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Overall rates of injury and death increase dramatically from childhood to late adolescence. In this article, it talks about the developmental and social factors that influence the high-risk taking behaviors children and adolescents put themselves in.  Violence and Unintentional injury are two interrelated areas the adolescents encounter while growing up in school.  The time spent without parental supervision and increasing independence, adolescents are more likely to engage in risk taking behaviors than younger children or adults. The uses of drug, alcohol, motor vehicle, and violent acts of behavior are highly influenced by the community a child is raised in and the circumstances around them.  It is important that schools implement a program that implements a strong sense of safety and awareness on the tragic accidents that can happen when poor decisions are made.  Brining in a professional multiple times a year to talk to the student community about violence and safety is essential for adolescents to wrap their heads around the importance.

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NCCP | Adolescent Violence and Unintentional Injury in the United States

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Overall rates of injury and death increase dramatically from childhood to late adolescence. This fact sheet presents basic facts about adolescent violence and unintentional injury, outlines barriers to ensuring their safety, and makes recommendations for addressing these barriers.

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Schools need role models that students can idolize in order to see how to be a strong and healthy person.  Students and young children enjoy copying what they see someone else doing, which is why it is so important to have positive role models within the school community in order to give the students an appropriate authority to look up to.  Making a positive impact on health and student wellness can be implemented by teacher and staff actions.  Teachers and staff can model eating healthy, drinking water instead of juice or soda, promoting daily exercise, and the concept of setting and reaching goals.  Engaging volunteers can widely effects the benefits and contributions by the students.  Providing and valuable lesson and extra helping hand in the school community will help students live a strong and healthy lifestyle.

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action for healthy kids® fights childhood obesity

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undernourishment and physical inactivity by helping schools become healthier places so kids can live healthier lives.

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Staff as Healthy Role Models - Action for Healthy Kids

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Action for Healthy Kids, childhood obesity, nutrition, healthy schools, healthy children, every kid healthy

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Keeping children safe at school and having a safe environment at schools is important for students of all ages.  Having a safe learning environment will create a boundary for students enabling them to focus on schoolwork and the skills needed to improve in their academics.  Safety within schools is not only a local concern but a federal concern and the federal government is making changes in order to promote and implement school safety and law enforcement.  Violence in schools is an epidemic in some areas and needs to change in order for the students to feel comfortable and in a stable environment.  Students will feel safe in their school community when they have trust in the faculty and administration and know how to get help when they need it.

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Keeping schools safe allows children to look forward to being in an encouraging environment that promotes social and creative learning. When their basic safety needs aren't met, children are at risk for not feeling comfortable at school and may stop showing up, or they may remain on edge throughout the day. Promoting school safety creates an open space for kids to explore, learn and grow.

Keeping Children Safe at School

A safe learning environment is essential for students of all ages. Without it they are unable to focus on learning the skills needed for a successful education and future. When violence is part of the educational setting, all students are affected in some way. Even though your child may not be the actual victim of violence in school, there is a very good chance that he or she will witness violent acts throughout the educational years. Research continues to illustrate children who feel unsafe at school perform worse academically and are more at risk for getting involved in drugs and delinquency.

The issue of school safety is a major concern at all levels of government, from local to federal. School boards meet with teachers and parents to listen to their concerns and suggest solutions. State and federal governments are taking steps to improve school safety and law enforcement as the nation realizes the importance of this issue and how it impacts children's futures.

Increased Violence in Schools

Although there are experts that say violence has always existed in schools, many are concerned about the increased number of violent acts taking place there. Some even argue violence in certain areas has reached epidemic proportions, desensitizing many students and leaving them feeling violence is a normal part of their school life. Sadly, violent acts in schools occur at all educational levels with 8 percent of students reporting they have been involved in at least one physical fight at school, and 6 percent reporting missing school at least once in a month long survey period because they did not feel safe.

Every child should feel safe from violence in their school, yet there are many that do not. Today, it is not unusual for students to violently attack other students, teachers, security guards, and school personnel, showing a complete lack of respect for authority. These attacks often result in injury and at times, death. Witnessing these acts can also cause intense fear and anxiety within other students as well as staff members, making the school environment a psychologically distressing place to be.

Prioritizing Digital Safety

With a higher number of teachers using technology to educate their students, the need to better understand and promote safe internet usage is critical. Online, children are at risk for being bullied by peers or anonymous users and being taken advantage of by adults preying on younger folks. Exposure to inappropriate content and disturbing images and language should also be considered when using computers or tablets in the classroom.

Safety online is just as important as physical safety. An estimated 55 percent of LGBT students report being cyber bullied, and 15 percent of high school students have experienced this as well. Kids who are in an environment where bullying takes place are more at risk for suicidal behaviors compared to students who are not exposed to bullying. Programs that support safe use of technology can greatly impact the mental health of the students using it.

Why Is School Safety Important?

When considering violence in schools, the horrific acts that occurred at Columbine High School, Virginia Tech, and Northern Illinois University come to mind. These incidents, and others like them, are some of the worst cases of violence in schools. It can be difficult to think about the increase of school violence and what that means for students.

School safety is important to protect all students and school personnel from violence that includes:

Assaults

Bullying

Victimization

Theft

Classroom disorder

Fights

Robbery

Use of weapons

Sexual attacks

Violent crime

The Need for School Safety

The following are a few of the many incidents that exemplify the need for school safety.

A first grader from Michigan shot and killed another first grade child.

A 14-year-old student attending a school in Ohio for high achieving students shot and killed two students and two teachers and then himself. The day before he had been suspended because of a fight with another student.

A Philadelphia kindergartner repeatedly punched his pregnant teacher in the stomach during an attack.

A teen from Milwaukee physically assaulted his teacher during class.

A California high school student threatened to shoot students at their school and was later taken into custody.

A pregnant teacher in Ohio was brutally attacked by a student.

In Texas, a ten year old boy was set on fire in the school playground by a group of kids.

Within two years of the Columbine High School shootings there were eight similar school attacks, each resulting in severe injuries and death.

The crisis of violence in schools has devastating effects. All necessary steps and precautions need to be taken to ensure the safety of all students. Zero tolerance policies and violence prevention programs need to be instituted in schools. Parents, schools and communities need to work together to take measures to make their schools a safe place for everyone.

Encouraging Healthy Environments

Safety in schools is necessary to support the academic success of each child, giving them the opportunity to learn and achieve in a safe and nurturing environment. Strict policies on school safety promote increased learning, feelings of school unity, higher levels of pro-social behavior and decreased levels of violence.

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Why Is School Safety Important | LoveToKnow

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Keeping schools safe allows children to look forward to being in an encouraging environment that promotes social and creative learning. When their basic safety needs aren't met, children are at risk for not feeling comfortable at school and may stop showing up, or they may remain on edge throughout the day.

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Physical education programs help students stay active and keep their bodies moving during the long school day.  Today, in society, childhood obesity is at an all-time high due to the lack of physical activity, unhealthy eating habits, and low socioeconomic status.  It is essential to have a high-quality health and physical education in order to teach children the importance of physical activity as well as social development.  Adolescents are spending too much time in front of computer screens, cell phones, TV, and video games, which is taking them away from physical activity that children usually get when playing outside.  Factoring in diet, children who spend much time in front of electronics do not get the normal amount pf physical activity or nutrition.  Physical education is important in order to give children the knowledge and power to live a healthy lifestyle in a balanced way.  Gym class and physical/health education is so important in elementary schools to allow students to blow off steam after sitting in the classroom and learning all day.

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Substance abuse is something that cannot be taking lightly.  Our society is so accepting of illegal drugs and the use of alcohol at an early age.  Educating students about substance abuse is important in helping individuals understand the severity of substance abuse and the effects they have on the body.  Educating our students about alcohol and drug abuse is essential because there are high chances that it runs in the families of our students and to help them be more aware and knowledgeable on how to be supportive and help the people around us get help.  Drugs and alcohol affect our bodies immensely including the brain, our organs, and out minds, and educating our students about the risks is something that needs to be highlighted.  Awareness can help students and adolescents realize the potential damage that can occur when using these substances.

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Education about substance abuse is an important part of helping individuals understand the many aspects of this topic. This information can include factual data about what substance abuse is; warning signs of addiction; information about how alcohol and specific drugs affect the mind and body; the consequences that addiction can have on one's physical and mental health, family, relationships, and other areas of functioning; and how and why substances are abused.

Education may also include information on how to deal with a family member or friend who is struggling with a substance use disorder, and how to be supportive during the detoxification and rehabilitation process.

This could also include counseling education, which helps everyone involved-from the person abusing substances to family and friends. It is important that people who abuse substances are aware of how a drug can affect their minds, bodies, relationships, and functioning. This awareness can help them realize the potential damage that could occur, or the damage that has already occurred. Substance abuse education may also include information about what treatment entails to prepare everyone involved for the potential outcomes.

The Importance of Drug Education

The main focus of substance abuse education is teaching individuals about drug and alcohol abuse and how to avoid, stop, or get help for substance use disorders-and this can begin at a young age. Education can start with parents educating their children, and in primary school programming designed to increase knowledge about substance abuse and the associated risks. For teenagers, substance abuse education is generally incorporated into school curriculum as well. Adults who want to learn more about substance abuse (that they can then share with their kids) can attend classes, group meetings, and research information online in order to learn more about the topic.

Substance abuse education is important for children, teenagers, and adults alike; there are many misconceptions about commonly used legal and illegal substances, such as alcohol and marijuana. Ensuring that children are educated about drugs can help prevent them from using them, especially ones that are made to sound harmless, but are in reality very addictive or dangerous to the body. Helping adults understand the repercussions of drug use can prevent a problem from forming and can provide information they can share with their children to prevent future issues.

If you or a loved one are struggling with substance abuse, contact us today at 1-888-287-0471 Who Answers? for help and see what treatment options are right for you.

Knowledge is power, and with accurate information about the topic, a person will be more likely to make a fact-based and informed decision. When educating people, all drugs should be covered, regardless of the strength or perceived risk of harm. While opioids, cocaine, and methamphetamine are viewed as "hard drugs," and therefore have serious consequences, "minor drugs," such as marijuana and alcohol can still be addictive and are frequently abused. People of all ages should be aware of the damage that all drugs and alcohol have the potential to do to the body, mind, and relationships.

With the availability of internet resources, there is unlimited access to knowledge about drugs and alcohol, but not every site provides reliable information. If you are preparing to teach a substance abuse education course to adults or deliver a school presentation for children or teenagers, make sure that you know your information well, and verify it as accurate. This website has a number of excellent, reliable, and well-researched resources that can be used to educate yourself about drugs, so read them thoroughly. Having accurate and reliable information is the best way to identify yourself as a knowledgeable teacher who students will listen to, regardless of their age.

How Drug Education Can Help

Studies have shown that substance abuse prevention programs are effective if they are research-based and implemented properly. ¹ Research-based education programs are rooted in scientific evidence and tested thoroughly, and have been shown to significantly reduce substance abuse behaviors, including use of nicotine, alcohol, and drugs. ¹

These programs boost protective factors, which decrease the likelihood of substance abuse issues, while reducing the impact of risk factors that make individuals more susceptible to substance abuse. ¹ It is especially important to include substance abuse education and prevention in schools, because they can help students avoid trying substances and reduce the risk of developing a substance use disorder later in life. Substance abuse education can begin as early as preschool to help reduce the impact of risk factors on later decision-making-especially during the turbulent adolescent years-where substance use disorders often begin. 2 Of course, it is important to adjust the material to be age-appropriate.

Recent surveys show drops in alcohol, tobacco, and substance use in American teenagers in grades 8, 10, and 12. ³ Use of alcohol and cigarettes were at a record low in 2015, and are currently at the lowest rate they have reached since 1975. ³ Drugs such as MDMA (ecstasy or Molly), heroin, prescription drugs, bath salts, hallucinogens, crack cocaine, synthetic marijuana ( K2 or spice), and amphetamines have all declined in use among American students in grades 8, 10, and 12. ³ And binge drinking rates in American students have also dropped significantly. ³ Marijuana use rates in American students have remained fairly stable since 2010. ³

This universal drop is attributed to increased prevention programming that is incorporated into school curriculums, which seems to deter students from trying illicit substances, alcohol, and tobacco. Education is especially important for newer, "designer" drugs, such as synthetic marijuana (e.g., Spice and K2) and bath salts (e.g., synthetic cathinones), which can be marketed as harmless, but are incredibly dangerous drugs that often have unpredictable results when taken.

Effective drug education campaigns should be ongoing, with recurring programming to fortify the original prevention message. ² Studies show that lack of follow-up programming can reduce the benefits of prevention campaigns. ² In addition, interactive prevention programming has better outcomes, allowing participants to play an active role in drug abuse education and the development of prevention skills, especially when role-playing and discussion groups with peers are included. ²

When research-based drug abuse education campaigns are implemented, they are not only effective, they can also reduce the cost of future substance use disorders. ² Studies show that for every dollar allocated toward prevention campaigns, there is a ten-fold savings in treatment for substance use disorder treatment. ²

Drug Education Resources on Prevention and Safety

There are many reliable, informative substance abuse education sources available on the internet. The following is a list of some of the sources that can be accessed to learn more about substance use and prevention.

National Institute on Drug Abuse. This site provides information on substance use prevention for all ages, and also offers a family checkup, a questionnaire that helps parents learn about parenting skills that help prevent future substance use in children or teens.

NIDA for Teens. This site is an offshoot of the National Institute on Drug Abuse website that provides information aimed at teens in an interactive, interesting, and easy-to-understand format that appeals to young people.

Substance Abuse and Mental Health Services Administration. This link contains a wealth of knowledge about prevention, substance use disorders, and treatment. It addresses prevention programming at several different levels, including school, family, and community settings, as well as providing information about risk and protective factors and evidence-based practices.

Monitoring the Future survey. This website surveys American 8th, 10th, and 12th graders to provide current statistics on teen alcohol, drug, and tobacco use. The results are analyzed to determine trends based on the results from previous years.

Youth.gov. This is a government site that offers information about substance use prevention, as well as links to all areas of prevention, including articles, programs, publications, research, training resources, and websites.

Above the Influence. This is the website for a popular nationwide substance use prevention campaign. This program was developed as part of the National Youth Anti-Drug Media Campaign, and works to encourage teenagers to resist peer pressure and negative influences that promote substance use.

AWARxE Prescription Drug Safety Program. This site provides information about proper use, storage, disposal, and prevention for prescription drugs. Prescription drug awareness events occurring throughout the United States are also listed on this site.

Too Smart To Start. This is an educational program funded by the Substance Abuse and Mental Health Services Administration. Its aim is to spark conversations between adults and adolescents about the risks and harm of underage alcohol consumption, and to increase awareness of underage drinking as a detrimental thing. This website offers different areas for children, teenagers, families, teachers, and leaders in the community, providing different information and resources for each group.

Preventing Drug Use Among Children and Adolescents: A Research-Based Guide for Parents, Educators, and Community Leaders. This is a publication from the National Institute on Drug Abuse that provides comprehensive information on substance use prevention. It addresses risk and protective factors, community-based drug prevention, incorporating the principles of prevention into programs, and even provides examples of evidence-based prevention programs.

Drug Enforcement Administration. This is a government website that offers community outreach information, and provides links to helpful publications and websites regarding prevention of substance use.

There are many other prevention resources available online, but be aware that not all of the information is reliable. Look for community, state, or government resources for the most up-to-date, effective, research-based prevention information.

Sources

1. National Institute on Drug Abuse. (2014). Drugs, brains, and behavior: The science of addiction.

2. National Institute on Drug Abuse. (2003). Preventing drug abuse among children and adolescents (in brief).

3. University of Michigan. (2015). Use of ecstasy, heroin, synthetic marijuana, alcohol, cigarettes declined among US teens in 2015.

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Education about substance abuse is an important part of helping individuals understand the many aspects of this topic. This information can include factual data about what substance abuse is; warning signs of addiction; information about how alcohol and specific drugs affect the mind and body; the consequences that addiction can have on one's physical and mental health, family, relationships, and other areas of functioning; and how and why substances are abused.

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Promoting mental, emotional, and behavioral health is extremely important and involves the implementation of strategies to enhance the well-being of our youth.  Teaching young students’ ways to manage and cope with their insecurities, their internal and external thoughts, social behaviors and their decision-making processes, will help them make positive relationships among people and in their lifetime.  Promoting mental health and behavioral health are so important for young people especially when they are in such a setting like the school.  The Safe Schools/Healthy Students (SS/HS) initiative thrives to decrease the number of students to abuse substances, while improving the school community while also decreasing the violence students are exposed to.  These goals are spread across mental health organizations and schools to facilitate prevention and promote early intervention in supporting our students.  This Safe Schools/Healthy Students, is a program that invites the positive outlook on mental health and enhances students’ knowledge on social and emotional competence which will create a positive and safe school community.

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2. Promoting Mental, Emotional, and Behavioral Health

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Promoting mental, emotional, and behavioral health involves the implementation of strategies to enhance the well-being of youth by promoting pro-social behavior, teaching coping skills, and developing students' skills at decision making, self-awareness, and conducting relationships.

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MyPlate is a program used in schools that promotes what should be on your plate during each meal.  MyPlate was created to remind you how to eat healthy in order to have a healthy life and a strong body.  Eating healthy is essential to adolescents’ developmental growth in many areas, mentally, physically, and emotionally.  MyPlate focus’ on variety, portion control, and nutrition.  It teaches students and even adults which foods and drinks you should choose and how much saturated fat, sodium, and added sugars are in food and beverages.  MyPlate guides you to live large but also teaches you how to live through healthy eating habits.  MyPlate promotes the importance of the five main food groups, fruits, vegetables, grains, protein, and dairy by organizing a plate by colors. Teaching elementary education students about healthy eating habits and living a healthy lifestyle will create awareness and can promote the habits of eating healthy on a day-to-day basis.

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Start Simple with MyPlate

Start Simple with MyPlate and get tips, ideas and a personalized plan to meet your food group targets. Find what works for you and your family within your food preferences, health goals, and budget.

Get started with tips from the MyPlate Food Groups. Or, jump down to Start Simple with MyPlate resources.

Fruits - Focus on whole fruits:

Eat seasonally! Checking what fruits are in season in your area can help save money.

Craving something sweet? Try dried fruits like cranberries, mango, apricots, cherries, or raisins.

To meet your fruit goal-keep fresh fruit rinsed and where you can see it. Reach for a piece when you need a snack.

Vegetables - Vary your veggies:

Vary your veggies by adding a new vegetable to a different meal each day.

Add color to salads with baby carrots, shredded red cabbage, or green beans. Include seasonal veggies for variety throughout the year.

Vegetables go well with a dip or dressing. Try a low-fat dip or hummus with raw broccoli, red and yellow peppers, sugar snap peas, celery, cherry tomatoes or cauliflower.

Grains - Make half your grains whole grains:

Popcorn is a whole grain! Pop a bag of low-fat or fat-free popcorn for a healthier snack.

Whole grain pasta is great in baked dishes or pasta salad. If you choose refined grain pasta, make sure it's enriched by checking the ingredient list.

Ready-to-eat, wholegrain cereal is a tasty breakfast option or can be enjoyed as a whole grain snack.

Protein Foods - Vary your protein routine:

Make dinner once and serve it twice. Roast a larger cut of lean meat. Make a second meal using the 'planned-over' meat.

For car trips, pack a mixture of unsalted nuts, seeds and dried fruit for a crunchy, protein-packed snack.

Keep seafood on hand. Seafood, such as canned salmon, tuna, or crab and frozen fish is quick and easy to prepare.

Dairy - Move to low-fat or fat-free milk or yogurt:

Make a smoothie by blending fat-free milk or yogurt with fresh or frozen fruit. Try bananas, peaches, or mixed berries.

For breakfast try low-fat or fat-free yogurt. Mix in cereal or fruit for extra flavor, texture and nutrients.

Adding 8 oz. of low-fat or fat-free milk to your meal is one of the easiest ways to get dairy.

Limits - Drink and eat less sodium, saturated fats and added sugars: Tips for Salt and Sodium:

Many processed foods contain high amounts of sodium. Choose fresh vegetables, meats, poultry, and seafood when possible.

Using spices or herbs, such as dill, chili powder, paprika, or cumin, and lemon or lime juice, can add flavor without adding salt.
Tips for Saturated Fats:
Keep it lean and flavorful. Try grilling, broiling, roasting, or baking-they don't add extra fat.

Simple substitutions can help you stay within your saturated fat limit. Try using nonfat yogurt when you make tuna or chicken salad.
Tips for Added Sugars:
Split the sweet treats and share with a family member or friend.

Cut calories by drinking water or unsweetened beverages. Soda, energy drinks, and sports drinks are a major source of added sugars.

Start Simple with MyPlate Resources

MyPlate Plan

Ready to get started? Find your personal food group targets with the MyPlate Plan! Just enter your age, sex, height, weight, and physical activity level. You can even see your physical activity recommendations!

Action Guide

After you've found your MyPlate Plan, use the resources in the Action Guide to put your plan into action and reach your goals!

Start Simple with MyPlate Tip Sheet

Print this handout with tips from the five MyPlate food groups that you can easily incorporate into your busy life.

Professional Toolkit

The Start Simple with MyPlate Toolkit for Professionals provides promotion ideas, graphics, a tip library, and social media for communicating the campaign effectively and efficiently.

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Start Simple with MyPlate Start Simple with MyPlate and get tips, ideas and a personalized plan to meet your food group targets. Find what works for you and your family within your food preferences, health goals, and budget. Get started with tips from the MyPlate Food Groups.

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Tobacco use is the leading cause of death in the United States and about 82% of smokers began before 18 years old and more than 3,000 people begin smoking each day.  The CDC developed guidelines with experts in order to prevent the use of tobacco.  School-based programs offer an opportunity to prevent the initiation of tobacco use and therefore help people avoid beginning to smoke.  Teaching our students how bad the effects of smoking have on the body as much as we can is going to be important for the chances they begin smoking and the ability to not be open to experimenting with tobacco.  We as educators need to encourage students to not smoke or tamper with an illegal substances and to assist the students who are in need of help to quit.

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Summary

Tobacco use is the leading cause of preventable death in the United States. The majority of daily smokers (82%) began smoking before 18 years of age, and more than 3,000 young persons begin smoking each day. School programs designed to prevent tobacco use could become one of the most effective strategies available to reduce tobacco use in the United States. The following guidelines summarize school-based strategies most likely to be effective in preventing tobacco use among youth. They were developed by CDC in collaboration with experts from 29 national, federal, and voluntary agencies and with other leading authorities in the field of tobacco-use prevention to help school personnel implement effective tobacco-use prevention programs. 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 physiologic 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 kindergarten through 12th grade, d) provide program-specific training for teachers, e) involve parents or families in support of school-based programs to prevent tobacco use, f) support cessation efforts among students and all school staff who use tobacco, and g) assess the tobacco-use prevention program at regular intervals.

INTRODUCTION

Tobacco use is the single most preventable cause of death in the United States (1). Illnesses caused by tobacco use increase demands on the U.S. health-care system; lost productivity amounts to billions of dollars annually (2-3).

Because four out of every five persons who use tobacco begin before they reach adulthood (1), tobacco-prevention activities should focus on school-age children and adolescents. Evidence suggests that school health programs can be an effective means of preventing tobacco use among youth (4-7). The guidelines in this report have been developed to help school personnel plan, implement, and assess educational programs and school policies to prevent tobacco use and the unnecessary addiction, disease, and death tobacco use causes. Although these guidelines address school programs for kindergarten through 12th grade, persons working with youth 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 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 Programs (4) and the findings of the 1994 Surgeon General's Report, Preventing Tobacco Use Among Young People (8).

CDC developed these guidelines in consultation with experts representing the following organizations:

American Academy of Pediatrics American Association of School Administrators American Cancer Society American Federation of Teachers American Heart Association American Lung Association American Medical Association Association of State and Territorial Directors of Public Health Education Association of State and Territorial Health Officials Council of Chief State School Officers Health Resources and Services Administration Indian Health Service National Association of School Nurses National Association of Secondary School Principals National Association of State Boards of Education National Cancer Institute National Center for Nursing Research National Congress of Parents and Teachers National Education Association National Heart, Lung, and Blood Institute National Institute of Child Health and Human Development National School Boards Association National School Health Education Coalition Office of Disease Prevention and Health Promotion Office of Minority Health Substance Abuse and Mental Health Services Administration The Society of State Directors of Health, Physical Education, and Recreation U.S. Department of Education Western Consortium for Public Health

BACKGROUND

School-based programs 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 (1). Recent estimates suggest that cigarette smoking annually causes more than 400,000 premature deaths and 5 million years of potential life lost (2). The estimated direct and indirect costs associated with smoking in the United States in 1990 totalled $68 billion (3).

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 (9). Subsequent reports from the Surgeon General's office have documented that smoking causes coronary heart disease (10), atherosclerotic peripheral vascular disease (1), cerebrovascular disease (1), chronic obstructive pulmonary disease (including emphysema) (11), intrauterine growth retardation (1), lung and laryngeal cancers in women (12), oral cancer (13), esophageal cancer (13), and cancer of the urinary bladder (14). Cigarette smoking also contributes to cancers of the pancreas, kidney, and cervix (1,14). Further, low birth weight and approximately 10% of infant mortality have been attributed to tobacco use by pregnant mothers (1). 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 unfavorable effects on blood lipid levels (which may accelerate development of cardiovascular diseases) (8).

Breathing environmental tobacco smoke -- including sidestream and exhaled smoke from cigarettes, cigars, and pipes -- also causes serious health problems (15-16 ). For example, exposure to environmental tobacco smoke increases the risk for lung cancer and respiratory infections among nonsmokers and may inhibit the development of optimal lung function among children of smokers (16). Exposure to environmental tobacco smoke also may increase the risk for heart disease among nonsmokers (17-18). The Environmental Protection Agency recently classified environmental tobacco smoke as a Group A carcinogen, a category that includes asbestos, benzene, and arsenic (19).

Use of smokeless tobacco, including chewing tobacco and snuff, also can be harmful to health. A report of the Advisory Committee to the Surgeon General indicated that using smokeless tobacco causes oral cancer and leukoplakia (20). Early signs of these diseases, particularly periodontal degeneration and soft tissue lesions, are found among young people who use smokeless tobacco (8).

Tobacco use is addictive and is responsible for more than one of every five deaths in the United States. 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 (1). On average, more than 3,000 young persons, most of them children and teenagers, begin smoking each day in the United States (21). Approximately 82% of adults ages 30- 39 years who ever smoked daily tried their first cigarette before 18 years of age (8). National surveys indicate that 70% of high school students have tried cigarette smoking and that more than one-fourth (28%) reported having smoked cigarettes during the past 30 days (22).

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

The challenge to provide effective tobacco-use prevention programs to all young persons is an ethical imperative. Schools are ideal settings in which to provide such programs to all children and adolescents. School-based tobacco prevention education programs 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 programs that vary in format, scope, and delivery method (8).

To be most effective, school-based programs must target young persons before they initiate tobacco use or drop out of school. In 1992, 18% of surveyed U.S. high school seniors reported smoking their first cigarette in elementary school, and 30% started in grades seven to nine (23). Among persons age 17-18 years surveyed in 1989, substantially more high school dropouts (43%) than high school attendees or graduates (17%) had smoked cigarettes during the week preceding the survey (24).

Because considerable numbers of students begin using tobacco at or after age 15, tobacco-prevention education must be continued throughout high school. Among high school seniors surveyed in 1991 who had ever smoked a whole cigarette, 37% initiated smoking at age 15 or older (grades 10-12).

School-based programs offer an opportunity to prevent the initiation of tobacco use and therefore help persons avoid the difficulties of trying to stop after they are addicted to nicotine. The majority of current smokers (83%) wish they had never started smoking, and nearly one-third of all smokers quit for at least a day each year (25). Most smokers (93%) who try to quit resume regular smoking within 1 year (21,26). Of those persons who successfully quit smoking for 1 year or longer, one-third eventually relapse (14).

By experimenting with tobacco, young persons place themselves at risk for nicotine addiction. Persons who start smoking early have more difficulty quitting, are more likely to become heavy smokers, and are more likely to develop a smoking-related disease (1,27). Between 1975 and 1985, approximately 75% of persons who had smoked daily during high school were daily smokers 7-9 years later; however, only 5% of those persons had predicted as high school students that they would "definitely" smoke 5 years later (23). Smoking is addictive; three out of four teenagers who smoke have made at least one serious, yet unsuccessful, effort to quit (28). The 1994 Surgeon General's report on smoking and health concludes that the probability of becoming addicted to nicotine after any exposure is higher than that for other addictive substances (e.g., heroin, cocaine, or alcohol). Further, nicotine addiction in young people follows fundamentally the same process as in adults, resulting in withdrawal symptoms and failed attempts to quit (8). Thus, cessation programs are needed to help the young persons who already use tobacco (4).

School-based programs to prevent tobacco use should be provided for students of all ethnic/racial groups. In high school, more white (31%) and Hispanic (25%) students than black students (13%) are current smokers (29). Although ages and rates of initiation vary by race and ethnicity, tobacco use is a problem for all ethnic/racial groups. Given the diversity of cultures represented in many schools, it is important to tailor prevention programs for particular ethnic/racial subgroups of students. However, programs should be sensitive to, and representative of, a student population that is multicultural, multiethnic, and socio-economically diverse.

Effective school-based programs to prevent tobacco use are equally important for both male and female students. From 1975 to 1987, daily smoking rates among 12th-grade females were as high or higher than males. Since 1988, smoking rates for males and females have been nearly identical (23). However, rates of smokeless tobacco use differ by sex: in 1991, 19% of male high school students and only 1% of females reported use during the past 30 days (22). Given the growing popularity of smokeless tobacco use, particularly among males (30), and given the prevalent misconception that smokeless tobacco is safe (23), school-based programs to prevent tobacco use must pointedly discourage the use of smokeless tobacco.

Despite gains made in the 1970s, progress in reducing smoking prevalence among adolescents slowed dramatically in the 1980s. For example, the percentage of seniors who report that they smoked on one or more days during the past month has remained unchanged since 1980 -- at approximately 29% (23). Further, despite negative publicity and restrictive legislation regarding tobacco use, the proportion of high school seniors who perceive that cigarette users are at great risk for physical or other harm from smoking a pack a day or more has increased only minimally -- from 64% in 1980 to 69% in 1992 (23). Thus, efforts to prevent the initiation of tobacco use among children and adolescents must be intensified.

School-based programs to prevent tobacco use also can contribute to preventing the use of illicit drugs, such as marijuana and cocaine, especially if such programs are also designed to prevent the use of these substances (31). Tobacco is one of the most commonly available and widely used drugs, and its use results in the most widespread drug dependency. Use of other drugs, such as marijuana and cocaine, is often preceded by the use of tobacco or alcohol. Although most young persons who use tobacco do not use illicit drugs, when further drug involvement does occur, it is typically sequential -- from use of tobacco or alcohol to use of marijuana, and from marijuana to other illicit drugs or prescription psychoactive drugs (32). This sequence may reflect, in part, the widespread availability, acceptability, and use of tobacco and alcohol, as well as common underlying causes of drug use, such as risk-seeking patterns of behavior and deficits in communication and refusal skills. Recent reports on preventing drug abuse suggest that approaches effective in preventing tobacco use can also help prevent the use of alcohol and other drugs (33-35).

PURPOSES OF SCHOOL HEALTH PROGRAMS TO PREVENT TOBACCO USE AND ADDICTION

School-based health programs should enable and encourage children and adolescents who have not experimented with tobacco to continue to abstain from any use. For young persons who have experimented with tobacco use, or who are regular tobacco users, school health programs should enable and encourage them to immediately stop all use. For those young persons who are unable to stop using tobacco, school programs should help them seek additional assistance to successfully quit the use of tobacco.

NATIONAL HEALTH OBJECTIVES, NATIONAL EDUCATION GOALS, AND THE YOUTH RISK BEHAVIOR SURVEILLANCE SYSTEM

CDC's Guidelines for School Health Programs to Prevent Tobacco Use and Addiction were designed in part to help attain published national health objectives and education goals. In September 1990, 300 national health objectives were released by the Secretary of the Department of Health and Human Services as part of Healthy People 2000: National Health Promotion and Disease Prevention Objectives (36). The objectives were designed to guide health promotion and disease prevention policy and programs at the federal, state, and local levels throughout the 1990s. School-based programs to prevent tobacco use can help accomplish the following objectives from Healthy People 2000 (37):

3.4 Reduce cigarette smoking to a prevalence of no more than 15%

among people aged 20 and older. (Baseline: 29% in 1987) 3.5 Reduce the initiation of cigarette smoking by children and

youth so that no more than 15% have become regular cigarette smokers by age 20. (Baseline: 30% in 1987) 3.7 Increase smoking cessation during pregnancy so that at least

60% of women who are cigarette smokers at the time they become pregnant quit smoking early in pregnancy and maintain abstinence for the remainder of their pregnancy. (Baseline: 39% in 1985) 3.8 Reduce to no more than 20% the proportion of children aged 6

and younger who are regularly exposed to tobacco smoke at home (Baseline: 39% in 1986) 3.9 Reduce smokeless tobacco use by males aged 12 through 24 to a

prevalence of no more than 4%. (Baseline: 6.6% for age 12-17 in 1988) 3.10 Establish tobacco-free environments and include tobacco use

prevention in the curricula of all elementary, middle, and secondary schools, preferably as part of quality {comprehensive} school health education. (Baseline: 17% of school districts were smoke-free, and 75%-81% of school districts offered antismoking education in 1988) 3.11 Increase to at least 75% the proportion of worksites {such as

schools} with a formal smoking policy that prohibits or severely restricts smoking at the workplace. (Baseline: 54% of medium and large companies in 1987) 3.12 Enact in 50 states comprehensive laws on clean indoor air that

prohibit or strictly limit smoking in the workplace and enclosed public places {such as schools}. (Baseline: 13 states in 1988)

School-based programs to prevent tobacco use can also help accomplish one of the six National Education Goals (38): By the year 2000, every school in America will be free of drugs and violence and will offer a disciplined environment conducive to learning (Goal 6).

In 1990, CDC established the Youth Risk Behavior Surveillance System to help monitor progress toward attaining national health and education objectives by periodically measuring the prevalence of six categories of health risk behaviors usually established during youth that contribute to the leading causes of death and disease (39); tobacco use is one of the six categories. CDC conducts a biennial Youth Risk Behavior Survey (YRBS) of a national probability sample of high school students and also enables interested state and local education agencies to conduct the YRBS with comparable probability samples of high school students in those states and cities (22 ). The specific tobacco-use behaviors monitored by the YRBS include (40):

ever tried cigarette smoking

age when first smoked a whole cigarette

ever smoked cigarettes regularly (one cigarette every day for 30 days)

age when first smoked regularly

number of days during past month that cigarettes were smoked

number of cigarettes smoked per day during past month

number of days during past month that cigarettes were smoked on school property

ever tried to quit smoking cigarettes during past six months

any use of chewing tobacco or snuff during past month

any use of chewing tobacco or snuff during past month on school property.

States and large cities are encouraged to use the YRBS periodically to monitor the comparative prevalence of tobacco use among school students in their jurisdictions, and school officials are encouraged to implement programs specifically designed to reduce these behaviors. These national, state, and local data are being used to monitor progress in reducing tobacco use among youth and to monitor relevant national health objectives and education goals.

RECOMMENDATIONS FOR SCHOOL HEALTH PROGRAMS TO PREVENT TOBACCO USE AND ADDICTION

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

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

2. Provide instruction about the short- and long-term negative physiologic 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 kindergarten through 12th grade; this instruction should be especially intensive in junior high or middle school and should be reinforced in high school.

4. Provide program-specific training for teachers.

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

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

7. Assess the tobacco-use prevention program 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 state and local laws and should include the following elements (41):

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 programs 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 (41), 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 (42). Policies that prohibit tobacco use on school property, require prevention education, and provide access to cessation programs rather than solely instituting punitive measures are most effective in reducing tobacco use among students (43).

A tobacco-free school environment can provide health, social, and economic benefits for students, staff, the school, and the district (41). These benefits include decreased fires and discipline problems related to student smoking, improved compliance with local and state smoking ordinances, and easier upkeep and maintenance of school facilities and grounds.

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

Some tobacco-use prevention programs have been limited to providing only factual information about the harmful effects of tobacco use. Other programs have attempted to induce fear in young persons about the consequences of use (44). 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 (45- 47).

Successful programs to prevent tobacco use address multiple psychosocial factors related to tobacco use among children and adolescents (48-51). These factors include:

Immediate and long-term undesirable physiologic, cosmetic, and social consequences of tobacco use. Programs should help students understand that tobacco use can result in decreased stamina, stained teeth, foul-smelling breath and clothes, exacerbation of asthma, and ostracism by nonsmoking peers.

Social norms regarding tobacco use. Programs should use a variety of educational techniques to decrease the social acceptability of tobacco use, highlight existing antitobacco norms, and help students understand that most adolescents do not smoke.

Reasons that adolescents say they smoke. Programs should help students understand that some adolescents smoke because they believe it will help them be accepted by peers, appear mature, or cope with stress. Programs should help students develop other more positive means to attain such goals.

Social influences that promote tobacco use. Programs should help students develop skills in recognizing and refuting tobacco-promotion messages from the media, adults, and peers.

Behavioral skills for resisting social influences that promote tobacco use. Programs should help students develop refusal skills through direct instruction, modeling, rehearsal, and reinforcement, and should coach them to help others develop these skills.

General personal and social skills. Programs should help students develop necessary assertiveness, communication, goal-setting, and problem-solving skills that may enable them to avoid both tobacco use and other health risk behaviors.

School-based programs should systematically address these psychosocial factors at developmentally appropriate ages. Particular instructional concepts should be provided for students in early elementary school, later elementary school, junior high or middle school, and senior high school ( Table_1). Local school districts and schools should review these concepts in accordance with student needs and educational policies to determine in which grades students should receive particular instruction.

Recommendation 3: Provide tobacco-use prevention education in kindergarten through 12th grade. This instruction should be especially intensive in junior high or middle school and should be reinforced in high school.

Education to prevent tobacco use should be provided to students in each grade, from kindergarten through 12th grade (4). Because tobacco use often begins in grades six through eight, more intensive instructional programs should be provided for these grade levels (4-5). Particularly important is the year of entry into junior high or middle school when new students are exposed to older students who use tobacco at higher rates. Thereafter, annual prevention education should be provided. Without continued reinforcement throughout high school, successes in preventing tobacco use dissipate over time (52,53). Studies indicate that increases in the intensity and duration of education to prevent tobacco use result in concomitant increases in effectiveness (54- 56).

Most evidence demonstrating the effectiveness of school-based prevention of tobacco use is derived from studies of schools in which classroom curricula focused exclusively on tobacco use. Other evidence suggests that tobacco-use prevention also can be effective when appropriately embedded within broader curricula for preventing drug and alcohol use (57) or within comprehensive curricula for school health education (31). The effectiveness of school-based efforts to prevent tobacco use appears to be enhanced by the addition of targeted communitywide programs that address the role of families, community organizations, tobacco-related policies, antitobacco advertising, and other elements of adolescents' social environment (8).

Because tobacco use is one of several interrelated health risk behaviors addressed by schools, CDC recommends that tobacco-use-prevention programs be integrated as part of comprehensive school health education within the broader school health program (58).

Recommendation 4: Provide program-specific training for teachers.

Adequate curriculum implementation and overall program effectiveness are enhanced when teachers are trained to deliver the program as planned (59,60). Teachers should be trained to recognize the importance of carefully and completely implementing the selected program. Teachers also should become familiar with the underlying theory and conceptual framework of the program as well as with the content of these guidelines. The training should include a review of the program content and a modeling of program activities by skilled trainers. Teachers should be given opportunity to practice implementing program activities. Studies indicate that in-person training and review of curriculum-specific activities contribute to greater compliance with prescribed program components (4,5,61,62).

Some programs may elect to include peer leaders as part of the instructional strategy. By modeling social skills (63) and leading role rehearsals (64), peer leaders can help counteract social pressures on youth to use tobacco. These students must receive training to ensure accurate presentation of skills and information. Although peer-leader programs can offer an important adjunct to teacher-led instruction, such programs require additional time and effort to initiate and maintain.

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

Parents or families can play an important role in providing social and environmental support for nonsmoking. Schools can capitalize on this influence by involving parents or families in program planning, in soliciting community support for programs, and in reinforcing educational messages at home. Homework assignments involving parents or families increase the likelihood that smoking is discussed at home and motivate adult smokers to consider cessation (65).

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

Potential practices to help children and adolescents quit using tobacco include self-help, peer support, and community cessation programs. In practice, however, these alternatives are rarely available within a school system or community. Although the options are often limited, schools must support student efforts to quit using tobacco, especially when tobacco use is disallowed by school policy.

Effective cessation programs for adolescents focus on immediate consequences of tobacco use, have specific attainable goals, and use contracts that include rewards. These programs provide social support and teach avoidance, stress management, and refusal skills (66-69). Further, students need opportunities to practice skills and strategies that will help them remain nonusers (66,67,70).

Cessation programs with these characteristics may already be available in the community through the local health department or voluntary health agency (e.g., American Cancer Society, American Heart Association, American Lung Association). Schools should identify available resources in the community and provide referral and follow-up services to students. If cessation programs for youth are not available, such programs might be jointly sponsored by the school and the local health department, voluntary health agency, other community health providers, or interested organizations (e.g., churches).

More is known about successful cessation strategies for adults. School staff members are more likely than students to find existing cessation options in the community. Most adults who quit tobacco use do so without formal assistance. Nevertheless, cessation programs that include a combination of behavioral approaches (e.g., group support, individual counseling, skills training, family interventions, and interventions that can be supplemented with pharmacologic treatments) have demonstrated effectiveness (71). For all school staff, health promotion activities and employee assistance programs that include cessation programs might help reduce burnout, lower staff absenteeism, decrease health insurance premiums, and increase commitment to overall school health goals (41).

Recommendation 7: Assess the tobacco-use prevention program at regular intervals.

Local school boards and administrators can use the following evaluation questions to assess whether their programs are consistent with CDC's Guidelines for School Health Programs to Prevent Tobacco Use and Addiction. Personnel in federal, state, and local education and health agencies also can use these questions to

assess whether schools in their jurisdicition are providing effective education to prevent tobacco use and b) identify schools that would benefit from additional training, resources, or technical assistance. The following questions can serve as a guide for assessing program effectiveness:

1. Do schools have a comprehensive policy on tobacco use, and is it implemented and enforced as written?

2. Does the tobacco education program foster the necessary knowledge, attitudes, and skills to prevent tobacco use?

3. Is education to prevent tobacco use provided, as planned, in kindergarten through 12th grade, with special emphasis during junior high or middle school?

4. Is in-service training provided, as planned, for educators responsible for implementing tobacco-use prevention?

5. Are parents or families, teachers, students, school health personnel, school administrators, and appropriate community representatives involved in planning, implementing, and assessing programs and policies to prevent tobacco use?

6. Does the tobacco-use prevention program encourage and support cessation efforts by students and all school staff who use tobacco?

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 programs 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 programs 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 programs to prevent tobacco use so that they are most effective. Carefully planned school programs can be effective in reducing tobacco use among students if school and community leaders make the commitment to implement and sustain such programs.

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TABLE 1. Instructional concepts (kindergarten through grade twelve)
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Early Elementary School                   Later Elementary School

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KNOWLEDGE:  Students will learn           KNOWLEDGE:  Students will learn
  that                                       that
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- A drug is a chemical that changes     - Stopping tobacco use has short- and
  how the body works.                     long-term benefits *

- All forms of tobacco contain a drug   - Environmental tobacco smoke is
  called nicotine.                        dangerous to health. *

- Tobacco use includes cigarettes and   - Most young persons and adults do
  smokeless tobacco.                      not use tobacco *

- Tobacco use is harmful to health.     - Nicotine, contained in all forms of to-
                                          bacco, is an addictive drug.
- Stopping tobacco use has short-term
  and long-term benefits.               - Tobacco use has short-term and
                                          long-term physiologic and cosmetic
- Many persons who use tobacco have       consequences.
  trouble stopping.
                                        - Personal feelings, family, peers, and
- Tobacco smoke in the air is danger-     the media influence decisions about
  ous to anyone who breathes it.          tobacco use.

- Many fires are caused by persons      - Tobacco advertising is often directed
  who smoke.                              toward young persons

- Some advertisements try to per-       - Young persons can resist pressure to
  suade persons to use tobacco.           use tobacco.

- Most young persons and adults do      - Laws, rules, and policies regulate
  not use tobacco.                        the sale and use of tobacco.

- persons who choose to use tobacco
  are not bad persons.
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ATTITUDES:  Students will               ATTITUDES:  Students will
  demonstrate                             demonstrate
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- A personal commitment not to use      - A personal commitment not to use
  tobacco.                                tobacco *

- Pride about choosing not to use to-   - Pride about choosing not to use to-
  bacco.                                  bacco *

                                        - Support for others' decisions not to
                                          use tobacco

                                        - Responsibility for personal health.
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SKILLS:  Students will be able to       SKILLS: Students will be able to
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- Communicate knowledge and per-        - Communicate knowledge and per-
  sonal attitudes about tobacco use.      sonal attitudes about tobacco use. *

- Encourage other persons not to use    - Encourage other persons not to use
  tobacco.                                tobacco. *

                                        - Demonstrate skills to resist tobacco
                                          use.

                                        - State the benefits of a smoke-free en-
                                          vironment.

                                        - Develop counterarguments to to-
                                          bacco advertisements and other
                                          promotional materials

                                        - Support persons who are trying to
                                          stop using tobacco.
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Middle School/Junior High School        Senior High School

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KNOWLEDGE:  Students will learn         KNOWLEDGE:  Students will learn
  that                                    that
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- Most young persons and adults do      - Most young persons and adults do
  not smoke. *                            not smoke. *

- Laws, rules, and policies regulate    - Tobacco use has short- and long-
  the sale and use of tobacco. *          term physiologic, cosmetic, social,
                                          and economic consequences. *
- Tobacco manufacturers use various
  strategies to direct advertisements   - Cigarette smoking and smokeless to-
  toward young persons, such as "im-      bacco use have direct health con-
  age" advertising. *                      sequences. *

- Tobacco use has short- and long-      - Community organizations have in-
  term physiologic, cosmetic, social,     formation about tobacco use and can
  and economic consequences. *            help persons stop using tobacco. *

- Cigarette smoking and smokeless to-   - Smoking cessation programs can be
  bacco use have direct health con-       successful. *
  sequences. *
                                        - Tobacco use is an unhealthy way to
- Maintaining a tobacco-free environ-     manage stress or weight. *
  ment has health benefits.
                                        - Tobacco use during pregnancy has
- Tobacco use is an unhealthy way to      harmful effects on the fetus.
  manage stress or weight.
                                        - Schools and community organiza-
- Community organizations have in-        tions can promote a smoke-free
  formation about tobacco use and can     environment.
  help persons stop using tobacco.
                                        - Many persons find it hard to stop us-
- Smoking cessation programs can be       ing tobacco, despite knowledge
  successful.                             about the health hazards of tobacco
                                          use.
- Tobacco contains other harmful sub-
  stances in addition to nicotine.
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ATTITUDES:  Students will               ATTITUDES:  Students will
  demonstrate                             demonstrate
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- A personal commitment not to use      - A personal commitment not to use
  tobacco. *                               tobacco. *

- Pride about choosing not to use to-   - Pride about choosing not to use to-
  bacco. *                                bacco. *

- Responsibility for personal health. * - Responsibility for personal health. *

- Support for others' decisions not to  - Support for others' decisions not to
  use tobacco. *                           use tobacco. *

- Confidence in personal ability to     - Confidence in personal ability to
  resist tobacco use.                     resist tobacco use. *

                                        - Willingness to use school and com-
                                          munity resources for information
                                          about, and help with, resisting or
                                          quitting tobacco use.
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SKILLS:  Students will be able to       SKILLS: Students will be able to
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- Encourage other persons not to use    - Encourage other persons not to use
  tobacco. *                              tobacco. *

- Support persons who are trying to     - Support persons who are trying to
  stop using tobacco. *                    stop using tobacco. *

- Communicate knowledge end per-        - Communicate knowledge and per-
  sonal attitudes about tobacco use. *    sonal attitudes about tobacco use. *

- Demonstrate skills to resist tobacco  - Demonstrate skills to resist tobacco
  use. *                                   use. *

- Identify and counter strategies used  - Identify and counter strategies used
  in tobacco advertisements and other     in tobacco advertisements and other
  promotional materials. *                promotional materials. *

- Develop methods for coping with to-   - Develop methods for coping with to-
  bacco use by parents and with other     bacco use by parents and with other
  difficult personal situations, such     difficult personal situations, such
  as peer pressure to use tobacco.        as peer pressure to use tobacco. *

- Request a smoke-free environment.     - Use school and community re-
                                          sources for information about and
                                          help with, resisting or quitting to-
                                          bacco use.

                                        - Initiate school and community action
                                          to support a smoke-free environ-
                                          ment.
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* These concepts reinforce content introduced during earlier grades.
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Guidelines for School Health Programs to Prevent Tobacco Use and Addiction

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Summary Tobacco use is the leading cause of preventable death in the United States. The majority of daily smokers (82%) began smoking before 18 years of age, and more than 3,000 young persons begin smoking each day. School programs designed to prevent tobacco use could become one of the most effective strategies available to reduce tobacco use in the United States.