School Health Guidelines
Every day, approximately 4,000 American youth aged 12-17 try their
first cigarette, and an estimated 1,140 young people become daily
cigarette smokers.1 Most start this deadly habit not fully
understanding that nicotine in tobacco is as addictive as heroin,
cocaine, or alcohol. Most also underestimate the health consequences,
even though tobacco use is the leading cause of preventable death in the
United States. School programs to prevent tobacco use among young people
can make a major contribution to the health of the nation, particularly
when these programs are combined with community efforts.
Benefits of Preventing Tobacco Use Among Young People
- Helps prevent long-term health problems and premature death.
- Promotes optimal health and decreases school days missed because
of respiratory illnesses.
- Dramatically decreases the likelihood that a young person will
be a regular tobacco user as an adult.
Consequences of Tobacco Use
- Tobacco use causes more premature deaths in the United States
than any other preventable risk.
- Cigarette smoking causes heart disease; stroke; chronic lung
disease; and cancers of the lung, mouth, pharynx, esophagus, and
- Cigarette smoking increases coughing, shortness of breath, and
respiratory illnesses; decreases physical fitness; and adversely
affects blood cholesterol levels.2,3
- Smokeless tobacco is not a safe alternative to cigarettes. Using
it causes cancers of the mouth, pharynx, and esophagus; gum
recession; and an increased risk for heart disease and stroke.2,3
- Smoking cigars increases the risk of oral, laryngeal,
esophageal, and lung cancers.3,4
- Secondhand smoke puts children in danger of developing severe
respiratory diseases and may hinder the growth of their lungs.3,5
- Exposure to secondhand smoke as a child or adolescent may
increase the risk of developing lung cancer as an adult,7
and may contribute to new cases of asthma or worsen existing asthma.3,5
- Tobacco use causes stained teeth, bad breath, and foul-smelling hair
Tobacco Use By Teens
- Although the percentage of high school students who smoke has
declined in recent years, rates remain high: 20% of high school students
report current cigarette use (smoked cigarettes on at least 1 day during
the 30 days before the survey).6
- Forty-six percent of high school students have ever tried cigarette
smoking, even one or two puffs.6
- Eleven percent of high school students have smoked a whole
cigarette before age 13.6
- Nearly nine percent of high school students (15% of male and 2% of
female students) used smokeless tobacco (e.g., chewing tobacco, snuff,
or dip), on at least 1 day during the 30 days before the survey.6
Adolescents who use smokeless tobacco are more likely than nonusers to
become cigarette smokers.3
- Fourteen percent of high school students smoked cigars, cigarillos,
or little cigars on at least 1 day during the 30 days before the survey.6
- The younger people begin smoking cigarettes, the more likely they are
to become strongly addicted to nicotine.2
- Young people who try to quit suffer the same nicotine withdrawal
symptoms as adults who try
- Among high school students who are current smokers, 51% have tried
to quit smoking cigarettes during the 12 months before the survey.6
Current Cigarette Use* Among High School Students,
United States, 1991-2009
*Smoked cigarettes on 1 or more of the 30 days before the survey.
Well-designed, well-implemented school programs to prevent tobacco use
- Have proved effective in preventing tobacco use.
- Provide prevention education during the years when the risk of becoming
addicted to tobacco is greatest.
- Provide a tobacco-free environment that establishes nonuse of tobacco as
a norm and offers opportunities
for positive role modeling.
- Can help prevent the use of other drugs, especially if the program
addresses the use of these substances.
CDC�s Guidelines for School Health Programs
CDC�s Guidelines for School Health Programs to
Prevent Tobacco Use and Addiction were designed
to help achieve national health and education goals. They were developed in collaboration with experts from 29 national,
federal, and voluntary agencies and are based on an extensive review of
research and practice.
School programs to prevent tobacco use and
addiction will be most effective if they:
- Prohibit tobacco use at all school facilities and events.
- Encourage and help students and staff to quit using tobacco.
- Provide developmentally appropriate instruction in grades K�12 that
addresses the social and psychological causes of tobacco use.
- Are part of a coordinated school health program through which teachers,
students, families, administrators, and community leaders deliver
consistent messages about tobacco use.
- Are reinforced by communitywide efforts to prevent tobacco use and
The guidelines include seven recommendations for ensuring a quality
school program to prevent tobacco use.
Develop and enforce a school policy on tobacco use.
The policy, developed in collaboration with students,
parents, school staff, health professionals, and school
- Prohibit students, staff, parents, and visitors from using tobacco on
school premises, in school vehicles, and at school functions.
- Prohibit tobacco advertising (e.g., on signs, T-shirts, or caps or
through sponsorship of school events) in school buildings, at school
functions, and in school publications.
Require that all students receive instruction on avoiding tobacco use.
- Provide access and referral to cessation programs for students and
- Help students who violate tobacco-free policies to quit using
tobacco rather than
just punishing them.
Provide instruction about the short- and long-term
negative physiologic and social consequences of
tobacco use, social influences on tobacco use, peer
norms regarding tobacco use, and refusal skills. This
- Decrease the social acceptability of tobacco use and show that most
young people do not smoke.
- Help students understand why young people start to use tobacco and
identify more positive activities to meet their goals.
- Develop students� skills in assertiveness, goal setting, problem
solving, and resisting pressure from the media and peers to use tobacco.
Programs that only discuss tobacco�s harmful effects
or attempt to instill fear do not prevent tobacco use.
Provide tobacco-use prevention education in grades K�12.
- This instruction should be introduced in elementary school and
intensified in middle/ junior high school, when students are exposed to
older students who typically use tobacco at higher rates.
- Reinforcement throughout high school is essential to ensure that
successes in preventing tobacco use do not dissipate over time.
Provide program-specific training on tobacco-use prevention for
teachers. The training should include reviewing the curriculum, modeling
instructional activities, and providing opportunities to practice
implementing the lessons. Well-trained peer leaders can be an important
adjunct to teacher-led instruction.
- Family Involvement
Involve parents or families in supporting school-based programs to prevent tobacco use. Schools should:
- Promote discussions at home about tobacco use by assigning homework and
projects that involve families.
- Encourage parents to participate in community efforts to prevent tobacco
use and addiction.
- Tobacco-Use Cessation Efforts
Support cessation efforts among students and school staff who use
tobacco. Schools should provide access to cessation programs that help
students and staff stop using tobacco rather than punishing them for
violating tobacco-use policies.
Assess the tobacco-use prevention program at regular intervals. Schools
can use CDC�s Guidelines for School Health Programs to Prevent Tobacco
Use and Addiction to assess whether they are providing effective
policies, curricula, training, family involvement, and cessation
Substance Abuse and Mental Health Services Administration.
Results From the 2005 National Survey on Drug Use and Health.
[pdf 943K] (Office of Applied Studies, NSDUH Series H-27, DHHS Publication No. SMA
05�4061) [Accessed 2008 Jun 13]. Rockville, MD.
Preventing Tobacco Use Among Young People: A Report of the Surgeon
General. [pdf 28M] Atlanta, GA: U.S. Department of Health and Human Services,
1994. [Accessed 2008 Jun 23].
The Health Consequences of Smoking: A Report of the Surgeon General.
Atlanta, GA: U.S. Department of Health and Human Services, 2004.
[Accessed 2008 Jun 23].
Cigar smoking among teenagers�United States, Massachusetts, and New
York, 1996 [pdf 302K] Morbidity & Mortality Weekly Report 1997;46(20):433�439.
[Accessed 2008 Jun 23].
The Health Consequences of Involuntary Exposure to Tobacco Smoke: A
Report of the Surgeon General. Atlanta, GA: U.S. Department of
Health and Human Services, 2006. [Accessed 2008 Jun 23].
CDC. Youth Risk Behavior Surveillance—United States, 2009.
[pdf 3.5M] MMWR 2010;59(SS-5):1–142.
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