Policy! Policy! Policy!!Workplace and SchoolJane PritzlCDC - Division of Adolescent and School Health

Iowa 04

Centers for Disease Control and PreventionDivision of Adolescent and School Health

POLICY

1. A method or course of action adopted by a government, business organization, etc. designed to influence and determine decisions

2. A guiding principal or procedure

Individual Environmental

Elements of a Policy Initiative

1. Belief or Mandate - What’s driving us? Protection from second-hand smoke

2. A team

3. Data - What’s our situation?

4. Strategy - What’s our plan?

Educate and Advocate – a

communication plan

Assist, Reduce Barriers,

Monitor and Provide Feedback

Advocate

What Workplaces??

Start with a clear goal and a clear target

Think broadly about worksites

1. Consider numbers, proportion - During the normal workday you can find 20% of the population in schools – where else are you’re people

government buildings

hospitals

airports

2. Consider vulnerable populations – children, elderly

rec centers

shopping centers

restaurants

prisons

Workplace Policies

Tobacco-free buildings

Smoke-free buildings, that disallow smoking near

entrances, windows, and air intake units,

Separate, contained indoor smoking areas that are

under negative pressure relative to non-smoking areas

Smoking restricted campuses

The Team

Make it a group effort

You can bring in a crowd faster with a choir than with a solo

1. Committee – standing or ad hoc

2. Identify partners close to the action,

shared mission

3. Collect testimony

The Data

CPS Data (Current Population Survey)

69.9% - no smoking in common areas and work areas

National average 69%

State Dept of Labor – Labor Market Info

can sort by name, industry, size

Chamber

State or Regional Organizational Training Organizations

Specifc Industry Associations - BOMA

A. Educate and Advocate

Compelling argument? Sales pitch? Your message?

Broad brush – your media campaign – second hand smoke

Targeting can be a challenge – different channels, different plans

Organizations don’t innovate or implement change, individuals do.

Who are the individuals?

Relationship, Relationship, Relationship

Who do you have to reach and where do you need to be

Rotary

Lions Clubs

Hospital Association Conferences

Human Resource Management Meeting

Restaurant Associations

Recreation Association Meetings

Small Business Association

Be Where The Tobacco Industry Is

Who’s the Audience?

What do they need to hear?

What do they need to hear?

From whom should the message come?

Who’s responsible for making this happen?

Results?

Rocky Mountain Emp

Association

City Rec

Center Board

Restaurant

Association

Rotary

B. Assist, Reduce Barriers, Make it Easy

Before you get out there –

cessation programs

signage - restaurants

testimony

model policies

workplace implementation guides

TA, handholding

keep you ear to the ground

C. Monitoring or Tracking: Be Thinking . . .

CPS

Local tracking –

Large employers

Restaurants – GASP

Public Places –

Employer’s Organization - survey

BOMA

Testimony -

“I don’t mind the policy coming in, it will help

me quit”

“ I think it’s cleaner around here.”

“I feel I’ve reduced my liability as an employer and overall most employees are much happier.”

Elements of a Policy Initiative

1. Belief or Mandate - What’s driving us? Protection from second-hand smoke

2. A team

3. Data - What’s our situation?

4. Strategy - What’s our plan?

Educate and Advocate – a

communication plan

Assist, Reduce Barriers,

Monitor and Provide Feedback

Advocate

At the Outset. …..…Our Mission Our Network

Start with a clear goal and a clear target/ channel

100% Tobacco-Free Schools

Make it a group effort

You can bring in a crowd faster with a choir than with a solo

1. Committee – standing or ad hoc

2. Identify partners close to the action, shared mission

3. Collect testimony

Pro-Children Act

No person shall permit smoking within any indoor facility utilized for services to kindergarten, elementary, or secondary education or library services to children. Also included is children’s services for routine health care or day care or early childhood development.

This applies to all schools and programs that are funded by the Federal Government or through State or local Governments by Federal grant, loan, loan guarantee or contract programs.

…penalty not to exceed $1000 ….each day

Comprehensive School Tobacco Policy

1. Rationale

2. Tobacco-Free Environment

3. Advertising and promotion

4. Tobacco prevention instruction

5. Tobacco use cessation

6. Communication plan

7. Enforcement plan

Collaboration With the Private Sector

Is there a fit between mission and priorities?

What is the effect of the potential partner’s products or services on health?

What is the behavior of the potential private partner?

How would a collaboration fit with our public image?

School Tobacco PolicyTobacco-Free Environment

Prohibits tobacco use

on school property,

in school vehicles,

at school- sponsored events (on and off school property)

for students, staff, and visitors

Bottom Line ………

1. Protect all occupants from second-hand

smoke

2. Eliminate the opportunity to participate

in tobacco use

3. Eliminate access to tobacco

4. Reduce the instances to observe

use by peers or adults

Our Data, Baseline – Local Level

Colorado

North Carolina

New York

Georgia

Oregon

Wisconsin grantees

Dear Superintendent;

1. Do you have a district-wide tobacco use policy?……………………..…….yes no

2. If you have a policy, what areas does it cover and for whom? Please check all that apply.

Students Staff Visitors

Prohibits tobacco use in all school buildings by

Prohibits tobacco use on all school property including, grounds, parking lots, play fields

Prohibits tobacco use in school vehicles, buses, etc.

Prohibits tobacco use at all school sponsored events, on and off school property, athletic events, concerts, field trips

3. Is your policy in effect at all times?………………………………………..yes no

A. Educate and Advocate

Compelling argument? Your Message??

Broad brush

Presentations at conferences?

Endorsement of State Dept of Ed?

National School Association – local?

very targeted personal presentations

How To Work With Schools Identify decision makers

Respect the hierarchy but keep things moving

Schools share a mission to develop health but are rewarded for academic achievement

What’s in it for them?

Relationship, relationship

Be brief, be positive, be prepared to deal with objections

Timing has an impact

Be persistent

Review of The Case(1) Preventing tobacco use and promoting a tobacco-free lifestyle is a critical public

health priority.

(2) Preventing tobacco use and promoting a tobacco-free lifestyle among youth is essential.

(3) Promoting the health of youth, especially preventing tobacco use among youth is an important educational priority.

Causes of All Deaths in the U.S., 1998

CardiovascularDisease

39%

Cancer23%

COPD5%

Diabetes3%

Other Causes30%

Source: CDC, National Vital Statistics Reports 2000: 48(11)

This is equivalent to three jumbo jets crashing each day!This is equivalent to three jumbo jets crashing each day!

Actual Causes of Death in the United States, 1990

Source: McGinnis JM, Foege WH. JAMA 1993;270:2207-12.

100,000 90,000

30,000 20,000

0

100,000

200,000

300,000

400,000

500,000

Tobacco Diet/Activity Alcohol Microbialagents

Sexualbehavior

Illicit use ofdrugs

300,000

400,000

Percentage (of all deaths)

Heart Disease

Cancer

Chronic lower respiratory disease

Unintentional Injuries

Pneumonia/influenza

Diabetes

Alzheimer’s disease

Kidney Disease

Stroke

0 5 10 15 20 25 30 35

* National Center for Health Statistics. Mortality Report. Hyattsville, MD: US Department of Health and Human Services; 2002† Adapted from McGinnis Foege, updated by Mokdad et. al.

Causes of DeathUnited States, 2000

Actual Causes of Death†Leading Causes of Death*

Tobacco

Poor diet/lack of exercise

Alcohol

Infectious agents

Pollutants/toxins

Firearms

Sexual behavior

Motor vehicles

Illicit drug use

Percentage (of all deaths)0 5 10 15 20

• 80% of adult smokers started smoking before they finished

high school. 1

Why Focus on Youth?

Sources: (1) U.S. DHHS. Surgeon General’s Report: Preventing Tobacco Use Among Young People, 1994

(2) CDC, National Youth Risk Behavior Survey, 1997

Sources: (1) U.S. DHHS. Surgeon General’s Report: Preventing Tobacco Use Among Young People, 1994

(2) CDC, National Youth Risk Behavior Survey, 1997

• 25% of high school students smoked a whole cigarette before age 13. 2

Why Focus on Youth?

• If current patterns of smoking behaviors continue, an estimated 6.4 million of today’s children can be expected to die prematurely from a smoking-related disease

• If current patterns of smoking behaviors continue, an estimated 6.4 million of today’s children can be expected to die prematurely from a smoking-related disease

Percentage of Adults and High School Students Who Smoked Cigarettes*, 1991-2001

0

5

10

15

20

25

30

35

40

45

1991 1993 1995 1997 1999 2001

years

perc

ent

Adults (1)High School Students (2)

*Any use in the past 30 daysSource: (1) SAMHSA, National Household Survey on Drug Abuse (2) CDC, Youth risk Behavior Surveillance System

Percentage of Adults and Youth Who Smoked Cigarettes*, 1990-2001

90

0

5

10

15

20

25

30

35

40

45

91 92 93 94 95 96 97 98 99 2000 2001

Perc

en

t

YearYear*Any use in the past 30 daysSource: (1) SAMHSA, National Household Survey on Drug Abuse (2) Monitoring the Future Study, Univ. of Michigan

Adults (35 and older)1

-16%

Youth age 12 thru 17 1 -37%

Youth age 18-26 1

no change

High School Seniors 2

no change

Rank

2

3

4

5

6

7

8

9

10

11

12

Average % of“Definitely” responses

62.6

59.4

57.4

50.1

49.8

49.0

48.7

48.2

44.2

42.5

Average Percentage of Respondents Who Said Students Should Definitely Know or Be Able to Do

Subject Standards by High School Graduation Subject

1 73.9Health

40.8

Work SkillsLanguage ArtsTechnologyMathematicsThinking and ReasoningScienceCivicsBehavioral StudiesPhysical EducationEconomicsHistory

Source: McREL. What Americans Believe Students Should Know, 1999

Who’s the Audience?

What do they need to hear?

What do they need to hear?

From whom should the message come?

Who’s responsible for making this happen?

Results?

School Board

Superintendents

Principals (HS)

Parents

Students

Youth Advisory Group

Objections to Tobacco Free Schools

1. We stick with the law and don’t go beyond that

2. I’m not about to offend parents and visitors

3. It’s not the norm around here

4. I’m not going to pull a chaw out of some cowboys’ jaw

5. This will never work for the alternative school kids, this is their last chance and if a policy like this goes in, they won’t come to school

6. I don’t want kids crossing the street, creating a safety hazard for themselves and a liability issue for me

7. I don’t want kids out in the neighborhood. I’ll get complaints

8. I don’t want kids over in the park where they will be exposed to gangs and drugs.

B. Assist, Reduce Barriers, Make it Easy

Before you get out there –

alternative to suspension

cessation programs

signage

testimony

model policies

keep you ear to the ground

C. Monitoring or Tracking: Be Thinking . . .

YRBS / YTS

CDC’s School Health Profiles

State Assessment directed to

Policy Makers or

Safe & Drug Free School Coordinators or ….

On-site surveillance by official types

Reported compliance by parents or insiders

Recording contacts via data base or contact management software

Testimony -

"I really expected to have problems with

enforcing it. I have been surprised that there

have been no real difficulties at all. I announce it at every game- and so far there has been maybe one time that someone lit up before they left campus." Principal

“ I hear administrators complaining that implementing a tobacco free policy is hard. Heck! Teaching math is hard! Doesn’t mean we shouldn’t be doing it.” Principal

“Anyone who says they can’t enforce this is just whining”Principal

Schools could do more than perhaps any other single institution in society to help young people, and the adults they will become, to live healthier, longer, more satisfying, and more productive lives.

Carnegie Council on Adolescent Development

I in 20, 000 for airplane crash

Second hand smoke 1 in 55