Healthy Tobacco-Free Schools CDC’s Division of Adolescent and School Health (DASH)

1. Healthy Tobacco-Free Schools CDC’s Division of Adolescent and School Health (DASH)

2. DASH’s Mission To promote the health and well being of children and adolescents so they become healthy and well-functioning adults. 3/10/2014

3. Key Health Issues for Young People Intentional and unintentional injuries Alcohol/drug use Sexual risk behaviors Tobacco use Physical inactivity Poor eating habits Asthma Mental health

4. Coordinated School Health Programs Health Education Physical Education Family and Community Involvement Health Services Health Promotion for Staff Nutrition Services Healthy and Safe School Environment Counseling, Psychological, and Social Services

5. CDC/DASH-Funded Coordinated School Health Programs WA ME ND Nez Perce Tribe MN MA ID SD WI NY MI CT OH NJ WV CO CA KY NC AZ AR SC MS Funded States

6. School Health Guidelines

8. Guidelines Review Process • Literature search • Convene DASH workgroup • Code articles (approx. 500) • Copies stored in hard copy and Ref. Mgr. • Draft list of strategies • Convene experts/partner panel • Draft for CDC internal review/partner review • CDC clearance process

9. 1994 Guidelines for School Health Programs to Prevent Tobacco Use and Addiction 1. Policy 2. Instruction 3. Curriculum 4. Training 5. Family Involvement 6.Tobacco-Use Cessation 7. Evaluation

10. 2010 Guidelines Revisions • Health Services: school health nurses, health care providers, counselors; cessation programs • Community + School Efforts • Parental Involvement • School Staff Involvement • After School/Advocacy Programs • Tobacco Awareness Events • Media/Advertising • Effects of Secondhand Smoke

11. Comprehensive School Tobacco-Free Environment • Creation of a strong tobacco-free policy • Communication of the policy • Enforcement of the policy • Prohibiting advertising and promotion • Tobacco-use cessation advice and referral • Tobacco-use prevention instruction

12. Tobacco-Free Environment • Emphasis on total tobacco-free environment at all times (24/7) • New research on secondhand smoke’s lingering effects in buildings • Secondhand smoke and asthma • Influence of role modeling by teachers, staff, visitors, and parents

13. Exposure to Secondhand Smoke 2006 Surgeon General’s Report: • There is no “risk-free” level of exposure to secondhand smoke. • Only eliminating smoking in indoor spaces fully protects non-smokers from exposure to secondhand smoke. Separating smokers from non-smokers, cleaning the air, and ventilating buildings cannot eliminate exposure.

14. Exposure to Secondhand SmokeSGR, 2006, continued • Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke. • Children exposed to secondhand smoke are at increased risk for SIDS, acute respiratory infections, ear problems, and more severe asthma.

15. Guidelines also cover… Effects on students from : - Attitudes of teachers and parents toward school tobacco-free policies - Harmful effects of minimal exposure to secondhand smoke - Secondhand smoke and impaired cognition - Schools and students raising tobacco crops

16. Tobacco-Free Policy: Cornerstone • Prohibit all tobacco use on all school property, in school vehicles, at school- sponsored events (on and off school property) for students, staff, and visitors 24/7.

17. School, District, and State Tobacco-Use Prevention Policies • Schools: 64% • Districts: 55% • States: 38% • Policies are least likely to address smokeless tobacco use and tobacco use among visitors Source: CDC, School Health Policies and Programs Study 2006

18. School Policies Prohibiting Tobacco Advertisements • In school buildings, outside on school grounds, on school buses or other vehicles, in school • publications, through sponsorship of school events • Source: CDC, School Health Policies and Programs Study 2006

19. Communication and Enforcement of the Policy • Clear communication to students, staff, visitors, contractors, and the community • Remedial* sanctions work best for students. *Remedial = counseling, alternatives to suspension programs instead of suspension or expulsion, cessation programs, etc.

20. Recommendations for School-based Tobacco-Use PreventionEducationCommunity Guide to Preventive Services, 2004 • The Task Force recommends use of school-based interventions when combined or coordinated with mass media campaigns and community education activities based on strong evidence of effectiveness in reducing tobacco use by students. • There is insufficient evidence to determine the effectiveness of school-based education (classroom programs) and other activities when implemented without additional community activities.

21. Tobacco-Use Prevention Education Classroom programs should be delivered in conjunction with community and media messages. Instruction should be K-12 and include: • Short- and long-term health consequences • Social influences • Peer norms • Refusal skills • Life and decision-making skills • Emphasis during middle and high school

22. Guidance, tools, and resources for a clear, complete, and consistent analysis of health education curricula • Based on CDC School Health Guidelines and National Health Education Standards • Identifies common characteristics of effective health education curricula • Higher expectations for and greater rigor in curriculum development and selection • Improved health education

23. Tobacco-Use Cessation for Students and Staff • Schools should identify students and staff who need assistance • Schools should give “brief advice” on quitting to students and staff • Schools should refer students and staff to outside providers • Schools should refer to the CDC guidance document if adopting an evaluated program or if developing its own program

24. CDC’s Guidance Tool “Youth Tobacco Cessation: A Guide to Making Informed Decisions” (2004) Contributors: Youth Tobacco Cessation Collaborative American Legacy Foundation National Cancer Institute Canadian Tobacco Control Research Initiative

25. Parent Involvement • Program planning • Reinforcing messages • Role modeling • Garner community support for tobacco-free policies and programs • Encourage smoke-free homes and cars

26. Classroom Education Community School Media Parents Environment Student Led Programs School + Community Model

27. Enables schools to identify strengths and weaknesses of health policies and programs • Enables schools to develop an action plan for improving student health • Engages teachers, parents, students, and the community in promoting health enhancing behaviors and better health http://www.cdc.gov/HealthyYouth/SHI

28. School Health Index Topics • Physical activity • Healthy eating • Tobacco use prevention • Unintentional injuries and violence prevention (safety) • Asthma

29. A national cadre of master trainers for DASH tools, including the SHI and the HECAT DASH Dissemination and Diffusion: “D-Train”

30. National Association of State Boards of Education

31. Resources • www.cdc.gov/healthyyouth (CDC/DASH) • www.nsba.org/schoolhealth (National School Boards Association) • www.nasbe.org (National Association of State Boards of Education) Linda Crossett: LCrossett@cdc.gov