Healthy Tobacco-Free Schools
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Healthy Tobacco-Free Schools CDC’s Division of Adolescent and School Health (DASH). 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. Key Health Issues for Young People.

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Healthy Tobacco-Free Schools

CDC’s Division of Adolescent and School Health (DASH)

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DASH’s Mission

To promote the health and well being of children and adolescents so they become healthy and well-functioning adults.


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Key Health Issues for Young People

Intentional and unintentional injuries

Alcohol/drug use

Sexual risk behaviors

Tobacco use

Physical inactivity

Poor eating habits


Mental health

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Coordinated School Health Programs

Health Education

Physical Education

Family and Community Involvement

Health Services



for Staff



Healthy and Safe School Environment

Counseling, Psychological, and Social Services

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CDC/DASH-Funded Coordinated School Health Programs




Nez Perce Tribe




















Funded States

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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

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1994 Guidelines for School Health Programs to Prevent Tobacco Use and Addiction

1. Policy

2. Instruction

3. Curriculum

4. Training

5. Family




7. Evaluation

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2010 Guidelines Revisions Tobacco Use and Addiction

  • 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

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Comprehensive School Tobacco Use and Addiction 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

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Tobacco-Free Environment Tobacco Use and Addiction

  • 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

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Exposure to Secondhand Smoke Tobacco Use and Addiction

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.

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Exposure to Secondhand Smoke Tobacco Use and AddictionSGR, 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.

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Guidelines also cover… Tobacco Use and Addiction

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


- Schools and students raising

tobacco crops

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Tobacco-Free Policy: Tobacco Use and Addiction 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.

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School, District, and State Tobacco Use and AddictionTobacco-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

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School Policies Prohibiting Tobacco Advertisements Tobacco Use and Addiction

  • 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

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Communication and Enforcement of the Policy Tobacco Use and Addiction

  • 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.

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Recommendations for School-based Tobacco-Use Prevention Tobacco Use and AddictionEducationCommunity 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.

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Tobacco-Use Prevention Education Tobacco Use and Addiction

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

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  • 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

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Tobacco-Use Cessation for Students and Staff consistent analysis of health education curricula

  • 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

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CDC’s Guidance Tool consistent analysis of health education curricula

“Youth Tobacco Cessation: A Guide to Making Informed Decisions” (2004)


Youth Tobacco Cessation Collaborative

American Legacy Foundation

National Cancer Institute

Canadian Tobacco Control Research Initiative

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Parent Involvement consistent analysis of health education curricula

  • Program planning

  • Reinforcing messages

  • Role modeling

  • Garner community support for tobacco-free policies and programs

  • Encourage smoke-free homes and cars

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Classroom consistent analysis of health education curricula







Student Led Programs

School + Community Model

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School Health Index Topics health policies and programs

  • Physical activity

  • Healthy eating

  • Tobacco use prevention

  • Unintentional injuries and violence prevention (safety)

  • Asthma

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A national cadre of master trainers for DASH tools, including the SHI and the HECAT


Dissemination and Diffusion: “D-Train”

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National Association of State Boards of Education including the SHI and the HECAT

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Resources including the SHI and the HECAT




    (National School Boards Association)


    (National Association of State Boards of Education)

    Linda Crossett: