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TECP: A Tobacco TECP: A Tobacco Control Approach In A Control Approach In A

All-girl Youth All-girl Youth Correctional FacilityCorrectional Facility

Youth Rehabilitation & Youth Rehabilitation &

Treatment Center-Geneva, NETreatment Center-Geneva, NE

Donald P. Belau, Ph.D.Donald P. Belau, Ph.D.

402-759-3164 ext, 265402-759-3164 ext, 265

don.belau@ hhss.govdon.belau@ hhss.gov

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Facility DescriptionFacility Description The YRTC-Geneva of Geneva, Nebraska The YRTC-Geneva of Geneva, Nebraska

is an all-female adolescent correctional is an all-female adolescent correctional facility located in a rural setting.facility located in a rural setting.

The average daily count at the facility The average daily count at the facility is 90 youth.is 90 youth.

The YRTC-Geneva was the first juvenile The YRTC-Geneva was the first juvenile female correctional facility accredited female correctional facility accredited by the American Correctional by the American Correctional Association and has received Association and has received continuing full accreditation for the continuing full accreditation for the past 20 years. past 20 years.

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Facility DescriptionFacility Description

In keeping with this standard of In keeping with this standard of excellence, a level of staff excellence, a level of staff commitment and resources was commitment and resources was dedicated to the development of a dedicated to the development of a tobacco education and cessation tobacco education and cessation program for the youth.program for the youth.

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Assessment PracticesAssessment Practices The first stage in the development of the The first stage in the development of the

tobacco education and cessation tobacco education and cessation programming called for the programming called for the standardization of an assessment standardization of an assessment practice.practice.

This written survey is administered This written survey is administered within a youth’s first few days of within a youth’s first few days of admission to the YRTC-Geneva. admission to the YRTC-Geneva.

Questions are asked in the following Questions are asked in the following areas: personal smoking experience, areas: personal smoking experience, smoking environment, smoking pattern, smoking environment, smoking pattern, motivation to quit smoking, and who are motivation to quit smoking, and who are the supportive individuals willing to help the supportive individuals willing to help her quit. her quit.

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Assessment PracticesAssessment Practices With this level of assessment, a picture With this level of assessment, a picture

as to the age of onset, frequency of use, as to the age of onset, frequency of use, supportive environment, and motivation supportive environment, and motivation to quit using tobacco emerges. to quit using tobacco emerges.

Identifying patterns of use then allowed Identifying patterns of use then allowed for the development of individualized for the development of individualized tobacco treatment programming as well tobacco treatment programming as well as generalized programming addressing as generalized programming addressing the total population of the YRTC-the total population of the YRTC-Geneva. Geneva.

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Tobacco Use SurveyTobacco Use Survey

2002 2003 2004

Median 12 12 12

Mode 12 12 13

10 & under 26% 21% 22%

11 & 12 36% 31% 29%

13 & 14 28% 32% 40%

15 & older 10% 16% 9%

Nonsmokers 4% 7% 18%

Admissions 123 109 89

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Tobacco Use SurveyTobacco Use Survey

2002 2003 2004

½ pack or less 42% 63% 41%

½ pack to 1 pack

22% 7% 22%

1 to 2 packs 13% 30% 13%

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Tobacco Use SurveyTobacco Use Survey 2002 2003 2004

15 min. after waking up

67% 70% 49%

Breakfast 35% 25% 17%

Lunch 72% 60% 51%

Dinner 63% 48% 39%

Work breaks 62% 43% 39%

In bed 49% 34% 29%

While driving 76% 52% 55%

Relaxing 70% 61% 52%

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Tobacco Use SurveyTobacco Use Survey

2002 2003 2004

Using other substances

74% 44% 52%

Smoking with peers

92% 81% 74%

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Tobacco Use SurveyTobacco Use Survey

2002 2003 2004

Thought a lot about quitting

57% 37% 21%

Thought a little about quitting

34% 27% 23%

Have not thought about quitting

20% 17% 17%

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YRTC-Geneva Youth ProfileYRTC-Geneva Youth Profile

91 % ARE SMOKERS91 % ARE SMOKERS 39% SMOKE A PACK @ DAY39% SMOKE A PACK @ DAY 54% HAVE MOTHERS WHO SMOKE54% HAVE MOTHERS WHO SMOKE 63% SMOKE WHEN USING 63% SMOKE WHEN USING

SUBSTANCESSUBSTANCES 75% REPORT 1/2 OF THEIR PEERS 75% REPORT 1/2 OF THEIR PEERS

SMOKESMOKE

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YRTC-Geneva Youth ProfileYRTC-Geneva Youth Profile

97 % IDENTIFY SOMEONE THAT 97 % IDENTIFY SOMEONE THAT WOULD SUPPORT THEM QUITTING WOULD SUPPORT THEM QUITTING SMOKINGSMOKING

49% REPORT THEY ARE VERY 49% REPORT THEY ARE VERY MOTIVATED QUITMOTIVATED QUIT

NICOTINE DEPENDENCE NICOTINE DEPENDENCE INCREASINGINCREASING

(n of 323 girls)(n of 323 girls)

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YRTC-Geneva Youth ProfileYRTC-Geneva Youth Profile

Intuitively, it appears that the girls Intuitively, it appears that the girls are using for a variety of reasons are using for a variety of reasons including coping with anxiety, including coping with anxiety, depression, attempting to fit in depression, attempting to fit in with peers, efforts to lose weight, with peers, efforts to lose weight, parental use, myths surrounding parental use, myths surrounding child birth, etc.child birth, etc.

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MythsMyths

Smoking reduces childbirth painSmoking reduces childbirth pain Smoking attracts boys Smoking attracts boys Smoking is fashionable Smoking is fashionable Smoking is something everybody Smoking is something everybody

doesdoes Smoking controls my appetite and Smoking controls my appetite and

my weightmy weight My mother smoked, so does my My mother smoked, so does my

grandmother, so what is the big deal?grandmother, so what is the big deal?

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Educational ProgrammingEducational Programming Education is identified as a critical method Education is identified as a critical method

of approaching the individual, as well as of approaching the individual, as well as the total population at the YRTC-Geneva. the total population at the YRTC-Geneva.

It is reasoned that It is reasoned that providingproviding education to education to the youth regarding the dangers of tobacco the youth regarding the dangers of tobacco use becomes a preventive approach. use becomes a preventive approach.

Education programming is provided within Education programming is provided within the two-week orientation program that the two-week orientation program that each girl participates in upon arrival at the each girl participates in upon arrival at the YRTC-Geneva. YRTC-Geneva.

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Education ProgrammingEducation Programming This basic education program is This basic education program is designeddesigned to to

present the dangers of tobacco use. present the dangers of tobacco use. Factual information is taught along with a Factual information is taught along with a

holistic view of personal health that holistic view of personal health that emphasizes the minimization of risk emphasizes the minimization of risk behaviors. behaviors.

All incoming youth receive five, 1-hour All incoming youth receive five, 1-hour classes on tobacco use as part of 14 hours of classes on tobacco use as part of 14 hours of drug/alcohol education. Each class drug/alcohol education. Each class incorporates a video, discussion, and the use incorporates a video, discussion, and the use of visual aids. Each session is structured with of visual aids. Each session is structured with a cumulative, instructional approach that a cumulative, instructional approach that addresses a wide range of health issues addresses a wide range of health issues relating to tobacco use. relating to tobacco use.

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Education ProgrammingEducation Programming In addition to the classes that deal with In addition to the classes that deal with

tobaccotobacco use only, as noted, there are other use only, as noted, there are other classes taught during the youths’ classes taught during the youths’ orientation program that treat tobacco use orientation program that treat tobacco use as being as harmful as other drugs.as being as harmful as other drugs.

For example, the toxicity of marijuana and For example, the toxicity of marijuana and tobacco use is examined in relationship to tobacco use is examined in relationship to oral cancers and lung disease. In another oral cancers and lung disease. In another class, the long-term effects of drug use class, the long-term effects of drug use including tobacco use by a pregnant woman including tobacco use by a pregnant woman on her unborn child are addressed candidly.on her unborn child are addressed candidly.

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Educational ProgrammingEducational Programming

Other educational activities Other educational activities embrace the total population as a embrace the total population as a whole through activities such as whole through activities such as Tobacco Education classes, Media Tobacco Education classes, Media Literacy classes, Tobacco Literacy classes, Tobacco Awareness Week, and a Tobacco Awareness Week, and a Tobacco House of Horrors supported by the House of Horrors supported by the No Limits foundation.No Limits foundation.

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Education ProgrammingEducation Programming In addition, individualized instruction is In addition, individualized instruction is

offeredoffered to girls who are pregnant. It has to girls who are pregnant. It has been learned from assessments that a been learned from assessments that a variety of myths exist within this population variety of myths exist within this population that promote smoking. that promote smoking.

For example, the girls have learned (probably For example, the girls have learned (probably from public school or peers) that smoking from public school or peers) that smoking reduces birth weight, therefore they reason, reduces birth weight, therefore they reason, childbirth will be less painful, if they smoke! childbirth will be less painful, if they smoke!

Myths such as this are attacked, along with Myths such as this are attacked, along with providing information relating to second providing information relating to second hand smoke effects upon infants.hand smoke effects upon infants.

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Educational InterventionsEducational Interventions

EDUCATION PRESENTED DURING EDUCATION PRESENTED DURING ORIENTATION CLASSESORIENTATION CLASSES

TOBACCO EDUCATION CLASSES TOBACCO EDUCATION CLASSES WITHIN SUMMER SCHOOL WITHIN SUMMER SCHOOL PROGRAMMINGPROGRAMMING

INDIVIDUAL INSTRUCTION FOR INDIVIDUAL INSTRUCTION FOR MOTHERS & EXPECTANT MOTHERSMOTHERS & EXPECTANT MOTHERS

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Cessation InterventionsCessation Interventions Cessation efforts are focused upon youth Cessation efforts are focused upon youth

that are identified as being nicotine that are identified as being nicotine dependentdependent. .

Those youth are identified through Those youth are identified through substance abuse assessments conducted substance abuse assessments conducted by certified alcohol and drug addiction by certified alcohol and drug addiction counselor(s) (CADAC) or by licensed mental counselor(s) (CADAC) or by licensed mental health practitioner(s) (LMHP).health practitioner(s) (LMHP).

Cessation programming is also offered to Cessation programming is also offered to youth that have had a history of abusing youth that have had a history of abusing tobacco as well. tobacco as well.

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Cessation ProgrammingCessation Programming A relapse prevention planA relapse prevention plan This plan acknowledges that a youth’s This plan acknowledges that a youth’s

tobacco use is a major health risk, and that tobacco use is a major health risk, and that identifying triggers for relapsing to tobacco identifying triggers for relapsing to tobacco and other drug use is critical if the girl is to and other drug use is critical if the girl is to stay substance/tobacco free.stay substance/tobacco free.

Wellness activities are identified as Wellness activities are identified as replacement behaviors that the youth is able replacement behaviors that the youth is able to use as a means to cope with emotions to use as a means to cope with emotions and changing environments rather than and changing environments rather than resorting to tobacco use to cope with these resorting to tobacco use to cope with these situations. situations.

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Cessation StrategiesCessation Strategies Referral to QuitlinesReferral to Quitlines Integrated substance abuse relapse Integrated substance abuse relapse

prevention plansprevention plans Consultation with Aftercare planning Consultation with Aftercare planning

staff and consultation with familiesstaff and consultation with families Follow up phone callsFollow up phone calls Involvement with IMPROV activities Involvement with IMPROV activities

in the home school districtin the home school district Encouragement of Social ActivismEncouragement of Social Activism

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ConclusionsConclusions

The data accumulated thus far The data accumulated thus far clearly indicates that within this clearly indicates that within this juvenile justice population of girls, juvenile justice population of girls, tobacco use (smoking) is a tobacco use (smoking) is a significant behavior, with nicotine significant behavior, with nicotine abuse and nicotine dependence abuse and nicotine dependence becoming identified routinely becoming identified routinely through multiple assessments.through multiple assessments.

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ConclusionsConclusions

It is suggested that female It is suggested that female residential correctional programs residential correctional programs routinely assess youth for nicotine routinely assess youth for nicotine abuse/dependency issues, and abuse/dependency issues, and then develop a level of then develop a level of programming that addresses the programming that addresses the respective levels of use. respective levels of use.

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YRTC-Geneva Tobacco YRTC-Geneva Tobacco Education & Cessation Future Education & Cessation Future

DirectionsDirections

Conduct family orientation classes that Conduct family orientation classes that inform the families as to the dangers inform the families as to the dangers of secondhand smokeof secondhand smoke

Continue to refine data collection Continue to refine data collection processes that will allow for processes that will allow for understanding of the patterns of understanding of the patterns of tobacco use tobacco use

Development of Quitlines that are Development of Quitlines that are focused upon female juvenile justice focused upon female juvenile justice issuesissues

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Youth Rehabilitation & Youth Rehabilitation & Treatment Center-Treatment Center-Geneva Geneva, Geneva Geneva, Nebraska 68361Nebraska 68361

Donald P. Belau, Ph.D.Donald P. Belau, Ph.D.402-759-3164 ext, 265402-759-3164 ext, 265don.belau@ hhss.govdon.belau@ hhss.gov