Problem: The Youth Risk Behavior Surveillance System Survey and parent/community observations identified increasing rates of tobacco use among students in public schools within Cherokee Nation. The latest weighted data from the Cherokee Nation YRBSS estimated that among American Indian high school students, 20.7% had smoked at least one cigarette in the last 30 days, 14.0% smoked cigarettes every day, and 26.9% had used any type of tobacco at least once in the last 30 days.1
PSE Change Solution: The Cherokee Nation Comprehensive Cancer Control Program (CCC Program) worked with partners from the Cherokee County Community Health Coalition to better understand the problem. Based on the results of a scan of community partners and an assessment of available data, the CCC Program established a task force that communicated with school principals and superintendents. These efforts led to the establishment and implementation of a smoke-free policy regarding the use and possession of commercial tobacco products in public schools within Cherokee Nation Tribal Jurisdictional Service Area.
1. Hopkins, D., Razi, S., Leeks, K.D., Priya Kalra, G., Chattopadhyay, S.K., & Soler, R.E. (2010). Smokefree policies to reduce tobacco use: A systematic review. American Journal of Preventive Medicine, 38(2Suppl), S275-289. http://dx.doi.org/10.1016/j.amepre.2009.10.029
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Problem
The Youth Risk Behavior Surveillance System (YRBSS) Survey and parent/community observations reflect increasing rates of tobacco use among students in public schools within Cherokee Nation. Cherokee Nation is located within the 14 counties (includes all of six counties and portions of eight other counties) of northeastern Oklahoma.
PSE Solution
Implement a smoke-free policy regarding the use and possession of commercial tobacco products in public schools within Cherokee Nation.
Actions/Results
Even before beginning work on the Tobacco-Free Schools initiative, Cherokee Nation was a partner of the Cherokee County Community Health Coalition. Made up of local leaders of business, media, community and health services organizations, the Coalition was a ready source of partners for this PSE effort (Step 1: Engage).
A scan of target community members and stakeholders showed an underlying history of competition among the schools, which was used to fuel and advance the PSE objectives (Step 2: Scan).
An assessment of available data was used to establish and clarify the goals and objectives (Step 3: Assess). Based on the results of the assessment, the following steps were taken:
- Cherokee Nation Comprehensive Cancer Control Program established a task force comprised of public health representatives with a vested interest in—and established relationships with—the schools in the targeted community of the Cherokee Nation Tribal Jurisdictional Service Area (TJSA).
- The task force communicated the problem and the PSE solution to school principals/superintendents and asked for their help in implementation (Step 5: Promote).
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Initially, six schools in the Cherokee Nation TJSA were targeted in small groups (1-3 at a time), efforts were later expanded aim to establish tobacco-free policies in all schools within the TJSA (Step 6: implement).
Success Factors and Key Questions Addressed
What data were needed to support your position on the issue(s)?
We needed data about the rate of tobacco use among students in Cherokee Nation TJSA schools. We also needed data about the disproportionate burden of tobacco use in American Indian/Alaska Native (AI/AN) communities as well as information about the positive impact of smoke-free policies.
What kind of data did you obtain (qualitative, quantitative, peer reviewed journals, trusted sources, etc.)?
We obtained quantitative data from the Youth Risk Behavior Surveillance System (YRBSS) Survey regarding student-smoking rates and from the American Journal of Preventive Medicine regarding the impact of smoke-free policies and the burden of second-hand smoke on AI/AN communities. We also used the Center for Disease Control and Prevention’s School Health Index: A Self-Assessment and Planning Guide to assess and improve schools’ tobacco-use prevention programs and policies. In addition, we used qualitative data from parent and community observations on students’ tobacco use as well as parent interviews.
The latest weighted data from the Cherokee Nation YRBSS estimated that among American Indian high school students, 20.7% had smoked at least one cigarette in the last 30 days, 14.0% smoked cigarettes every day, and 26.9% had used any type of tobacco at least once in the last 30 days. According to the research, smoke-free policies have been shown to reduce morbidity and mortality associated with exposure to second-hand smoke (Hopkins et al., 2010). In addition, AI/AN communities are disproportionately impacted by second-hand smoke and its health effects (Mowery et al., 2015). Without concerted effort to reach students before they start smoking, AI/AN communities would continue to experience a significantly higher burden of tobacco-related cancers and disease.
What were your SMART (specific, measurable, attainable, relevant and time-bound) goals and objectives?
- By September 2012, facilitate the implementation of 24/7 tobacco-free policies in 6 schools within the Cherokee Nation TJSA.
- By September 2012, increase the number of smoke-free parks from 1 to 2 in the CN TJSA.
- By September 2012, increase the number of multi-unit smoke-free housing units in the CN TJSA.
We collected baseline data to be used after the policy was implemented in order to provide a comparison for assessing whether the policy made the kind of community-wide improvements our coalition wanted. Now, after the policy implementation, our coalition will need to gather and compare this new, post-policy data to the pre-policy baseline data.
Related Resources
Read more from the Centers for Disease Control and Prevention about tribal health disparities.
REFERENCES
Hopkins, D., Razi, S., Leeks, K.D., Priya Kalra, G., Chattopadhyay, S.K., & Soler, R.E. (2010). Smokefree policies to reduce tobacco use: A systematic review. American Journal of Preventive Medicine, 38(2Suppl), S275-289. http://dx.doi.org/10.1016/j.amepre.2009.10.029
Mowery, P. D., Dube, S. R., Thorne, S. L., Barrett, B. E., Homa, D. M., & Henderson, P. N. (2015). Disparities in smoking-related mortality among American Indians/Alaska Natives. American Journal of Preventive Medicine, 49(5):738-44. http://doi.org/10.1016/j.amepre.2015.05.002
Resources to Support Similar Evidence-Based Initiatives
What Works for Health: Smoke-free policies for indoor areas
The Community Guide: Tobacco Use: Smoke-Free Policies
EBCCP: Smoke-free policies for indoor areas in tribal communities