1. Implementing CDC’s School Guidelines: Challenges And Opportunities Joy Larson Utah Department of Health Tobacco Prevention & Control Program

2. Goal Explain challenges to implementing CDC’s Guidelines for School Health Programs to Prevent Tobacco Use and Addiction at the state and local levels and identify a process to address these challenges.

3. Presentation Overview CDC’s School Guidelines (overview) Utah’s School Tobacco Prevention Project (history) Challenges and Opportunities A School’s Guide to Comprehensive Tobacco Control & The Project in Action Lessons Learned

4. CDC’s School Guidelines 1. Policy: Develop and enforce a school policy on tobacco use. 2. Instruction: Provide instruction about the short- and long-term negative physiologic and social consequences of tobacco use, social influences on tobacco use, peer norms regarding tobacco use, and refusal skills. 3. Curriculum: Provide tobacco-use prevention education in grades K-12.

5. CDC’s School Guidelines 4. Training: Provide program-specific training for teachers. 5. Family Involvement: Involve parents or families in supporting school-based programs to prevent tobacco use. 6. Tobacco Cessation Efforts: Support cessation efforts among students and school staff who use tobacco. 7. Evaluation: Assess the tobacco-use prevention program at regular intervals.

6. Utah’s School Tobacco Prevention Project In the past, Utah’s Tobacco Prevention and Control Program (TPCP) placed a strong emphasis on guidelines 2 & 3: Instruction and Curriculum.

7. Utah’s School Tobacco Prevention Project 2001-02 Conducted research (literature review & key informant interviews) Implemented pilot project Contracted with Grand School District to implement CDC’s School Guidelines, with an emphasis on policy change

8. Utah’s School Tobacco Prevention Project 2001-02 Decided to contract directly with school districts to implement CDC’s School Guidelines Benefits: increased school district interest, built infrastructure and sustainability Created A School’s Guide to Comprehensive Tobacco Control A step-by-step guide to lead school districts and others through the process of implementing CDC’s School Guidelines

9. Utah’s School Tobacco Prevention Project Contracting with School Districts: The Process Identified target school districts to pilot the project Informed and partnered with state and local agencies (State Office of Education, Local Health Departments, etc.) Proposed the project to targeted school districts

10. Utah’s School Tobacco Prevention Project What are the School Districts Doing? Hire a ½ employee to oversee the project Follow A School’s Guide to Comprehensive Tobacco Control to implement CDC’s School Guidelines Work closely with local partners

11. Utah’s School Tobacco Prevention Project 2002-03 Utah’s School Tobacco Prevention Project implemented in six school districts 2003-04 Expanded project to include four additional districts

12. Utah’s School Tobacco Prevention Project 3 Challenges Initially Encountered: 1. The need to find partners at the school district level 2. The need to prioritize school districts due to limited funding 3. The need for a step-by-step guide to lead school districts through the implementation process

13. Challenge #1 Challenge: The need to find partners at the school district level. By partnering with the school districts, we build interest, infrastructure and sustainability of the project. But… Tobacco is not a top priority for schools. Schools are busy! Territorial issues often exist.

14. Challenge #1 Challenge: The need to find partners at the school district level. Opportunities to overcome: Educate stakeholders Provide a plan Utilize the project as an “umbrella” for all who want to be involved

15. Challenge #2 Challenge: The need to prioritize school districts due to limited funding. 40 School Districts in Utah (more in other states!) Initial project start-up takes time and technical assistance Project funding increases implementation, but is limited

16. Challenge #2 Challenge: The need to prioritize school districts due to limited funding. Opportunities to overcome: Utilize a selection process rather than a competitive funding process. Identify indicators related to tobacco use to select target districts: Tobacco Use Rates Socioeconomic status Availability of prevention programs

17. Challenge #2 Source: Utah YRBS 1991- 2003

18. Challenge #3 Challenge: The need for a step-by-step guide to lead school districts through the implementation process. “School people” know the school system, but often are not tobacco prevention experts. One-on-one training and technical assistance is time intensive and can be expensive.

19. Challenge #3 Challenge: The need for a step-by-step guide to lead school districts through the implementation process. Opportunities to overcome: Utilizing A School’s Guide to Comprehensive Tobacco Control: Provides school districts with a step-by-step resource to lead them through the process of implementing CDC’s School Guidelines Helps to institutionalize efforts Creates a uniform process across several districts Reduces expenses related to training and time

20. A School’s Guide to Comprehensive Tobacco Control CDC’s School Guidelines 1. Policy 2. Instruction 3. Curriculum 4. Training 5. Family Involvement 6. Tobacco Cessation Efforts 7. Evaluation A School’s Guide 1. Policy 2. Community & Family Involvement 3. Instruction & Curriculum 4. Training 5. Tobacco Cessation Efforts 6. Evaluation

21. The Project in Action Steps Challenges Successes Utilizing A School’s Guide to Comprehensive Tobacco Control, Component #1 Policy

22. The Project in Action CDC: Develop and enforce a school policy on tobacco use. Guide: Evaluate, update, and reinforce the school policy on tobacco use. Currently, Utah school tobacco policies: Are not comprehensive Lack consistent enforcement Are not well-communicated

23. The Project in Action Step 1: Review the current policy. Step 2: Get commitment. Step 3: Form an advisory committee to revise the tobacco policy. Adapted from: Creating and Maintaining a Tobacco-Free School Policy. Partnership For A Tobacco-Free Maine, Bureau of Health, Department of Human Services.

24. The Project in Action “T” Activity

25. The Project in Action “T” Activity

26. The Project in Action Step 4: Develop a draft of the new policy. Step 5: Present the new policy to the school board. Step 6: Plan implementation strategies. Adapted from: Creating and Maintaining a Tobacco-Free School Policy. Partnership For A Tobacco-Free Maine, Bureau of Health, Department of Human Services.

27. The Project in Action Step 7: Communicate the policy throughout the school and community. Step 8: Implement the policy. Step 9: Conduct ongoing advocacy and evaluation of the policy. Adapted from: Creating and Maintaining a Tobacco-Free School Policy. Partnership For A Tobacco-Free Maine, Bureau of Health, Department of Human Services.

28. Lessons Learned Early findings from this project suggest: School districts at high-risk for tobacco use are enthusiastic to implement CDC’s School Guidelines and are able to do so following A School’s Guide to Comprehensive Tobacco Control.

29. Lessons Learned Early findings from this project suggest: Directly funding school districts allows the districts to institutionalize efforts and build community and internal support to sustain tobacco prevention efforts beyond funding opportunities.

30. Questions?