Sally M. Adkin: Smoking Cessation

Sally M. Adkin: Smoking Cessation

North Carolina School of Science and Mathematics (NCSSM)
An Evaluation of the 1999-00 Implementation of
The Student Tobacco Cessation Program
NCSSM Office of Research and Evaluation
Sally M. Adkin
May 2000

The North Carolina School of Science and Mathematics is a public, residential, coeducational high school for juniors and seniors with commitment to scholarship. The North Carolina General Assembly established the school in 1978 to provide challenging educational opportunities for students with special interest and potential in the sciences and mathematics and to provide a catalyst for statewide education improvement. Approximately 550 students age 14 – 18 years are living and learning on the NCSSM campus in Durham.

The NCSSM Division of Student Life administers the residential aspects of the NCSSM program. This includes aligned programs such as athletics, physical wellness, and life skills programming that emphasize behaviors that promote personal success. The Division has also taken leadership to set codes of conduct relating to dorm life and student conduct. Conduct regarding substance abuse has always been taken very seriously at NCSSM. The school has always had a clear policy against alcohol use. The enrolling student form includes a sign-off that alcohol use is a dismissible infraction.

Dormitories have always been smoke free, but prior to fall of 1998, the school did have on-campus designated smoking areas. Beginning with the 1995-96 school year through the 1997-98 school year, NCSSM experienced an increase in the number of students who were smoking. Data indicated that students who were not successful in academics and who were charged with disciplinary infractions, most notably alcohol use, were also smokers. Further there was evidence indicating an increase in the number of students who were starting to smoke after their arrival at NCSSM.

On a recommendation of the administrative cabinet and presented by the Director of Student Life, the NCSSM Board of Trustees approved for fall 1998 disallowing any student smoking on the NCSSM campus. Beginning with the 1998-99 school year, every junior and senior signed an enrolling student form acknowledging the use of tobacco products on campus was prohibited. The transition to a smoke-free campus 1998-99 was a rocky transition. Student smokers compensated by collecting in three or four locations just over NCSSM campus boundaries. Since, the students were technically "off-campus" the school could not take punitive actions against the students. Although smoking was a little more inconvenient for students, the new policy did not seem to deter smoking.

Actually the public’s attention was drawn to the now highly visible NCSSM smokers and neighborhood problems resulted. In addition, many were concerned about students’ safety so close to busy roadways. There were some instances of abusive taunts to the student smokers from drive-by traffic. There was dissatisfaction from smoking and non-smoking students about the situation. Data continued to confirm a high correlation between smoking and other NCSSM non-success behaviors.

The NCSSM Board of Trustees followed the events surrounding the smoking issues at NCSSM throughout the school year. At the May 1999 Board of Trustees Meeting, the Board responded to a recommendation of the Director of Student Life with the endorsement of the administration to tighten the NCSSM no-smoking policy and to put in place a total program of tobacco cessation. The new policy stated, "Possession of tobacco products on or off campus while under the jurisdiction of the School is a violation of the Code of Conduct." This gave NCSSM the authority to bring sanctions against students no matter where they were observed smoking.

This is the current policy. Students and parents are made aware of the policy in recruitment literature, information sessions, and students sign a new enrollment form that makes clear the more stringent tobacco prohibition. The program described in detail below responds to 1998-99 student input about the difficulty of controlling smoking habits. It also responds to the Board of Trustee and others concerns that violation of smoking rules should have special treatment in the code of conduct. Students should be given assistance in managing their smoking behaviors and suspension from NCSSM should be a last resort. Board action also included a plan for the NCSSM Office of Research to evaluate the new policy and the tobacco cessation program.

The NCSSM Comprehensive Tobacco Cessation Program is part of a comprehensive educational program that emphasizes a healthy life style – including physical activity, good nutrition and stress management to encourage behaviors that promote academic and personal success. The policy is under the Code of Conduct, but

not included in the disciplinary section (called "Levels") of the Code. This shifts the focus of the TCP from punishment (negative) to intervention and support (positive). The program has three elements essential to success: Prevention, Intervention and Support. Figure 1 graphically illustrates the program. [See attachment to view Figure 1.]

The TCP will involve parents, faculty, staff and students in helping those students who smoke to stop – and those who don’t smoke, not to start. NCSSM has collaborated with the American Lung Association’s Not-On-Tobacco (N-O-T) program and Duke University’s Alcoholism and Addictions Program to develop the policies, and these groups will continue to be involved as the program is implemented.

Prevention is one part of the program. This component will develop students’ awareness of the hazards of using tobacco products and will encourage them to commit not to begin or to stop. Recruiters and all those involved in the admissions process will make applicants aware that NCSSM is a tobacco-free environment. The TCP policy, with clear expectations and consequences, will be distributed to incoming juniors and rising seniors during the summer. Student Life Instructors (adults who live on the residence halls) will organize a "Teens Against Tobacco Use" program, and during Orientation will instruct students how to achieve the healthy, academically successful lifestyle noted above. During the academic year, students attend monthly sessions ("Student Life 101/102") which will include information on preventing and stopping tobacco use.

Intervention is the other part of the TCP. It focuses on support rather than punishment. To participate in this component, students may identify themselves as tobacco users to avoid disciplinary consequences, or they will be required to participate if

they violate the School’s tobacco policy. Participants who are "social" (infrequent) tobacco users will be required to do any of a variety of consequences: pick up cigarette butts around the campus, perform community service in an emphysema unit at a local hospital, or attend a conference with their parents. They may be asked to attend a smoking cessation program available through Duke’s Addictions Program. Participants who are "addicted" tobacco users must enroll in the Duke Addictions Program (which also addresses drug & alcohol use).

NCSSM will use incentives and support to help students stop using tobacco, and to promote a climate where students are encouraged (rather than forced) to participate. Enforcement is the responsibility of parents, faculty and staff. Faculty and staff will receive training during the summer and Orientation.

Following the approval of the new smoking policy and the tobacco cessation program, the following goals were drafted. NCSSM partners at the Duke University Medical Center reviewed these.

TCP GOALS MAY 1999

1. NCSSM’s expectations will be clearly outlined including student responsibility and accountability, staff and parent roles.
2. Students will develop an awareness of the hazards of using tobacco products.
3. Students who do not smoke when they enroll at NCSSM will not begin to smoke.
4. Students who do smoke will either modify their smoking habits to comply with NCSSM’s smoking policies or they will quit smoking.
5. Students will not congregate to smoke in the Watts-Hillandale neighborhood.
6. Student safety and security will not be jeopardized as would-be smokers seek smoking spots.
7. Students, staff and parents will view tobacco cessation program as positive and will cooperate.

EVALUATION QUESTIONS MATCHED WITH DATA SOURCES

The NCSSM Research Office developed an evaluation crosswalk, Table 1, which matches evaluation questions with data sources. The questions are based on the program goals.

Data Sources:
I. Pre/Post Student Survey
II. Staff/Student email query
III. Disciplinary Records
IV. Security Reports
V. Adult Authority Figure Interviews
VI. Student Life 101/102 Records
VII. TCP Participation Records

Evaluation Questions	I	II	III	IV	V	VI	VII
1. To what extent have programs been put in place to educate students on the hazards of smoking?
To what extent have staff been trained in tobacco cessation program?
To what extent are would-be smokers safe and secure?
To what extent are students participating and completing the Cessation Program?
A.To what extent did students self-selected /how many completed?
To what extent did students enter the program as a consequence of being caught/ how many completed?
To what extent has assessment resulted in student placement in an intervention program? Did they complete this program?
To what extent has assessment resulted in student placement in a treatment program? Did they complete this program?
1. To what extent are NCSSM students smoking? (male, female, junior, senior, etc.)
Of these smokers how many got caught? (counts for on and off campus while under jurisdiction of the school)
Of these smokers how many started after they enrolled at NCSSM?
Of these smokers how many have modified their smoking habit to comply with policy?
Of these smokers how many have stopped smoking since coming to NCSSM?
Of these smokers what is the incidence of off-campus smoking while under the jurisdiction of the school?
To what extent are student, staff, and parents cooperating with this program?
A. How is the program viewed by students, staff, and parents?
To what extent are staff contributing to program success?
To what extent are parents contributing to program success?
1. What generalizations can be made about the Comprehensive Tobacco Cessation Program?
A. What links are there to change in smoking habits and TCP?
What lessons have been learned from TCP that could improve the program and/or help others?

RESULTS

Programs that Educate Students on the Hazards of Smoking

The TCP policy including expectations and consequences was part of the NCSSM handbook mailed to incoming juniors and rising seniors during the summer. Fall 1999 Orientation included junior student sessions about the new policy including the history behind the new policy and justification that set forth the school’s concerns linking student tobacco use to non-success. Students were advised that help was available to those who were trying to give up smoking. All NCSSM juniors through the SL101 session on substance abuse considered the hazards of smoking. Seniors through the SL 102 session on preparation for college discussed substance abuse including the hazards of smoking.

Staff Training

Student Life Instructors reviewed the new policy and procedures as part of the new year orientation. The Director of Student Life addressed a faculty meeting concerning the new policy and discussed procedures the faculty should follow for offenders. The school did not conduct formal training for faculty and staff other than SLIs. The proposed new policy and TCP was discussed with parents at their Spring 1999 Parent’s Meeting.

Safety of Would-Be Smokers

There have been no formal or informal reported instances of harm or threat of harm to any NCSSM student smokers.

Extent NCSSM Students are Smoking

NCSSM Juniors (n=258) were surveyed their first week of school August 1999 and again in May 2000. The results of that survey are reported in Table 2. There is no similar survey for NCSSM Seniors. The Head of NCSSM Security and the security supervisor of the student center report no smoking sightings of juniors or seniors other than those described in the "Got Caught" section below. The Director of Student Life, the Director of Academic Programs, and the Assistant Director of Academic Programs report no sightings from faculty or staff of junior or seniors smoking on campus or in the Watts-Hillandale neighborhood. However, some faculty have reported suspicions that students who they observe walking off campus might be headed toward spots where they smoke. Some persons have indicated that they believe NCSSM smokers are among those young people seen smoking at a nearby bakery in Erwin Square. Security officers on campus patrols have on occasions found an accumulation of cigarette butts indicating outbreaks in outback areas of the campus.

Table 2

Data from Pre/Post Survey Adapted from the American Lung Association N-O-T Program

NCSSM Juniors	August 1999 N=258	May 2000 N=158
Q2. Have you ever smoked on a regular basis?	Yes = 25 (10%) No = 233 (90%)	Yes= 12 (7.6%) No= 126 (92.4%)
Q3. Are you currently smoking?	Yes = 9 (3%) No = 249 (97%)	Yes= 7 (4.5%) No= 130 (95.5%)

The best comparison data from the 1998-99 school year is reported in Table 3. This information comes from a Student Government Association Survey administered to all students fall of 1998.

There were three incidents where students were caught smoking. See Table 4 for individualized data. All three involved two or more students.

1st incident – involved two females first quarter who were observed by neighbors and reported as smoking and apprehended by NCSSM as they walked from an adjacent neighborhood toward the school. Initially they denied smoking, but when one of the females was caught with a cigarette in her mouth the next day, both admitted smoking.

2nd incident – involved 8 students (3 females & 5 males) caught during the third quarter outside a local bakery away from campus.

3rd incident – involved 4 males caught during fourth quarter in the residence hall smoking and with alcohol.

Students involved in the first and second incidents received a comprehensive assessment with Drs. Georgi and Hanusa from the Duke Addictions Program. This was done in three sessions on our campus. Four students were taken to Duke’s facilities for a tour and overview of their program. One junior student has asked to participate in the Duke program and will begin this next year.

There have been no complaints to the administration concerning the new smoking policy and the TCP program. The Director of Student Life reported that no parents have complained about the procedures, including those parents of students who have been caught.

There have been no phone calls from neighbors, except for incident 1 above, complaining about smokers. Several neighbors have commented to school personnel that they are very pleased with the turn around from last year.

Just prior to the publication of this report the NCSSM Research Associate posted an email to all students, staff, and faculty. (N = ~700)

The NCSSM Research and Evaluation Office is preparing an evaluation report on the new tobacco policy put in place this school year. If you have thoughts or reflections on how this new policy has worked, please forward your comment. We will be finishing this report in the next two weeks and will post it for your review. (4/28/00)

This email resulted in ten replies, 2 from faculty, 1 from staff, and 7 from students. The two faculty inquired about procedures for the evaluation. The one staff expressed concern that adults are still smoking around campus just off school property but in plain sight of students and neighbors. Six of the students wrote to say they did not support the ban on off-campus smoking. They feel it puts NCSSM would-be smokers at risk, and they further believe persons who can legally smoke (18 years of age) should be allowed to do so off campus.

The Director of Student Life reported she learned it is important to address such an important issue as youth smoking head on. She would like to have more student and staff training. Both Duke Addictions Center and the Durham Center have proposed direct instruction programs for NCSSM students. Because student instructional time is so limited, Dr. Barber did not schedule these. She hopes these groups can modify the amount of student time needed for their programs. The Assistant Director of Academic Programs is surprised and pleased with the effectiveness of the new policy. He commented that he has been all-over the campus at various times of day including evenings and that he has not seen any students smoking.

Although NCSSM has had very few instances of smoking this school year, those most responsible for the enforcement of the policy feel the school does not have the person power to adequately monitor the campus or to intervene in an ideal manner.

After three NCSSM students (two seniors, one junior) attended the Governor's Summit on Tobacco Issues, Governor Hunt personally appointed them to serve on his 15-member Youth Advisory Board on Teen Tobacco Issues. The Board's mission is to reduce teen tobacco use. The Board has developed an action plan and is working with Jim Martin, the Governor's Tobacco Advisor, to finalize this plan.

Approximately 45% of high school students in the state smoke or use other tobacco products. Students at the Summit created a petition to support tobacco-free schools for students, faculty & staff, parents and visitors both on campus and at school-sponsored events. NCSSM is among the few (5-7%) high schools in North Carolina that currently has a tobacco-free policy.

A minimal number of programs were instituted to educate students on the hazards of smoking. (More for juniors than seniors.) Although, Student Life Instructors did receive training in the new program, other adult members of the NCSSM community did not.

The new policy did not result in any student safety and security issues. School administrators still consider this a potential risk of the new policy and would like to have more person-power to monitor the students.

There has been a significant decrease in the number of NCSSM student smokers. Data indicates as many as 18% of students were smoking last school year. This school year only 3 – 4.5% report they are smoking. There is no indication that students have begun smoking after coming to NCSSM this year. Most NCSSM students have complied with the new policy. Only 13 students were "caught smoking." Five (5) of these are currently in good standing with the school. Five (5) of these exhibited other confounding disciplinary problems and are no longer with the school. This leaves only three (3) students who continue to exhibit problem behaviors, but these have not been charged with smoking again. The new policy has made a significant difference in the incidence of student smoking at NCSSM.

NCSSM has achieved its goal of eliminating the undesirable congregation of smokers on the periphery of its campus. In addition it has eliminated student-smoking complaints of its Watts-Hillandale neighbors.

Students, staff and parents have cooperated with TCP and the new policy. After a extremely emotional year 1998-99 that consumed much time of NCSSM administrators handling phone calls from neighbors and dealing with teens passionate about their smoking rights, the administration this year has spent considerably less time dealing with smoking issues. In fact, the spring email call for input on the new policy indicates it is virtually a non-issue. More importantly, the school seems to have achieved its goal of deterring student smoking.

1.	Sr.	F	Y	Good standing
2.	Sr.	F	Y	Reached step 5 of class attendance
3.	Sr.	M	Y	Good standing senior year – alcohol charge found valid junior year but not dismissed
4.	Sr.	M	Y	Reached step 5 class attendance junior year. Close friend with student dismissed for alcohol and smoking senior year.
5.	Sr.	F	Y	Good standing
6.	Jr.	M	Y	Concerned about depression. Parent has agreed to start off campus counseling for his senior year.
7.	Jr.	F	Y	Good standing.
8.	Jr.	M	Y	Dismissed for class attendance
9.	Jr.	M	Y	Dismissed for alcohol and smoking. Second time caught smoking
10.	Sr.	F	Y	Good standing.
11.	Sr.	M	N	Dismissed for alcohol and smoking
12.	Sr.	M	N	Dismissed for alcohol and smoking
13.	Sr.	M	N	Dismissed for alcohol and smoking.