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School-Based Tobacco Prevention and Cessation Programs

The goal of school-based tobacco prevention and cessation programs is to keep young people tobacco free so that they remain tobacco free for the rest of their lives. In 2000, the Surgeon General's Report stated that school-based interventions can reduce or postpone the onset of smoking among youth by 20 to 40%. In addition, the 2012 Surgeon General's Report reviewed the literature on school-based programs and determined that many can be effective in preventing and decreasing tobacco use in the short-term, and that certain programs demonstrated long-term prevention effects as well. The report emphasized that effective programs are integrated into community-wide prevention efforts.

School-based prevention programs: School-based prevention programs are often in the form of age-specific classroom curricula, but are also implemented as special school programs, media literacy training, and peer education programs. These programs can inform participants about the dangers of secondhand smoke, build participants' capacity to identify and resist the influence of peers and tobacco marketers, and teach refusal skills.

School-based cessation programs: School-based cessation programs focus on supporting students in their efforts to quit using tobacco products. These programs can teach students refusal skills and avoidance techniques, provide social support from peers and counselors, and link participants to resources in the community.

Examples of School-Based Tobacco Prevention and Cessation Programs

Several federal agencies have compiled information about evidence-based tobacco prevention and cessation programs in rural schools. Rural program planners should review the evaluation criteria and program content to determine if these programs can address the needs of their students.

The National Institute of Justice's database lists several school-based programs in rural settings that have evidence of preventing or decreasing tobacco use:

  • Effective programs:
    • LifeSkills┬« Training is a classroom-based drug prevention program that focuses on building self-management, social, and refusal skills to upper elementary and middle school-aged children.
    • Linking the Interests of Families and Teachers (LIFT) is a preventive intervention that seeks to prevent antisocial and aggressive behaviors and promote positive development among elementary school children.
    • The Midwestern Prevention Project (MPP) involves implementing community-wide strategies that reinforce anti-drug messaging among middle schoolers.
  • Promising programs:

The National Cancer Institute's Evidence-Based Cancer Control Programs database lists two school-based programs that have promising outcomes for decreasing tobacco use:

Considerations for Implementation

In 1994, the Centers for Disease Control and Prevention (CDC) released Guidelines for School Health Programs to Prevent Tobacco Use and Addiction. These guidelines suggested that schools implement seven recommendations to effectively prevent tobacco use among youth:

  1. Create school policies around tobacco use. There are several resources dedicated to promoting tobacco-free school policies, including North Carolina's Assessment Tool for Becoming a 100% Tobacco Free School District and Maine's guide to Implementing School Policies. For more information about tobacco free-policies, see Module 2.
  2. Educate students on the negative physiological and social effects of tobacco use. Rural school administrators should carefully review the content of their tobacco prevention and/or cessation programs to ensure that they meet the needs of their student population.
  3. Integrate tobacco prevention education for all students, with a focus on junior high and middle school grades. Program planners should tailor the content of their school-based prevention or cessation program to ensure it is appropriate for the target age group.
  4. Offer special training to educators and other program facilitators. Many school-based tobacco prevention and cessation programs provide self-led training materials to teachers and other facilitators. School administrators in rural communities may also seek to implement programs that enable teachers to receive training online or via video conferencing.
  5. Engage parents in tobacco prevention efforts. Some rural communities may choose to involve advisory councils or groups in their tobacco prevention and cessation efforts. Advisory councils can include school district personnel, students' family members, and other stakeholders. School administrators may need to seek permission from parents and guardians before providing a tobacco prevention or cessation intervention to students.

    Rural communities may also choose to involve students in the advisory group to ensure that programs will be well accepted and meet their needs. One school system in a county with a largely rural population that served high school students expanded an existing tobacco use prevention program to include information about cessation. The school system established a workgroup that included student representatives who solicited feedback from their peers about important components for a cessation curriculum.
  6. Offer tobacco cessation support to students and staff. School administrators may consider building partnerships with local providers in order to strengthen the efficacy of school-based cessation programs. Students may need referrals to a provider in order to receive tobacco cessation medication or more intensive tobacco cessation counseling.
  7. Consistently evaluate tobacco prevention programs. See Module 5 for evaluation considerations for a rural tobacco prevention and cessation program.

School based health centers (SBHC) provide another setting to reach students and promote tobacco prevention and cessation. The Rural Health and Schools Topic Guide outlines how SBHCs can be utilized to make positive health behavior changes in students. Further information on how to integrate health services within rural SBHCs can also be found in the Rural Services Integration Toolkit.

State and local health departments can be valuable resources to rural school districts seeking to implement a tobacco prevention program. For example, the Utah Department of Health Tobacco Prevention and Control Program has prepared School Resource Guide: Utah Comprehensive Tobacco-Free School Policy Toolkit to help school districts implement the CDC's recommendations listed above. The South Dakota Department of Health developed a K-12 Tobacco Prevention Toolkit that discusses best practices for tobacco use prevention in school and provides several implementation examples from rural schools. The Colorado Department of Public Health and Environment offers Second Chance, a free online program for youth who have violated their school's tobacco policy that serves as an alternative to suspension.

Program Clearinghouse Examples

Resources to Learn More

Wisconsin School Tobacco Prevention Resources
This collection of resources is hosted by the Wisconsin Department of Public Instruction. It contains resources for school districts and others working with youth in tobacco prevention. Resources include training for adults, education for youth, policy resources on other tobacco products (OTP), tobacco assessment tools, and school resources.
Organization(s): Wisconsin Department of Public Instruction