Passage of 100% TobaccoFree School Policies in North Carolina

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Passage of 100 Tobacco-Free School Policies in
North Carolina

• UNC Prevention Research Center
• 1-866-UNC-YES1

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Acknowledgements
This presentation was created by the following
researchers with the UNC North Carolina Youth
Empowerment Study (NC YES).
Arlana Bobo Peterson, MPH Eric Pevzner, MPH Adam
O. Goldstein, MD Kurt M. Ribisl, PhD Carol
Patterson, MA
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Objectives

• To provide brief background on 100 TFS
• To document which NC school districts have 100
  tobacco-free policies
• To describe the NC YES school policy survey
• Methods
• Results
• Implications
• Overview of 100 TFS Football Game Compliance
  Pilot Study

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National School Policy Data

• CDCs criteria for a tobacco-free school policy
• Bans all tobacco use by students, all school
  staff, and visitors on school property, in school
  vehicles, and at school functions away from
  school property

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Tobacco-free School Policies

• Data from the 2000 National SHPPS
• 44.6 of schools have 100 TFS policies
• 45.5 of districts have 100 TFS policies
• 24.5 of states have 100 TFS policies

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Impact of School Tobacco Use Policies

• A survey of high school students (n17,287) by
  the
• University of Illinois-Chicago reported that
• Smoking restrictions are related to a lower
  prevalence of teen smoking
• Enforcement is critical to policy effectiveness
• 11 lower rate of smoking if policy is enforced
• Students reported little / no enforcement in over
  2/3 of schools with smoking ban

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NC Public Opinion on 100 TFS

• Registered voters were asked,
• Do you support policies that require NC public
  school campuses (buildings and grounds) to be
  100 tobacco free for all students, staff and
  visitors at all times?
• 87 strongly support/support 100 TFS policy
• Strong support existed across all demographic
  characteristics (race, age, education level,
  health, and presence of children in household)
• Data from the NC Center for Health Statistics
  (n777)

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NCYES School Policy Study

• To examine how 15 districts in NC were able to
  pass 100 tobacco-free school policies

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Methods

• Study Sample
• 2-6 key people interviewed in each 100 TFS
  district
• 43 interviews total (27 Female, 16 Male)
• Positions held
• 24 district employees
• 6 school board members
• 3 youth
• 10 other (health professionals, school health
  advisory groups, coalition members)
• 5 parents (overlap)

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Methods (cont.)

• Procedure
• Conducted telephone interviews lasting approx. 25
  min
• Analysis
• Qualitative computer analysis of interviews
• Inter-rater reliability of coding was high
  (kappa.91)
• Readers identified key themes

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Results Emerging Themes

• Key Players in Initiating Policy Adoption
• Recipes for Success
• Potential Obstacles to the Change
• Role of Media
• Key messages
• Enforcement

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1. Key Players in Policy Adoption

• School staff (e.g., school board members,
  superintendents, principals, Health or Safe and
  Drug Free Schools Coordinators)
• Governor
• Volunteer coalitions
• Student champions
• Adult champions
• Parents

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Cumulative School Policy Changes
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1. Initiating Policy Change

• 1) Administrator or other adult initiated
• Administrator or other adult(s) initiated the
  change. No evidence of youth involvement.
• 2) Adult initiated with youth involvement
• Administrator or other adult(s) initiated change,
  but process of policy adoption involved youth
  participation at some levels.
• 3) Youth initiated with adult involvement
• Youth very involved and identified as major
  player in initiation and passage of policy. Adult
  facilitation of youth involvement was key.

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Youth Initiation of School Policy
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Role of Governors Summit/Letter
Jan 2000 Governors Summit
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1. Initiating Policy Change

• 1) Administrator or other adult initiated (10)
• Cabarrus, Caldwell, Cartaret, Gates, Hickory
  City,
• Kannapolis City, New Hanover/Brunswick,
• Perquimans, Polk, Rowan-Salisbury
• 2) Adult initiated with youth involvement (2)
• Chapel Hill-Carrboro, Guilford
• 3) Youth initiated with adult involvement (3)
• Asheville, Henderson, Hertford

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2. Recipes for Success Adult Initiated

• The impact of adult champions
• The driving force was the Drug Education
  Coordinator. She made it her own personal
  crusade. - School Principal
• I just put it forth to the School Board that we
  had to go tobacco-free I kept pushing until we
  got it to a vote. School Board Member

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2. Recipes for Success Adult Initiated

• As an administrator, be sure you have the
  School Board with you. Have your school
  administrators for it, particularly principals.
  - School Board Member

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2. Recipes for Success Adult Initiated

• The importance of youth champions
• Youth were a big influence on my support of it
  the same with testimony from coalitions and
  people from the local hospital. Superintendent
• Make the policy a student initiative. Have
  students present the issue to the School Board.
  The Board will have a difficult time saying no to
  students on this issue. Superintendent

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2. Recipes for Success Adult Initiated

• Impetus for adopting TFS policy . . .
• It occurred because of a combination of
  several events That was the year when the
  Governors memo (letter) came out. At the next
  Board meeting we unanimously voted (and went
  tobacco free.) - Board Member
• At a football game I saw lots of students
  smokingI proposed that all campuses be smoke
  free. - Board Member

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2. Recipes for Success Youth Initiated

• Adults as facilitators . . .
• The coalition coordinator did not plan it for
  (the students) she just guided. Adult
• Students were the propelling force I as an
  adult worked under the radar. Adult

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2. Recipes for Success Youth Initiated

• Stimulus for pursuing a TFS policy . . .
• The (Summit) itself was invigorating. All of
  it was coming together. We could not come back
  and not do anything. The youth were fired up.
  - Adult leader
• The Summit helped get us in gear. It gave us
  backing with the School Board. Youth

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2. Recipes for Success Youth Initiated

• Importance of policy advocacy by youth . . .
• Teens attended Board of Education meetings,
  spoke in favor of going tobacco-freewrote in the
  school newspaper and started a letter writing
  campaign.

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2. Youth Activities

• Advocate with School Board member
• Testify at School Board meeting
• Attend Governors summit
• Petition among youth
• Complaints about smoking
• Surveys of students
• Public education of students
• Collaborate with other agencies (e.g. ASSIST)
• Recognition awards

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3. Potential Obstacles to the Change

• Concerns regarding opposition from teachers
• There was a little opposition from smoking
  staff because we wouldnt leave designated areas
  for teachersAdult employees were concerned about
  the Board telling them what they could doNobody
  left the school system as a result.
• Some teachers squirmed a little but there was
  no big dissension.

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3. Potential Obstacles to the Change

• Concerns regarding policy enforcement
• The principals did not want to judge who (could
  smoke at sporting events). It was going to create
  another headache (for the principals).
• Other obstacles were what to do about
  football games and visitors on campus
• Most problems we anticipated didnt happen.

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3. Potential Obstacles to the Change

• Tobacco industry not necessarily a barrier
• People were afraid there would be opposition
  (from the tobacco companies).
• "We took a risk because (a tobacco manufacturer)
  is one of the top 3 taxpayers in this countyWe
  did not approach them, but feel we would have
  gotten support there as well.

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4. Role of Media

• Not a major incentive or deterrent
• The schools wanted to keep it low key.
• There wasnt much of a way for them (media) to
  sway things.
• The media covered it as they did usual topics
  but it was covered positively. No fanfare.

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5. Key Messages

• Focus on health issues (e.g. Secondhand
• smoke at sporting events, childrens health)
• Have the data available on the impact of
  smoking on healthit makes it a lot easier.

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5. Key Messages

• Personalize the issue (e.g. Stories regarding
• people with asthma and cancer survivors)
• We got support from those affected by smoking,
  such as asthma patients, football fans
• and players, and band affiliates. The band was
  crucial because members could not choose where
  they sat in the stadium.

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5. Key Messages

• Adults as role models for youth
• It was hypocritical for us to say to students
  not to smoke when we allowed adults. I thought
  this was the biggest thing of all.
  Superintendent

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6. Enforcement

• Concerns regarding non-compliance
• There are a few hardheads and some mumbling
  about the policy when officers ask people not to
  continue smoking. There has been no
  confrontation or escorting off since the
  adoption of the 100 tobacco-free policy.

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6. Enforcement

• Post-adoption fears did not materialize
• Of course, still some go to the bathroom to
  smoke, but we don't have a lot of that anymore.
• Most of the problems we anticipated didnt
  happen.

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6. Enforcement

• Special concerns regarding sporting events
• The only complaints were at the ball games.
  Some people would sneak around at games and
  smoke.
• Chew was a problem. As a principal, I had to
  speak to the coaches about this. It did settle
  down.

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6. Enforcement

• Importance of being prepared to address
• policy violations
• When you pass it, stand firm behind the policy.
  Policies are one of those things that, until
  challenged, are just words on a piece of paper.

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6. Enforcement

• Offer range of services
• Cessation programs for adults youth
• Alternatives to suspension
• Gentle, firm and repeated reminders
• Consistent enforcement (i.e., students, staff,
  visitors)

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6. Enforcement Range of Services

• Alternatives to suspension
• If they're caught, they get a choice...to go to
  the alternative suspension program or they go to
  suspensionThe parents come in and help decide
  (the penalty).

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6. Enforcement Range of Services

• Gentle, firm and repeated reminders
• Initially a few people who maybe didnt know
  were gently reminded. They were supportive.
• It's posted 'Smoke Free School' signs at ball
  games and visibly all around campuses.

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Implications of NC YES School Policy Study
Findings

• Different models of adoption viable
• Majority of policy change initiated by
  administrators or other adults without youth
  involvement
• More recent adopters more likely to have youth
  involved in initiation/passage
• What worked for early adopters may not work for
  later adopters (i.e. picking low lying fruit)

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Implications

• Role of Summits
• Governors Summit and letter stimulated the
  passage of policies
• Recruit youth and adult champions
• Garner support of key players

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Implications

• Be strategic
• Great opportunities exist (e.g. many youth
  empowerment programs do not have 100 TF policies
  in their districts)
• Focus on health symbols
• Personalize issues

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Implications

• Enforcement
• Enforcement was not viewed as a barrier to policy
  adoption
• Prepare strategies to defuse enforcement as
  barrier to adoption
• Implement strategies to ensure enforcement
  carried out after adoption

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Limitations

• This is a preliminary analysis.
• We have only heard the success stories.
• The data do not reflect incremental changes in TF
  school policies.
• This does not describe actual enforcement
  practices in each district.

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Conclusions

• Do it! Put aside the fears and the ideas that
  the policy is not going to work. It was better
  than we ever anticipated.

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Are 100 TFS schools tackling smoking at football
games?

• Pilot Study

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Study Rationale

• Football games include the intersection of
  students, staff, and community members and
  therefore represent a critical period of
  behavioral modeling

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Study Rationale (cont.)

• School Policy Interviews identified concerns
  regarding enforcement and compliance with 100
  TFS policies

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Study Rationale (cont.)

• Based on a review of the scientific literature no
  studies were identified that examined compliance
  with tobacco-free school policies.

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Research Questions

• Do people comply with TFS policies?
• Is the prevalence of tobacco use at high school
  football games lower at TFS schools vs. non-TFS
  schools?

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Study Sample

• The sample is based on 2 TFS districts and 2
  non-TFS districts in NC
• 11 TFS games and 11 control games were randomly
  selected for data collection

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Methodology

• Data collected by observation of public behavior
• Teams of data collectors utilize a standardized
  checklist and protocol to record all observed
  instances of smoking
• Systematic observations are conducted before the
  game, during 1st quarter, 2nd quarter, halftime,
  3rd quarter, 4th quarter, and post-game

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Data Collection

• The following variables are assessed
• Instances of smoking (location and student/adult)
• TFS signage
• Announcements re TFS policy
• Smoking within 10 feet of a child

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Preliminary Findings
of Instances of smoking
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Preliminary Findings (cont.)

• Smoking is most likely to occur during the 2nd
  quarter and halftime of games
• Schools with both signs and announcements stating
  that smoking is prohibited had the fewest
  observed instances of smoking

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Goal of the 100 TFS Football Game Pilot
Compliance Study
To provide school districts with data to support
the adoption or enforcement of 100 TFS policies
and put a STOP to tobacco use in our schools!