Smoking Prevention Guidelines

Summary

Tobacco use is the leading cause of preventable death in the United States and U.K. The majority of daily smokers (90%) began smoking before they were 18 years old, and more than 350 young people begin smoking each day. School programmes designed to prevent tobacco use could become one of the most effective strategies available to reduce tobacco use in the U.S.A. & U.K. The following guidelines summarise school-based strategies most likely to be effective in preventing tobacco use among young people. The CDC originally developed these ideas in America with experts from 29 national, federal, and voluntary agencies and with other leading authorities in the field of tobacco-use prevention. These guidelines are based on an in-depth review of research, theory, and current practice in the area of school-based tobacco-use prevention. The guidelines recommend that all schools:

a) Develop and enforce a school policy on tobacco use

b) provide instruction about the short- and long-term negative physiological and social consequences of tobacco use, social influences on tobacco use, peer norms regarding tobacco use, and refusal skills,

c) provide tobacco-use prevention education in reception through to year 11

d) provide programme-specific training for teachers

e) involve parents or families in support of school-based programmes to prevent tobacco use

f) support cessation efforts among students and all school staff who use tobacco, and

g) assess the tobacco-use prevention programme at regular intervals.

Introduction

Illnesses caused by tobacco use increase demands on the U.K. health-care system; lost productivity amounts to billions of pounds annually. Because 90% of smokers begin before they reach adulthood, tobacco-prevention activities should focus on school-age children and adolescents. Evidence suggests that school health programmes can be an effective means of preventing tobacco use among young people. The guidelines in this report have been developed to help school personnel plan, implement, and assess educational programmes and school policies to prevent tobacco use and the unnecessary addiction, disease, and death tobacco use causes. Although these guidelines address school programmes for K.S. 1 through K.S. 4, persons working with young people in other settings also may find the guidelines useful. The guidelines are based on a synthesis of results of research, theory, and current practice in tobacco-use prevention. To develop these guidelines, CDC staff in America convened meetings of experts from the fields of tobacco-use prevention and education, reviewed published research, and considered the conclusions of the National Cancer Institute Expert Advisory Panel on School-Based Smoking Prevention Programme and the findings of the 1994 Surgeon General's Report, Preventing Tobacco Use Among Young People.

Background

School-based programmes to prevent tobacco use can make a substantial contribution to the health of the next generation. In this report, the term "tobacco use" refers to the use of any nicotine-containing tobacco product, such as cigarettes, cigars, and smokeless tobacco. These products often contain additional substances (e.g., benzo(a)pyrene, vinyl chloride, polonium 210) that cause cancer in animals and humans. Recent estimates suggest that cigarette smoking annually causes more than 120,000 premature deaths and 4 million years of potential life lost in the UK alone. The estimated direct and indirect costs associated with smoking in the United States in 1990 totaled $68 billion. In 1964, the Surgeon General's first report on smoking and health documented that cigarette smoking causes chronic bronchitis and lung and laryngeal cancer in men. Subsequent reports from the Surgeon General's office have documented that smoking causes coronary heart disease, atherosclerotic peripheral vascular disease, cerebrovascular disease, chronic obstructive pulmonary disease (including emphysema), intrauterine growth retardation, lung and laryngeal cancers in women, oral cancer, esophageal cancer, and cancer of the urinary bladder. Cigarette smoking also contributes to cancers of the pancreas, kidney, and cervix. Further, low birth weight and approximately 10% of infant mortality have been attributed to tobacco use by pregnant mothers. The 1994 Surgeon General's report on smoking and health describes numerous adverse health conditions caused by tobacco use among adolescents, including reductions in the rate of lung growth and in the level of maximum lung function, increases in the number and severity of respiratory illnesses, and unfavourable effects on blood lipid levels (which may accelerate development of cardiovascular diseases). Breathing environmental tobacco smoke -- including side stream and exhaled smoke from cigarettes, cigars, and pipes -- also causes serious health problems. For example, exposure to environmental tobacco smoke increases the risk for lung cancer and respiratory infections among non-smokers and may inhibit the development of optimal lung function among children of smokers. Exposure to environmental tobacco smoke also may increase the risk for heart disease among non-smokers. The Environmental Protection Agency recently classified environmental tobacco smoke as a Group A carcinogen, a category that includes asbestos, benzene, and arsenic.

Tobacco use is addictive and is responsible for more than one of every five deaths in the U.K. However, many children and adolescents do not understand the nature of tobacco addiction and are unaware of, or underestimate, the important health consequences of tobacco use. On average, 350 people, most of them children and teenagers, begin smoking each day in the UK.

Approximately 90% of adult’s age’s 30- 39 years who ever smoked daily tried their first cigarette before 18 years of age.

THE NEED FOR SCHOOL HEALTH PROGRAMMES TO PREVENT TOBACCO USE AND ADDICTION

The challenge to provide effective tobacco-use prevention programmes to all young persons is an ethical imperative. Schools are ideal settings in which to provide such programmes to all children and adolescents. School-based tobacco prevention education programmes that focus on skills training approaches have proven effective in reducing the onset of smoking, according to numerous independent studies. A summary of findings from these studies demonstrates positive outcomes across programmes that vary in format, scope, and delivery method.

To be most effective, school-based programmes must target young people before they initiate tobacco use or drop out of school. In 1996, 37% of surveyed high school pupils reported smoking their first cigarette before the end of year 8, and 13% of 11 to 15 year olds were regular smokers.

RECOMMENDATIONS FOR SCHOOL HEALTH PROGRAMMES TO PREVENT TOBACCO USE AND ADDICTION

The seven recommendations below summarise strategies that are effective in preventing tobacco use among young people. To ensure the greatest impact, schools should implement all seven recommendations.

Recommendations

1. Develop and enforce a school policy on tobacco use.

2.Provide instruction about the short- and long-term negative physiological and social consequences of tobacco use, social influences on tobacco use, peer norms regarding tobacco use, and refusal skills.

3. Provide tobacco-use prevention education in infant through year 11; this instruction should be especially intensive in primary or middle school and should be reinforced in high school.

4. Provide programme-specific training for teachers.

5. Involve parents or families in support of school-based programmes to prevent tobacco use.

6. Support cessation efforts among students and all school staff who use tobacco.

7. Assess the tobacco-use prevention programme at regular intervals.

Discussion of Recommendations

Recommendation 1: Develop and enforce a school policy on tobacco use. A school policy on tobacco use must be consistent with LEA regulations and should include the following elements:

An explanation of the rationale for preventing tobacco use (i.e., tobacco is the leading cause of death, disease, and disability)

· Prohibitions against tobacco use by students, all school staff, parents, and visitors on school property, in school vehicles, and at school-sponsored functions away from school property

· Prohibitions against tobacco advertising in school buildings, at school functions, and in school publications

· A requirement that all students receive instruction on avoiding tobacco use

· Provisions for students and all school staff to have access to programmes to help them quit using tobacco

· Procedures for communicating the policy to students, all school staff, parents or families, visitors, and the community

· Provisions for enforcing the policy

To ensure broad support for school policies on tobacco use, representatives of relevant groups, such as students, parents, school staff and their unions, and school board members, should participate in developing and implementing the policy. Examples of policies have been published, and additional samples can be obtained from state and local boards of education. Clearly articulated school policies, applied fairly and consistently, can help students decide not to use tobacco. Policies that prohibit tobacco use on school property, require prevention education, and provide access to cessation programmes rather than solely instituting punitive measures are most effective in reducing tobacco use among students.

A tobacco-free school environment can provide health, social, and economic benefits for students, staff, the school, and the district. These benefits include decreased fires and discipline problems related to student smoking, improved compliance with local and city smoking ordinances, and easier upkeep and maintenance of school facilities and grounds.

Tobacco - The Facts

Tobacco was introduced to Europe from the New World at the end of the fifteenth century. Smoking spread rapidly and was long regarded as having medicinal value. It was not until the 20th century, however, that smoking became a mass habit and not until after the Second World War that the dangers of smoking were firmly established.

Cancer Facts

Tobacco use, particularly cigarette smoking, is the single most preventable cause of death in the United Kingdom. Cigarette smoking alone is directly responsible for at least one-third of all cancer deaths annually in the United Kingdom, and contributes to the development of low birth weight babies and cardiovascular disease.

Time Heals

I do feel better, not a lot but enough that I'm glad that I quit. A lot of my "mysterious" ailments are gone, ones that I used to experience on a daily basis. I know for a fact that my stomach pains are gone due to the decrease of stomach acid since I quit. People with any form of stomach irritation should not smoke.

Recommendation 2: Provide instruction about the short- and long-term negative physiological and social consequences of tobacco use, social influences on tobacco use, peer norms regarding tobacco use, and refusal skills.

Some tobacco-use prevention programmes have been limited to providing only factual information about the harmful effects of tobacco use. Other programmes have attempted to induce fear in young persons about the consequences of use. However, these strategies alone do not prevent tobacco use, may stimulate curiosity about tobacco use, and may prompt some students to believe that the health hazards of tobacco use are exaggerated.

School-based programmes should systematically address these psychosocial factors at developmentally appropriate ages. Particular instructional concepts should be provided for students in early primary school, later junior school, middle school, and high school.

Conclusion

In 1964, the first Surgeon General's report on smoking and health warned that tobacco use causes serious health problems. Thirty years later, in 1994, the Surgeon General reports that tobacco use still presents a key threat to the well being of children. School health programmes to prevent tobacco use could become one of the most effective national strategies to reduce the burden of physical, emotional, and monetary expense incurred by tobacco use.

To achieve maximum effectiveness, school health programmes to prevent tobacco use must be carefully planned and systematically implemented. Research and experience acquired since the first Surgeon General's report on smoking and health have helped in understanding how to produce school policies on tobacco use and how to plan school-based programmes to prevent tobacco use so that they are most effective. Carefully planned school programmes can be effective in reducing tobacco use among students if school and community leaders make the commitment to implement and sustain such programmes.