Every day in the U.S. 3,200 people under the age of 18 smoke their first cigarette while an additional 2,100 youth and young adults become daily smokers. School personnel can play a vital role in early tobacco prevention and intervention.1
Prevalence of Youth Smoking in the United States:
Between 80-90% of adult smokers began smoking before the age of 18. 2,3
Youth begin smoking in Middle School (6th-8th grade). The CDC tracked statistics in 2015 which measured tobacco use in the past month: 2.3% of 6th through 8th graders had smoked cigarettes, 5.3% had smoked e-cigarettes, 2% had smoked hookah, and 1.8% had used smokeless tobacco.2
While cigarette use has decreased among High School students, overall tobacco use has stayed about the same since 2011. When asked about the past 30 days: a) 9.3% of High School students had smoked cigarettes, b) 16% smoked e-cigarettes, c) 7.2% smoked hookah, and d) 6% used smokeless tobacco.
The use of e-cigarettes has become the most popular form of nicotine among High School students. Additionally, smokeless tobacco has become more accepted by students, especially by athletes. Cigar use has primarily increased due to attractive flavors (see the Cigar Trap). 2
Tobacco use among youth is related to a number of social factors: 1) peer pressure, 2) peer approval, 3) social-economic status, 4) normalization of tobacco use in the environment, 5) use of tobacco in the media, 6) and accessibility to tobacco products. Tobacco use is also complicated by other sources including 1) genetic factors, 2) co-occurring behavioral health issues, 3) self-esteem, 4) and low-academic achievement. 2
There are several prevention strategies deemed effective by SAMSHA and NREPP, please refer to SAMHSA's National Registry of Evidence-Based Programs and Practices. Also, consult with our resource page to browse summaries of five effective smoking prevention programs.
Why both prevention and cessation programs?
To successfully address smoking cessation in a school, both prevention and intervention services should be offered. Prevention programs can help many students from starting tobacco products. Cessation programs can be implemented to help them quit 4. For students and school personnel who have begun using tobacco products
How can school personnel assist in preventing tobacco use among students?
a) Enforce School Policy
- Prohibit all tobacco use (including smokeless tobacco and vapes) on the school premises. 5,6
- Prohibit all tobacco use at school-sponsored events (i.e. football games). 5,
- Reject school funding provided by tobacco companies. 5
b) Implement Smoking Prevention Curriculum 5,6,7
- Provide tailored smoking prevention curriculum from K-12.
- Programming should be reviewed and reinforced through Middle and High school years.
- Students should be taught 1) short-term and long-term health consequences, 2) social consequences, 3) peer pressure, 4) resistance and refusal skills, and 5) dangers of tobacco advertising.
- Students taught social norms of tobacco: (i.e. most students do not actually use tobacco products).
- Students need to understand why young people choose to smoke and how to find healthier alternatives.
- Students should be taught communication strategies, goal-setting, and other life skills to prevent start.
- Assess quality assurance and program outcomes regularly.
c) Involve Parents and the Community 8,9
- Involve parents in smoking prevention program by sending information and assignments home
- Involve students in interactive prevention activities, such as Kick Butts Day in which students create a community project to end pro-tobacco beliefs.
- Invite coaches to discourage tobacco use, especially smokeless tobacco with athletes.
How can school personnel intervene with student smokers
a) Implement a smoking cessation intervention 5,6,7
- Consider teaming-up with local health departments or hospital staff and co-teach cessation programs
- Provide tools for self-help and options for peer support
- Include immediate consequences of tobacco use, refusal skills, avoidance, and how to deal with stress
- Focus on achievable goals and reward students for reaching intervals along the way
- Assess outcomes of the program regularly
b) Provide outside services 5,6,7
- Promote and advertise MDQUIT Line for students
- Advertise resources in the local community, including clinics and community centers
- Create a referral system to local resources and follow-up after each made referral
- Offer students options to quitting tobacco use: individual or family counseling, possible pharmacological
- Assess barriers-- Strategies should be discussed to overcome problems.
c) Community Involvement 5,7
- Create an Anti-Tobacco Committee that includes law enforcement officials, religious leaders, and other prominent figures to reinforce smoking cessation for youth in a variety of settings.
- Educate parents on dangers of smoking, and if applicable, offer them cessation services as well
- Invite outside resource centers to help with training school personnel responsible for cessation services.
Overall, what makes for successful prevention and intervention programs?
A School's Guide to Comprehensive Tobacco Control5 outlines the following domains for successful tobacco
prevention and intervention in schools. Note that the 7 domains should not be thought of as steps but as areas that should be addressed simultaneously:
5. Family Involvement
6. Tobacco Cessation Efforts
Examples of successful smoking prevention/ intervention programs in schools:
Check out this link for more information about the following programs:
Curriculum-Based Support Group (CBSG) 10
CBSG is a secondary preventative intervention for girls and boys aged 4-17 in school or community settings
- The program is designed for students who are at increased risk for substance use, delinquency, and violence.
- Students meet in small peer groups where confidentiality is assured.
- The themes of the program include a) coping skills for family situations, b) resistance and negotiation skills against alcohol, drugs, and peer pressure, c) goal setting, d) peer respect, and e) making healthy decisions.
- The program has been found to be successful for reducing antisocial and rebellious behavior, increasing anti-drug beliefs, and increasing coping skills.
- Two levels are available: Kid's Connection (ages: 4-12) and Youth Connection (ages: 10-17)
Life Skills Training (LST)11
- A preventative program for grades 3-10
- Program focuses on reducing alcohol, drug, tobacco, and violence risk
- Curriculum aims to teach a) resistance and refusal skills, b) self-esteem and confidence, c) coping with stress, and d) avoiding short-term consequence
- 3 categories: Elementary School (grades 3-6), Middle School (grades 6-9), High School (grades 9-10)
- Noted by Wiehe et al. (2005)12 as the only intervention that maintained significant long-term benefits.
- Probably due to multiple levels of student interaction and participation in the program
Project Alert 13
- A completely online and free preventative program for Grades 7 and 8
- Goals include: a) non-drug use, b) developed refusal skills, and c) creation of new attitudes
- Curriculum consists of 14 lessons (only lessons 2, 10, 11 specifically target smoking)
- Objectives include a) refusal skills, b) short-term consequences of smoking, and c) why it is difficult to quit.
- An 8-session prevention and cessation program for grades 7-12; includes individual and group interventions.
- Students are taught a) refusal skills, b) communication skills, c) decision making skills, d) stress and anger management, e) dealing with peer pressure, and f) problem-solving skills.
Project TNT (Towards No Tobacco Use)15
- A prevention and cessation program, comprised of 12 lessons, for 5th-9th Graders
- Innovative program where students are encouraged to interact with materials (games, videos, role-play, etc.)
- Teaches students a) dangers of tobacco in advertising and the media, b) how to refuse peer pressure, and c) identify short-term consequences
In short, providing successful smoking cessation programs requires addressing both prevention and intervention.
The previous real-world programming examples have illustrated three key strategies for successful intervention: 1) tailoring programs for various age groups, 2) making the programs interactive and fun for students, 3) teaching life-skills which can be implemented in various situations.
- U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Office on Smoking and Health, 2012
- Centers for Disease Control and Prevention. (2016). Youth and tobacco use. Retrieved November 14, 2016 from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youthdata/tobacco_use/in....
- U.S Department of Health and Human Services. (2016). Trends in adolescent tobacco use. Retrieved November 14, 2016 from http://www.hhs.gov/ash/oah/adolescent-health-topics/substance-abuse/tobacco/trends.html
- Campaign for Tobacco Free Kids. (2016). The path to addiction starts at very young ages. Retrieved October 31, 2016 from https://www.tobaccofreekids.org/research/factsheets/pdf/0127.pdf
- The Utah Department of Health Tobacco Prevention and Control Program. (2010). A school’s guide to comprehensive tobacco control. Retrieved from http://www.health.utah.gov/tobacco/pdfs/schoolguide.pdf
- Campaign for Tobacco Free Kids (2016). How schools can help students stay tobacco-free. Retrieved November 7, 2016 from https://www.tobaccofreekids.org/research/factsheets/pdf/0153.pdf
- Centers for Disease Control and Prevention. (1994). Guidelines for school health programs to prevent tobacco use and addiction. Retrieved November 7, 2016. from http://www.cdc.gov/mmwr/preview/mmwrhtml/00026213.htm
- Campaign for Tobacco Free Kids (2016). Kick butts day. Retrieved November 7, 2016 from http://www.kickbuttsday.org/
- Maine Center for Disease Control and Prevention. (2016). Tobacco-Free Athletes. Retrieved November 7, 2016 from http://www.tobaccofreemaine.org/channels/educators/tobacco_free_athletes...
- Rainbow Days. (2016). CBSG Program. Retrieved November 21, 2016 from http://rainbowdays.org/our-services/cbsg-program-2/
- Life Skills Training. (2016). Life Skills Training Overview. Retrieved November 21, 2016 from http://www.lifeskillstraining.com/
- Wiehe, S. E., Garrison, M. M., Christakis, D. A., Ebel, B. E., & Rivara, F. P. (2005). A systematic review of school-based smoking prevention trials with long-term follow-up. The Journal of Adolescent Health: Official Publication Of The Society For Adolescent Medicine, 36(3), 162-169.
- Project Alert. (2016). Program Overview. Retrieved November 21, 2016 from https://www.projectalert.com/
- Student Assistance Services Cooperation. (2011). Project Success. Retrieved November 21, 2016 from http://www.sascorp.org/success.html
- University of Southern California Institute for Prevention Research. (2016). Program Approach. Retrieved November 21, 2016 from http://tnt.usc.edu/program_approach.php