The comprehensive approach requires a well developed health education curricula including tobacco prevention programs, easy access to smoking cessation programs, social support in the home and community, and a consistent, healthy environment where non-smoking is the norm.Health Education and the Prevention of Tobacco Use: Health education curricula should emphasize the development of decision making and assertiveness skills, critical thinking, and self-esteem through both subject matter and appropriate teaching techniques. A planned, sequential program for elementary and high school grades requires the allocation of sufficient classroom time, adequately trained staff, and effective educational materials. The tobacco use prevention component of the curricula must incorporate the latest knowledge in terms of goals, focus, duration, resources, and reinforcement of the program.
Intervention and Support Services: Students and staff who are using tobacco products should have ready access to smoking cessation information and programs, as well as support once they have quit. Teachers, guidance counselors, school health nurses and other school professionals must be well informed on how to support those who want to stop smoking or maintain the decision to quit. This is best accomplished through an interagency arrangement between school boards, health units and voluntary health agencies for referral, programs and support both within schools and in the community. In addition, school boards, boards of health, and social services agencies need to have complementary health promotion policies that incorporate guidance, psychological, crisis intervention and health clinic services for youth.
Social Support: Support in the home and community is central to preventing and reducing tobacco use by youth. Such support includes tobacco and health programs for families, public awareness campaigns, regular smoking prevalence surveys, media exposure, effective public policy, a "mentorship" approach for high-risk youth, and mobilizing self-help groups and community organizations. Peer leadership programs for young people which include a focus on smoking prevention help to provide peer support for healthy lifestyle choices.
A Consistent, Healthy Environment: The overall environment in the school, home and community should support a consistent message that non-smoking is the norm. This means schools, school boards, health units and other community organizations should have well publicised comprehensive smoking policies and effective enforcement procedures in place. Adequate tobacco control legislation is required at municipal, state/provincial and national levels. Local businesses, service clubs, media, and health care professionals need to play a central role in supporting tobacco control policies and legislation.
Compliance: Responsibility for policy enforcement should rest with assigned district administrators, principals and teachers. A specified procedure for reporting infractions should be in place.
Collaboration and Coordination: Smoking control policies should be part of a school/school board effort to work with the community to prevent tobacco use. Programs of voluntary and other community agencies dealing with tobacco should be linked to school policy implementation.
Communication: The policy should be proactively communicated to students, staff, parents and the community on a regular basis.
Concordance: The policy should be at least as strong as municipal by-laws and state/provincial/territorial directives which restrict or prohibit smoking.
Enforcement: Clearly specify penalties, reporting, enforcement and follow-up procedures to students, parents and staff and also their respective responsibilities at the beginning of each school year. Use prominent no-smoking signs to support the policy.
Resistance to a New Role for Schools: Schools are being asked to play an increasing role in preventing health and social problems. AIDS, substance abuse and many other issues are competing for space in already overcrowded curricula. Resistance to new demands on schools can be reduced by integrating smoking policies and programs with other health-related policies and programs. It is also important to use the social norms of the local community and involve parents, health professionals and community leaders in the process.
Additional Costs: Resistance can arise if implementation of the policy is perceived to involve extra costs. Studies indicate that almost all additional expenses are associated with start-up. Once implemented, smoking control policies pose little additional financial burden. At all times, emphasis should be placed on long-term savings in terms of absenteeism and improved health.
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