Skip Navigation LinksSkip Navigation Links
Centers for Disease Control and Prevention
Safer Healthier People
Blue White
Blue White
bottom curve
CDC Home Search Health Topics A-Z spacer spacer
Blue curve MMWR spacer

Survey of Smoking-Prevention Education Efforts in Elementary Schools -- Washington State, 1989

To achieve the Surgeon General's challenge of a smoke-free society by the year 2000 (1), the initiation of smoking must be prevented in school-aged children. In Washington state, recently enacted legislation will restrict smoking in elementary schools by fall 1991.* In addition, the Washington State Smoke-Free Class of 2000 Program** (SFC 2000), initiated in September 1988, endeavors to create a smoke-free generation beginning with high school students in the year 2000. This report summarizes a 1989 survey by the Washington Department of Health to assess the implementation of SFC 2000 in first-grade classrooms and to characterize smoking policies in elementary schools.

A principle strategy of SFC 2000 is to provide the state's public elementary schools with teaching materials for preventing smoking. The materials are organized into program packets that include activities (e.g., language and art), posters, certificates of recognition, student's pledge, and discussion questions. By January 5, 1989, 555 (53%) of the state's 1049 elementary schools had been provided the modules for use in kindergarten through sixth grade. In May 1989, questionnaires were mailed to a systematic sample of 345 (33%) of the 1049 schools. Nonrespondents received a follow-up mailing and were contacted by telephone. Forty-one schools were excluded because they did not have a first-grade class. Of the remaining 304 schools, 225 (74%) responded.

The questionnaire asked each school about 1) the school district's policy on smoking and smokeless tobacco use by teachers, staff, and students; 2) teachers' attitudes toward teaching smoking prevention; 3) use of SFC 2000 materials or other smoking-prevention teaching materials; and 4) teachers' opinions about the most helpful teaching materials.

Of the 225 schools, 59 (26%) prohibited faculty and staff from smoking in the buildings and on the grounds, and 27 (12%) prohibited smoking only in the buildings. However, 133 (59%) permitted faculty and staff to smoke in designated areas. Six (3%) schools did not respond to the question. Fifty-two (23%) schools were in districts that permitted high school students to smoke; 146 (65%) were in districts that prohibited student smoking in the buildings and on the school grounds; and 27 (12%) did not respond to the question. Forty-one (18%) had no policy regarding smokeless tobacco use.

In 119 (53%) schools, modules about smoking were presented three or more times during the year. In 121 (54%), a smoking-prevention curriculum was considered important.

One hundred twelve (50%) schools had received and were using SFC 2000 materials in first-grade classes. Sixty-seven (30%) schools had not received these materials but had implemented other approaches to teach first graders about nonsmoking. Thirty-six (16%) did not include a smoking-prevention program in the curriculum, and none of these had received the SFC 2000 materials. For 10 (4%) schools, the status of smoking-prevention efforts could not be determined.

All the elementary schools that had received SFC 2000 materials had incorporated them into their curricula. For the 36 schools that did not include a smoking-prevention module in their first-grade curriculum, the most commonly cited reasons were unavailability of appropriate instructional materials, lack of sufficient classroom time, and inadequate curriculum guidelines. Reported by: J Onitsuka, MHS, K Williams, MS, B Pizacani, MPH, V Taylor, BM BS, F Frost, PhD, K Amburgy, MPH, K Tollestrup, PhD, Washington State Dept of Health. Epidemiology Br, Office on Smoking and Health, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: SFC 2000 is the collaborative response of the American Cancer Society (ACS), the American Heart Association (AHA), and the American Lung Association (ALA) to the Surgeon General's challenge to achieve a smoke-free society by the year 2000 (1). The four goals of SFC 2000 are to 1) provide the children of the class of 2000 and their parents and teachers with specifically designed antismoking education materials, 2) focus media and community attention on these children as the vanguard of a new "smoke-free" generation, 3) build and strengthen local coalitions of the three agencies, and 4) increase volunteer participation in coalition activities. Since 1988, more than 60,000 first-grade teachers nationwide have received material on SFC 2000 to integrate into their curricula.

In 1987, the National Adolescent Student Health Survey determined that, among eighth- and 10th-grade students, 11.0% of all boys and 8.5% of all girls had smoked a cigarette by the fourth grade (2). Because the inclusion of antismoking instruction in school health education curricula reduces initiation of smoking among children and adults (3), the need for early intervention within school health curricula is crucial. In 1988, the National School Boards Association (NSBA) reported that 75% of school districts had antismoking educational programs at the elementary school level (4,5). Of these schools, 74% received materials from volunteer health organizations (e.g., ACS, ALA, and AHA). NSBA also reported that 24% of school districts prohibited smoking by faculty, staff, and administrators and that 96% of schools with written policies on smoking addressed smoking by faculty, staff, and administrators. The findings in Washington were consistent with these national trends.

The National Cancer Institute advisory panel on smoking and school health recently recommended essential elements for school-based smoking-prevention programs (6). These elements include emphasizing the adverse or harmful social and short-term physiologic consequences of tobacco use; training students in refusal skills; involving parents, trained teachers, and peers in smoking-prevention activities; and designing a curriculum that reflects the needs of the community.

To provide local school districts with support for these programs, state health agencies and state superintendents of public instruction should emphasize smoking-prevention education and assist local school districts in obtaining appropriate and useful teaching modules.

Comprehensive teaching materials and supplemental smoking-prevention programs are available from the local ACS, ALA, and AHA offices. Information on the Washington SFC 2000 is available from the Program Director, SFC 2000, ACS, 2120 First Avenue North, P.O. Box 19140, Seattle, WA 98109-1140. Information on the national SFC 2000 is available from the Program Director, SFC 2000, 20 North Wacker, Chicago, IL 60606; telephone (312) 346-4675.


  1. Koop CE. Presentation made to the annual meeting of the American Lung Association, May 1984.

  2. Office of Disease Prevention and Health Promotion. The National Adolescent Student Health Survey: a report on the health of America's youth. Oakland, California: US Department of Health and Human Services, Public Health Service, 1989.

  3. Christenson GM, Gold RS, Katz M, Kreuter MW. Results of the School Health Education Evaluation: preface. J School Health 1985;55:295-6.

  4. National School Boards Association. Smoke-free schools: a progress report. Alexandria, Virginia: National School Boards Association, 1989.

  5. CDC. School policies and programs on smoking and health--United States, 1988. MMWR 1989;38:202-3.

  6. Glynn TJ. Essential elements of school-based smoking prevention programs. J School Health 1989;59:181-8. *RCW 28A.120.032. ** Sponsored by the American Cancer Society, Washington Division, Inc.; the American Heart Association, Washington Affiliate; and the American Lung Association of Washington.

Disclaimer   All MMWR HTML documents published before January 1993 are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

**Questions or messages regarding errors in formatting should be addressed to

Page converted: 08/05/98


Safer, Healthier People

Morbidity and Mortality Weekly Report
Centers for Disease Control and Prevention
1600 Clifton Rd, MailStop E-90, Atlanta, GA 30333, U.S.A


Department of Health
and Human Services

This page last reviewed 5/2/01