Tobacco control programs can help reduce 

youth access to flavored tobacco products by:110

• Educating youth on the facts about candy-flavored tobacco products

• Training youth in presentation skills, media literacy, and generating news coverage

• Including flavored tobacco products in store assessments

Partnering with parent groups and other community organizations to build community awareness about 

the risks of candy-flavored tobacco products 

Image raising awareness about candy-flavored tobacco products Source: Tobacco Free Florida

Youth Engagement l 19

HOW TO
Promoting National Media Campaigns with Youth Audiences

Many high-quality national 

media campaigns have been 

developed in recent years 

to educate youth about the 

dangers of tobacco use. For 

instance, the Truth Initiative’s 

Finish It campaign aims to 

empower youth and young 

adults to be the generation that 

ends smoking for good. The 

campaign exposes youth to the 

tactics of the tobacco industry, 

the truth about addiction, and 

the health effects and social 

consequences of smoking.112

FDA has also launched three 

national campaigns aimed 

at preventing and reducing 

tobacco use among youth. 

The Real Cost campaign seeks 

to raise awareness about the 

health consequences of tobacco 

use among youth who are open to smoking or are experimenting with tobacco. From 2014 to 2016, the 

campaign prevented an estimated 350,000 youth ages 11–18 from smoking.113 Building on this success, 

FDA added new ads designed for rural male youth at risk for smokeless tobacco use. FDA also launched the

Fresh Empire campaign to reach multicultural youth who identify with hip-hop culture and are at risk for 

smoking, and This Free Life, a campaign to prevent and reduce smoking among LGBT young adults.

General audience campaigns that feature hard-hitting messages about the negative health consequences 

of tobacco use are effective with many different audiences.1

 Programs can save time and resources and 

avoid duplicating efforts by promoting existing media campaigns instead of creating new ones. Program 

staff can use the following low-cost strategies to promote existing campaigns:

• Run “Ads in Cycle,” ads available in the CDC’s Media Campaign Resource Center that are on air 

and can be circulated without added cost114

• Share messages on social media when a national campaign airs on TV114

• Distribute free campaign materials to youth, such as posters and postcards115

• Encourage youth to share campaign messages with their peers116

• Direct teens to campaign websites and social media channels116

• Share campaign resources with other organizations that work with youth116

Social media post from the “Finish It” campaign Source: Truth Initiative

Youth Engagement l 20

HOW TO
Generating News Coverage

Youth voices can gain the attention of news media, 

generate coverage of tobacco control efforts, and extend 

campaign messages at little or no cost. Media coverage 

adds legitimacy and importance to tobacco control 

efforts. It can also boost participation in events and 

activities. To generate media coverage, youth can host 

press conferences, write Op-Eds (stand-alone pieces of 

writing that express strong opinions), and write letters 

to the editor (short pieces that express an opinion 

about a recent news item). Youth can write about their 

own experiences with tobacco, their tobacco control 

activities, or data they have collected.

Sharing Messages on Social Media

As of 2018, 97% of teens use at least one social media 

platform.117 Since social media is a major way that 

youth communicate with one another, it is an 

important tool for youth to get involved in tobacco 

control. Youth can use social media to share tobacco 

control messages and interact with community 

members. They can also create posts, select hashtags, 

and help select the best social media sites for sharing 

messages. Young people can use social media to recruit 

volunteers, organize events and activities, and monitor 

tobacco product marketing.

Image from Florida’s Students Working Against Tobacco’s (SWAT) 

#NotAReplacement social media campaign Source: Tobacco Free Florida 

Reducing Onscreen Tobacco Use

Depictions of smoking in movies cause young people to 

start smoking.2 Despite recent declines in the number 

of movies depicting tobacco use, incidences of onscreen 

tobacco use have actually increased.118 From 2010 to 

2016, the number of tobacco incidents in top-grossing 

movies increased by 43% in movies rated PG-13.118

Smoking is not limited to the big screen; tobacco 

imagery is also found in streaming shows and video 

games popular among youth.119,120 Ninety-two percent 

of the most popular streaming and cable shows 

among youth contained tobacco imagery in 2018.119

Forty-two percent of video games include tobacco 

imagery.120 These numbers are especially concerning 

because of the popularity of these channels among 

youth; in 2018, teens watched more than twice as 

much Netflix as cable TV, and more than half of teens 

reported playing video games.121,122

To reduce the impact of onscreen tobacco use on youth, 

young people can encourage the entertainment industry 

and decision makers to take the following steps:

• Rate onscreen media that depict tobacco use as

“R” or “Mature”123

• Reduce or ban identifiable tobacco brands in

onscreen media123

• Restrict the tobacco industry’s ability to pay for

tobacco use in onscreen media123

• Require onscreen media that depicts tobacco use

to include tobacco control messages123

• Limit state subsidies for onscreen media that

depicts tobacco use119

Youth can also monitor tobacco depictions in onscreen 

media, including streaming and gaming.119,120 Learn 

more about how youth can work to reduce onscreen 

tobacco use in the Reality Check resource, Smoke Free 

Media Guide.

Youth Engagement l 21

HOW TO
A CLOSER LOOK: Iowa Youth Educate Dollar General about Tobacco 

Advertising

Youth can share an important perspective with decision makers about how tobacco use harms their 

communities. In 2016, members of the Audubon, Iowa, chapter of Iowa Students for Tobacco Education 

and Prevention (ISTEP) wrote a letter to the Dollar General Corporation after seeing large tobacco product 

ads outside their local chain store. As a result, Dollar General not only took down ads in Audubon but 

across the state.124 The achievement was especially meaningful for the program because the idea came from 

youth. The chapter then focused on persuading local grocery stores to remove outdoor ads.124

Although there are many ways to educate decision makers, meeting representatives in person is 

important.125 Before sitting down with decision makers, it can be helpful to learn about their past work 

and organizational affiliations. It is also important for youth to know the facts about the tobacco control 

issue they will be speaking about. Beforehand, they can research the issue, prepare talking points, and 

practice sharing their message.126 Using personal or local stories to convey a message is a particularly 

effective way to inform decision makers.125 Decision makers are given lots of information and often have 

limited time to review, so youth can also prepare a fact sheet to share with their audience.125 Youth can 

also educate decision makers about the dangers of tobacco use by:

• Submitting letters to the editor in local publications125

• Speaking at city council meetings or hearings125

• Hosting a letter-writing gathering with peers127

• Arranging meetings with local or regional decision makers, such as local business owners125

• Holding a town hall meeting with community leaders128

• Sharing facts on Twitter, Facebook, or email123 

Training Youth in Media Literacy

Media literacy training teaches youth to analyze 

tobacco industry messages, understand how 

these messages impact them, and create effective 

communications.129 Training often includes evaluating 

tobacco industry messages to learn about manipulative 

advertising practices and creating brief, educational 

public service announcements that can be placed for 

free by media outlets, shared with community partners, 

or posted online.129

Building Community Awareness

Community-based activities help shape how the 

public views tobacco use. Programs or groups that 

involve youth can deepen community networks and 

pool resources by developing partnerships with local 

organizations. As community interest groups join 

forces, public health concerns are communicated 

and shared by diverse groups, increasing awareness 

of tobacco control issues. Community engagement 

activities also help recruit new youth members and 

build momentum for tobacco control strategies.130

Involving Youth in Community Engagement 

Young people have access to other youth and are 

often savvy communicators on social media and 

in their communities. Youth can use their talents 

and connections to host community events that 

get people talking about tobacco control issues and 

encourage them to take action. Well-publicized events 

can also help grab the attention of the media, build 

partnerships, and recruit new youth members.131

Youth Engagement l 22

HOW TO
The Role of School-Based Tobacco Prevention Programs

Schools are an 

important setting 

for tobacco control 

efforts. Youth 

spend much of 

their day at school, 

where students can 

experience peer 

pressure to try 

tobacco products.127

Although schoolbased programs 

to prevent youth 

tobacco use were 

once thought to be 

ineffective, recent 

research suggests 

that when programs 

follow evidencebased best practices, school-based programs can prevent initiation in the short term and, in some cases, 

achieve longer-term outcomes.2

Effective school-based prevention programs span multiple years instead of hosting one-time speakers and 

special events.2

 Generally, they begin in middle school or earlier and end with reinforcement of learning 

during high school.132 These long-term programs work best when part of a comprehensive tobacco control 

program that includes tobacco-free school environments, community-wide strategies, and media literacy 

training.2

 School-based programs can also include these effective elements:

• Interactive role-playing and discussion about social influences2

• Life skills practice (e.g., goal setting, refusal skills, and communication skills)2

• Information about the risks of other tobacco products, including e-cigarettes34

• Education by peer leaders2

• Opportunities for youth involvement in activities outside the classroom127

• Access to cessation services designed for youth, such as strategies that help both frequent and 

occasional tobacco users quit2

School administrators and teachers can access resources and learn more about school-based tobacco 

prevention in Stanford Medicine’s Tobacco Prevention Toolkit.

Youth Engagement l 23

HOW TO
Events may include:14 

• Demonstrations to 

educate people about the 

dangers of tobacco use 

and the industry’s tactics

• Tobacco-free movie 

nights or litter cleanups 

to raise awareness about 

key tobacco control issues

• Rallies or tobacco-free 

days to build enthusiasm 

for tobacco control

• Tobacco exchanges 

where users trade 

tobacco accessories for 

promotional items like 

tobacco-free T-shirts or 

bumper stickers

• Community forums to 

share survey results or 

store assessment data

• Local events to coordinate with national days of 

significance, such as the Great American Smoke 

Out, Kick Butts Day, or Earth Day

Members of The 84 Movement (a program of the Massachusetts Tobacco Cessation and Prevention Program) 

rally at the Massachusetts State Capitol to raise awareness of the tobacco industry’s marketing tactics 

Source: the84.org ©2017 Marilyn Humphries 

Youth can also encourage leaders to make other 

community events tobacco free. At these events, 

youth can educate people about tobacco use or survey 

community members about their support for tobacco 

control strategies. More ideas for community events 

are available from the Massachusetts statewide youth 

program, The 84 Movement, and Campaign for 

Tobacco-Free Kids’ Kick Butts Day website. 

Planning Community Events

Planning for events often begins weeks or even months 

ahead. Youth can start by organizing a planning team 

to bring together partners, get permits or permissions, 

gather supplies, and recruit volunteers. The planning 

team also assesses whether youth need training before 

the event, such as practice speaking in public. The week 

before, youth can promote the event on the radio, in 

school newsletters, and on social media.

Interacting with the public is an important part of 

community engagement. Some people may be open 

to learning about tobacco control; others may express 

opposition. Youth can effectively communicate their 

message by:133

• Preparing ahead of time, including responses to 

potential opposition

• Relating tobacco control to topics that are 

important to the audience, such as the 

environment or youth

• Sharing their personal experiences with tobacco 

or tobacco-related illness

• Asking people to share how tobacco has affected 

their lives

Monitoring and Enforcing Tobacco 

Control Policies

Monitoring and enforcement activities communicate 

new policies and ensure they are followed. Past 

enforcement efforts have shown the importance of 

these activities. For example, federal enforcement 

efforts as part of the Synar Amendment reduced 

illegal tobacco sales to minors from over 40% in the 

late 1990s to just 9.8% in 2014.134 When policies are 

fully and fairly enforced, they help avoid unintended 

consequences and achieve tobacco control goals.

Youth Engagement l 24

HOW TO
Involving Youth in Monitoring and 

Enforcement

As students, employees, and residents of places covered 

by tobacco control policies, youth play an important 

role in monitoring and enforcing new policies. Students 

can report when they see other students or school staff 

violating tobacco-free policies. Underage youth may 

also conduct store compliance checks.135 For example, 

through Arizona’s Counter Strike program, youth 

volunteers and special investigators from the Attorney 

General’s Office visit tobacco retailers where youth try to 

buy tobacco products. Stores that sell tobacco products 

to youth may be fined and offered more training. 

Businesses who refuse to sell to youth are celebrated for 

their work to limit youth access to tobacco.

Youth can also help monitor and enforce policies by:

• Monitoring tobacco product advertising at 

local stores14

• Writing letters to decision makers asking them 

to support enforcement of existing local and 

state policies14

• Speaking at public meetings in support of 

enforcing existing policies14

• Modeling healthy behaviors for other youth and 

community members136

• Posting tobacco-free signs and other 

information about new policies67

• Sharing information about local cessation 

resources137

A CLOSER LOOK: Refocusing and Revitalizing Efforts in Oklahoma41

The Oklahoma State Department of 

Health founded Students Working 

against Tobacco (SWAT) in 1999 to 

engage youth in community action 

against tobacco and build state and 

local youth coalitions. Supported by 

a grant from the American Legacy 

Foundation, SWAT teams developed 

their own objectives and priorities. 

Many teams decided to focus on 

local, high-impact policy work. 

When the grant ended in 2004, the 

Department continued SWAT but 

shifted focus to other initiatives. 

Over time, SWAT staff positions were dissolved and integrated into other programs. The activities, 

programs, and trainings of SWAT teams began to vary as the program’s management decentralized. 

SWAT teams lacked structure and were using out-of-date materials. As a result, many teams shifted to 

lower-impact efforts such as peer education.

In 2010, SWAT refocused its efforts on high-impact strategies. The Department partnered with the 

Tobacco Settlement Endowment Trust to launch three campaigns to reenergize the program: 24/7, which 

engaged youth in creating tobacco-free schools; In the Clear, designed to reduce secondhand smoke 

exposure through local smoke-free laws; and No Minor Issue, focused on youth access at the point of 

sale. The Department created updated materials for each campaign and followed a coordinated program 

structure that included youth training, campaign objectives, and measures of progress. After the changes, 

youth reported greater confidence in their ability to implement a tobacco control campaign. 

SWAT’s logo 

Youth Engagement l 25

HOW TO
Implementing Youth 

Engagement Efforts

Youth can be valuable partners, but engaging youth 

effectively takes time and planning. To engage youth, 

program staff can use the strategies outlined in the 

following sections:

• Preparing to engage youth

• Developing an action plan

• Involving youth in reducing tobacco-related 

disparities

• Evaluating youth engagement

• Sustaining youth engagement

Preparing to Engage Youth

Strong youth engagement efforts are well-thought-out 

and intentional. Programs can ensure they are ready to 

engage youth in meaningful ways by assessing program 

readiness, securing organizational support, and 

planning multiple ways for youth to get involved.25,57,138

Assessing Capacity to Engage Youth

Before engaging youth, it is critical to take time to 

assess the program’s readiness to work with youth. 

Understanding the program’s strengths and potential 

obstacles to engaging youth 

can help build a successful 

program and anticipate 

challenges. Program staff 

interested in engaging youth 

can start by asking:25

• Why do we want to 

engage youth?

• How do we want to 

engage youth (e.g., one 

time or long-term)?

• What strengths do we 

have that can support 

youth engagement?

• What obstacles have we 

faced in the past?

• Who can help us engage youth? 

• What can we offer these partners in return?

Equally important as why the program wants to 

engage youth is why youth might want to engage with 

the program. Gathering input from a small group of 

youth on what they would be interested in working 

on and what skills they want to learn can help develop 

a relevant program that youth want to join. To assess 

program readiness and begin developing a plan to 

engage youth, use the self-assessment tool included 

in the California Youth Advocacy Network’s Regional 

Youth Engagement Workshops Summary Report.

Securing Organizational Support

It is critical not to underestimate the challenges 

that might arise during youth engagement efforts.8

For instance, program staff are sometimes faced 

with limited resources for youth engagement or 

an organizational culture that is unfriendly toward 

involving youth.139,140 Building support among program 

and agency leaders can help staff access critical 

resources and sustain youth engagement efforts.140 To 

secure organizational support, program staff can share 

three key messages with leaders:8

• Why they want to involve youth

• How youth can get involved in program activities

• How involving youth will benefit the program

HOW TO

Youth Engagement l 26
Offering Multiple Levels of Engagement

Programs can strengthen youth engagement by offering 

multiple ways for youth to take part in activities. Some 

youth may have the time and interest to commit to 

long-term activities. They may be best suited for highintensity strategies that require significant planning and 

take months or even years to carry out.14 Although these 

kinds of activities take more time and resources, they can 

help communities mobilize to make a lasting impact.14

Other youth might want to get involved, but may not 

have time for a deeper level of commitment. Lowintensity activities, such as one-time events or projects, 

can help engage youth until they are ready to take on 

greater responsibility.14 While these activities often 

require fewer resources, they may have a limited impact 

on tobacco control goals.14

Keeping Youth Safe

All programs that work with youth have a responsibility 

to minimize risk to the youth they serve.142 Conducting 

background checks of adults who work with youth is 

just one important step. A comprehensive screening 

process includes:142

• National and state criminal background checks

• State and national public sex-offender website 

checks

• State child-abuse registry checks

• Interviews

• Reference checks

• Observations

Each element adds another layer of protection for 

youth.142 It is important that all adults who may work 

with youth are screened, including volunteers. Learn 

more about screening in the Department of Justice 

resource, What You Need to Know about Background 

Screening. 

Working with Youth

Adults who have not worked with young 

people before may not know how to 

effectively engage youth. Strong youth 

engagement efforts allow youth to take 

charge in planning and carrying out 

activities, with support from staff as 

needed.27 Staff can offer technical assistance 

and expert advice and provide resources 

such as materials, event space, and 

training.27,141 It is also critical for program 

staff to listen to youth just as they would 

adults. Engaged youth are given an equal 

opportunity to share their ideas, knowledge, 

and perspectives.23,138 To work effectively 

with youth, program staff can also:

• Thoroughly screen adults by 

conducting background and reference 

checks, interviews, and observations142

• Train adults who will be working 

with youth31

• Develop ground rules for youth-adult 

interactions7

• Recognize youth ideas and 

achievements23

• Treat youth as equal partners27

• Address power imbalances if they 

occur8 

Developing an Action Plan

An action plan guides how youth and staff will 

work together. The plan describes the problem to 

be addressed, lays out key strategies, and identifies 

important partners. It is important that the action 

plan is developed with input from both program staff 

and youth. Reserving time to reflect and evaluate after 

the plan is in place can help improve future youth 

engagement efforts.

Describing the Problem

Fully understanding the tobacco issues the community 

faces helps program staff and youth choose appropriate 

strategies.14 Community assessments are an important 

tool for building this understanding. Staff and youth 

can use community assessments to:14

HOW TO

Youth Engagement l 27
• Learn more about community members’ 

tobacco-related attitudes and behaviors

• Identify the populations that are most affected 

by tobacco use

• Collect information about how tobacco is 

advertised and sold

• Document and research the tobacco control 

policies that already exist

Choosing Strategies 

Allowing youth to take the lead in choosing strategies 

helps ensure that activities focus on issues important 

to them. Working on issues youth are passionate 

about and have personal connections to can keep 

them engaged.8 Program staff can help youth choose 

successful strategies by focusing on those that are 

visible to a wide audience, have a long-term impact, 

encourage collaboration between youth and adults, and 

produce meaningful results. 

Brainstorming generates fresh ideas. FACT, Wisconsin’s 

youth-led tobacco prevention movement, uses 

brainstorming to develop FACTivisms, activities to 

spread the truth about tobacco. In 2016, FACT held a 

contest for youth chapters to brainstorm ideas for new 

FACTivisms.143 The winning activities were professionally 

developed and shared statewide. To learn more about 

brainstorming, see the FACT resource, Facilitation 

Techniques: Get the Most Out of Brainstorming.

Other tobacco control programs may also be able to offer 

suggestions and share resources and materials.31 Staff and 

youth may decide to adapt strategies that have worked 

well for other programs to save time and resources.

Developing Partnerships

Strong partnerships help integrate youth engagement 

efforts into the community.138 Partnerships bring 

together people and organizations with diverse skills 

and experiences to reach a common goal. Many 

different partners can contribute to youth engagement 

efforts by speaking in support of tobacco control 

strategies, providing time and expertise, and helping 

access key audiences.144 Partners can also share their 

success stories with other potential partners and 

encourage them to join youth engagement efforts.

Key partners could include:14

• Local tobacco control coalitions

• Parent-teacher organizations

• K-12 schools and colleges

• Organizations that work with youth, such as 

Boys & Girls Clubs of America or the YMCA

• Public health organizations, such as the 

American Cancer Society, American Lung 

Association, and American Heart Association

If youth engagement efforts reach across counties, 

program staff may consider forming a regional 

partnership. This can allow youth and their partners 

to pool resources, publicize events to a broader 

audience, and leverage the power of youth groups in 

each county.139

Writing the Plan

Once youth have selected strategies and identified 

key partners, they can put everything together in a 

detailed action plan. Action plans outline the goals, 

objectives, activities, and available resources for youth 

engagement efforts.145

An action plan begins with the goals that program 

staff and youth want to accomplish.145 For example, 

they might aim to educate the community about the 

importance of limiting tobacco retailers near schools. 

Objectives are the smaller successes that help staff 

and youth reach their goals.145 For instance, objectives 

might include completing 30 store assessments and 

creating a map that shows all of the community’s 

tobacco retailers. Strong, clear objectives use the 

SMART approach (Specific, Measurable, Achievable, 

Relevant, Time Bound).146

The action plan also outlines what program staff and 

youth will do to achieve goals and objectives.145 This 

section of the action plan describes:145

• Who is responsible for specific activities

• When the activity will occur or be completed

• What resources are needed (e.g., funding, 

people, and supplies)

• Potential barriers

HOW TO

Youth Engagement l 28
Including as many details as possible in the action plan 

helps identify resource gaps and potential roadblocks. If 

youth find that they are missing critical resources, they 

can create plans to pursue new sources of support or 

ask partners for help.

Implementing the Plan

Focusing first on short-term objectives can help show 

youth that they are making progress and keep them 

motivated.47 For example, West Virginia’s youthled tobacco prevention initiative, Raze, plans and 

implements activities called Commotions. These shortterm activities are meant to keep youth efforts visible in 

the community and maintain youth enthusiasm.146

Meetings are important times for youth and staff to 

plan and prepare for upcoming activities. Youth can 

have busy schedules, so it is important for program staff 

to schedule meetings at convenient times for youth, 

such as evenings or weekends.7

 Learning the schedules 

of activities that youth are involved with can help 

programs plan meeting times that fit with their other 

commitments.25 Meetings can be led by adults, jointly 

directed by adults and youth, or completely youth led.147

During meetings, it is critical that youth feel welcome, 

valued, and heard.147 To create a fun and inviting 

environment, program staff can incorporate icebreakers 

or team-building activities, provide food and snacks, 

and allow time for socializing.147

Reflecting and Evaluating

Community change can take a long time, so it is 

important that youth reflect on and evaluate their 

progress often.14 Reflecting on efforts as a group can 

help identify challenges, reveal new opportunities, 

and celebrate successes.148 Looking back collectively 

can also help identify ways to enable staff and youth to 

work together more effectively.8 Depending on the time 

and resources available, staff and youth may decide to 

hold informal check-ins or conduct a more thorough 

evaluation of their efforts.8 Learn more about how to 

evaluate youth engagement efforts on page 31.

Involving Youth in Reducing Disparities

Tobacco-related disparities are differences in tobaccorelated health outcomes between population groups. 

These differences can be based on characteristics 

like age, disability, education, income, occupation, 

geographic location, race, ethnicity, sexual orientation, 

gender identity, mental health status, substance use, 

and military status.1

 For example, groups such as 

American Indians and people living in poverty have 

higher tobacco use prevalence, lower cessation rates, 

and poorer health outcomes.149 Reducing tobaccorelated disparities protects youth at high risk of trying 

and using tobacco products.

As members of communities affected by tobaccorelated disparities, young people want to work to 

counter pro-tobacco 

influences. For 

example, lowerincome and 

African-American 

neighborhoods have 

more tobacco 

product marketing, 

exposing young 

people in these 

communities to 

pro-tobacco 

messages.150 Youth 

can help assess 

tobacco retailers in 

these communities 

and survey people 

about their support 

HOW TO

Youth Engagement l 29
for tobacco control strategies.151 They can use this 

information to design health communications 

campaigns and other strategies to reduce tobacco use. 

For more information on how programs can reduce 

tobacco-related disparities, see the CDC Best 

Practices User Guide: Health Equity in Tobacco 

Prevention and Control.

Screenshot from the truth® “#STOPPROFILING” campaign Source: Truth Initiative

Recruiting and Involving Diverse Youth 

Youth from groups most affected by tobacco use are 

often not involved in tobacco control.30,151 They may 

face barriers that make engagement more difficult, 

such as family obligations, economic pressures, or 

transportation challenges, or have different interests 

and skills than youth involved in the program.56

Involving these youth takes strategy and care, but it 

ensures that activities are relevant to their communities. 

Developing interest among young people with varied 

backgrounds can also draw other diverse youth to the 

program and develop the next generation of leaders.152

To recruit diverse youth, it can help to develop 

relationships with their 

family members and reach 

out to partner organizations 

that work with priority 

populations.140,153 Youth from 

the community can also help 

recruit their peers. Program 

staff can reduce barriers 

to youth engagement by 

providing transportation and 

planning convenient meeting 

locations and activities. 

Matching activities to youth’s 

skills and cultural experiences 

and offering training can help 

generate interest.154

Youth from diverse 

backgrounds may require 

different kinds of support than other youth. For example, 

youth who are affected by violence, hunger, or other 

community issues may have priorities other than tobacco 

control. To support diverse youth, programs can:

• Ask youth about the relevance of activities to 

their communities23

• Notice how youth with different backgrounds 

express themselves and behave153

• Offer leadership opportunities and recognize 

that youth may be unfamiliar or uncomfortable 

with leading at first56

• Pair youth with adults of similar backgrounds to 

nurture understanding151

• Celebrate differences when opportunities arise, 

such as National Hispanic Heritage Month, 

Black History Month, or LGBT Pride155

• Treat youth as equals and be willing to learn 

from them156

• Connect tobacco control to other issues youth 

care about, like social justice or the environment72

HOW TO

Youth Engagement l 30
Evaluating Youth Engagement

Evaluating youth activities helps program staff 

understand and improve the effectiveness of youth 

engagement efforts. Evaluation results tell programs, 

partners, and young people if youth engagement 

activities are going as planned and achieving goals.56

Sharing evaluation results with community leaders and 

youth builds continued support for youth engagement.56

Evaluating Youth Engagement Progress

Evaluating the progress of youth activities as they are 

happening allows program staff to quickly change 

strategies. It can also help staff understand what 

activities work best to develop the skills for youth 

to achieve tobacco control goals.56 Evaluating youth 

engagement progress answers questions such as:

• How many youth are engaged?56

• What kinds of activities are youth involved in, 

and how many?56

• How long do youth stay engaged?56

• Which activities are successful, which are not, 

and why?14

• Do the youth involved reflect the diversity of 

the community?54

Simple data collection activities such as sign-in sheets 

and event and activity logs can track progress.56 Youth 

can also create logs to document media coverage of 

their activities and use surveys to measure youth and 

adult attitudes about youth engagement.56 See Table 1 

below for sample evaluation measures.

Evaluating Youth Engagement Outcomes

Evaluating outcomes helps programs assess whether 

youth engagement contributed to goals such as 

preventing initiation among youth and young adults. 

Evaluating youth engagement outcomes answers 

questions such as:

• Did knowledge, skills, attitudes, and behaviors 

toward tobacco use change among youth or 

community members?41

• Did youth increase their self-esteem or 

confidence in their ability to achieve goals?7

• Were new tobacco control strategies adopted?41

• Did any unintended consequences occur?14

• Did tobacco use prevalence decline?

Table 1. Sample Measures for Evaluating Youth Engagement

EVALUATION TYPE SAMPLE MEASURES

Measuring progress Progress toward tobacco control goals

• Quantity of activities conducted

• Quantity and quality of media coverage

• Extent to which activities are conducted according to plans

Quality of youth engagement

• Number and types of recruitment activities conducted

• Number of youth engaged

• Quality of youth involvement (e.g., youth leadership in decision making)

• Number, type, and quality of youth trainings

Youth skills, ability, and confidence

• Increased confidence in ability to achieve tobacco control goals

• Heightened knowledge about the dangers of tobacco use

• Improved skills for tobacco control activities

Measuring outcomes • Increased number of youth engaged

• Improved youth knowledge and skills

• Implementation of tobacco control strategies

• Reduced youth smoking initiation

• Reduced youth tobacco use

Youth Engagement l 31

HOW TO
Involving Youth in Evaluation

Youth bring valuable perspectives to evaluation. For 

instance, they can help recruit youth participants 

and design evaluation questions that reflect youth 

priorities.49 Youth can also contribute to evaluation by:31

• Developing criteria for success

• Developing youth-friendly surveys and 

interview questions 

• Collecting data

• Analyzing and interpreting results

• Sharing results with peers, decision makers, and 

other community members

Involving youth in evaluation will be most successful if 

youth are prepared to take part in evaluation activities.49

Youth may need training in technical skills, such as 

collecting data, and interpersonal skills, such as talking 

with survey participants.8

 Staff may supervise youth 

until they are comfortable conducting evaluations on 

their own.49 Youth may also need help understanding 

materials, staying engaged, and telling their stories.

Sharing Results

Evaluation results show stakeholders the value of youth 

engagement. Sharing ensures that results get used and 

helps secure future support for youth engagement.56

Results can be shared through formal reports, success 

stories, short briefs, or presentations. Effective reports:56

• Explain how the evaluation was conducted

• Use data to demonstrate major findings about 

youth engagement

• Summarize the successes and outcomes of youth 

engagement activities

• Describe the challenges of involving youth

• Include lessons learned for future youth 

engagement efforts

Collecting, analyzing, and interpreting data takes 

time, and evaluation results may not be ready to share 

until well after an effort has ended. For this reason, 

it is important to make time to celebrate successes 

throughout youth engagement efforts. For instance, 

programs can host events where youth can share videos 

and presentations about their hard work and successes 

with stakeholders and the media. Learn more about 

sharing results in the CDC resource, Developing an 

Effective Evaluation Report. 

Sustaining Youth Engagement

Sustained youth engagement efforts give program staff 

and youth time to achieve goals and create long-lasting 

change.157 A strong program infrastructure, strategies 

to retain youth, and ongoing recruitment help sustain 

youth engagement.

Developing Infrastructure for Youth 

Engagement

Infrastructure is the basic underlying framework 

of policies, financial and human resources, and 

organizational structures that help programs develop 

and grow.158 A strong infrastructure for youth 

engagement efforts can help support program capacity 

and implementation, achieve goals, and sustain 

programs.1,39 Developing strong infrastructure for 

youth engagement involves:146

• Creating a sustainability plan

• Developing youth leaders

• Maintaining partnerships

• Managing staff and funding resources

• Using data to improve efforts

Creating a Sustainability Plan

A sustainability plan outlines what resources the 

program has for youth engagement, which activities 

will be sustained, and how resources and funding 

will be acquired.144 Integrating youth involvement 

into the program’s sustainability plan ensures that 

youth engagement is considered throughout program 

planning and creates a culture of youth inclusion within 

the overall program. The best time to incorporate youth 

engagement into the sustainability plan is before those 

efforts begin.157 It is also important to regularly update 

the plan to incorporate new evidence, respond to 

changes in tobacco prevention and control, and better 

meet program needs.144 Learn more about creating a 

sustainability plan at sustaintool.org.

Youth Engagement l 32

HOW TO
Developing Youth Leaders

Youth leaders are committed to the program and drive 

progress. Developing leadership skills among youth of 

all ages helps prepare new, younger leaders to assume the 

responsibilities of older youth who leave for college or 

begin careers. To cultivate new youth leaders, staff can:

• Have older youth leaders train and mentor the 

next generation of leaders10

• Delegate smaller tasks such as leading meetings 

and team building exercises to “leaders in 

training” to help boost their confidence146

• Enable and support youth to take the lead in 

planning and carrying out activities159

Maintaining Partnerships 

Partnerships help sustain youth engagement by 

providing resources like space, equipment, volunteers, 

supplies, and funding.160 They also help garner 

community support.140 Program staff can maintain 

strong youth engagement partnerships by:

• Clearly defining the purpose of the partnership138

• Creating a sense of ownership among partners138

• Regularly communicating with partners about 

activities161

• Evaluating and improving how programs work 

with partners161

Managing Staff and Funding Resources

Securing the resources to carry out activities is 

critical to sustain youth engagement efforts. Staff and 

volunteers provide ongoing support and training to 

youth. Hiring skilled staff, offering ongoing training 

and professional development, and offering competitive 

salaries and career advancement help recruit and keep 

qualified staff.146

Youth engagement programs will also want to conduct 

thorough staff background screenings, which may 

require additional resources. Including these costs in 

program budgets and funding plans is important to 

ensure a consistent screening process for all staff and 

volunteers.

A funding plan that outlines the steps to secure longterm support can help sustain youth engagement and 

lessen the impact of funding changes.146 Responding to 

funding opportunities takes time and resources, so it 

is critical that program staff and youth identify future 

sources before current funding ends and focus on 

opportunities that fit with youth engagement goals.146 A 

plan for collaborating across departments (e.g., sharing 

communications materials, administrative support, and 

staff with special skills like grant writing) can also be 

useful when resources are scarce.146 Learn more about 

managing staff and funding resources in the CDC 

Best Practices User Guide: Program Infrastructure in 

Tobacco Prevention and Control.

Keeping Youth Engaged 

During the Summer162

Take advantage of young people’s more 

flexible schedules during the summer by:

• Inviting youth to meetings, 

conferences, or trainings

• Planning field tips to tobacco control 

coalition or city council meetings

• Holding focus groups to gather 

youth feedback

• Having youth hand out information at 

summer festivals or farmer’s markets

• Creating summer internship 

opportunities

• Hosting a “kick-off ” event for the 

coming school year 

Using Data 

Data can help determine if youth engagement efforts 

are working, refine activities and strategies, and make 

decisions about future efforts.146 Information about the 

effectiveness of youth engagement efforts can be shared 

with partners and decision makers to secure future 

funding and continued support.144 Learn more about 

how to evaluate youth engagement efforts on page 31.

Youth Engagement l 33

HOW TO
Strategies for Retaining Youth

School, extracurricular activities, jobs, and other 

interests often demand young people’s time and 

attention.163 Because community change can take a long 

time, keeping youth involved can pose a significant 

challenge.31 Staff can keep youth interested by clearly 

defining objectives and roles so youth can see the impact 

of their contributions. Allowing youth to lead meetings 

and activities can also build their sense of ownership.25

Programs can also keep youth engaged by:

• Removing participation barriers such as 

transportation or inconvenient meeting times138

• Offering a variety of activities that connect with 

young people’s talents and concerns44

• Creating leadership and skill-building 

opportunities30

• Checking on progress and updating youth 

through email, texts, and social media25

• Brainstorming ways to keep youth busy and 

involved during slow periods128

• Recognizing youth for their efforts by awarding 

certificates or writing thank-you notes164

Cultivating relationships between youth and adults 

that are built on respect, support, and trust can also 

be an effective way to keep youth engaged.10,44 Staying 

connected with youth’s lives and interests within 

and outside the program can help build meaningful 

relationships.10 For example, staff may plan activities 

when school is not in session.45

Conducting Ongoing Recruitment

Older youth may eventually move away for college, begin 

careers, or age out of youth efforts. Programs can keep 

engagement steady by developing a plan to regularly 

recruit youth.138 This helps to ensure that progress toward 

goals continues even as the youth involved change. To 

recruit new youth, program staff can repeat many of the 

strategies described on page 7. Ongoing recruitment 

plans can also focus on:

• Identifying gaps in youth leadership and skills146

• Examining what has worked in past recruitment 

efforts and what has not165

• Empowering current youth leaders to recruit 

and train upcoming leaders138

Keeping Younger and Older 

Youth Engaged

Keeping youth engaged can be a special 

challenge for programs that work with youth 

of different ages, such as middle and high 

school youth. Recognizing the different 

developmental needs of younger and older 

youth can help keep involvement high 

among all youth.

To keep younger youth engaged, programs 

can:

• Build in time to socialize10

• Offer chances to try many different 

activities10

• Focus on making youth feel 

comfortable and safe10

• Emphasize the immediate outcomes 

of youth’s contributions25

To engage older youth, programs can:10

• Help youth explore issues in greater 

depth

• Emphasize how activities help youth 

prepare for job opportunities and 

college applications

• Offer opportunities to mentor younger 

youth or complete internships

• Focus less on attendance 

requirements and more on the quality 

of engagement

Youth Engagement l 34

HOW TO
PROVIDING SUPPORT

How Can Tobacco Control Programs Support Youth 

Engagement?

Engaging youth requires thoughtful preparation and ongoing support from program staff. Although youth 

engagement efforts will vary by program, staff can take the following actions to support youth engagement: 

Coordination & Collaboration 

8

8

8

Act as the convener. Bring all partners, including youth members and organizations, to the table on a regular basis. 

Involve youth in brainstorming ideas, selecting strategies, and carrying out activities. 

Make youth engagement a priority during strategic planning and incorporate youth engagement into the 

program’s comprehensive statewide tobacco control plan. 

Administrative Support 

8

8

8

8

Share tobacco use and other surveillance data with local partners to design youth programs. 

Share results of successful youth engagement initiatives with partners.

Develop and share materials that can be used locally. 

Provide a forum for youth to interact (e.g., website, conference calls, or blog). 

Training & Technical Assistance 

8

8

8

Ensure adults who work with youth have been thoroughly screened and trained on how to work with youth.

Sponsor local, regional, and statewide trainings and conferences that involve youth. 

Provide ongoing technical assistance to youth partners. 

Youth Engagement l 35
Case Study #

1: Indiana

Indiana creates meaningful opportunities for youth to reduce tobacco use

Indiana forms partnership to create youth 

empowerment movement

Indiana recognized the importance of youth 

engagement early in its tobacco control efforts. In 2002, 

as part of its tobacco health communications work, 

the Indiana Tobacco Prevention and Cessation Agency 

partnered with the Indiana Teen Institute to host a 

summer youth capacity-building summit. During the 

summit, the teens created VOICE, Indiana’s statewide 

youth empowerment movement against tobacco 

use. Although the teen summits are no longer held, 

the Institute continues to partner with the tobacco 

control program, which now operates within the 

Indiana Department of Health as the Indiana Tobacco 

Prevention and Cessation Commission.

VOICE is not a youth organization but a brand that 

provides resources and opportunities for engaging, 

empowering, and educating teens to promote a 

tobacco-free lifestyle.166 The Commission supports 

VOICE in developing initiatives, responding to 

emerging opportunities to reduce tobacco use, and 

educating the public about the tobacco industry’s 

marketing tactics. To further its goal of lowering 

Indiana’s youth tobacco use prevalence, the 

Commission also supports VOICE through funding 

and strategic planning, and by sharing VOICE messages 

with local programs. 

VOICE offers opportunities for all teens

VOICE activities include campaigns to expose the 

tobacco industry’s influence in popular culture, clean 

up cigarette waste, and promote tobacco-free lifestyles 

on social media. Many of these initiatives are organized 

locally or even individually; VOICE reaches out to 

youth groups of all sizes, ranging from national youth 

organizations to high school clubs. 

The VOICE website and digital communications help 

the program reach youth who may not be affiliated 

with an existing organization or club. “It could be that 

lone teen who’s in an unfunded county [without a local 

tobacco control coalition] somewhere in rural Indiana 

or it could be a group of young people in one of the 

funded counties that have a coalition and a whole 

group of people working to support them,” said Mark 

R. Kaser, VOICE’s state coordinator and director of 

the Institute. “Our goal is that we make the resources 

available to anyone.” 

Reaching today’s technologically savvy teens can 

also present challenges. As the number of ways to 

communicate continues to grow, a flood of information 

competes for teens’ attention through many different 

channels. To break through the noise, VOICE focuses 

on continually finding out how youth prefer to 

communicate by asking for the best way to reach them 

on every sign-up form and application. Kaser notes that 

it is important not to expect youth to communicate in 

the same way as adult colleagues. Instead, VOICE’s goal 

is to be flexible, engaging with youth through many 

different and often evolving channels. 

Core youth leadership team keeps VOICE authentic 

and relevant

VOICE offers many ways for youth to get involved, such 

as following the movement on social media, attending 

single events, or taking on local leadership roles at 

their schools or community groups. A small number 

of youth become part of the core leadership team that 

helps keep VOICE authentic to the youth brand and 

culturally relevant. Known as the VOICE Action Squad, 

these youth serve as speakers, social marketers, brand 

ambassadors, and influencers to help share VOICE’s 

tobacco-free message.166 They share messages on social 

media and travel throughout the state, attending events 

like fairs, festivals, and summer camps to raise awareness 

about tobacco control issues and engage other youth. 

Youth Engagement l 36

CASE STUDIES
VOICE sustains youth engagement through 

meaningful opportunities

Providing meaningful opportunities for youth to 

develop skills or take action is central to VOICE’s 

approach. For example, VOICE holds “meet-ups,” or 

capacity-building events, where youth work on skills 

like public speaking, Tobacco 101, and social media 

content creation. “If you are asking young people to 

do too much without effectively preparing them, that 

leads to problems. If you’re not giving them meaningful 

opportunities to act but you’re investing in capacity 

building, they’re going to go find another cause where 

they can use those skills,” Kaser said. 

When young people make meaningful connections to 

the program by identifying with the topic or forming 

relationships with other like-minded youth, their 

participation can snowball from a single event to a 

longer commitment. VOICE has found that the most 

effective way to create meaningful opportunities is to 

find adult champions who understand the importance 

of involving youth. These champions may already work 

for youth-serving organizations or may hold other roles 

in law enforcement, government, or business. 

VOICE Action Squad visiting the Clark County Fair during their 2017 Maximum Velocity Tour 

Source: Indiana State Department of Health, Tobacco Prevention and Cessation Commission 

Indiana tobacco control leaders 

see youth as one of its greatest 

assets 

Youth involvement is vital for 

a successful tobacco control 

program, said Miranda 

Spitznagle, director of 

Indiana’s Tobacco Prevention 

and Cessation Commission. 

“Engaging young people is 

critical to the sustainability 

of state and local programs. 

It’s a way to train up the next 

generation of your work force. It’s 

a way to get them exposed to this 

critical public health issue,” said 

Spitznagle. 

Indiana continues to look 

for ways to strengthen youth 

engagement, such as enhancing 

outreach through local tobacco control programs and 

involving youth in emerging tobacco control issues. 

E-cigarettes are now the most commonly used tobacco 

product among Indiana youth.167 To meet an increased 

demand for e-cigarette resources and education, 

VOICE is preparing educational materials on 

e-cigarettes for teens to present at school and to other 

youth groups. VOICE youth are actively involved in 

creating the materials, making sure that the language, 

format, and content are relevant to youth. VOICE also 

plans to introduce new materials to raise awareness of 

the tobacco industry’s changing use of popular media 

to normalize tobacco use.

Youth Engagement l 37

CASE STUDIES

“Engaging young people is critical 

to the sustainability of state and 

local programs.”

– Miranda Spitznagle
Case Study #

2: Vermont

Youth use STARS tool to assess Vermont’s tobacco retailers

State program expands youth efforts to assess tobacco 

retailers in Vermont

Since 1995, the Vermont Tobacco Control Program 

has engaged young people in efforts to reduce youth 

tobacco use. The state program developed the middle 

school youth group Vermont Kids Against Tobacco 

(VKAT), in 1995, and the high school youth group Our 

Voices Xposed (OVX), in 2001. Partnering with these 

groups to assess tobacco retailers throughout the state 

has always been a central activity of the state program. 

However, data collected from earlier local assessments 

did not give a complete picture of Vermont’s tobacco 

retail environment. With the introduction of Counter 

Tools’ Standardized Tobacco Assessment for Retail 

Settings (STARS), the state program saw an opportunity 

to expand its efforts. Eoana Sturges, Vermont’s Tobacco 

Control Manager, said, “These assessments came about 

because we knew we needed more data. Getting a tool 

like STARS allowed us to expand and use the data on a 

more statewide level.” In 2014, OVX and VKAT groups 

partnered with state-funded community coalitions 

to assess all of Vermont’s nearly 900 tobacco retailers 

using STARS. 

Coalition used mock store to train youth

One community coalition, located in Windsor County, 

was particularly successful at involving youth in 

tobacco retail assessments: the Mt. Ascutney Prevention 

Partnership (MAPP). To get Windsor youth excited 

about the state effort, staff from the Partnership focused 

on engaging high school students from OVX. MAPP’s 

Youth Outreach Coordinator, Rachel Williams, noted 

that the older youth were more passionate about 

conducting the store assessments because they knew 

people their age who used tobacco products. MAPP 

also generated enthusiasm among youth by creating 

a mock store where older youth practiced conducting 

store assessments. The high school students then 

trained younger students in the mock setup. This peerto-peer education model gave students an opportunity 

to lead and develop ownership over the assessments. 

Following the trainings, youth began the store 

assessments. After conducting the first few 

assessments with Williams, the youth were able to 

introduce themselves to the store owners and 

complete the assessments on their own. Williams said, 

“At first it was so out of their comfort zone to 

approach store owners and managers and tell them 

that they wanted to assess their store. But they came to 

really enjoy it. They saw the community buy-in and 

wanted to look at the data themselves.” Williams 

added, “The kids went beyond what was what was 

requested of them because they really enjoyed getting 

into the stores.” 

Map of tobacco retail stores assessed by youth groups

Youth Engagement l 38

CASE STUDIES
Youth shared results with local decision makers

Between November and December 2014, community 

coalitions, Windsor county youth, and other OVX and 

VKAT groups across the state assessed 767 stores.168

The state program compiled all of the data into a 

comprehensive report, which revealed that 85% of 

tobacco retailers in Vermont sold flavored tobacco 

products and 82% of tobacco retailers within 1,000 feet 

of a school sold these products.168 These results, coupled 

with the knowledge that flavored tobacco products can 

attract new youth users, led the state, youth groups, 

and coalitions to focus their efforts on reducing the 

availability of flavored tobacco products.2,34

Youth groups from Windsor County shared the 

data and their personal stories about the availability 

of flavored tobacco in their community with state 

legislators. Legislators shared the youths’ stories later in 

town hall meetings they held across the state. Williams 

reflected on the experience. “Taking that data and 

working with the youth to develop their narratives 

about what they saw enabled them to go talk to decision 

makers,” she said. “Knowing that their legislators used 

the data was so empowering for the youth.”

Gaining youth buy-in is critical for statewide initiatives

When state tobacco control programs choose the 

direction for youth engagement efforts, it can be 

challenging to get youth invested. Local coalitions like 

MAPP engaged youth and built trust by giving them 

support, recognition, and opportunities to lead. Some 

youth groups chose to shift their focus and pursue other 

strategies unrelated to the assessment results because 

the youth did not feel connected to the topic. The 

coordinators for these groups stressed the importance 

of selecting activities that align with the youths’ 

interests and ensuring that youth’s goals are reflected 

throughout the process. When discussing how to 

engage youth, Sturges noted, “It is critical to ensure that 

youth have an opportunity to be heard, are supported, 

and are respected.” 

Youth gather at the Vermont State House to raise awareness of the dangers of flavored tobacco products Source: Vermont Tobacco Control Program

Youth Engagement l 39

CASE STUDIES
CASE FOR INVESTMENT

Why Invest in Youth Engagement?

Youth play a critical role in achieving tobacco control goals. Young people bring enthusiasm, creativity, and a 

powerful voice to tobacco control efforts. Youth input and involvement help communicate the impact of tobacco 

use on young people, implement effective strategies to reduce youth tobacco use, and shift social norms.5 This case 

for investment gives information to educate decision makers and leadership about the important role of youth 

engagement in a comprehensive tobacco control program.

History and Adoption

For over 25 years, public health experts have agreed 

that it is critical to prevent young people from trying 

and using tobacco.169 Early efforts focused on health 

education, but by the 1990s, new strategies began to 

engage youth as important partners in combatting 

the tobacco industry.12 The youth-led truth® media 

campaign in Florida encouraged youth to take an 

active role in exposing the industry’s manipulative 

tactics.13 The campaign and complementary youth 

engagement efforts greatly reduced teen smoking.170

Following this success, the American Legacy 

Foundation (now the Truth Initiative) funded efforts 

to empower youth in 19 states.15

Youth engagement is now a common practice in 

coordinated tobacco control strategies.16 Many states 

and localities have involved youth in tobacco control 

efforts in some way.14 In recent years, youth have helped 

inform the public about the dangers of secondhand 

smoke, the influence of the tobacco industry in stores, 

and the importance of increasing the sales age to 21.17-19

Scientific Evidence

Evidence linking the involvement of youth in tobacco 

control to positive health outcomes is still emerging, 

due to limited evaluation of youth engagement.3 But this 

does not mean that engaging youth is not important 

or that it is not considered an important tobacco 

control strategy. Research has shown that involving 

youth in implementing communications campaigns, 

creating tobacco-free environments, and reducing the 

influence of tobacco product advertising and promotion 

are effective when there is sustained funding and 

commitment from partners.171-174 Other research has 

noted that the popularity of youth engagement as a 

practice far outpaces the research on its effectiveness.175

Supporting youth engagement research is critical to grow 

the evidence for involving youth in tobacco control.

Examples of successful youth engagement continue to 

grow as programs involve youth in strategies proven 

to reduce youth tobacco use and prevent initiation. 

These strategies include creating tobacco-free 

environments, increasing the price of tobacco products, 

reducing youth exposure to tobacco advertising, and 

communicating the dangers of youth tobacco use 

through hard-hitting media campaigns.1,2,59,61,73,176

For instance, youth have helped ban tobacco price 

discounts in Providence, Rhode Island, restrict sales of 

flavored tobacco products in Minneapolis, Minnesota, 

and increase the legal age to buy tobacco products to 

21 in Hawaii.1,19,63,81 Even youth engagement efforts 

with limited resources have impacted tobacco control. 

Despite a significantly reduced budget, the North 

Carolina youth engagement program helped create 

tobacco-free environments throughout the state, 

protecting youth and others from tobacco smoke in 

parks, colleges, and multi-unit housing.14,139

Youth Engagement l 40
Cost 

Tobacco use and secondhand smoke exposure is the 

leading cause of preventable disease and death in the 

U.S.3 Cigarette smoking resulted in $170 billion in 

direct health care costs in 2013 and $156 billion in 

annual productivity losses.3,177 The burden of tobacco 

use is particularly high for young people. If smoking 

prevalence continues to follow current trends, an 

estimated 5.6 million youth will die early from a 

smoking-related illness.3 By reducing the impact of 

tobacco use and exposure on young people, youth 

engagement efforts help decrease both the health and 

financial burdens of tobacco use. 

The cost of engaging youth varies depending on the 

level of youth involvement and the type of funding. 

Many programs operate with only the help of youth 

volunteers and in-kind donations. With available 

funds, others have invested in an adult staff person 

who specializes in working with youth. While the latter 

approach requires funding, the return on investment 

can be great when that adult effectively engages youth. 

Involving youth in existing efforts is more cost-effective 

than building youth engagement from the ground up. 

Programs that involve youth in environmental and 

social norm change, rather than individual change, can 

provide a better return on investment. Past experiences 

in Florida suggest that the large and immediate gains 

made by comprehensive tobacco control efforts with 

strong youth engagement are in danger of being 

reversed if funding is reduced.171

Sustainability

Youth can make meaningful contributions that build 

the capacity and sustainability of tobacco control 

programs. Young people infuse programs with energy 

and creativity. They can offer new perspectives and 

ensure that activities will resonate with youth.7 Youth 

engagement can help achieve better outcomes for the 

young people and adults involved with the program, 

for young people served by the program, and for the 

community as a whole.175 When youth get involved in 

tobacco control programs, they are forming the next 

generation of tobacco control leadership.10 Youth who 

see the impact of their efforts may even choose to devote 

their careers to building tobacco-free communities.8

Involving young people also helps spread messages 

to a wider audience. Youth use their influence with 

peers and community leaders to change social 

norms around tobacco use and build support for 

tobacco control strategies.5 Their messages can also 

help sustain programs by educating people about 

the importance of long-term, adequately funded 

comprehensive tobacco control programs.

Youth Engagement l 41

CASE FOR INVESTMENT
RESOURCES

Tobacco Prevention and 

Control

Anti-lobbying Restrictions for CDC Grantees

Publisher: Centers for Disease Control and Prevention

Summary: What lobbying activities are allowed and not 

allowed for grantees receiving CDC funding

http://bit.ly/cdc_lobbyingrestrictions

Assessing Retail Environments with STARS: 

Standardized Tobacco Assessment for Retail 

Settings (2015)

Publisher: Center for Public Health Systems Science 

Summary: States’ experiences using the STARS tool to 

survey retail stores

http://bit.ly/cphss_stars

Best Practices for Comprehensive Tobacco Control 

Programs (2014)

Publisher: Centers for Disease Control and Prevention

Summary: Strategies and funding recommendations to 

plan and implement state tobacco control programs

http://bit.ly/bp_2014 

Best Practices User Guide: Health Communications 

in Tobacco Prevention and Control (2018)

Publisher: Centers for Disease Control and Prevention

Summary: Steps that state tobacco control staff 

and partners can take to develop effective health 

communications

http://bit.ly/cdc_communications

Best Practices User Guide: Health Equity in Tobacco 

Prevention and Control (2015)

Publisher: Centers for Disease Control and Prevention 

Summary: Steps that state tobacco control staff and 

partners can take to promote health equity and reduce 

tobacco-related disparities

http://bit.ly/cdc_healthequity

Best Practices User Guide: Program Infrastructure 

in Tobacco Prevention and Control (2017)

Publisher: Centers for Disease Control and Prevention 

Summary: Steps that state tobacco control staff and 

partners can take to build strong program infrastructure

http://bit.ly/cdc_programinfrastructure

Create Change: A Student Toolkit 

Publisher: Tobacco-Free College Campus Initiative

Summary: Toolkit for college students interested in 

promoting smoke-free or tobacco-free campuses

http://bit.ly/tfcci_studenttoolkit

Developing an Effective Evaluation Report: Setting 

the Course for Effective Program Evaluation (2013)

Publisher: Centers for Disease Control and Prevention

Summary: Workbook to develop a final evaluation report

http://bit.ly/cdc_evalreport

E-cigarette Use among Youth and Young Adults: A 

Report of the Surgeon General (2016)

Publisher: Centers for Disease Control and Prevention

Summary: Comprehensive review of the public health 

issue of e-cigarettes and their impact on U.S. youth and 

young adults 

http://bit.ly/cdc_sgr2016

E-cigarettes Shaped like USB Flash Drives: 

Information for Parents, Educators, and Health 

Care Providers 

Publisher: Centers for Disease Control and Prevention 

Summary: Infographic about the health risks and rise in 

popularity of e-cigarettes shaped like USB flash drives

http://bit.ly/cdc_ecigarettesUSB

Evaluation Guide: Writing SMART Objectives 

Publisher: Centers for Disease Control and Prevention 

Summary: Workbook on using the SMART approach to 

create realistic and measurable program objectives

http://bit.ly/cdc_smartobjectives

Youth Engagement l 42
Fresh Empire

Publisher: U.S. Food and Drug Administration

Summary: Public education campaign designed to prevent 

and reduce tobacco use among at-risk multicultural 

youth who identify with hip-hop culture 

http://bit.ly/fda_freshempirecampaign

Health Care Professionals: Educate Your Young 

Patients about the Risks of E-cigarettes

Publisher: Centers for Disease Control and Prevention 

Summary: Healthcare provider card with guided discussion 

points for talking with young patients about e-cigarettes 

http://bit.ly/surgeongeneral_providers

The Health Consequences of Smoking—50 Years of 

Progress: A Report of the Surgeon General (2014)

Publisher: Centers for Disease Control and Prevention

Summary: Overview of the progress made to reduce 

tobacco use over the last 50 years and the continued 

burden of tobacco-related death and disease

http://bit.ly/cdc_sgr2014

How to Conduct Store Observations of Tobacco 

Marketing and Products (2016)

Publisher: Preventing Chronic Disease

Authors: Feld A, Johnson T, Byerly K, Ribisl K

Summary: Detailed steps for conducting store 

observations of tobacco marketing and products

http://bit.ly/feld_storeobservations

Implementing Photovoice in Your Community

Publisher: Community Tool Box 

Summary: Guide to the Photovoice process of using 

photos and videos to share one’s environment and 

experiences with others 

http://bit.ly/ctb_photovoice

Kick Butts Day Activities

Publisher: Campaign for Tobacco-Free Kids

Summary: Featured activities for the annual Kick Butts 

Day national day of youth activism

http://bit.ly/tfk_kickbutts

Know the Risks: A Youth Guide to E-cigarettes

Publisher: Centers for Disease Control and Prevention

Summary: Presentation for youth on the dangers of 

e-cigarettes

http://bit.ly/cdc_knowtherisks

Media Campaign Resource Center 

Publisher: Centers for Disease Control and Prevention

Summary: Searchable archive of CDC-licensed tobacco 

control ads

http://www.cdc.gov/tobacco/media_campaigns

MyMaps

Publisher: Google

Summary: Free tool to create and share custom maps 

https://www.google.com/maps/about/mymaps

Oklahoma’s Youth-Driven Tobacco Policy Campaigns: 

Assessment of Impacts and Lessons Learned (2015)

Publisher: American Journal of Preventive Medicine

Authors: Ross H, Dearing J, Rollins A

Summary: Lessons learned from the realignment of 

Oklahoma’s Students Working Against Tobacco 

initiative to focus on high-impact activities 

http://bit.ly/ross_okyouthcampaign

Playing Tobacco Free: Making Your Community’s 

Outdoor Recreational Facilities Tobacco Free 

Publisher: Tobacco-Free Youth Recreation, Association 

for Nonsmokers-Minnesota

Summary: Steps for adults and youth interested in 

promoting tobacco-free outdoor recreational facilities 

http://bit.ly/tfyr_playtobaccofree

Point-of-Sale Strategies: A Tobacco Control Guide 

(2014)

Publisher: Center for Public Health Systems Science and 

the Tobacco Control Legal Consortium

Summary: Strategies to reduce marketing and promotion 

of tobacco products in retail stores 

http://bit.ly/cphss_pointofsale

Youth Engagement l 43

RESOURCES
Policy Strategies: A Tobacco Control Guide (2014)

Publisher: Center for Public Health Systems Science and 

the Tobacco Control Legal Consortium

Summary: Strategies to implement evidence-based 

tobacco control policies 

http://bit.ly/cphss_policystrategies

Preventing Tobacco Use among Youth and Young 

Adults: A Report of the Surgeon General (2012)

Publisher: Centers for Disease Control and Prevention

Summary: Comprehensive review of the health effects of 

tobacco use among youth and young adults in the U.S. 

http://bit.ly/cdc_sgr2012

Pricing Policy: A Tobacco Control Guide (2014)

Publisher: Center for Public Health Systems Science and 

the Tobacco Control Legal Consortium

Summary: Information on implementing pricing policies 

http://bit.ly/cphss_policypricing

Program Sustainability Assessment Tool 

Publisher: Center for Public Health Systems Science 

Summary: Free 40-question self-assessment to evaluate 

the sustainability capacity of a program 

https://sustaintool.org

The Real Cost Campaign

Publisher: U.S. Food and Drug Administration

Summary: Public education campaign designed to 

educate youth on the dangers of tobacco use 

http://bit.ly/fda_therealcost

Smoke Free Media Guide (2014)

Publisher: Reality Check 

Summary: Information and strategies for working with 

youth interested in reducing onscreen tobacco use 

http://bit.ly/realitycheck_mediaguide

Spark Advocacy Guide (2014)

Publisher: Spark

Summary: Action guide for young adults interested in 

promoting tobacco-free college campuses 

http://bit.ly/spark_advocacy

STARS Policy Crosswalk (2015)

Publisher: Center for Public Health Systems Science

Summary: Table of STARS assessment items and related 

tobacco retail policies 

http://bit.ly/cphss_starscrosswalk

Store Assessment Tools

Publisher: Counter Tobacco

Summary: Tools and resources to collect data about 

tobacco product marketing and promotion in stores

http://bit.ly/ct_tools

Strategies for the Long-Term Sustainability of an 

Initiative 

Publisher: Community Tool Box

Summary: Eight steps to plan for program sustainability 

http://bit.ly/ctb_sustainability

Taking Down Tobacco

Publisher: Campaign for Tobacco-Free Kids

Summary: Free online and in-person training program for 

middle and high school youth

http://www.takingdowntobacco.org

Talk with Your Teen about E-cigarettes: A Tip Sheet 

for Parents

Publisher: Centers for Disease Control and Prevention

Summary: Tips and guided discussion points for parents 

to talk with their teens about e-cigarettes 

http://bit.ly/cdc_teentalk

This Free Life

Publisher: U.S. Food and Drug Administration 

Summary: Public education campaign designed to prevent 

and reduce tobacco use among LGBT young adults 

http://bit.ly/fda_thisfreelife

Tobacco Prevention Toolkit 

Publisher: Stanford Medicine

Summary: Adaptable toolkit of lessons, presentations, 

worksheets, and activities designed for schools and other 

organizations to prevent student initiation of tobacco use 

http://bit.ly/stanford_preventiontoolkit

Youth Engagement l 44

RESOURCES
Truth®

Publisher: Truth Initiative 

Summary: Tobacco control information for youth and 

ways to get involved in reducing tobacco use 

https://www.thetruth.com

Walking Tobacco Audit 

Publisher: Counter Tobacco

Summary: Guide for youth to assess tobacco retailers and 

advertisements visible on their walk to school

http://bit.ly/ct_walkingaudit

Youth Participation in a Community Campaign to 

Pass a Clean Indoor Air Ordinance (2010)

Publisher: Health Promotion Practice

Authors: Bozlak C, Kelley M 

Summary: Lessons learned from involving youth in a clean 

indoor air campaign

http://bit.ly/bozlak_youthcampaign

Youth Engagement

ACT for Youth

Publisher: ACT for Youth Center of Excellence

Summary: Information and resources for promoting 

positive youth development 

http://www.actforyouth.net

Being Y-AP Savvy: A Primer on Creating and 

Sustaining Youth-Adult Partnerships (2010)

Publisher: ACT for Youth Center of Excellence

Author: Zeldin S, Collura J

Summary: Manual to strengthen youth-adult partnerships 

within organizations and communities 

http://bit.ly/zeldin_yapartnerships

Engaging Older Youth: Program and City-Level 

Strategies to Support Sustained Participation in 

Out-of-School Time (2010)

Publisher: Harvard Family Research Project

Summary: Strategies from out-of-school time programs 

that keep middle and high school youth engaged 

http://bit.ly/hfrp_engagingolderyouth

Engaging Youth in Community Decision Making 

(2007)

Publisher: Center for the Study of Social Policy

Summary: Toolkit for creating strong youth-adult 

partnerships to change communities 

http://bit.ly/cssp_youthcommunity

Engaging Youth in Partnership: A Resource 

Document for Youth Serving Agencies and 

Programs (2011)

Publisher: National Initiative to Improve Adolescent Health 

Summary: Youth engagement best practices and resources 

http://bit.ly/niiah_youthpartnership

Equipping Public Health Professionals for Youth 

Engagement: Lessons Learned from a 2-Year Pilot 

Study (2012)

Publisher: Health Promotion Practice

Authors: Sahay T, Rempel B, Lodge J

Summary: Insights from a pilot project to build the capacity 

of public health professionals to engage youth 

http://bit.ly/sahay_youthengagement

Facilitation Techniques: Get the Most Out of 

Brainstorming (2015)

Publisher: FACT

Summary: Techniques to involve youth in decision making 

http://bit.ly/fact_facilitationtechniques

Involving Youth

Publisher: Youth.gov

Summary: Strategies and resources to meaningfully 

involve youth in program development 

http://bit.ly/youthgov_involvingyouth

New Generation Initiative: Community 

Engagement Guide (2012)

Publisher: Rural Economic Development Center

Summary: Workbook for engaging young people in rural 

communities 

http://bit.ly/redc_communityengagement

Youth Engagement l 45

RESOURCES
Regional Youth Engagement Workshops: Summary 

Report - June 2016

Publisher: California Youth Advocacy Network

Summary: Challenges and solutions to recruit and retain 

youth shared during regional workshops with youth 

engagement partners

http://bit.ly/CYAN_report

Sustaining Youth Engagement Initiatives: 

Challenges and Opportunities (2009)

Publisher: The Finance Project

Summary: Framework for sustaining youth engagement 

initiatives 

http://bit.ly/fp_sustaininginitiatives

What You Need to Know about Background 

Screening (2013)

Publisher: U.S. Department of Justice, National Center for 

Missing and Exploited Children 

Summary: Guidebook for youth-serving organizations on 

screening potential employees and volunteers that will 

work with youth 

http://bit.ly/usdoj_backgroundscreening

Youth Engagement Alliance

Publisher: Campaign for Tobacco-Free Kids

Summary: Resource network supporting adult program 

coordinators who work with youth in tobacco control

http://bit.ly/tfk_youthalliance

Youth Engagement Toolkit 

Publisher: Texas School Safety Center 

Summary: Toolkit of strategies to recruit and involve 

youth in tobacco control efforts 

http://bit.ly/txssc_youthtoolkit

Youth Engagement Toolkit

Publisher: Tobwis

Summary: Toolkit for recruiting, working with, and 

retaining youth involvement in tobacco control efforts 

http://tobwis.org/youth-engagement

Featured Youth 

Engagement Programs

The 84

Sponsor: Massachusetts Tobacco Cessation and 

Prevention Program

Summary: Massachusetts’s statewide youth movement to 

educate peers and reduce the influence of tobacco in 

their communities

http://the84.org

Counter Strike

Publisher: Arizona STAND

Summary: Program in which teens work with local law 

enforcement to identify stores that sell tobacco to minors 

http://www.counterstrikeaz.com

FACT

Summary: Wisconsin youth-led movement to spread the 

truth about tobacco throughout the state 

https://factmovement.org

Iowa Students for Tobacco Education and Prevention

Sponsor: Iowa Division of Tobacco Use Prevention and 

Control

Summary: Iowa’s youth-led movement focused on 

ending tobacco in the state through education and 

awareness events

https://www.iowastep.org

Raze

Sponsor: West Virginia Division of Tobacco Prevention 

Summary: West Virginia’s youth-led antitobacco movement 

dedicated to educating communities about tobacco use 

https://www.razewv.com

Students Working Against Tobacco (SWAT)

Sponsor: Oklahoma State Department of Health

Summary: Oklahoma’s movement to empower youth to 

resist tobacco

https://www.ok.gov/okswat

Youth Engagement l 46

RESOURCES
Youth Council

Sponsor: Coalition for a Tobacco-Free Hawai‘i

Summary: High school and college leaders who deliver 

peer-to-peer presentations and organize local 

awareness activities 

https://hiphi.org/youth

Y Street

Sponsor: Virginia Foundation for Healthy Youth 

Summary: Virginia volunteer initiative for high school 

students to promote healthy, tobacco-free lifestyles 

http://ystreet.org

Case Studies 

Indiana

Tobacco Prevention and Cessation Commission

Publisher: Indiana Department of Health 

Summary: Resources and information about state tobacco 

prevention and cessation efforts in Indiana

https://www.in.gov/isdh/tpc/index.htm

VOICE Indiana

Sponsor: Indiana Teen Institute 

Summary: Indiana’s statewide youth empowerment brand 

designed to engage, educate, and empower teens to 

celebrate a tobacco-free lifestyle

https://www.voiceindiana.org

Vermont

CounterBalance

Summary: Vermont program focused on countering the 

tobacco industry’s influence in retail stores 

http://counterbalancevt.com

Tobacco Control Program

Publisher: Vermont Department of Health 

Summary: Information, resources, and data from the 

Vermont Tobacco Control Program

http://healthvermont.gov/wellness/tobacco

Vermont Tobacco Control Program: 2014 Counter 

Tools Store Audit Report (2015)

Publisher: Vermont Tobacco Control Program 

Summary: Results from the Counter Balance campaign’s 

store audit of more than 750 Vermont tobacco retailers 

http://bit.ly/vttcp_countertoolsaudit

Youth Engagement l 47

RESOURCES
REFERENCES

1. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs—2014. Atlanta, GA: 

US Dept 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; 2014.

2. US Department of Health and Human Services. Preventing Tobacco Use among Youth and Young Adults: A Report of the Surgeon 

General. Atlanta, GA: US Dept 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; 2012.

3. US Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the 

Surgeon General. Atlanta, GA: US Dept 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; 2014.

4. Gentzke AS, Creamer M, Cullen KA, et al. Vital Signs: Tobacco product use among middle and high school students—United 

States, 2011–2018. MMWR Morbidity and Mortality Weekly Report. 2019;68(6):157–164. https://www.cdc.gov/mmwr/

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This document was produced for the Centers for Disease Control and Prevention by the 

Center for Public Health Systems Science at the Brown School at Washington University 

in St. Louis.

Suggested citation:

Centers for Disease Control and Prevention. Best Practices User Guide: Youth Engagement in 

Tobacco Prevention and Control. Atlanta: 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, 2019.

Ordering information:

To download or order copies of this report, go to www.cdc.gov/tobacco or to order single copies, 

call toll-free 1-800-CDC-INFO or 1-800-232-4636.

More information:

For more information about tobacco control and prevention, visit CDC’s Smoking & Tobacco Use 

website at www.cdc.gov/tobacco.