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Rural Health Information Hub - School-Based Tobacco Prevention and Cessation Programs

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Rural Health Information Hub - School-Based Tobacco Prevention and Cessation Programs

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School-Based Tobacco Prevention and Cessation Programs - RHIhub Toolkit

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School-based interventions can reduce or postpone the onset of smoking among youth.

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ACPM - Tobacco Cessation Resources for Youth 

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ACPM - Tobacco Cessation Resources for Youth 

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Youth report using a diversity of tobacco products, including cigarettes, e-cigarettes, cigarillos, hookah, smokeless tobacco, and a variety of new and emerging products. Nicotine exposure during youth can harm the developing adolescent brain and can lead to a lifetime of nicotine addiction and tobacco use. Nicotine exposure can also prime the adolescent brain for addiction to other drugs. Helping youth quit using tobacco products is critical for protecting their health now and in the future.

Below is a list of tools and resources for those seeking to help youth quit tobacco use. Through this page, parents, educators, healthcare professionals and others who work with young people can find the latest information, resources, and programs created specifically for youth tobacco cessation.
For information on how to prevent youth tobacco use, the Centers for Disease Control and Prevention (CDC) provides data, reports and other resources on youth tobacco prevention as well as information about youth e-cigarette use and prevention.

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Youth report using a diversity of tobacco products, including cigarettes, e-cigarettes, cigarillos, hookah, smokeless tobacco, and a variety of new and emerging products. Nicotine exposure during youth can harm the developing adolescent brain and can lead to a lifetime of nicotine addiction and tobacco use.

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American Heart Association - Kids Heart Challenge - Youth and Tobacco (Elementary)

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American Heart Association - Kids Heart Challenge - Youth and Tobacco (Elementary)

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The Kids Heart Challenge is a fun and exciting event where your student learns about their heart while helping others by raising money for the American Heart Association. It prepares your child for success through physical and emotional well-being.

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Model Grade-Level Outcomes - by Standard

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Model Grade-Level Outcomes - by Standard

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Model Grade-Level Outcomes - by Grade Level

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Model Grade-Level Outcomes - by Grade Level

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National PE Standards-Highly Effective Physical Education

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SHAPE America’s National Standards & Grade-Level Outcomes for K-12 Physical Education define what a student should know and be able to do as result of a highly effective physical education program.

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American Heart Association - American Heart Challenge - Youth: Tobacco and Vaping (MS & HS)

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American Heart Association - American Heart Challenge - Youth: Tobacco and Vaping (MS & HS)

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The American Heart Challenge is a service-learning program that gives middle and high school students the opportunity to do good, while feeling good. It's a way for students to better their lives - all while saving someone else's.

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American Heart Association - Quit Smoking, Vaping and Tobacco Use

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American Heart Association - Quit Smoking, Vaping and Tobacco Use

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Quit Vaping - Quit Smoking - Quit Tobacco

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The American Heart Association states that smoking is the most important preventable cause of premature death in the United States. Learn how to quit smoking, the risks of smoking, the damage of smoking, how to get ready to quit smoking, medicines to help quit smoking.

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House Bill 2407 - Nonacademic Questionnaires

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House Bill 2407 - Nonacademic Questionnaires

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House Bill 2238 - Fairness in Women's Sports (Transgender Athletes)

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House Bill 2238 - Fairness in Women's Sports (Transgender Athletes)

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Senate Bill 233 - Gender Transition Surgery & Hormone Treatment 

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Senate Bill 233 - Gender Transition Surgery & Hormone Treatment 

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Senate Bill 180 - Women's Bill of Rights (Locker Rooms & Restrooms)

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Senate Bill 180 - Women's Bill of Rights (Locker Rooms & Restrooms)

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Recess Guidelines Vary Greatly From State to State

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Recess Guidelines Vary Greatly From State to State

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Get important education news and analysis delivered straight to your inbox
Editor's note: This story was a special edition of the Early Childhood newsletter, which is delivered free to subscribers' inboxes every other Wednesday with trends and top stories about early learning. Subscribe today!

Ask any young child their favorite part of a school day and you're likely to hear it's recess. Recess is often the only time kids get for free play during jam-packed school days- and it's brief: The average length of recess is 25 minutes per day. This time can benefit kids and their teachers, research shows: children are more attentive, productive and perform better cognitively after recess. Elementary school principals have reported that recess has a positive impact on students' ability to focus. The American Academy of Pediatrics even took a stance on recess in 2013, calling it a " crucial and necessary component of a child's development" and stating that it should not be withheld.

However, even a brief amount of recess is far from guaranteed in schools nationwide, as I reported in a story published last week on the practice of withholding recess. On any given day, young children have their recess taken away for academic or behavioral reasons and must stay inside, walk laps or sit on a sidewalk and watch their friends play. This is a long-standing and common punishment in schools. Up to 86 percent of teachers have denied or decreased recess time as a punishment for behavior. While it may work in the short term to get some students to comply quickly, experts say the practice can be harmful in the long term, and possibly make behaviors worse.

"When we take that away, we're not working in our own self-interest," said William Massey, an assistant professor at Oregon State University and a researcher who focuses on play, physical activity and child development. "If your goal is to have more regulated and engaged, productive kids in the classroom, removing opportunities for them to move is about the worst way you can go about doing that."

Part of the challenge in curbing the practice is that teachers may not have support to roll out some of the alternative methods play advocates and child development experts say should be used in place of withholding recess. Many schools lack social workers, counselors and other resources that could help teachers get to the root cause of difficult behaviors. And on a state level, the laws and policies addressing recess vary greatly and often have loopholes that still allow children to miss out:

A handful of states have laws that establish a minimum number of minutes for recess each day or week, but those laws may not mention withholding recess. Parents in one state with a mandate told me recess still gets taken away after kids reach that minimum time.

About one-third of states broadly require a minimum amount of physical activity time each day or week for elementary students, but may not specifically mention recess. That physical activity time can be met through recess, but also through physical education or other forms of movement that don't offer the benefits kids reap through unstructured, free play.

Some state agencies or committees offer guidance to schools on "best practices" around recess policies, but stop short of establishing a requirement, effectively leaving it up to districts or even individual schools.

Nine states don't address recess through any formal law, guidance or policy, according to a Hechinger review of data collected by the King County Play Equity Coalition.

States also differ greatly when it comes addressing the use of recess as punishment:

A handful of states broadly require that physical activity should not be withheld as a punishment, which could include recess and physical education.

A few states address withholding recess, some with stronger language than others. While Illinois' law says all public schools must prohibit the withholding of play time as a disciplinary or punitive action (except when a student's participation is an immediate threat to someone's safety), Rhode Island's law says teachers shall make a "good-faith effort" to not withhold recess. New Jersey's law says schools cannot withhold recess more than twice each week and only for a violation of a district's student code of conduct.

In the absence of state policies, some districts have taken it upon themselves to set their own rules around recess, although interviews with parents in three such districts - Minneapolis, Minnesota; Austin, Texas; and Wichita, Kansas - show enforcement can be weak. Some districts still leave room for recess withholding to happen. In Wichita, for example, the district's policy states that physical activity should not be "routinely" used or withheld as a consequence, leaving teachers and principals to decide what counts as "routine."

There are also school districts that make withholding recess part of their formal discipline policy, identifying recess detention as a possible or mandatory consequence for various behaviors. These districts often publish these consequences publicly in student handbooks. When that is the policy, there's little recourse for parents unless the school or district adopts a new policy, or a state law is enacted. (Research shows that laws, rather than district policies, make the greatest difference in protecting recess.)

Jessica, a Kentucky parent who spoke on the condition that her last name be withheld because she fears school officials will retaliate against her and her child, tried last year to organize fellow parents to support a law that would make it illegal in that state to remove recess for punitive reasons. She made little progress. The district that Jessica's son attends lists "in-school (lunch/recess) detention" as an intervention to be used for a host of behaviors, including "back talking," regular tardiness, or failure to follow a "reasonable request" from a teacher or school official.

Jessica's son, who has a sensory processing disorder, said his recess was frequently withheld in kindergarten and first grade for things like falling out of his seat, fidgeting or playing with pencils. Instead of playing, he had to sit on a bench next to the teacher and watch his classmates.

Jessica said the punishment took a toll on her son, now 8, and on his self-image. "He would come home really upset pretty often," Jessica said. "He told me, 'They don't let me play on recess because I'm bad. I'm a bad kid.'" Eventually, she retained a lawyer who helped push for official special education paperwork to give her son more movement opportunities in school.

But there was nothing stopping Jessica's son's teachers from turning to the punishment. Kentucky does not have a law protecting recess. A 2015 state legislative report found teachers at two-thirds of the schools in Kentucky "commonly withhold recess" for behavior or missing work. In 2016, in response to that report, the Kentucky Department of Education issued guidance that allows schools to count recess as instructional time, under certain conditions. If counted as such, recess cannot be withheld as a punishment. Otherwise, it can be withheld "at the discretion of the district or school."

Although the state allows withholding recess, Kentucky's Commissioner of Education, Jason E. Glass, said in a statement to the Hechinger Report that he did not recommend using withholding recess to punish students, noting it "may be counterproductive, leading to more student behavior problems."

Despite her attempts to curb the practice, Jessica found out this spring that her son, now a third grader, is once again occasionally losing part of his recess. She is sympathetic to teachers' need to enforce rules through consequences, but she disagrees with recess being a punishment.

Teachers need more "modern options," she said. "It's completely counterintuitive to punish a child who can't hold still by taking away the time they are meant to move, to get them to hold still. It's just ridiculous."
This story about recess guidelines was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for Hechinger's newsletter.

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Recess guidelines vary greatly from state to state

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Get important education news and analysis delivered straight to your inbox Editor's note: This story was a special edition of the Early Childhood newsletter, which is delivered free to subscribers' inboxes every other Wednesday with trends and top stories about early learning. Subscribe today!

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Centers for Disease Control and Prevention

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Youth use of tobacco products in any form is unsafe, irrespective of whether it is smoked, smokeless, or electronic. If smoking continues at current rates, 5.6 million-or 1 out of every 13-of today's children will ultimately die prematurely from a smoking-related illness.

Find links to data, infographics, reports and other resources.

Notes from the Field: E-cigarette Use Among Middle and High School Students - United States, 2022
October 7, 2022 / Vol. 71(40);1283-1285

Notes from the Field: E-Cigarette Use Among Middle and High School Students - National Youth Tobacco Survey, United States, 2021
September 29, 2021, 2021 / Vol. 70:1387-9

Tobacco Product Use and Associated Factors Among Middle School and High School Students-United States, 2019
December 6, 2019 / Vol. 68 / 12

Tobacco Use in Top-Grossing Movies - United States, 2010-2018
November 1, 2019, 2019 / Vol. 68 / 43

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Youth use of tobacco products in any form is unsafe, irrespective of whether it is smoked, smokeless, or electronic. If smoking continues at current rates, 5.6 million-or 1 out of every 13-of today's children will ultimately die prematurely from a smoking-related illness. Find links to data, infographics, reports and other resources.

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CDC - Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults

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CDC - Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults

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Centers for Disease Control and Prevention

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The use of e-cigarettes is unsafe for kids, teens, and young adults.

Most e-cigarettes contain nicotine. Nicotine is highly addictive and can harm adolescent brain development, which continues into the early to mid-20s.1

E-cigarettes can contain other harmful substances besides nicotine.

Young people who use e-cigarettes may be more likely to smoke cigarettes in the future.

Find Data on E-cigarette Use Among Youth

E-cigarettes are electronic devices that heat a liquid and produce an aerosol, or mix of small particles in the air.

E-cigarettes come in many shapes and sizes. Most have a battery, a heating element, and a place to hold a liquid.

Some e-cigarettes look like regular cigarettes, cigars, or pipes. Some look like USB flash drives, pens, and other everyday items. Larger devices such as tank systems, or "mods," do not look like other tobacco products.

E-cigarettes are known by many different names. They are sometimes called "e-cigs," "e-hookahs," "mods," "vape pens," "vapes," "tank systems," and "electronic nicotine delivery systems (ENDS)."

Using an e-cigarette is sometimes called "vaping."

Some e-cigarettes look like regular cigarettes, cigars, or pipes.
Some look like USB flash drives, pens, and other everyday items.

E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine, flavorings, and other chemicals that help to make the aerosol.

The liquid used in e-cigarettes often contains nicotine and flavorings. This liquid is sometimes called "e-juice," "e-liquid," "vape juice," or "vape liquid."

Users inhale e-cigarette aerosol into their lungs. Bystanders can also breathe in this aerosol when the user exhales it into the air.

E-cigarette devices can be used to deliver marijuana and other drugs.

News outlets and social media sites report widespread use of JUUL by students in schools, including classrooms and bathrooms.

JUUL is a brand of e-cigarette that is shaped like a USB flash drive. Like other e-cigarettes, JUUL is a battery-powered device that heats a nicotine-containing liquid to produce an aerosol that is inhaled.

All JUUL e-cigarettes have a high level of nicotine. According to the manufacturer, a single JUUL pod contains as much nicotine as a pack of 20 regular cigarettes.2

JUUL is one of a few e-cigarettes that use nicotine salts, which allow particularly high levels of nicotine to be inhaled more easily and with less irritation than the free-base nicotine that has traditionally been used in tobacco products, including e-cigarettes.

News outlets and social media sites report widespread use of JUUL by students in schools, including classrooms and bathrooms.

Approximately two-thirds of JUUL users aged 15 - 24 do not know that JUUL always contains nicotine.

Although JUUL is currently the top-selling e-cigarette brand in the United States, other companies sell e-cigarettes that look like USB flash drives. Examples include the MarkTen Elite, a nicotine delivery device, and the PAX Era, a marijuana delivery device that looks like JUUL.

Additional information about USB-shaped e-cigarettes and actions that parents, educators, and health care providers can take to protect kids is available at CDC's Infographic [PDF - 1.2MB]

Most e-cigarettes (vapes) contain nicotine-the addictive drug in regular cigarettes, cigars, and other tobacco products.

A CDC study found that 99% of the e-cigarettes sold in assessed venues in the United States contained nicotine.1

Some vape product labels do not disclose that they contain nicotine, and some vape liquids marketed as containing 0% nicotine have been found to contain nicotine.

Nicotine can harm the developing adolescent brain.2 The brain keeps developing until about age 25.

Using nicotine in adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control.2

Each time a new memory is created or a new skill is learned, stronger connections - or synapses - are built between brain cells. Young people's brains build synapses faster than adult brains. Nicotine changes the way these synapses are formed.

Using nicotine in adolescence may also increase risk for future addiction to other drugs.2

When a person is dependent on (or addicted to) nicotine and stops using it, their body and brain have to get used to not having nicotine. This can result in temporary symptoms of nicotine withdrawal.

Nicotine withdrawal symptoms include irritability, restlessness, feeling anxious or depressed, trouble sleeping, problems concentrating, and craving nicotine.3 People may keep using tobacco products to help relieve these symptoms.4

Youth may turn to vaping to try to deal with stress or anxiety, creating a cycle of nicotine dependence. But nicotine addiction can be a source of stress.

What may start as social experimentation can become an addiction.

The most common reason U.S. middle and high school students give for trying an e-cigarette is "a friend used them." 5

The most common reason youth give for continuing to use e-cigarettes is "I am feeling anxious, stressed, or depressed." 5

Youth e-cigarette and cigarette use have been associated with mental health symptoms such as depression.9, 10

Yes. As long as a person stays quit, withdrawal symptoms will fade over time as the brain gets used to not having nicotine.

Scientists are still learning about the effects of quitting vaping on mental health. Quitting smoking cigarettes is associated with lower levels of anxiety, depression, and stress, as well as improved positive mood and quality of life.9

Scientists are still learning about the long-term health effects of e-cigarettes.

Some of the ingredients in e-cigarette aerosol could also be harmful to the lungs in the long-term. For example, some e-cigarette flavorings may be safe to eat but not to inhale because the gut can process more substances than the lungs.1

Defective e-cigarette batteries have caused some fires and explosions, a few of which have resulted in serious injuries.

Children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid through their skin or eyes. Nationally, approximately 50% of calls to poison control centers for e-cigarettes are for kids 5 years of age or younger.

E-cigarette aerosol is NOT harmless "water vapor."

The e-cigarette aerosol that users breathe from the device and exhale can contain harmful and potentially harmful substances, including:

Nicotine

Ultrafine particles that can be inhaled deep into the lungs

Flavorings such as diacetyl, a chemical linked to a serious lung disease

Volatile organic compounds

Cancer-causing chemicals

Heavy metals such as nickel, tin, and lead1

The aerosol that users inhale and exhale from e-cigarettes can expose both themselves and bystanders to harmful substances.

It is difficult for consumers to know what e-cigarette products contain. For example, some e-cigarettes marketed as containing zero percent nicotine have been found to contain nicotine.3

E-cigarettes come in various flavors, including fruit, candy, mint, and menthol.

A study from 2013-2014 showed that most youth who use e-cigarettes first start with a flavored variety, and flavors are the primary reason youth report using e-cigarettes.⁶

In 2023, most youth who reported using e-cigarettes used flavored varieties (89.4%). Among middle and high school students who currently used any type of flavored e-cigarette in 2023, the most commonly used flavors were fruit (63.4%), candy, desserts, or other sweets (35%), mint (27.8%), and menthol (20.1%).¹¹

On January 2, 2020, the U.S. Food and Drug Administration (FDA) finalized an enforcement policy that prohibits the sale of prefilled cartridge e-cigarettes in any flavor other than tobacco or menthol, unless authorized by FDA. FDA has since taken additional steps to prohibit certain companies from selling youth-appealing, flavored disposable e-cigarettes and flavored e-liquids without authorization.⁷

Several states and communities have restricted the sale of flavored tobacco products, including menthol-flavored products.⁸

E-cigarettes are also advertised using the same themes and tactics that have been shown to increase youth initiation of other tobacco products, including cigarettes. In 2021, approximately 76% of students reported exposure to tobacco product marketing through traditional sources and approximately 74% of students who used social media had seen e-cigarette-related posts or content.¹²

Widespread advertising for e-cigarettes, including via media for which advertising for conventional tobacco products is prohibited (e.g., TV), and the lower costs of some e-cigarettes relative to regular cigarettes has contributed to use among youth.¹

Many youth also report using e-cigarettes because they are curious about these products.¹

Many young people who use e-cigarettes also smoke cigarettes.1 There is some evidence that young people who use e-cigarettes may be more likely to smoke cigarettes in the future.

Specifically, a 2018 National Academy of Medicine report found that there was some evidence that e-cigarette use increases the frequency and amount of cigarette smoking in the future.4

E-cigarettes also can be used to deliver other drugs, including marijuana; in 2016, approximately one-third of U.S. middle and high school students who have ever used an e-cigarette reported using marijuana in the device.

But e-cigarette use among young people is still unsafe, even if they do not progress to future cigarette smoking.

E-cigarettes expose users to fewer harmful chemicals than burned cigarettes.1

But burned cigarettes are very dangerous, killing half of all people who smoke long-term.

The use of any tobacco product, including e-cigarettes, is unsafe for young people.

Yes. In August 2016, the regulatory authority of the FDA was extended to cover e-cigarettes through the agency's "deeming rule."

Through authority granted by the Family Smoking Prevention and Tobacco Control Act (FSPTCA), FDA has authority to develop regulations that address the manufacturing, marketing, and sale of e-cigarettes.

There are some strategies that the FDA does not have authority to implement, such as including e-cigarettes in smoke-free policies or increasing the minimum legal sales age for these products, unless directed to do so by Congress. However, the FSPTCA does not prevent states and communities from including e-cigarettes in smoke-free policies or from regulating the sale and distribution of e-cigarettes. These types of strategies can include further raising the minimum legal sales age, licensing retailers, implementing price policies, and restricting or prohibiting the sale of tobacco products.

Yes. In 2018, the FDA expanded its successful youth tobacco prevention campaign, "The Real Cost," to reach the more than 10 million youth aged 12-17 who have used e-cigarettes or are open to trying them. The campaign educates youth about the potential risks of using e-cigarettes.

The "Real Cost" reaches teens where they spend most of their time: in school and online. The campaign is also placing e-cigarette prevention materials in high schools across the nation, both in school bathrooms and on educational digital platforms accessed by students during the school day.

Heated tobacco products (HTPs) like IQOS and Eclipse, sometimes marketed as "heat-not-burn" technology, represent a diverse class of products that heat the tobacco leaf to produce an inhaled aerosol. They are different from e-cigarettes, which heat a liquid that can contain nicotine derived from tobacco.

HTPs are available in at least 40 countries and several have been authorized for sale in the United States by the FDA. In 2018, few U.S. adults (2.4% of all surveyed, including 6.7% of people who currently smoke surveyed) had ever used HTPs. In 2023, 1.0% of U.S. middle and high school students, combined, reported having used heated tobacco products in the past 30 days.¹¹

Scientists are still learning about the short-term and long-term health effects of HTPs, but the available science shows they contain harmful and potentially harmful ingredients. Youth use of any tobacco products, including heated products, is unsafe.

It is important that we continue to modernize proven tobacco prevention and control strategies to include newer products entering the market such as HTPs.

Talk to your child or teen about why e-cigarettes are harmful for them. It's never too late.

Set a good example by being tobacco-free and ensure that your kid is not exposed to the secondhand emissions from any tobacco products, including e-cigarettes.

If you use tobacco, it's never too late to quit. For free help, visit smokefree.gov or call 1-800-QUIT-NOW.

Talk to your child or teen about why e-cigarettes are harmful for them. It's never too late.

Get the Talk With Your Teen About E-cigarettes [PDF - 5.2MB] tip sheet for parents. Start the conversation early with children about why e-cigarettes are harmful for them.

Let your child know that you want them to stay away from all tobacco products, including e-cigarettes, because they are not safe for them. Seek help and get involved.

Set up an appointment with your child's health care provider so that they can hear from a medical professional about the health risks of tobacco products, including e-cigarettes.

Speak with your child's teacher and school administrator about enforcement of tobacco-free school grounds policies and tobacco prevention curriculum.

Encourage your child to learn the facts and get tips for quitting tobacco products at Teen.smokefree.gov.

Fact Sheet for Educators:

Conversation Card for Educators:

1. U.S. Department of Health and Human Services. Smoking Cessation: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020 [accessed 2022 April 4].

2. Truth Initiative Mental Health x Vaping Headline Survey Internal Data - August 2021.

3. Gentzke AS, Wang TW, Cornelius M, et al. Tobacco Product Use and Associated Factors Among Middle and High School Students - National Youth Tobacco Survey, United States, 2021. MMWR Surveill Summ 2022;71(No. SS-5):1-29. DOI: http://dx.doi.org/10.15585/mmwr.ss7105a1.

4. U.S. Department of Health and Human Services. The Health Consequences of Smoking-50 years of Progress: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

5. Birdsey J, Cornelius M, Jamal A, et al. Tobacco Product Use Among U.S. Middle and High School Students - National Youth Tobacco Survey, 2023. MMWR Morb Mortal Wkly Rep 2023; 72(44);1173-1182.

6. Cooper M, Park-Lee E, Ren C, Cornelius M, Jamal A, Cullen KA. Notes from the Field: E-cigarette Use Among Middle and High School Students - United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:1283-1285. DOI: http://dx.doi.org/10.15585/mmwr.mm7140a3

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Quick Facts on the Risks of E-cigarettes for Young People

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Learn quick facts on the risks of e-cigarettes for kids, teens, and young adults, including how they work, why nicotine is unsafe, what is in e-cigarette aerosol, and resources for parents to prevent their child from using e-cigarettes or help them stop.

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CDC - Quitlines and Other Cessation Support Resources 

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CDC - Quitlines and Other Cessation Support Resources 

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Centers for Disease Control and Prevention

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A broad range of cessation support resources are available for patients who want to quit using tobacco. Combined with your ongoing monitoring, support, and treatment, referring patients to a quitline or other cessation resource can improve their chances of quitting.

Quitlines are telephone-based resources available in every US state, the District of Columbia, Puerto Rico, and Guam. See the Frequently Asked Questions (FAQs) that follow for more information about quitlines.

Text Messaging Support through the National Texting Portal can help patients who need on-demand encouragement.
Text QUITNOW to 333888 for free help in English and Spanish, or text DÉJELOYA to 333888 for free help in Spanish (data and message rates may apply).

Web-Based Support can connect patients to cessation-related links and resources for more information. Examples include:

Smartphone Apps may support patients in quitting for good. The National Cancer Institute's quitSTART app offers tips, information, and challenges to keep app users engaged on their quit journey.

Cessation Support Programs, including support groups or intensive counseling, may be available in your health system or local community. Check in your community for more information.

Quitline FAQs

Quitlines are effective, evidence-based tobacco cessation interventions that help tobacco users quit through a variety of service offerings, including counseling, practical information on how to quit, referral to other cessation resources, and mailed self-help materials. ¹

Quitlines:

Are free

Can be easily accessed by calling 1-800-QUIT-NOW

Are confidential

Overcome some of the barriers to seeking tobacco treatment, such as transportation, child care, financial or geographical barriers

Tailor their help to meet the needs of individual callers

Increase a tobacco user's chances of successfully quitting (the 2008 update to the Public Health Service's Clinical Practice Guideline Treating Tobacco Use and Dependence determined that quitlines increased the odds of 6-month abstinence by approximately 60%)²

Are staffed by counselors who are highly trained healthcare professionals

Quitlines may offer a variety of other services, such as web-assisted tobacco interventions and text messaging. They also offer information and support for family, friends, and healthcare professionals who want to help tobacco users quit.

When patients call the quitline, they will be asked about their tobacco use, previous quit attempts, how they heard about the quitline, and some basic demographic questions, including gender, age, race/ethnicity, and education level. Citizenship documentation is not asked. This initial process usually takes about 10 minutes. All information collected is kept strictly confidential and is treated as protected health information.

Callers then receive information about the services the quitline offers. If a caller is interested in receiving mailed self-help materials, an address is taken and materials are typically shipped within 24 hours. If a caller would like referrals to local cessation services or information on Web-based cessation help, that information is provided. If a caller is interested in receiving cessation counseling, he/she is typically transferred to a tobacco cessation counselor. Cessation counselors are highly trained professionals who are skilled in motivational interviewing and delivering client-centered interventions. The counseling session may focus on creating a tailored quit plan, providing medication or decision support in choosing medications, and discussing tips and tools for overcoming everyday urges to smoke.

It is important to note that during times of heavy call volume (especially during national media campaigns that promote 1-800-QUIT-NOW), a cessation counselor may not be immediately available. In these cases, the quitline will schedule an appropriate call-back time with the caller.

After asking if a patient uses tobacco and advising them to quit if they do, you will need to determine if they are ready to quit. For those patients who are not ready to quit, remind them that you have resources to help them quit when they are ready.

If a patient is ready to quit, you can refer them to your state quitline in one of two ways:

Provide your patient with the 1-800-QUIT-NOW number and briefly explain what will happen when they call. This referral method requires your patient to make the initial call to the quitline. For example, you might say:
"I am happy to hear you are ready to quit and I want you to know that help is available. Our state has a telephone-based tobacco quitline that is free and offers help to people who want to quit. When you call you will be asked a few questions about yourself and your tobacco use and then you will have the opportunity to talk to a person who has been trained to help you develop a quit plan."

Use your state quitline's proactive referral system. This referral method prompts the quitline to call your patient directly to start services. In most states, healthcare providers can send a referral with the patient's contact information to the state quitline through a fax or an electronic health record. This typically involves briefly explaining to the patient what will happen when the quitline calls, obtaining the patient's written consent to be contacted by the quitline, and faxing or electronically submitting the referral form. Many quitline referral programs offer feedback to referring providers to track patients' progress. To learn more about the healthcare provider referral program in your state, visit the NAQC Quitline Map. Click on your state to view the quitline profile page.

You can refer Spanish-speaking patients who want to quit to 1-855-DÉJELO-YA (1-855-335-3569), which means "Quit it now." This Spanish-language quitline, which is operated by the National Cancer Institute, functions similarly to 1-800-QUIT-NOW, with callers being automatically routed to their state quitline where they can receive services in Spanish.

1. U.S. Department of Health and Human Services. Smoking Cessation. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020. https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf [PDF - 9.8 MB]

2. Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, 2008. https://www.ahrq.gov/prevention/guidelines/tobacco/clinicians/update/index.html

3. 2012 Task Force on Community Preventive Services review on Quitline Interventions. https://www.thecommunityguide.org/sites/default/files/assets/Tobacco-Quitlines.pdf [PDF - 550 KB]

Quitlines 101 for Healthcare Providers

In addition to your treatment and support, referring your patient to a quitline, like 1-800-QUIT-NOW, can improve their chances of quitting. Quitlines provide free and confidential coaching to help your patients become-and stay-smoke free. Calling a quitline might be just what they need to quit for good. Many thanks to the California Smokers' Helpline for their participation in the creation of this video.

Quitlines Can Help Your Patients Quit Smoking

Combined with your support, calling a toll-free quitline can help your patients quit smoking for good. Refer your patients who smoke to your state quitline through 1-800-QUIT-NOW.

Quitlines Support Your Patients To Quit Smoking

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Quitlines and Other Cessation Support Resources

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A broad range of cessation support resources are available for patients who want to quit using tobacco. Combined with your ongoing monitoring, support, and treatment, referring patients to a quitline or other cessation resource can improve their chances of quitting. Quitlines are telephone-based resources available in every US state, the District of Columbia, Puerto Rico, and Guam.

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Centers for Disease Control and Prevention

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For support in quitting, including free quit coaching, a free quit plan, free educational materials, and referrals to local resources, call ( 1-800-QUIT-NOW 1-800-784-8669).

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See how CDC's Office on Smoking and Health offers links to the Tips® Campaign, benefits of quitting, quitting resources, and cessation materials for state tobacco control programs.

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American Academy of Pediatrics - Cessation Resources 

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American Academy of Pediatrics - Cessation Resources 

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Teachers Often Cancel Recess As A Punishment 

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Teachers Often Cancel Recess As A Punishment 

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Teachers often cancel recess as a punishment. A growing number of states want to change that.

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Taking away recess to discipline elementary school students doesn’t work. Experts say it’s time to stop.

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Tobacco-Free Schools Toolkit - American Heart Association

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Tobacco-Free Schools Toolkit - American Heart Association

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79-3321. It shall be unlawful for any person:

(a) Except as otherwise specifically provided by this act, to possess, sell, transport, import, distribute, wholesale or manufacture more than 1,000 cigarettes without the required tax indicia being affixed as herein provided.

(b) To mutilate or attach to any individual package of cigarettes any stamp that has in any manner been mutilated or that has been heretofore attached to a different individual package of cigarettes or to have in possession any stamps so mutilated.

(c) To prevent the director or any officer or agent authorized by law, to make a full inspection for the purpose of this act, of any place of business and all premises connected thereto where cigarettes are or may be manufactured, sold, distributed, or given away.

(d) To use any artful device or deceptive practice to conceal any violation of this act or to mislead the director or officer or agent authorized by law in the enforcement of this act.

(e) Who is a dealer to fail to produce on demand of the director or any officer or agent authorized by law any records or invoices required to be kept by such person.

(f) Knowingly to make, use, or present to the director or agent thereof any falsified invoice or falsely state the nature or quantity of the goods invoiced.

(g) Who is a dealer to fail or refuse to keep and preserve for the time and in the manner required by this act all the records required by this act to be kept and preserved.

(h) To wholesale cigarettes to any person, other than a manufacturer's salesperson, retail dealer or wholesaler who is:

(1) Duly licensed by the state where such manufacturer's salesperson, retail dealer or wholesaler is located; or

(2) exempt from state licensing under applicable state or federal laws or court decisions including any such person operating as a retail dealer upon land allotted to or held in trust for an Indian tribe recognized by the United States bureau of Indian affairs.

(i) To have in possession any evidence of tax indicia provided for herein not purchased from the director.

(j) To fail or refuse to permit the director or any officer or agent authorized by law to inspect a carrier transporting cigarettes.

(k) To vend small cigars, or any products so wrapped as to be confused with cigarettes, from a machine vending cigarettes, nor shall a vending machine be so built to vend cigars or products that may be confused with cigarettes, be attached to a cigarette vending machine.

(l) To sell, furnish or distribute cigarettes, electronic cigarettes or tobacco products to any person under 18 years of age.

(m) Who is under 18 years of age to purchase or attempt to purchase cigarettes, electronic cigarettes or tobacco products.

(n) Who is under 18 years of age to possess or attempt to possess cigarettes, electronic cigarettes or tobacco products.

(o) To sell cigarettes to a retailer or at retail that do not bear Kansas tax indicia or upon which the Kansas cigarette tax has not been paid.

(p) To sell cigarettes without having a license for such sale as provided herein.

(q) To sell a vending machine without having a vending machine distributor's license.

(r) Who is a retail dealer to fail to post and maintain in a conspicuous place in the dealer's establishment the following notice: "By law, cigarettes, electronic cigarettes and tobacco products may be sold only to persons 18 years of age and older."

(s) To distribute samples within 500 feet of any school when such facility is being used primarily by persons under 18 years of age unless the sampling is:

(1) In an area to which persons under 18 years of age are denied access;

(2) in or at a retail location where cigarettes and tobacco products are the primary commodity offered for sale at retail; or

(3) at or adjacent to an outdoor production, repair or construction site or facility.

(t) To sell cigarettes, electronic cigarettes or tobacco products by means of a vending machine, including vending machines that sell packaged, single cigarettes, in any establishment, or portion of an establishment, which is open to minors, except that this subsection shall not apply to:

(1) The installation and use by the proprietor of the establishment, or by the proprietor's agents or employees, of vending machines behind a counter, or in some place in such establishment, or portion thereof, to which minors are prohibited by law from having access; or

(2) the installation and use of a vending machine in a commercial building or industrial plant, or portions thereof, where the public is not customarily admitted and where machines are intended for the sole use of adult employees employed in the building or plant.

(u) To sell cigarettes, electronic cigarettes or tobacco products by means of a self-service display in any establishment, except that the provisions of this subsection shall not apply to:

(1) A vending machine that is permitted under subsection (t);

(2) a self-service display that is located in a tobacco specialty store; or

(3) a self-service display located in a facility where the retailer ensures that no person younger than 18 years of age is present or permitted to enter at any time.

(v) To sell or distribute in this state; to acquire, hold, own, possess or transport for sale or distribution in this state; or to import or cause to be imported, into this state for sale or distribution in this state:

(1) Any cigarettes the package of which: (A) Bears any statement, label, stamp, sticker or notice indicating that the manufacturer did not intend the cigarettes to be sold, distributed or used in the United States, including but not limited to, labels stating "For Export Only," "U.S. Tax-Exempt," "For Use Outside U.S." or similar wording; or (B) does not comply with: (i) All requirements imposed by or pursuant to federal law regarding warnings and other information on packages of cigarettes manufactured, packaged or imported for sale, distribution or use in the United States, including but not limited to the precise warning labels specified in the federal cigarette labeling and advertising act, 15 U.S.C. § 1333; and (ii) all federal trademark and copyright laws;

(2) any cigarettes imported into the United States in violation of 26 U.S.C. § 5754 or any other federal law, or federal regulations implementing such laws;

(3) any cigarettes that such person otherwise knows or has reason to know the manufacturer did not intend to be sold, distributed or used in the United States; or

(4) any cigarettes for which there has not been submitted to the secretary of the U.S. department of health and human services the list or lists of the ingredients added to tobacco in the manufacture of such cigarettes required by the federal cigarette labeling and advertising act, 15 U.S.C. § 1335a.

(w) To alter the package of any cigarettes, prior to sale or distribution to the ultimate consumer, so as to remove, conceal or obscure:

(1) Any statement, label, stamp, sticker or notice described in subsection (v); or

(2) any health warning that is not specified in, or does not conform with, the requirements of, the federal cigarette labeling and advertising act, 15 U.S.C. § 1333.

(x) To affix any stamp required pursuant to K.S.A. 79-3311, and amendments thereto, to the package of any cigarettes described in subsection (v) or altered in violation of subsection (w).

(y) To possess, sell, transport, import, distribute, wholesale or manufacture cigarettes, smokeless tobacco or roll-your-own tobacco in violation of K.S.A. 50-6a01 et seq., and amendments thereto.

(z) To sell cigarettes, smokeless tobacco or roll-your-own tobacco in any manner that is not a direct, face-to-face exchange between the retailer and the consumer, except: (1) Mail-order sales, which shall not include mail-order redemption coupons and distribution of free samples through the mail; (2) vending machines as provided in subsection (t); and (3) self-service displays as provided in subsection (u).

History: L. 1933, ch. 122, § 18 (Special Session); L. 1939, ch. 329, § 18; L. 1967, ch. 498, § 14; L. 1969, ch. 460, § 1; L. 1988, ch. 384, § 1; L. 1996, ch. 214, § 7; L. 2000, ch. 92, § 3; L. 2010, ch. 8, § 10; L. 2012, ch. 127, § 1; L. 2017, ch. 96, § 11; June 22.

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79-3321. It shall be unlawful for any person: (a) Except as otherwise specifically provided by this act, to possess, sell, transport, import, distribute, wholesale or manufacture more than 1,000 cigarettes without the required tax indicia being affixed as herein provided.

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E-cigarette Policies in Kansas Schools Report - 9-1-21

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E-cigarette Policies in Kansas Schools Report - 9-1-21

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E-cigarette Policies in Kansas Schools Report Final Sept 2021

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Kansas Tobacco Infraction Procedure - 2019 Kansas Statues

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Kansas Tobacco Infraction Procedure - 2019 Kansas Statues

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Time to Play: More State Laws Require Recess

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Time to Play: More State Laws Require Recess

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Jana Della Rosa's 7-year-old son, Riley, never had any particular interest in her job as an Arkansas state representative. At least, not until she started pushing for students to get 40 minutes of recess each day. Then, she says, he transformed into a little lobbyist.

"All this time I haven't had a cool job," said Della Rosa, a Republican from the city of Rogers and a mother of two. "Now Mom has a cool job. He asks me at least weekly, 'Have you got me more recess time yet?'"

Against a backdrop of teacher strikes aimed at systems that feel unresponsive to teachers and students, an effort to pass laws mandating recess for elementary-age children has picked up steam. Kids like Riley aren't the only ones who think it's a good idea: Study after study has shown that unstructured play time is crucial to development, not only benefiting physical health but also improving cognitive faculties not normally associated with play, including focus and recall.

Sensing a movement in the making-one driven by frustrated teachers, parents, and advocacy groups like the National PTA -politicians across the U.S. are introducing legislation that will square the school calendar with the available research and require schools to provide more playtime for young students.

The Research Says...

The benefits of a break in the school day extend beyond the value of the time outside.

A 2014 study of more than 200 elementary students, for example, found that physical activity improved students' fitness and brain function, enhancing their accuracy and reaction time in cognitive tasks. Other studies have concluded that children who have unstructured time during the school day exhibit greater creativity and problem-solving skills, are less disruptive, and learn crucial social lessons like how to resolve disputes and form cooperative relationships.

Citing all of those factors, in 2017 the Centers for Disease Control and Prevention (CDC)-which pointedly differentiates play from physical education, defining recess as "unstructured physical activity and play"-recommended at least 20 minutes of recess a day at the elementary school level.

The American Academy of Pediatrics also weighed in, describing recess in a 2012 policy statement as a "necessary break in the day for optimizing a child's social, emotional, physical, and cognitive development" that should "not be withheld for punitive or academic reasons."

'It Makes Me Want to Cry'

In the last two decades, as the federal No Child Left Behind Act ushered in a new focus on standardized testing-and schools responded to new security concerns and shrinking budgets-recess was increasingly seen as dispensable.

In a push to emphasize core subjects, 20 percent of school districts reduced recess time between 2001 and 2006, according to a study by the Center on Education Policy at George Washington University. And by 2006, the CDC had concluded that one-third of elementary schools did not offer daily recess for any grades.

"When you go back to the start of public schools and the drive to get kids educated 135 years ago, they all had recess," said Robert Murray, a pediatrician who co-authored the American Academy of Pediatrics statement.

"In the '90s, as we got more and more focused on the core courses and academic performance and test scores and all that, people began to look at recess as free time that could be taken away," Murray said.

Researchers and teachers alike say kids have suffered for it. Deb McCarthy, a fifth-grade teacher at Lillian M. Jacobs Elementary School in Hull, Massachusetts, said she started seeing an increase in behavioral problems and anxiety about eight years ago. She blames it on the heightened expectations and loss of playtime at school. There are schools where kids have no recess at all, she said, because time once set aside for play is now dedicated to testing prep.

"It makes me want to cry," McCarthy said, echoing the frustrations of many elementary teachers across the nation, who have argued that more 'seat time' was not developmentally appropriate. "I've been teaching for 22 years, and I've seen firsthand the change."

States of Play

Now some states are trying to reverse course. At least five have a recess law on the books: Missouri, Florida, New Jersey, and Rhode Island mandate 20 minutes of recess daily for elementary students, while Arizona requires two recess periods without specifying a length.

Seven more states-Iowa, North Carolina, South Carolina, Louisiana, Texas, Connecticut, and Virginia-require between 20 and 30 minutes of daily physical activity for elementary schools, leaving it up to schools how to allocate the time. Recently, legislators in Connecticut proposed a bill to increase that state's time commitment to 50 minutes.

Much of the legislation of the last few years has been initiated at the urging of parents and teachers. Florida's law, first proposed in 2016, passed in 2017 after "recess moms" across the state organized on Facebook and lobbied lawmakers. The group now helps parents in other states mount their own fights for free play.

A bill that would have required 20 minutes of recess in Massachusetts failed last year, but McCarthy, a member of the Massachusetts Teachers Association's government relations committee, is hopeful it will pass this year. "We came really close the last time, but then they decided to put it to a study," she said. "I don't know what there really is to study, in all honesty."

Some educators have raised concerns that recess laws add another mandate to a school day that's already jam-packed with requirements. Anna Fusco, president of the Broward Teachers Union and a onetime fifth-grade teacher, said Florida's recess requirement was "a good thing, but they forgot to figure out where it's going to fit."

Others have decided to rethink recess at the school or district level. A program called LiiNK -Let's Inspire Innovation 'N Kids-in several Texas school districts sends kids outside for four 15-minute recess periods daily.

Debbie Rhea, a professor and associate dean at Texas Christian University, launched the initiative after seeing a similar practice in Finland. It reminded her of her own elementary school years.

"We have forgotten what childhood should be," said Rhea, who was a physical education teacher before going into academia. "And if we remember back to before testing-which would be back in the '60s, '70s, early '80s-if we remember back to that, children were allowed to be children."

LiiNK was a big change for the Eagle Mountain Saginaw Independent School District, where schools saw their recess time quadruple after implementing the program four years ago.

"We've seen some amazing changes in our students," said district LiiNK coordinator Candice Williams-Martin. "Their creative writing has improved. Their fine motor skills have improved, their [body mass index] has improved. Attention in the classroom has improved."

New Beginnings

The trend of embracing recess encourages researchers like Murray, who is hopeful that schools will continue giving kids back that critical free time. "I think a lot of schools are starting to say, 'Gee, if our purpose is to try to help students learn, this turns out to be a benefit, not a detriment,'" Murray said.

Betty Warren, a kindergarten teacher at Banyan Elementary in Broward County, Florida, said she always carves out time for her students to unwind. Even when she taught upper grades, she had her math club students hula hoop or bounce balls while doing times tables.

"It's just hard for them to sit for long periods of time, so taking the breaks is very helpful. They're more focused and ready to settle down and listen and learn," she said. "Plus, it makes school fun. I'm a big believer that it's got to be fun."

Back in Arkansas, Della Rosa jokes that she feels like she's "finally able to fulfill that campaign promise I made when I was in fifth grade and running for class president: more recess for everybody."

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Time to Play: More State Laws Require Recess

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Jana Della Rosa's 7-year-old son, Riley, never had any particular interest in her job as an Arkansas state representative. At least, not until she started pushing for students to get 40 minutes of recess each day. Then, she says, he transformed into a little lobbyist.

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Monitored by trained staff or volunteers, recess encourages students in grades K-12 to be physically active and engaged in activities of their choice.

Who Will Benefit From These Resources?
State and school district leaders who provide technical assistance and professional development on recess, as well as:

classroom teachers

recess and playground supervisors

support staff

school administrators

parent-teacher organizations

school health coordinators

advisory councils

parents

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Monitored by trained staff or volunteers, recess encourages students in grades K-12 to be physically active and engaged in activities of their choice. Who Will Benefit From These Resources?

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Kansas Physical Education Competencies - 2024

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Kansas Physical Education Competencies - 2024

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SHAPE - National Physical Education Standards - 2024

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SHAPE - National Physical Education Standards - 2024

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SHAPE America's National Physical Education Standards define what a student should know and be able to do as result of a highly effective physical education program. The standards serve as an important framework to address the holistic development of students and ensure consistency and quality in physical education programs nationwide. States and local school districts across the country use the National Physical Education Standards to develop or revise existing standards, frameworks and curricula.

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New National Physical Education Standards

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SHAPE America's National Physical Education Standards define what a student should know and be able to do as result of a highly effective physical education program. The standards serve as an important framework to address the holistic development of students and ensure consistency and quality in physical education programs nationwide.

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Kansas Health Education Standards - 2018

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Kansas Health Education Standards - 2018

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SHAPE - National Health Education Standards - 2024

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SHAPE - National Health Education Standards - 2024

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SHAPE America's National Health Education Standards define what a student should know and be able to do as result of a highly effective health education program. States and local school districts across the country use the National Health Education Standards to develop or revise existing standards, frameworks and curricula.

The new National Health Education Standards - released in March 2024 after a multi-year revision process - provide a comprehensive framework for educators to deliver high-quality instruction and make a positive difference in the health and well-being of every student.

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National Health Education Standards (NHES)

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SHAPE America supports the National Health Education standards, PreK-12 and supports health educators with tools and information to establish, promote, and support health-enhancing behaviors in schools.