Research Papers School Tobacco Policies in a Tobacco-Growing State Ellen J. Hahn, Mary Kay Rayens, Rob Rasnake, Nancy York, Chizimuzo T.C. Okoli, Carol A. Riker ABSTRACT: This study examined factors associated with tobacco-free policies and tobacco cessation in schools serving children in grades 6 to 12 in a tobacco-growing state using a cross-sectional telephone survey of school administrators from public and private middle and high schools (N = 691), representing 117 of the 120 Kentucky counties. Trained health department staff contacted 1028 schools; 691 (67%) participated in a phone survey, which lasted an average of 19 minutes. Variables of interest were indoor and outdoor smoking policies, fund-raising in Bingo halls, provision of cessation and prevention programs, owning or leasing a tobacco base, if the school received money from tobacco companies, type of school (public vs private), and school setting (urban vs rural). Only 20% of Kentucky schools reported comprehensive tobacco-free policies. Urban area schools were nearly twice as likely to have a tobacco-free campus than rural schools. Schools that did fund-raising in smoky Bingo halls were 30% less likely to have tobacco- free school policies. While few schools had a tobacco affiliation, those that received money from tobacco companies or grew tobacco were nearly 3 times as likely to provide cessation resources, compared to schools without tobacco affiliation. Rural schools were less likely to be tobacco free and provide cessation services. School-related, off-campus, extracurricular events might be considered as an element of tobacco-free school policy. Schools with tobacco affiliation may provide more cessation resources due to the increased prevalence of tobacco use in these areas. (J Sch Health. 2005;75(6):219-225) T he prevalence of youth smoking, while showing a downward trend, still bodes poorly for the future health of Americans. According to the 2002 Youth Tobacco Survey, 11% of US middle school students and 28% of high school students smoked cigarettes in the past 30 days. 1 Smoking is established early and is a difficult addiction to break. Young people overrate their ability to quit. 2 In fact, symptoms of tobacco dependence develop rapidly even after the onset of intermittent smoking, eg, 2 cigarettes, 1 day per week. 3 Despite the fact that only 5% of high school daily smokers predicted they would be smoking in 5 years, three quarters of those in the Monitor- ing the Future Study were daily smokers 7 to 9 years later. 2 If current teenage smoking behaviors continue, an esti- mated 6.4 million of today’s children will die prematurely from a smoking-related disease. 4 The development, implementation, and strong enforce- ment of tobacco-free policies in schools may result in lower rates of smoking among adolescents. 5-7 Smoke-free policies may not only facilitate prevention efforts but also contribute to improved cessation rates. The report of the 1999-2000 Statewide Tobacco Control Program in Oregon concluded that school-based programs including smoke- free policies and community involvement as part of a state- wide program may contribute to cessation efforts in eighth- grade smokers. 8 Hamilton et al 9 found lower smoking rates at schools that used education or counseling along with dis- ciplinary sanctions for violators than schools using only disciplinary measures. Peck et al 10 suggested that schools’ efforts to eliminate tobacco use by adolescents are more effective when health education is combined with school policies and adult role models convey the message that tobacco use is unhealthy and unacceptable. Not only is it critical to consider tobacco-free policies in the school building but it is also important to provide protection from secondhand smoke exposure for children and their families during extracurricular, school-related fund-raising activities such as Bingo. Tobacco-free school policies designed, im- plemented, and evaluated to support students and faculty in the process of improving health-related outcomes may be most beneficial to facilitate positive behavioral change. 11 Little empirical data document the predictors of enact- ment and/or enforcement of school antismoking policies. School policies vary from state to state, with stronger state antismoking laws supporting successful implementa- tion of local school antismoking polices. 12 Tencati et al 13 found that high school students already engaged in advo- cacy related to alcohol, tobacco, and other drugs produced policy-level changes in their schools and communities. North Carolina school districts that passed 100% tobacco- free policies typically harvested less tobacco than districts that did not pass such policies. 14 Counties with signifi- cant tobacco production required additional resources and strategies to enact tougher school policies. In regard to the potential impact of tobacco industry corporate influence on schools, Rosenberg and Siegel 15 found that ‘‘tobacco corporate sponsorship involved small, community-based organizations, both through direct funding and through grants to larger umbrella organizations.’’ Ellen J. Hahn, DNS, RN, Professor, (ejhahn00@email.uky.edu), Univer- sity of Kentucky College of Nursing and College of Public Health, 760 Rose St, Lexington, KY 40536-0232; Mary Kay Rayens, PhD, Associate Professor, (mkrayens@uky.edu), University of Kentucky Colleges of Nursing, Medicine, and Public Health, Lexington, KY 40536-0232; Rob Rasnake, MA, LPCC, NCC, Data Management Coordinator, (robrasnake@ hotmail.com), Kentucky Tobacco Policy Research Program; Nancy York, MSN, RN, PhD, Student and Research Assistant, (lyork2@uky.edu); Chizimuzo T.C. Okoli, MSN, RN, PhD, Candidate and Research Assis- tant, (ctokol1@uky.edu); and Carol A. Riker, MSN, RN, Associate Profes- sor, (riker@uky.edu), University of Kentucky College of Nursing, Lexington, KY 40536-0232. This study was funded through a contract with the Kentucky Cabinet for Health and Family Services. Journal of School Health d August 2005, Vol. 75, No. 6 d 219