A Comparison of Changes in Tobacco Control Practices in Intervention and
Non-Intervention Schools From Baseline (2000) to Follow-Up (2002)
Melynda C. Boerm, M.Ed. & Phyllis M. Gingiss, Dr.P.H.
University of Houston, Department of Health and Human Performance, Houston, Texas, USA
PURPOSE To provide information to local, regional, and state school and health officials about the
status of school tobacco prevention and control policies and practices in the Texas Department of Health
(TDH) Texas Tobacco Prevention Initiative East Texas study area from baseline (2000) to follow-up (2002) in
intervention and non-intervention schools.
METHODS
Participants: A representative sample of 171 schools serving students in grades 6 to 12 from within each
geographic area within the study area received two surveys at baseline, one for the Principal to complete
and one for the Health Coordinator; 134 (78%) completed one or more surveys and were sent follow-up
surveys. Subsequently, 68 schools completed both surveys at both baseline and follow-up; half of these
schools (n=34) received school-level interventions based on TDH funding and contractual guidelines.
Questionnaire: The Principal and Health Coordinator Surveys were designed to correspond to the School
Health Education Profile Tobacco Module (SHEP) developed by the Centers for Disease Control and Prevention (CDC) and to further probe use of “best practice guidelines” identified in the Guidelines for School
Health Programs to Prevent Tobacco Use and Addiction1 (Guidelines). The SHEP was designed to monitor
health education characteristics in
Guidelines for School Health Programs to Prevent Tobacco middle and high schools in the
United States; the tobacco module exUse and Addiction1
panded specifically on tobacco¾ Develop and enforce a school policy on tobacco use;
related policies and practices. In
¾ Provide instruction about the short- and long-term negative
2000, a focus group of health
physiologic and social consequences of tobacco use, social
coordinators from 13 of the 20 Texas
influences on tobacco use peer norms regarding tobacco use,
Education Service Centers modified
and refusal skills;
the SHEP to comprehensively reflect
¾ Provide tobacco-use prevention education in kindergarten
school policies and practices in Texas.
through 12th grade; this instruction should be especially
At follow-up in 2002, key compointensive in junior high or middle school and should be
nents of the baseline questionnaires
reinforced in high school;
were retained to track changes in pol¾ Provide program-specific training for teachers;
icy and practices. The surveys were
¾ Involve parents or families in support of school-based
modified to reflect school activity
programs to prevent tobacco use;
in the 2001-2002 school year.
¾ Support cessation efforts among students and all school staff Analysis: A comparison of mean
who use tobacco; and
scores was used to compare changes
¾ Assess the tobacco-use prevention program at regular
in school tobacco prevention and conintervals. (p. 7)
trol activity in intervention and non1Centers
for Disease Control and Prevention (1994). Guidelines for school
health programs to prevent tobacco use and addiction (Rep. No. 43). U.S. Department of Health and Human Services.
12th World Conference on Tobacco or Health
Helsinki, Finland
Tuesday, August 5, 2003
intervention schools from baseline to
follow-up.
RESULTS
¾ From baseline to follow-up, significant increases in activity levels were noted for classroom instruction,
student cessation support, assessment of prevention programs, teacher training, and family involvement
(Figure 1).
¾ Intervention schools reported
more positive changes than comparison schools from baseline to
present in the following areas:
Student cessation support, assessment of prevention programs, teacher training, instruction and family involvement
(Figure 1).
¾ Only in areas of enforcement,
policy change and faculty and
staff cessation support did activity levels remain the same or
slightly diminish. Since activity
for enforcement was already extremely high in almost all
schools, no changes were expected in that area.
Figure 1. A comparison of Texas intervention and non-intervention schools for changes in activity
levels from baseline to present for each of the CDC Guidelines components for “Best Practice.”
3.6
3.6
Enforcement of school policy on
tobacco use. **
Instruction on tobacco prevention
education.**
2.7
2.7
Establish or change school policy on
tobacco use.
Assessment of prevention
programs.**, ††
2.1
1.8
Family involvement in student tobacco
programs.*, †
0.0
90
85
79.9
0.5
1.0
1.5
2.2
2.8
2.2
2.2
2.5
2.0
Year Two 2002 - School Intervention
Year Two, 2002 - No School Intevention
Baseline, 2000 - School Intervention
Baseline, 2000 - No School Intervention
2.3
2.0
† Change across intervention groups from baseline to 2002, p < .05
††Change across intervention groups from baseline to 2002, p < .01
Intervention
No Intervention
95
1.9
1.8
1.9
1.8
100
75
2.1
1.8
2.0
* Change from baseline to 2002, p < .05
** Change from baseline to 2002, p < .01
2.7
2.2
2.3
2.2
Figure 2. A comparison of mean consistency scores for
instruction on consequences of tobacco use of
intervention and non-intervention schools from
baseline to present.
80
2.3
2.2
Student cessation support.*, †
Teacher training for tobacco
prevention education.**
3.9
2.4
1.8
Faculty and staff cessation support.
3.0
3.7
3.2
2.5
3.0
4 = Extremely active
3 = Moderate activity
3.5
4.0
2 = Low activity
1 = No activity
¾ Schools receiving intervention were significantly (p < .05) more consistent with the
CDC Guidelines for provision of instruction
about the consequences of tobacco use
(Figure 2).
¾ When compared by intervention status,
“fit” with CDC Guidelines for overall levels
of practice from baseline to follow-up was
significantly higher in intervention schools.
DISCUSSION AND
IMPLICATIONS The approaches im-
plemented by the Texas Department of
Health for involving and training schools
65
produced important gains in the scope and
60
56.8
nature of what intervention schools were
58.3
55
doing for tobacco prevention and control.
55.4
It is important that such efforts be sus50
Baseline, 2000
Year Two, 2002
tained and attention given to building
upon these gains. Research stresses the importance of supporting and maintaining new programs until the point they become locally institutionalized. The existing infrastructure may continue to be strengthened through assistance for new schools in
adoption and use of recommended programs. Use of strategies such as linkage of currently successful
70
CONTACT INFORMATION
Melynda Boerm, M.Ed.
University of Houston
3855 Holman, 104 Garrison Gym
Houston, Texas 77204-6015 USA
713-743-9953 [email protected]
Phyllis M. Gingiss, Dr.P.H.
University of Houston
3855 Holman, 104 Garrison Gym
Houston, Texas 77204-6015 USA
713-743-9843 [email protected]