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Policy! Policy! Policy!!Workplace and SchoolJane PritzlCDC - Division of Adolescent and School Health
Iowa 04
Centers for Disease Control and PreventionDivision of Adolescent and School Health
POLICY
1. A method or course of action adopted by a government, business organization, etc. designed to influence and determine decisions
2. A guiding principal or procedure
Individual Environmental
Elements of a Policy Initiative
1. Belief or Mandate - What’s driving us? Protection from second-hand smoke
2. A team
3. Data - What’s our situation?
4. Strategy - What’s our plan?
Educate and Advocate – a
communication plan
Assist, Reduce Barriers,
Monitor and Provide Feedback
Advocate
What Workplaces??
Start with a clear goal and a clear target
Think broadly about worksites
1. Consider numbers, proportion - During the normal workday you can find 20% of the population in schools – where else are you’re people
government buildings
hospitals
airports
2. Consider vulnerable populations – children, elderly
rec centers
shopping centers
restaurants
prisons
Workplace Policies
Tobacco-free buildings
Smoke-free buildings, that disallow smoking near
entrances, windows, and air intake units,
Separate, contained indoor smoking areas that are
under negative pressure relative to non-smoking areas
Smoking restricted campuses
The Team
Make it a group effort
You can bring in a crowd faster with a choir than with a solo
1. Committee – standing or ad hoc
2. Identify partners close to the action,
shared mission
3. Collect testimony
The Data
CPS Data (Current Population Survey)
69.9% - no smoking in common areas and work areas
National average 69%
State Dept of Labor – Labor Market Info
can sort by name, industry, size
Chamber
State or Regional Organizational Training Organizations
Specifc Industry Associations - BOMA
A. Educate and Advocate
Compelling argument? Sales pitch? Your message?
Broad brush – your media campaign – second hand smoke
Targeting can be a challenge – different channels, different plans
Organizations don’t innovate or implement change, individuals do.
Who are the individuals?
Relationship, Relationship, Relationship
Who do you have to reach and where do you need to be
Rotary
Lions Clubs
Hospital Association Conferences
Human Resource Management Meeting
Restaurant Associations
Recreation Association Meetings
Small Business Association
Be Where The Tobacco Industry Is
Who’s the Audience?
What do they need to hear?
What do they need to hear?
From whom should the message come?
Who’s responsible for making this happen?
Results?
Rocky Mountain Emp
Association
City Rec
Center Board
Restaurant
Association
Rotary
B. Assist, Reduce Barriers, Make it Easy
Before you get out there –
cessation programs
signage - restaurants
testimony
model policies
workplace implementation guides
TA, handholding
keep you ear to the ground
C. Monitoring or Tracking: Be Thinking . . .
CPS
Local tracking –
Large employers
Restaurants – GASP
Public Places –
Employer’s Organization - survey
BOMA
Testimony -
“I don’t mind the policy coming in, it will help
me quit”
“ I think it’s cleaner around here.”
“I feel I’ve reduced my liability as an employer and overall most employees are much happier.”
Elements of a Policy Initiative
1. Belief or Mandate - What’s driving us? Protection from second-hand smoke
2. A team
3. Data - What’s our situation?
4. Strategy - What’s our plan?
Educate and Advocate – a
communication plan
Assist, Reduce Barriers,
Monitor and Provide Feedback
Advocate
At the Outset. …..…Our Mission Our Network
Start with a clear goal and a clear target/ channel
100% Tobacco-Free Schools
Make it a group effort
You can bring in a crowd faster with a choir than with a solo
1. Committee – standing or ad hoc
2. Identify partners close to the action, shared mission
3. Collect testimony
Pro-Children Act
No person shall permit smoking within any indoor facility utilized for services to kindergarten, elementary, or secondary education or library services to children. Also included is children’s services for routine health care or day care or early childhood development.
This applies to all schools and programs that are funded by the Federal Government or through State or local Governments by Federal grant, loan, loan guarantee or contract programs.
…penalty not to exceed $1000 ….each day
Comprehensive School Tobacco Policy
1. Rationale
2. Tobacco-Free Environment
3. Advertising and promotion
4. Tobacco prevention instruction
5. Tobacco use cessation
6. Communication plan
7. Enforcement plan
Collaboration With the Private Sector
Is there a fit between mission and priorities?
What is the effect of the potential partner’s products or services on health?
What is the behavior of the potential private partner?
How would a collaboration fit with our public image?
School Tobacco PolicyTobacco-Free Environment
Prohibits tobacco use
on school property,
in school vehicles,
at school- sponsored events (on and off school property)
for students, staff, and visitors
Bottom Line ………
1. Protect all occupants from second-hand
smoke
2. Eliminate the opportunity to participate
in tobacco use
3. Eliminate access to tobacco
4. Reduce the instances to observe
use by peers or adults
Our Data, Baseline – Local Level
Colorado
North Carolina
New York
Georgia
Oregon
Wisconsin grantees
Dear Superintendent;
1. Do you have a district-wide tobacco use policy?……………………..…….yes no
2. If you have a policy, what areas does it cover and for whom? Please check all that apply.
Students Staff Visitors
Prohibits tobacco use in all school buildings by
Prohibits tobacco use on all school property including, grounds, parking lots, play fields
Prohibits tobacco use in school vehicles, buses, etc.
Prohibits tobacco use at all school sponsored events, on and off school property, athletic events, concerts, field trips
3. Is your policy in effect at all times?………………………………………..yes no
A. Educate and Advocate
Compelling argument? Your Message??
Broad brush
Presentations at conferences?
Endorsement of State Dept of Ed?
National School Association – local?
very targeted personal presentations
How To Work With Schools Identify decision makers
Respect the hierarchy but keep things moving
Schools share a mission to develop health but are rewarded for academic achievement
What’s in it for them?
Relationship, relationship
Be brief, be positive, be prepared to deal with objections
Timing has an impact
Be persistent
Review of The Case(1) Preventing tobacco use and promoting a tobacco-free lifestyle is a critical public
health priority.
(2) Preventing tobacco use and promoting a tobacco-free lifestyle among youth is essential.
(3) Promoting the health of youth, especially preventing tobacco use among youth is an important educational priority.
Causes of All Deaths in the U.S., 1998
CardiovascularDisease
39%
Cancer23%
COPD5%
Diabetes3%
Other Causes30%
Source: CDC, National Vital Statistics Reports 2000: 48(11)
This is equivalent to three jumbo jets crashing each day!This is equivalent to three jumbo jets crashing each day!
Actual Causes of Death in the United States, 1990
Source: McGinnis JM, Foege WH. JAMA 1993;270:2207-12.
100,000 90,000
30,000 20,000
0
100,000
200,000
300,000
400,000
500,000
Tobacco Diet/Activity Alcohol Microbialagents
Sexualbehavior
Illicit use ofdrugs
300,000
400,000
Percentage (of all deaths)
Heart Disease
Cancer
Chronic lower respiratory disease
Unintentional Injuries
Pneumonia/influenza
Diabetes
Alzheimer’s disease
Kidney Disease
Stroke
0 5 10 15 20 25 30 35
* National Center for Health Statistics. Mortality Report. Hyattsville, MD: US Department of Health and Human Services; 2002† Adapted from McGinnis Foege, updated by Mokdad et. al.
Causes of DeathUnited States, 2000
Actual Causes of Death†Leading Causes of Death*
Tobacco
Poor diet/lack of exercise
Alcohol
Infectious agents
Pollutants/toxins
Firearms
Sexual behavior
Motor vehicles
Illicit drug use
Percentage (of all deaths)0 5 10 15 20
• 80% of adult smokers started smoking before they finished
high school. 1
Why Focus on Youth?
Sources: (1) U.S. DHHS. Surgeon General’s Report: Preventing Tobacco Use Among Young People, 1994
(2) CDC, National Youth Risk Behavior Survey, 1997
Sources: (1) U.S. DHHS. Surgeon General’s Report: Preventing Tobacco Use Among Young People, 1994
(2) CDC, National Youth Risk Behavior Survey, 1997
• 25% of high school students smoked a whole cigarette before age 13. 2
Why Focus on Youth?
• If current patterns of smoking behaviors continue, an estimated 6.4 million of today’s children can be expected to die prematurely from a smoking-related disease
• If current patterns of smoking behaviors continue, an estimated 6.4 million of today’s children can be expected to die prematurely from a smoking-related disease
Percentage of Adults and High School Students Who Smoked Cigarettes*, 1991-2001
0
5
10
15
20
25
30
35
40
45
1991 1993 1995 1997 1999 2001
years
perc
ent
Adults (1)High School Students (2)
*Any use in the past 30 daysSource: (1) SAMHSA, National Household Survey on Drug Abuse (2) CDC, Youth risk Behavior Surveillance System
Percentage of Adults and Youth Who Smoked Cigarettes*, 1990-2001
90
0
5
10
15
20
25
30
35
40
45
91 92 93 94 95 96 97 98 99 2000 2001
Perc
en
t
YearYear*Any use in the past 30 daysSource: (1) SAMHSA, National Household Survey on Drug Abuse (2) Monitoring the Future Study, Univ. of Michigan
Adults (35 and older)1
-16%
Youth age 12 thru 17 1 -37%
Youth age 18-26 1
no change
High School Seniors 2
no change
Rank
2
3
4
5
6
7
8
9
10
11
12
Average % of“Definitely” responses
62.6
59.4
57.4
50.1
49.8
49.0
48.7
48.2
44.2
42.5
Average Percentage of Respondents Who Said Students Should Definitely Know or Be Able to Do
Subject Standards by High School Graduation Subject
1 73.9Health
40.8
Work SkillsLanguage ArtsTechnologyMathematicsThinking and ReasoningScienceCivicsBehavioral StudiesPhysical EducationEconomicsHistory
Source: McREL. What Americans Believe Students Should Know, 1999
Who’s the Audience?
What do they need to hear?
What do they need to hear?
From whom should the message come?
Who’s responsible for making this happen?
Results?
School Board
Superintendents
Principals (HS)
Parents
Students
Youth Advisory Group
Objections to Tobacco Free Schools
1. We stick with the law and don’t go beyond that
2. I’m not about to offend parents and visitors
3. It’s not the norm around here
4. I’m not going to pull a chaw out of some cowboys’ jaw
5. This will never work for the alternative school kids, this is their last chance and if a policy like this goes in, they won’t come to school
6. I don’t want kids crossing the street, creating a safety hazard for themselves and a liability issue for me
7. I don’t want kids out in the neighborhood. I’ll get complaints
8. I don’t want kids over in the park where they will be exposed to gangs and drugs.
B. Assist, Reduce Barriers, Make it Easy
Before you get out there –
alternative to suspension
cessation programs
signage
testimony
model policies
keep you ear to the ground
C. Monitoring or Tracking: Be Thinking . . .
YRBS / YTS
CDC’s School Health Profiles
State Assessment directed to
Policy Makers or
Safe & Drug Free School Coordinators or ….
On-site surveillance by official types
Reported compliance by parents or insiders
Recording contacts via data base or contact management software
Testimony -
"I really expected to have problems with
enforcing it. I have been surprised that there
have been no real difficulties at all. I announce it at every game- and so far there has been maybe one time that someone lit up before they left campus." Principal
“ I hear administrators complaining that implementing a tobacco free policy is hard. Heck! Teaching math is hard! Doesn’t mean we shouldn’t be doing it.” Principal
“Anyone who says they can’t enforce this is just whining”Principal
Schools could do more than perhaps any other single institution in society to help young people, and the adults they will become, to live healthier, longer, more satisfying, and more productive lives.
Carnegie Council on Adolescent Development
I in 20, 000 for airplane crash
Second hand smoke 1 in 55