State experiences with youth prevention – 2/18/11

Q: Have any states implemented/are implementing:

1. A school based tobacco cessation program for youth under 18;
2. A youth prevention campaign similar to TRUTH in schools; and/or
3. A targeted intervention with academically at-risk middle school youth?

A:

Editor’s note: The archived Help Your Peers request, “Effective prevention messaging for youth – 1/18/11” contains information about successful state tobacco prevention media campaigns for youth.

1. Massachusetts: Massachusetts’ youth tobacco prevention program is known as The 84 Movement, representing the 84% of high school youth who do not smoke. The 84 consists of youth groups (both schools and youth-serving community-based organizations) signing up as a Chapter of The 84 Movement and conducting tobacco prevention activities in their schools and communities with the primary purpose of promoting the social norms message that most youth in the state do not smoke.
    
   Once signed up, Chapters receive their own webpage on the84.org where they showcase their activities and receive important updates, resources, and announcements regarding helpful opportunities.
    
   Each Chapter also receives a free toolkit that contains a Chapter Manual (to help the group organize their Chapter), an Activities Manual (with a menu of easy-to-do activities, each activity having assigned points that can be earned once conducted), and items like posters and pin buttons to help in promoting the social norms message. Points earned are attached to a rewards system allowing the youth group to get recognized for their work.
    
   Chapters also receive trainings (all free of charge) at a statewide meeting at the beginning of the school year and during Kick Butts Day in March where they meet and network with other youth from across the state that are part of The 84 movement.
    
   Currently, there are eighty Chapters, all spread out across the state, a great number being from communities where the smoking rates are higher than the state’s smoking rate.
    
   It is important to always take into consideration that the approaches used for community-based youth groups will almost always have to be adapted for the school groups.
    
   To learn more about The 84 Chapters, visit www.the84.org.
    
2. New Jersey 1: In New Jersey, Hi Tops based in Princeton, NJ offers tobacco cessation counseling to teens www.hitops.org. American Lung Association ran a high school tobacco cessation program in NJ. Chantal Fields of ALA is in charge of programs and can provide information on which states have a current teen smoking cessation program.
    
3. New Jersey 2: HiTOPS is an adolescent health and education center in Princeton, NJ. We have been serving adolescents ages 13-26, as well as their parents and teachers for the past 24 years. We have provided smoking cessation counseling since 2001 and launched the iQuit! program in 2008. This is an on line website that has six podcasts taking users through a smoking cessation course through peer education scenarios. Users of the program can also receive a text message a day for the first thirty days of their quit for additional support. They can also opt to speak to the nurse practitioner in person for individual counseling and questions. The website can be accessed by going to www.iquitathitops.com.The Nurse practitioner at HiTOPS can prescribe any of the first line nicotine replacement medications, Chantix,or bupropion if determined appropriate by the nurse practitioner and client. The counseling is based in Motivational Enhancement Therapy.
    
   We have done a pilot study that showed a 65% significant reduction in smoking and 16% abstinence in six months. Some difficulties encountered were getting young people to try NRT (they prefer other methods to quit, i.e., exercise and distractions) and getting young people to try the program (we offered an incentive of an iPod Nano which we gave to the participants in the study and tried many outreach/marketing media including movie theatre ads, healthcare providers, school counselors, radio, Facebook, MySpace, a concert, brochures, the website).
    
4. New York: These school-based program ideas seem opposed to general CDC guidance regarding effective tobacco control programming. Policy-focused and health communications interventions are believed to be most effective at reducing youth tobacco use.
    
5. Utah: Here is what Utah has done:
    
   1. Utah's tobacco cessation program for youth under 18 is called Ending Nicotine Dependence (END). It is a peer group cessation program. It is generally taught by local health departments and/or school districts. Usually kids are court referred but they can also attend voluntarily. As of yet, no school district has made END a part of their school day; rather, it is taught before or after school. This does make it more difficult for some kids to attend, especially in rural areas of the state where some students live long distances from the school. Another challenge associated with END is making it sustainable without charging youth a fee to attend.
       
   2. We do have a youth prevention media campaign. As far as what we have done with the media campaign in schools, we have arranged for our anti-tobacco ads to be shown during Channel 1 each morning in schools where Channel 1 is shown. We have provided our ads to teachers to be shown during health class or when they are teaching about tobacco. We also provide schools with posters, banners, and quit cards created by our youth media campaign.
       
      • Successes: If you can get ads played during Channel 1 you have a captive audience and can reach the whole school at one time.
         
      • Challenges: Getting into schools is always difficult, and once you're in, getting teachers to use your resource can be difficult.
         
      • Lessons Learned: Use local health departments who have good relationships with schools to help you get an “in.” Funding the schools directly to do tobacco prevention is also a great way to get your foot in the door. Utilizing the school districts’ Safe and Drug Free Schools Coordinators is a good way to get materials out to schools and into the hands of teachers or someone who might use them.
         
   3. We haven't done anything specifically with academically at-risk middle school youth but we do have contractors who have youth groups that target this population and have found them to be great advocates.
       
6. Vermont: Vermont has been implementing all three of these areas for many years.
    
   1. A school based tobacco cessation program for youth under 18: We have granted the American Lung Association to offer training for facilitators in the Not On Tobacco program. NOT is the only evidence based teen cessation program that is designed for our demographic (mostly Caucasian) and it is approved by SAMHSA and has received numerous awards. Although mostly public high school based personnel train as facilitators, private and alternative school staff, teen center staff, and rehab facility staff also train and offer the course. We fully support the program and this year, we have active groups in a number of locations. Please see the attached 2009-2010 N-O-T Program Summary  or the program’s website, www.notontobacco.com.
       
   2. A youth prevention campaign similar to TRUTH in schools: Our Voices Xposed (OVX) has been offered in Vermont for 10 years. It is a high school based youth empowerment program that has morphed over the years from education about tobacco industry exploitation education to include policy action and advocacy - the latter within the confines of lobbying restrictions with public funds. (As of January 2011, we have policy action in the following areas: 7 second hand smoke, 2 school policy expansions, and 5 community tobacco advertising policy action plans being worked on by the OVX youth coalitions). This year we funded 14 OVX youth coalitions who received up to $3000 each. Each OVX coalition must have a committed adult and youth advisor role who agree to form a youth coalition and carry out the requirements in the attached OVX Agreement. Please check out our website.
       
      Also, our annual youth common theme campaign is directed this year to teens. The Gut Feelings FY11 Campaign Brief  is attached, and you can watch our TV spots and learn more about the characters on ovx.org. This year we have straddled the prevention / cessation areas with a message to teens who may have already tried smoking but don't necessarily want to become 'a smoker'.
       
      Last year's 'tweens' campaign was Misperceptions - middle school youth used to think that most high school kids smoked. The 8 out of 10 campaign changed perceptions (and therefore social norms) that most teens don't smoke. In 2000 46% thought that most teens smoke. In 2008 only 16% thought that most teens smoke.
       
   3. A targeted intervention with academically at-risk middle school youth? Not directly but indirectly. We have tried to reach this demographic through our middle school tobacco prevention coalition, VKAT. The competitive grant application requires applicants to address how they will reach 'at risk youth' , a catch-all phrase that seems to cover kids whose parents smoke, which tends to be kids from homes of lower SES. Success, which tracked on year end reports, indicates that last year, 37% of VKAT members have parent(s) who smoke. We also know that with the very rural nature of Vermont, the location these schools/coalitions is an indicator of lower SES as well. This remains a challenge - especially for recruitment - because as the youth get into 7th and 8th grades, these youth are "too cool" to join VKAT.
       
7. West Virginia: West Virginia has a successful youth prevention campaign called Raze. See www.razewv.com.
    
   • Raze, the thriving youth-led tobacco prevention initiative, has expanded beyond school-based implementation and now includes over 150 “crews” in communities around the state.
      
   • According to the 2009 Youth Tobacco Survey (YTS), between 2000 and 2009 West Virginia experienced:
      
     • A 90% increase in the percentage of high school students who have never used any form of tobacco (39.2% in 2009; was 20.6% in 2000).
     • An 86% increase in the percentage of high school students who have never tried cigarettes (47.8% in 2009; was 25.7% in 2000).
     • A 42% decrease in the percentage of high school students who currently smoke cigarettes (22.3% in 2009; was 38.5% in 2000).
     • A 38% increase in the percentage of middle school students who have never tried cigarettes (73.1% in 2009).
        
   • Fifty percent more participants completed the Not-On-Tobacco (N-O-T) teen cessation program than in the 2008-2009 year, and there was a 37% increase in the number of N-O-T clinics completed.
      
   West Virginia Division of Tobacco Prevention’s Youth Program Manager is David Deutsch, M.S.
    
8. Wisconsin: Wisconsin has instituted two programs that may be of interest--NOT (Not on Tobacco), which focuses on helping teen smokers quit; and FACT (Fighting Against Corporate Tobacco), which educates youth on the tobacco industry's manipulative practices through school and community outreach. More information is available on the program websites.

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Partner Response

1. Tobacco Technical Assistance Consortium (TTAC): The interventions that the requestor is asking about regarding youth prevention/cessation are cost and labor intensive. Before designing and implementing targeted interventions, it is highly recommended that all schools adopt and promote tobacco-free school policies. This type of policy intervention promotes the health and safety of students, staff and visitors on district property and during school-sponsored activities and creates a social norm that demonstrates the unacceptability of tobacco use. Also, this type of policy intervention is well suited for youth engagement and involvement. Young people who are given opportunities to contribute to positive public health outcomes of this sort also benefit their communities through continued social and civic engagement.
    
   For more information about engaging youth in such campaigns, a good resource is the CDC User Guide on Youth Engagement.

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