TECP: A Tobacco Control Approach In A All-girl Youth Correctional Facility

1. TECP: A Tobacco Control Approach In A All-girl Youth Correctional Facility Youth Rehabilitation & Treatment Center-Geneva, NE Donald P. Belau, Ph.D. 402-759-3164 ext, 265 don.belau@ hhss.gov

2. Facility Description • The YRTC-Geneva of Geneva, Nebraska is an all-female adolescent correctional facility located in a rural setting. • The average daily count at the facility is 90 youth. • The YRTC-Geneva was the first juvenile female correctional facility accredited by the American Correctional Association and has received continuing full accreditation for the past 20 years.

3. Facility Description • In keeping with this standard of excellence, a level of staff commitment and resources was dedicated to the development of a tobacco education and cessation program for the youth.

4. Assessment Practices • The first stage in the development of the tobacco education and cessation programming called for the standardization of an assessment practice. • This written survey is administered within a youth’s first few days of admission to the YRTC-Geneva. • Questions are asked in the following areas: personal smoking experience, smoking environment, smoking pattern, motivation to quit smoking, and who are the supportive individuals willing to help her quit.

5. Assessment Practices • With this level of assessment, a picture as to the age of onset, frequency of use, supportive environment, and motivation to quit using tobacco emerges. • Identifying patterns of use then allowed for the development of individualized tobacco treatment programming as well as generalized programming addressing the total population of the YRTC-Geneva.

6. Tobacco Use Survey

7. Tobacco Use Survey

8. Tobacco Use Survey

9. Tobacco Use Survey

10. Tobacco Use Survey

11. YRTC-Geneva Youth Profile • 91 % ARE SMOKERS • 39% SMOKE A PACK @ DAY • 54% HAVE MOTHERS WHO SMOKE • 63% SMOKE WHEN USING SUBSTANCES • 75% REPORT 1/2 OF THEIR PEERS SMOKE

12. YRTC-Geneva Youth Profile • 97 % IDENTIFY SOMEONE THAT WOULD SUPPORT THEM QUITTING SMOKING • 49% REPORT THEY ARE VERY MOTIVATED QUIT • NICOTINE DEPENDENCE INCREASING • (n of 323 girls)

13. YRTC-Geneva Youth Profile • Intuitively, it appears that the girls are using for a variety of reasons including coping with anxiety, depression, attempting to fit in with peers, efforts to lose weight, parental use, myths surrounding child birth, etc.

14. Myths • Smoking reduces childbirth pain • Smoking attracts boys • Smoking is fashionable • Smoking is something everybody does • Smoking controls my appetite and my weight • My mother smoked, so does my grandmother, so what is the big deal?

15. Educational Programming • Education is identified as a critical method of approaching the individual, as well as the total population at the YRTC-Geneva. • It is reasoned that providing education to the youth regarding the dangers of tobacco use becomes a preventive approach. • Education programming is provided within the two-week orientation program that each girl participates in upon arrival at the YRTC-Geneva.

16. Education Programming • This basic education program is designed to present the dangers of tobacco use. • Factual information is taught along with a holistic view of personal health that emphasizes the minimization of risk behaviors. • All incoming youth receive five, 1-hour classes on tobacco use as part of 14 hours of drug/alcohol education. Each class incorporates a video, discussion, and the use of visual aids. Each session is structured with a cumulative, instructional approach that addresses a wide range of health issues relating to tobacco use.

17. Education Programming • In addition to the classes that deal with tobacco use only, as noted, there are other classes taught during the youths’ orientation program that treat tobacco use as being as harmful as other drugs. • For example, the toxicity of marijuana and tobacco use is examined in relationship to oral cancers and lung disease. In another class, the long-term effects of drug use including tobacco use by a pregnant woman on her unborn child are addressed candidly.

18. Educational Programming • Other educational activities embrace the total population as a whole through activities such as Tobacco Education classes, Media Literacy classes, Tobacco Awareness Week, and a Tobacco House of Horrors supported by the No Limits foundation.

19. Education Programming • In addition, individualized instruction is offered to girls who are pregnant. It has been learned from assessments that a variety of myths exist within this population that promote smoking. • For example, the girls have learned (probably from public school or peers) that smoking reduces birth weight, therefore they reason, childbirth will be less painful, if they smoke! • Myths such as this are attacked, along with providing information relating to second hand smoke effects upon infants.

20. Educational Interventions • EDUCATION PRESENTED DURING ORIENTATION CLASSES • TOBACCO EDUCATION CLASSES WITHIN SUMMER SCHOOL PROGRAMMING • INDIVIDUAL INSTRUCTION FOR MOTHERS & EXPECTANT MOTHERS

21. Cessation Interventions • Cessation efforts are focused upon youth that are identified as being nicotine dependent. • Those youth are identified through substance abuse assessments conducted by certified alcohol and drug addiction counselor(s) (CADAC) or by licensed mental health practitioner(s) (LMHP). • Cessation programming is also offered to youth that have had a history of abusing tobacco as well.

22. Cessation Programming • A relapse prevention plan • This plan acknowledges that a youth’s tobacco use is a major health risk, and that identifying triggers for relapsing to tobacco and other drug use is critical if the girl is to stay substance/tobacco free. • Wellness activities are identified as replacement behaviors that the youth is able to use as a means to cope with emotions and changing environments rather than resorting to tobacco use to cope with these situations.

23. Cessation Strategies • Referral to Quitlines • Integrated substance abuse relapse prevention plans • Consultation with Aftercare planning staff and consultation with families • Follow up phone calls • Involvement with IMPROV activities in the home school district • Encouragement of Social Activism

24. Conclusions • The data accumulated thus far clearly indicates that within this juvenile justice population of girls, tobacco use (smoking) is a significant behavior, with nicotine abuse and nicotine dependence becoming identified routinely through multiple assessments.

25. Conclusions • It is suggested that female residential correctional programs routinely assess youth for nicotine abuse/dependency issues, and then develop a level of programming that addresses the respective levels of use.

26. YRTC-Geneva Tobacco Education & Cessation Future Directions • Conduct family orientation classes that inform the families as to the dangers of secondhand smoke • Continue to refine data collection processes that will allow for understanding of the patterns of tobacco use • Development of Quitlines that are focused upon female juvenile justice issues

27. Youth Rehabilitation & Treatment Center-Geneva Geneva, Nebraska 68361Donald P. Belau, Ph.D.402-759-3164 ext, 265don.belau@ hhss.gov