School Policies and Programs on Smoking and Health -- United States, 1988

In 1988, the National School Boards Association (NSBA), in collaboration with the American Cancer Society, the American Heart Association, and the American Lung Association, conducted a random sample mail survey of 2000 of the more than 15,000 public school districts in the United States to gather information on school smoking policies and programs (1); 1310 (66%) of the districts responded. A similar study was done in 1986 (2). Topics covered in the survey were districts' policies on tobacco smoking, development of school smoking policies, antismoking education programs in schools, assistance given to districts by voluntary health organizations, and demographics of each school district. Two hundred of the 690 nonrespondents were contacted and questioned by telephone; they were similar to respondents demographically and in their responses. Not all respondents answered all questions.

In 1988, 1239 (95%) of all responding school districts had a written policy or regulation on tobacco smoking in schools; in 1986, 622 (87%) of 714 school districts had a written policy or regulation. All the written policies addressed smoking by students, 1189 (96%) addressed smoking by faculty/staff/administration, and 1140 (92%) addressed smoking by other adults (e.g., parents, school visitors). Of the 71 (5%) responding districts with no written policy, 31 (44%) are considering developing such policies. Of the 1310 districts responding, 226 (17%) totally banned smoking (no smoking allowed by anyone on school premises or at school functions). From 1986 to 1988, the proportion of districts prohibiting adults from smoking in school buildings, on school grounds, and at school-related functions more than doubled. For example, the proportion prohibiting smoking by faculty/staff/administrators in school buildings increased from 11% in 1986 to 289 (24%) of 1188 in 1988.

Of the 1169 districts with written policies, 802 (69%) had enacted these policies within the last 6 years. Health hazards of tobacco use continued to be the reason most respondents (914/1188 (77%)) cited for instituting a nonsmoking policy, followed by belief in adult role models (574/1188 (48%)) and state or local antismoking legislation (525/1188 (44%)). Smoking policies were initiated by school boards (307/1203 (26%)), district administrations (226/1203 (19%)), teachers (156/1203 (13%)), building administration staff (143/1203 (12%)), parents (69/1203 (6%)), community (69/1203 (6%)), students (63/1203 (5%)), and other (48/1203 (4%)).

Most districts (1078/1239 (87%)) reported excellent or good compliance among faculty, and 1062 (86%) of 1239 reported similar compliance among students. Re- ported compliance was much higher in districts with total smoking bans than in districts with some restrictions.

In 1988, 942 (75%) of 1254 school districts had antismoking educational programs at the elementary school level, 1016 (81%) at the middle school level, and 982 (78%) at the high school level; in 1986, the corresponding proportions were 61% for ele- mentary schools, 64% for middle schools, and 62% for high schools. Voluntary health organizations were involved in providing antismoking education in 74% of the school districts. Reported by: P Smith, Dept of Communications, National School Boards Association, Alexandria, Virginia. Epidemiology Br, Office on Smoking and Health and Div of Adolescent and School Health, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Tobacco use by students remains a major public health problem. Approximately 3000 persons--most less than 21 years of age--begin to smoke each day in the United States (3,4). The findings that 95% of school districts now have a written policy regarding smoking and that this proportion has been increasing are encouraging. Smoking bans in schools accomplish several goals: 1) they discourage students from starting to smoke; 2) they reinforce knowledge of the health hazards of cigarette smoking and exposure to environmental tobacco smoke; and 3) they promote a smoke-free environment as the norm. It is particularly important that smoking policies are now directed at adults as well as students. School policies that restrict smoking have always applied to the students, but from 1986 to 1988, the proportion of districts having smoking restrictions for faculty/staff/administrators and other adults attending school functions increased substantially.

The 1990 health objectives for the nation include as a target that all 50 states enact laws that prohibit smoking in enclosed public places (5). Based on the present survey, a completely smoke-free environment for schools has been achieved in 17% of school districts. In accordance with its goal of eliminating smoking in the public schools, NSBA has published No Smoking: A Board Member's Guide to Nonsmoking Policies for the Schools (2), which includes the entire 1986 survey report, outlines implementation steps and guidelines concerning nonsmoking policies, and describes several antismoking school programs across the country.

The increase in antismoking instruction in schools is also encouraging. Studies show that such instruction, as part of a comprehensive school health education curriculum, is effective in preventing initiation of smoking among children and adolescents (6). A National Cancer Institute advisory panel on smoking and school health has developed recommendations for the essential elements of a school-based smoking prevention program (7). These elements include: emphasizing the social and short-term physiologic consequences of tobacco use; training students in refusal skills; involving parents, trained teachers, and peers in smoking-prevention activities; and designing a curriculum that reflects the needs of the community. The public health community has also identified the need to develop cessation programs for children and adolescents addicted to nicotine (4).

References

1. National School Boards Association. Smoke-free schools: a progress report. Alexandria, Virginia: National School Boards Association, 1989. 2.National School Boards Association. No smoking: a board member's guide to nonsmoking policies for the schools. Alexandria, Virginia: National School Boards Association, 1987. 3.Pierce JP, Fiore MC, Novotny TE, Hatziandreu EJ, Davis RM. Trends in cigarette smoking in the United States: projections to the year 2000. JAMA 1989;261:61-5. 4.CDC. Reducing the health consequences of smoking: 25 years of progress--a report of the Surgeon General, 1989. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC)89-8411. 5.Public Health Service. Promoting health/preventing disease: objectives for the nation. Washington, DC: US Department of Health and Human Services, Public Health Service, 1980. 6.Christenson GM, Gold RS, Katz M, Kreuter MW. Results of the School Health Education Evaluation: preface. J School Health 1985;55:295-6. 7.Glynn TJ. Essential elements of school-based smoking prevention programs. J School Health 1989;59 (in press).

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