De-normalization in schools
Research shows that tobacco use is a leading cause of preventable disease and death in Canada. In 2015, approximately 2780 new cancers diagnosed in Alberta were linked to tobacco smoking.1 Tobacco smoke contains over 7,000 chemicals, with at least 172 of these being toxic and 69 known to cause cancer.2 Tobacco is the only consumer product that will kill at least one in two regular users when used as it’s intended to be used.3 School based de-normalization attempts to create an environment where all forms of tobacco use are less desirable and acceptable.
Ways to get started
- Work with schools and school boards to develop a smoke-free policy or guideline that includes a smoke-free environment, enforcement, prevention and cessation services, and communication of the policy.4,5,6
- Consider including a smoke-free contract as a component of a school smoke-free policy. A smoke-free contract is a commitment students can make to abstain from smoking.7 Students can voluntarily join and sign the contract along with their classmates, parents, and teachers. The contract can specify an amount of time that signatories will remain smoke-free.7
- Students can volunteer8 or be nominated by their peers9 or teachers to take on the role of a smoke-free ambassador.10 Ambassadors act as smoke-free champions. Ambassadors may share smoking prevention and cessation information through social media8,11 or in-person conversations with their peers.8 Train ambassadors on the specific smoke-free messages to share; risks of smoking9 benefits of being smoke-free8,9 and/or prevention messages.8
- Include ambassador training on approaches to sharing messages with their peers.8, 9
- Work with ambassadors to create a list of specific apps that help to raise awareness about issues of smoking and support de-normalization. “Smokerface – Quit Smoking” app by med. Titus J. Brinker is one example. It shows the possible negative impacts of smoking on future appearance.12 Adolescents are able compare photo-aged images of themselves as smokers and non-smokers.12 Download the Smokerface app to computers or tablets capable of taking pictures.12 Students can also download the app to their personal devices. Use the opportunity to educate about other impacts of smoking, such as skin damage, harm to the rest of the body, drop in physical performance, and inhibited growth during adolescence.12 (Make sure to disclose how their pictures will be stored and handled after the activity—e.g., permanently delete them from device.)
- Use age-appropriate language and literacy level10 and include culturally and gender diverse images.13
Amplify your impact
For further action to reduce tobacco use in the community, see
- Incentivized behaviour change for youth strategy,
- Policies and regulations strategy,
- Facilitating links and access to tobacco cessation resources and services strategy,
- Smoke-free public spaces and parks strategy,
- Awareness and education strategy,
- Awareness and education (youth based) strategy
Multi-component community-wide interventions that increase awareness about and provide opportunities to reduce tobacco use in your community will have greater impact than implementing one-off strategies.
Evaluation measures the impact of all the hard work that went into developing a community initiative. Evaluating impact examines:
- What you expect to learn or change
- What you measure and report
- How to measure impact
What you expect to learn about de-normalization in schools may include:
- Learning that the strategy was implemented as planned
- Learning that the strategy reached those you wanted to reach
- Increased commitment to a smoke-free school environment
- Increased student-led tobacco/smoking activities
References Tobacco de-normalization school based
- Poirier AE, Ruan Y, Grevers X, Walter SD, Villeneuve PJ, Friedenreich CM, Brenner DR. Estimates of the current and future burden of cancer attributable to active and passive tobacco smoking in Canada. Preventive Medicine. 2019;122:9-19.
- United States Department of Health and Human Services (USDHHS). (2010). How tobacco smoke causes disease: The biology and behavioral basis for smoking-attributable disease: A report of the Surgeon General. Atlanta, GA: Author. Accessed at: http://www.cdc.gov/tobacco/data_statistics/sgr/2010/
- Els, C. (2009). Tobacco addiction: What do we know, and where do we go? Accessed at: https://www.researchgate.net/publication/237260617_Tobacco_Addiction_What_do_we_know _and_where_do_we_go
- Allara E, Engelini P, Gorini G, et al. Effects of a prevention program on multiple healthcompromising behaviours in adolescence: A cluster randomized controlled trial. Prev Med. 2019;124:1-10.
- Leiva A, Estelad A, M. B-V, Aguilóe A, Lloberaa J, Yáñeze AM. Effectiveness of a complex intervention on smoking in adolescents: A cluster randomized controlled trial. Prev Med. 2018;114:88-94.
- Cole AG, Aleyan S, Qian W, Leatherdale ST. Assessing the strength of secondary school tobacco policies of school in the COMPASS study and the association to student smoking behviours. Can J Public Health. 2019;110:236-243.
- Zagà V, Giordano F, Gremigni P, et al. Are the school prevention programmes-aimed at de-normalizing smoking among youths-beneficial in the long-term? An example from the smoke free class competition in Italy. Ann Ig. 2017;29:572-583.
- Evans W, Andrade E, Goldmeer S, Smith M, Snider J, Girardo G. The living the example social media substance us prevention program: A pilot evaluation. JMIR Ment Health. 2017;4(2):e24.
- Dobbie F, Purves R, McKell J, et al. Implementation of a peer-led school based scmoking prevention programme: A mixed methods process evaluation. BMC Public Health. 2019;19:742.
- McCallum GB, Chang AB, Saunders J, et al. Feasibility of a peer-led asthma and smoking prevention project in Australian schools with high Indigenous youth. Front Pediatr. 2017;5:33.
- Fletcher A, Willmott M, Langford R, et al. Pilot trial and process evaluation of a multilevel smoking prevention intervention in further education settings. Public Health Res. 2017;5(8).
- Brinker TJ, Owczarek AD, Seeger W, et al. A medical student-dellivered smoking prevention program, education against tobacco, for secondary schools in Germany: Randomized controlled trial. J Med Internet Res. 2017;19(6):e199.
- Kapitány-Fövény M, Vagdalt E, Ruttkay Z, Urbán5 R, Richman MJ, Demetrovics Z. Potential of an ineractive drug prevention mobile phone app (once upon a high): Questionnaire study among students. JMIR Serious Games. 2018;6(4):e19.
- Little MA, Pokhrel P, Sussman S, Dereﬁnko KJ, Bursac Z, Rohrbach LA. Factors associated with the adoption of tobacco cessation programmes in schools. J Smok Cessat. 2017;12(1):55-62.
- Rozema AD, Mathijssen JJP, van Oers HAM, Jansen MWJ. Evaluation of the process of implementing an outdoor school ground smoking ban at secondary schools. J Sch Health. 2018;88(11):859-867.