That's one conclusion of a new University of North Carolina at Chapel Hill study aimed at gauging how such efforts have fared statewide.
The study, conducted by Dr. Adam O. Goldstein, associate professor of family medicine at the UNC School of Medicine, and colleagues, covered through 2001, when 14 of the state's 117 school districts had adopted the policy. Since then, 11 more systems have implemented the policy, which prohibits smoking and other tobacco use on school grounds.
Researchers conducted detailed interviews with 40 key people in each of those first 14 districts, such as school board members, superintendents, principals, health coordinators and students, to learn what their experiences were.
Few of the potential problems expected before passage of the policy actually arose in any county, Goldstein said.
"A commonly cited barrier preventing passage of 100 percent Tobacco-Free School policies involves fear over loss of teachers or inability to enforce the policy," he wrote. "This research showed that despite the fear, enforcement problems were more manageable than anticipated, a finding demonstrated in other states."
No substantial loss of teachers occurred, and almost all short-term outcomes were more positive than expected, the physician said. Long-term outcomes, such as a lower likelihood of adolescents starting or continuing to smoke and probably less smoking-related illness, can only be positive.
"Comprehensive tobacco-free school policies constitute an important component of state tobacco control and public health efforts, but little research has been done about the adoption process," Goldstein said. "This work and these findings are important since tobacco use represents the leading preventable cause of premature death in the United States."
Others involved in the study, recently reported in the Journal of School Health, included Arlana Bobo Peterson of the University of New Mexico and Drs. Kurt M. Ribisl, Allan B. Steckler and Laura Linnan of the UNC School of Public Health. Others were Tim McGloin and Carol Patterson of UNC's Center for Health Promotion and Disease Prevention.
The research showed that local adults and youth "champions" facilitated policy changes, Goldstein said. In most cases, administrators or other adults initiated changes, but youth involvement was important and increasing.
Advocates successfully personalized health concerns by focusing on children and emphasizing how children adopt behaviors by copying adults, he said. Having N.C. governors write letters in support of prohibiting tobacco use at schools boosted the chance for the policy change's success, as did a state "summit" during which the issues were discussed.
"We also found the key to policy enforcement involved being consistent, supportive and firm, "Goldstein said. "Districts reported limited influence on policy adoption because of a local tobacco economy, but virtually all districts passing policies were located in counties with relatively little tobacco production."
Future leadership actions could include an annual governor's summit meeting on youth tobacco and 100 percent TFS policies, as well as annual letters signed by the governor to districts not yet adopting a policy change, Goldstein wrote. Other useful efforts could be supportive letters from districts that have passed such policies to districts that have not, public recognition for districts following the TFS model and perhaps incentives for doing so.
The new study is part of a larger research project known as the North Carolina Youth Empowerment Study (NC-YES).
By DAVID WILLIAMSON
UNC News Services
Note: Goldstein can be reached at 919-966-4090, 270-4872 or adam_goldstein@med.unc.edu.
Contact: David Williamson, 919-962-8596
Journal
Journal of School Health