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MMWR — Effectiveness
of
School-Based
Programs
as
a
Component
of
a
Statewide
Tobacco
Control
Initiative
—
Oregon,
1999–2000
Entire
Document
in
Adobe
Acrobat
Format
—
(PDF-170K)
With funds available from revenue generated by a
voter-initiated
ballot
measure
to
increase
the
state
cigarette
excise
tax
(1),
the
Oregon
Health
Division
(OHD)
created
the
Tobacco
Prevention
and
Education
Program
(TPEP)
in
1997.
Coalitions
in
all
Oregon
counties,
a
counter
marketing
campaign,
a
statewide
tobacco
cessation
quitters’
help
line,
and
competitive
grants
to
community
groups,
tribal
associations,
and
school
districts
are
supported
by
TPEP (2);
12%
of
TPEP’s
$8.5
million
annual
funding
was
used
to
implement
CDC’s
Guidelines
for
School
Health
Programs
to
Prevent
Tobacco
Use
and
Addiction
(3)
in
23
school
districts
or
consortia
of
districts.
Data
from
annual
school-based
surveys
conducted
to
monitor
adolescent
risk
behavior
indicated
that
from
1999
to
2000,
30-day
smoking
prevalence
among
eighth
grade
students
declined
more
in
funded
schools
than
in
a
comparison
group
of
nonfunded
schools.
The
declines
were
significantly
greater
among
schools
with
high
and
medium
levels
of
implementation.
These
results
suggest
that
comprehensive
school-based
programs
can
be
an
effective
component
of
statewide
antitobacco
efforts.
Data
on
smoking
behavior
among
students
were
collected
by
OHD
from
either
the
Oregon
Public
School
Drug
Use
Survey
(OPSDUS)
questionnaire
or
the
Youth
Risk
Behavior
Survey
(YRBS)
questionnaire.
In
1999,
49
(53%)
of
93
funded
schools
and
61
(25%)
of
246
nonfunded
schools
used
the
YRBS
questionnaire.
In
2000,
58
funded
schools
and
47
non
funded
schools
used
either
the
OPSDUS
or
YRBS
questionnaires.
All
analyses
were
based
on
data
from
38
funded
schools
and
14
nonfunded
schools
that
participated
in
both
1999
and
2000.
Eighth
graders
were
selected
for
analysis
because
TPEP’s
most
intensive
interventions
targeted
middle
schools,
which
meant
that
eighth
graders
in
2000,
who
were
seventh
graders
in
1999,
had
been
exposed
to
the
program
for
2
years.
Smoking
prevalence
for
1999
and
2000
was
measured
in
both
funded
and
nonfunded
schools,
and
multivariate
logistic
regression
was
used
to
compare
the
2000
difference
in
prevalence
between
the
two
groups
of
schools.
Prevalence
in
2000
in
schools
with
high,
medium,
or
low
program
implementation
scores
also
was
compared
with
2000
prevalence
in
nonfunded
schools.
Among
the
52
schools,
1942
(55%)
of
3519
eighth
graders
surveyed
attended
funded
schools
in
1999.
In
2000,
4089
(74%)
of
5556
eighth
graders
surveyed
attended
funded
schools.
Funded
schools
were
required
to
conduct
an
eighth
grade
student
census;
nonfunded
schools
participated
on
a
voluntary
basis.
The
number
of
participating
students
varied
as
a
result
of
differences
in
sampling
protocol
between
the
two
surveys.
Without
knowledge
of
the
school
survey
results,
each
funded
school
district
was
categorized
on
cumulative
implementation
(progress
before
and
during
funding)
of
six
areas
identified
in
CDC
guidelines
(3):
tobacco-free
school
policies,
family
involvement,
community
involvement,
tobacco
prevention
curriculum
instruction,
teacher/staff
training,
and
student
tobacco
use
cessation
support.
Tobacco-free
school
policies
were
assessed
by
summing
the
number
of
elements
completed
out
of
19
(3).
Family
involvement
and
student
tobacco
use
cessation
support
were
assessed
by
summing
the
total
completed
out
of
five
criteria
in
each
of
two
components
(3).
Community
involvement
was
measured
by
whether
the
district
sent
a
representative
to
community
tobacco
coalition
meetings;
teacher/staff
training
was
assessed
by
whether
the
district
had
provided
training
during
the
survey
period;
and
tobacco
prevention
curriculum
instruction
was
assessed
by
the
implementation
of
a
CDC-identified
curriculum.
The
quartile
score
for
the
first
three
areas
(scored
one
to
four)
was
added
to
the
dichotomous
measures
of
the
latter
three
areas
("yes"
was
scored
zero
and
"no"
was
scored
one)
for
a
final
score
that
ranged
from
three
(best
score)
to
15
(worst
score).
Based
on
natural
cut-off
points
in
the
distribution
of
scores,
the
schools
then
were
classified
as
low
(nine–15),
medium
(six–eight),
or
high
(three–five)
on
the
six
areas.
Of
the
38
participating
funded
schools,
14
were
in
low-ranked
districts,
15
were
ranked
medium,
and
nine
were
ranked
high
on
implementation
criteria.
Both
the
YRBS
and
OPSDUS
self-report
questionnaires
were
administered
anonymously
to
all
students
in
the
participating
eighth
grade
classrooms.
The
YRBS
question
used
to
determine
smoking
status
was
"During
the
past
30
days,
on
how
many
days
did
you
smoke
cigarettes?"
The
OPSDUS
question
was
"How
frequently
have
you
smoked
cigarettes
during
the
past
30
days?"
Students
who
indicated
that
they
had
smoked
on
>1
days
were
classified
as
smokers
on
each
survey.
In
1999,
no
statistical
differences
were
observed
in
student
or
school
characteristics,
including
eighth
grade
smoking
prevalence,
in
funded
versus
non
funded
schools.
The
30-day
smoking
prevalence
decreased
from
16.6%
in
1999
to
13.0%
in
2000
(P=0.002)
in
funded
schools
and
from
17.0%
in
1999
to
15.7%
in
2000
(P=0.47)
in
nonfunded
schools.
Stratified
by
implementation
level
in
1999
and
2000,
changes
in
prevalence
among
eighth
grade
students
were
larger
in
schools
in
districts
with
high
(from
14.2%
to
8.2%)
or
medium
(from
17.8%
to
13.9%)
ratings;
changes
in
smoking
prevalence
in
schools
in
districts
with
low
ratings
(from
17.1%
to
15.6%)
were
almost
equal
to
those
in
non
funded
schools
(from
17.0%
to
15.7%)
(Figure
1).
Logistic
regression
was
conducted
to
compare
prevalence
in
funded
and
non
funded
schools
and
was
adjusted
for
respondent
sex,
other
substance
use
(e.g.,
alcohol,
cocaine,
marijuana,
and
inhalants),
school
size,
school
geographic
location
in
state,
and
socioeconomic
status
of
each
school.
Based
on
the
regression
model,
students
in
the
funded
schools
in
2000
were
approximately
20%
less
likely
to
smoke
(odds
ratio=0.8;
95%
confidence
interval
[CI]=0.7–1.0*)
compared
with
students
in
nonfunded
schools.
School
funding
status
in
1999
was
not
associated
with
student
smoking
prevalence.
Based
on
similar
multivariate
logistic
regression
analyses
using
2000
results,
the
odds
of
an
eighth
grade
student
reporting
smoking
during
the
past
30
days
were
lowest
among
schools
in
districts
with
high
or
medium
cumulative
implementation
(Table
1).
Reported
by:
K
Rohde,
MA,
B
Pizacani,
MPH,
M
Stark,
PhD,
M
Pietrukowicz,
PhD,
C
Mosbaek,
C
Romoli,
MPH,
M
Kohn,
MD,
J
Moore,
PhD,
Oregon
Health
Div.
Office
on
Smoking
and
Health
and
Div
of
Adolescent
and
School
Health,
National
Center
for
Chronic
Disease
Prevention
and
Health
Promotion,
CDC.
Editorial
Note:
The
findings
in
this
report
suggest
that
a
comprehensive
school-based
tobacco
prevention
program
that
includes
tobacco-free
school
policies
and
community
involvement
as
one
component
of
a
statewide
tobacco
program
may
contribute
to reductions
in
current
smoking
among
eighth
graders
(3).
Figure
1.
Percentage
of
eighth
grade
public
school
students
who
reported
smoking
during
the
past
30
days,
by
tobacco
use
prevention
program
implementation
score — Oregon,
1999
and
2000*
*
1999
data
from
Youth
Risk
Behavior
Survey
(YRBS)
questionnaire,
and
2000
data
from
either
the
YRBS
or
the
Oregon
Public
School
Drug
Use
Survey
questionnaire.
TABLE
1.
Odds
ratios
for
completeness
of
program
implementation
and
reduction
in
smoking
prevalence
—
Oregon,
2000
Completeness |
No. schools |
No.students |
Smoking prevalence (%) |
Odds Ratio |
(95% CI†) |
Un funded |
14 |
1467 |
15.7% |
ref |
— |
Lowest ranked |
14 |
1303 |
15.6% |
1.0 |
(0.8-1.3) |
Medium ranked |
15 |
1725 |
13.9% |
0.8 |
(0.6-1.0)§ |
highest ranked |
9 |
1061 |
8.2% |
0,7 |
(0.5-0.9) |
* Past
30
day
prevalence
of
smoking
adjusted
for
sex
of
respondent;
other
substance
use;
size,
region,
socioeconomic
status
of
school;
and
school
clustering
effect.
†
Confidence
interval.
§
Values
rounded
to
one
decimal
place,
but
CI
did
not
include
1.0.
The
significantly
greater
declines
in
smoking
prevalence
in
the
schools
that
rated
high
and
medium
on
implementation
criteria
emphasize
the
importance
of
monitoring
activity
in
funded
school
programs
and
the
need
for
ongoing
assistance
to
facilitate
implementation
of
evidence
based
recommendations
(3).
The
findings
in
this
report
are
subject
to
multiple
limitations.
Two
different
student
surveys,
each
with
slightly
different
questions,
were
used
to
measure
prevalence.
Question
wording
and
context
in
the
questionnaires
may
have
affected
responses
(4).
Funded
districts
self-selected
to
apply
for
the
competitive
grants
to
implement
the
tobacco
prevention
program
and
represented
approximately
one
third
of
the
public
school
students
in
Oregon.
Among
them,
only
38
of
93
schools
conducted
school-based
surveys
in
both
1999
and
2000.
The
nonfunded
schools
also
represented
a
self-selected
sample,
and
the
14
nonfunded
schools
with
survey
data
from
both
1999
and
2000
represented
only
6%
of
all
nonfunded
Oregon
schools.
The
funded
and
nonfunded
schools
may
have
differed
in
unmeasured
characteristics
(e.g.,
the
effectiveness
of
a
county
coalition’s
anti
tobacco
activities)
that
may
have
influenced
2000
smoking
prevalence.
In
the
multivariate
analyses,
sample
clustering
by
school
was
represented
in
the
analysis;
however,
variable
sampling
rates
within
each
school
could
not
be
accounted
for
because
information
on
these
rates
was
unavailable.
Student
smoking
prevalence
was
based
on
self-reports,
and
in
schools
with
stronger
programs,
students
might
have
underreported
smoking
because
of
stronger
antismoking
norms.
No
information
was
available
on
the
student
response
rate
for
the
schools
in
this
study;
however,
the
average
student
response
rate
for
Oregon
surveys
using
the
YRBS
questionnaire
has
been
78%.
Changes
in
smoking
prevalence
from
1999
to
2000
were
based
on
comparisons
of
cross-sectional
samples
of
eighth
graders
rather
than
on
a
longitudinal
cohort.
Measurements
of
program
implementation
were
based
on
coordinator
self-reports
and,
although
these
reports
assessed
policies
for
a
range
of
characteristics,
they
did
not
include
measures
of
policy
enforcement,
and
the
self-reports
could
not
be
validated
externally.
Finally,
the
results
of
this
study
were
based
on
a
comparison
of
only
2
years
of
data,
and
further
surveillance
is
necessary
to
confirm
trends
and
the
impact
of
this
school-based
program.
The
implementation
of
a
tobacco
prevention
curriculum
alone
may
be
insufficient
to
prevent
cigarette
smoking
among
adolescents
(5).
CDC
recommends
a
combination
of
tobacco-free
school
policies
and
an
evidence-based
curriculum
linked
to community wide programs
involving
families,
peers,
and
organizations.
School-based
activities
are
most
effective
when
integrated
with
counter
marketing
campaigns
and
community-based
activities
(6).
Several
states,
including
Oregon,
have
reported
declines
in
youth
smoking
rates
after
implementing
multicomponent
tobacco
prevention
and
control
efforts
(2,7–
9).
Consistent
with
CDC’s
Best
Practices
for
Comprehensive
Tobacco
Control
Programs
(10),
the
data
in
this
report
suggest
that
school-based
programs
can
be
an
effective
element
of
statewide
tobacco
prevention
and
education.
References*
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CDC.
Decline
in
cigarette
consumption
following
implementation
of
a
comprehensive
tobacco
prevention
and
education
program—Oregon,
1996–1999.
MMWR
1999;48:140–3.
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Oregon
Health
Division.
Delivering
results:
saving
lives
and
saving
dollars.
Tobacco
prevention
and
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in
Oregon.
Portland,
Oregon:
Department
of
Human
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2000.
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MMWR
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Questions
and
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AV
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Kealey
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SL,
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PM,
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long-term
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J
Natl
Cancer
Inst
2000;92:1979–91.
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CDC.
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use:
a
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the
Surgeon
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Atlanta,
Georgia:
US
Department
of
Health
and
Human
Services,
Public
Health
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CDC,
2000.
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Oregon
Health
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Tobacco
prevention
and
education
program
report—1999.
Portland,
Oregon:
Department
of
Human
Services,
Oregon
Health
Division,
1999.
-
Bauer
UE,
Johnson
TM,
Hopkins
RS,
Brooks
RG.
Changes
in
youth
cigarette
use
and
intentions
following
implementation
of
a
tobacco
control
program:
findings
from
the
Florida
Youth
Tobacco
Survey,
1998–2000.
JAMA
2000;284:723–8.
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Massachusetts
Department
of
Public
Health.
Adolescent
tobacco
use
in
Massachusetts:
trends
among
public
school
students—1996–1999.
The
Commonwealth
of
Massachusetts,
Office
of
Health
and
Human
Services,
Department
of
Public
Health,
June
2000.
-
CDC.
Best
practices
for
comprehensive
tobacco
control
programs—August
1999.
Atlanta,
Georgia:
US
Department
of
Health
and
Human
Services,
Public
Health
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CDC,
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*All
MMWR
references
are
available
on
the
Internet
at
http://www.cdc.gov/mmwr.
Use
the
search
function
to
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