Reducing Tobacco Use in North Dakota Youth:

1
Reducing Tobacco Use in North Dakota Youth
Evidence For Using School-Based Curricula and
Media Center for Health Promotion and Transla
tion Research University of North Dako
ta School of Medicine and Health Sciences
2
Facts of life and Death on Tobacco Road

• Every Day in The U.S. 6000 kids try a
  cigarette, 3000 will become daily smokers and
  1000 will die from tobacco-related causes
  
• First cigarette tried at 14 and regular smoker by
  17 age of initiation has been dropping since
  the 1950s
  
• 8.4 billion spent by the tobacco industry on
  advertising and promotions in the U.S. in 1999
  50 times what states spent on preventing tobacco
  use
• 89 billion spent each year on health care
  services related to tobacco use
  
• Smoking is responsible for 1 in 5 deaths in the
  U.S.
  
• Average smoker loses 13 to 14 years of life to
  smoking
  
• If current smoking practices persist -- 6.4
  million children will die prematurely from
  tobacco, 58,332 in N.D.

3
Prevalence of Tobacco Use in North Dakota

• 23 of ND adults are regular smokers
• 43 of ND Native Americans are regular smokers
• 35.3 of ND youth (9-12) are current users
• 51.1 of ND Native American youth (9-12) are
  current users
  
• 10 of ND youth (7-8) are current users
• 33.5 of ND Native American youth (7-8) are
  current users
  
• 22.4 of ND boys (9-12) chew or snuff tobacco
• Sources 2001 Youth Risk Behavior Survey 2000
  Behavior Risk Factor Survey

4
Trends in Tobacco Use Among North Dakota Youth - I

• Smoking prevalence has decreased
• Less clearly so for females than males
• Less for 12th graders than 9th-11th graders
• Less for Native American youth than white youth
• Smoking prevalence increases
• Dramatically between 8th and 9th grade (2.5)
• Less dramatic between 10th and 11th (25) and
  11th and 12th (33)

5
Trends in Tobacco Use Among North Dakota Youth -
II

• Smoking Smokeless prevalence varies by region
• Highest in Regions 1 (Williston) and 3 (Devils
  Lake)
  
• Lowest in region 8 (Dickinson) (7th-8th
  smoking), region 6 (Jamestown) (9th-12th smoking)
  and region 2 (Minot) (7th-12th smokeless)
  
• Smoking Prevalence varies by rural/urban
  distinction
  
• Higher in rural school districts for 7th -8th
  graders but not 9th -12th graders
  
• Smokeless use higher in rural school districts
  for 7th 12th graders (but largest difference is
  in 7th -8th grade)
  

6
CHPTRs Monograph

• Historical context of tobacco
• Use of tobacco today in the United States
• Twenty-five years of empirical studies on tobacco
  prevention
  
• School-based prevention programs
• Multifaceted, community-wide interventions
• Media messages/campaigns
• Prevention issues in minority youth
• Comprehensive, statewide tobacco prevention
  programs - California, Massachusetts, Arizona,
  Florida, Oregon, and Mississippi.
  
• Translation and application in the State of North
  Dakota

7
Preventing Tobacco Use Summarizing 25 Years of
Empirical Studies

• Educationally-focused programs
• impact on knowledge, less on attitudes and
  behavior
  
• Social influence programs
• more impact upon attitudes and behavior, less on
  knowledge
  
• Preventive effects of school-based programs
• modest -- at best, 10 of kids who would have
  started smoking will not smoke if they receive a
  school-based program

8
Preventing Tobacco Use Summarizing 25 Years of
Empirical Studies

• Programs should include core of a social
  influences model
  
• information about social consequences
• short-term physiological effects of tobacco use
• information about social influences on tobacco
  use
  
• training in refusal skills, including modeling
  and practice of resistance skills,
  decision-making and problem solving.
  

9
Preventing Tobacco Use Summarizing 25 Years of
Empirical Studies

• Likely to enhance the success of a prevention
  program
  
• Teachers need to be adequately trained,
  motivated, and supervised to ensure that the
  program content is delivered as intended.
  
• Booster sessions/interventions appear to enhance
  the effect of school-based programs.
  
• Combination of a school prevention program and a
  media intervention appears more effective than a
  school program only and may be particularly
  effective for high-risk youths and girls.

10
Preventing Tobacco Use Summarizing 25 Years of
Empirical Studies

• Possibly will enhance prevention programs
• keep kids in school
• begin prevention programs earlier
• include cessation programs for those kids already
  smoking regularly
  
• consider gender and race when designing,
  developing, and implementing smoking prevention
  programs.
  

11
The School A Community Within a Community

• Implementation of school-based smoking prevention
  programs benefit from building connections from
  the classroom program to the students' broader
  environment (e.g., school, parents/family,
  peer-group, communities)
• Data demonstrate the preventive benefits of
  conducting a school-based smoking prevention
  program within the context of larger,
  community-wide efforts

12
The School A Community Within a Community

• CDC recognizes the importance of this concept
• Recommends implementing state-wide comprehensive
  programs such as in California, Massachusetts,
  Arizona, Florida, Oregon, and Mississippi.
  
• Data from these states continues to be gathered
  but .
  
• They have shown substantial declines in per
  capita cigarette consumption, adult smoking
  prevalence, and youth smoking prevalence.
  
• In the 1990s, US adult smoking rates declined
  only slightly but California and Massachusetts
  experienced a much greater decline.

13
Decreases in Youth Smoking by Fidelity of
Implementation
Oregon
14
Youth Tobacco Use Level of Community
Partnership Performance in Florida
High School
Middle School
15
CHPTR Goals Making it Work In ND

• North Dakota is a rural State
• 71.6 of the counties in North Dakota are
  designated as completely rural and 49 of 53 are
  classified as Nonmetro Counties
  
• Only 9.3 persons per square mile (and most
  counties less)
  

16
CHPTR Goals Making it Work In ND

• North Dakota is a poor State
• Median household income is only 35,590 (41st)
• Per capita income is only 25,411 (38th)
• The real wage per job is a meager 25,000 (48th)

17
CHPTR Goals Making it Work In ND

• North Dakota is a racially/ethnically homogenous
  state (92.4 of the population is White,
  Nonhispanic)
  
• Native Americans comprise an important and
  influential minority (4.9)
  
• The Hispanic population is growing particularly
  in the northeastern part of ND (comprising 2 to
  6 of pop)

18
CHPTR Goals Making it Work In ND
Health Disparities

• Age-adjusted death rate for people of white,
  nonhispanic descent is 760.1 per 100,000, for
  those of Native American descent its 1552.5 per
  100,000
• Average age of death for white persons is over 70
  years, for Native Americans slightly over 50
  years
  
• Age-adjusted YPLL shows that Native Americans
  have over 2.5 times the YPLL compared to whites

19
CHPTR Goals Making it Work In ND
Health Resources

• Physicians in ND
• 33 of North Dakotas 53 counties have no
  physician offices
  
• Only 25 of rural counties have a physicians
  office
  
• Northern and western borders of our State are
  particularly deficient
  
• Health Insurance
• 27 of children growing up in low-income working
  families do not have health insurance
  
• Overall North Dakota rate is about 13

20
CHPTR Current Future Directions

• North Dakota
• Rural, Poor, Health Resource and Health Disparity
  Challenges
  
• CHPTR Initiatives
• Evaluate school-based curricula and other
  components within ND contexts
  
• Identify community involvement, activities and
  partnerships that enhance school-based prevention
  programs
  
• Tailor school-based and community prevention
  programs to enhance effectiveness in ND (learn
  from MS)
  
• Evaluate media interventions developed
  specifically for and/or implemented in ND