TUPE Handbook

Tobacco Use Prevention Education

HANDBOOK

Contra Costa County Superintendent of Schools Lynn Mackey Contra Costa County Board of Education Area 1 Fatima S. Alleyne, Ph.D. Area 2 Sarah G. Butler Area 3 Vikki J. Chavez Area 4 Mike Maxwell Area 5 Annette Lewis

Visit us online at cocoschools.org/TUPE Site Coordinator and Peer Educator Digital Resources: Additional TUPE information, activities, and resources are available online.

Please contact us at tupe@cccoe.k12.ca.us for access.

This resource was developed by the Contra Costa County Office of Education (CCCOE), with grant funding from the California Department of Education, Tobacco Use Prevention Education (TUPE).

Do not use without permission.

Table of Contents Program Background ................................................................................................................. 4 Purpose ..................................................................................................................................... 4 Tobacco Overview & Products .............................................................................................. 4 Tobacco is a Social Justice Issue ......................................................................................... 11 Funding ................................................................................................................................... 14 Contra Costa County TUPE Collaborative .......................................................................... 15 Participating Districts & Schools ........................................................................................... 16 What Works: Our Comprehensive Program ........................................................................... 18 Classroom-Based Prevention Programs – Project ALERT & Stanford Tobacco Prevention Toolkit (TPT).............................................................................................................................. 21 Intervention & Cessation Support ........................................................................................ 26 Youth Development .............................................................................................................. 31 Pregnant Minors and Minor Parent Services....................................................................... 38 Family & Community Engagement ......................................................................................... 39 Staff Professional Development............................................................................................... 42 Telling Our Story – Activity Logs, Surveys, Reporting, & Outcomes ...................................... 43 Contact Information ................................................................................................................. 48

Program Background Purpose The purpose of the tobacco-use prevention education (TUPE) program is to prevent and reduce tobacco use and nicotine addiction through tobacco-specific, evidence-informed educational instruction and activities that build knowledge, social skills, and youth development assets. We work alongside middle and high school students, who are active tobacco prevention leaders within their schools and communities and the next generation of tobacco-free advocates.

Tobacco Overview & Products Tobacco remains the number one cause of preventable death in the United States, with over 480,000 people dying from tobacco-related causes each year.1 While the tobacco purchase age in California is now 21, most adult tobacco users began under the age of 21 – nearly 90% by the time they were 18.2 Tobacco products refer to any product containing, made, or derived from tobacco or nicotine that is intended for human consumption. This does not include products that have been approved by the U.S. Food & Drug Administration (FDA) for tobacco cessation. In California, the definition of tobacco products includes cigarettes, cigarillos (little cigars), smokeless/chew tobacco, and ecigarettes.

Tobacco products harm the user and others, primarily because of secondhand and thirdhand smoke, and have a negative impact on our environment. Many tobacco users want to quit, however, the nicotine in tobacco products is highly addictive and makes cutting back or quitting difficult. Difficult, although not impossible!

WHY TOBACCO PREVENTION? Age of Onset: 90% of adult smokers began using under the age of 18.

E-Cigarettes/Vape Pens: Use of these tobacco products now exceeds combustible tobacco use among young people.

Health Disparities: While we have seen an overall decrease in tobacco-use, rates remain high among certain populations.

While flavored cigarettes have been illegal since 2009, thousands of flavors of other tobacco products, including little cigars and e-cigarettes, 1 2

Center for Disease Control and Prevention (CDC) https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm CDC https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm

are still on the market. Flavors are particularly appealing for young people, with nearly 81% of young people who ever tried tobacco choosing a flavored product.3 California Health & Safety Code prohibits the use of tobacco anytime, anywhere, and by anyone on all school property, and at all school-sponsored events. This prohibition extends to e-cigarettes and any other product, with or without nicotine content, that mimics use.

Cigarettes Cigarettes are thinly rolled cylinders, wrapped in paper. While other substances may be rolled into this shape, commercially produced cigarettes contain tobacco. Tobacco is a plant that is dried and fermented for tobacco products.

Tobacco contains nicotine, which is highly addictive, as well as thousands of chemicals that are either already in the tobacco plant or are created when the product is burned. Many of these are toxic and cancer-causing chemicals.

The Family Smoking Prevention and Tobacco Control Act, signed into law by President Barack Obama in 2009, banned all flavored cigarettes, except for menthol. There is no evidence that tobacco products that have menthol are safer than other cigarettes and some research shows that menthol cigarettes can be more addictive than nonmenthol cigarettes.4 Historically, menthol cigarettes have been targeted heavily toward certain racial/ethnic groups, especially African Americans. Among African American adult, adolescent, and young adult cigarette smokers, the most popular brands are all mentholated.

The most popular brands of cigarettes include Marlboro, Newport, and Camel, which are also the three most advertised brands.

3 4

Truth Initiative https://truthinitiative.org/news/flavored-tobacco-use-among-youth-and-young-adults https://smoke-free.gov/quit-smoking/ecigs-menthol-dip/menthol

Little Cigars/Cigarillos Unlike cigarettes, which are wrapped in paper, little cigars are wrapped in tobacco leaf or paper that contains tobacco. These products contain nicotine, as well as all the other toxic and cancer-causing chemicals found in cigarettes. While menthol is the only legal flavor of cigarettes, this restriction does not apply to little cigars/cigarillos which can be found in thousands of different flavors.

The most popular brands of little cigars/cigarillos include Swisher (Little/Sweets) and Black and Mild. Some people hollow out little cigars/cigarillos in order to fill them with cannabis/marijuana. Below is more information about dual use of tobacco and cannabis.

Blunts (Tobacco/Marijuana) A blunt is a hollowed-out cigar, filled with cannabis (marijuana, weed, pot, etc.) A common misconception among blunt users is that they are not using tobacco. In fact, blunt users are inhaling all the same chemicals found in a cigarette because, unlike cigarettes, which are wrapped in paper, little cigars are wrapped in tobacco leaf or paper that contains tobacco.

Tobacco & Marijuana Use Fast Fact In California, an estimated 790,000 high school-age students co-use marijuana and tobacco products. (includes vape products) CA Student Tobacco Survey, 2015-16

Under California law, it is legal for adults 21 or older to possess, consume and cultivate cannabis. Sale of cannabis from licensed retail outlets became legal January 1, 2018. Someone age 18 or older can also use cannabis if they have a current qualifying physician’s recommendation or a valid county-issued medical marijuana identification card.5 The adolescent brain is still developing until the early to mid-20s. Using cannabis regularly in the teens and early 20s may lead to physical changes in a young person’s brain. Cannabis can harm a young person’s memory and ability to learn and pay attention. Some studies suggest a permanent impact as well. These harmful effects may make it harder for youth to achieve their educational and professional goals and impact how successful they are in life. Cannabis use also increases the risk for anxiety, depression, suicide and schizophrenia as well as substance use or abuse.6 5 California Department of Public Health (CDPH) https://www.cdph.ca.gov/Programs/DO/letstalkcannabis/Pages/LetsTalkCannabis.aspx 6 CDPH https://www.cdph.ca.gov/Programs/DO/letstalkcannabis/Pages/youth.aspx

E-Cigarettes/Vape Pens/Pod-Based Systems E-cigarettes are battery-operated devices that deliver an aerosol to the user. Ecigarettes are commonly known as vape pens, or mods. The e-liquid in e-cigarettes may contain nicotine, flavoring, and other chemicals. Some of the newest ecigarettes/vape pens on the market are what we refer to as pod-based systems. These include popular brands such as Juul, Suorin, and Phix, as well as newer disposable pod devices designed for single use, such as Puff Bar, Wave Bar, and STIG. It is important to note that the term e-cigarette or vape pen is often used as an umbrella term that includes many different types of products.

Examples of e-cigarette products, CDC

Types of e-cigarette products7: • Cig-a-likes first entered the market in 2007. Like the product on the far right of the image above, these products mimic the size and shape of a tobacco cigarette and the are sold with the nicotine in pre-filled cartridges. They are often disposable.

• Vape pens, or medium-size tank devices, are larger than cig-a-likes and often have the appearance of an ink pen. Vape pens can have rechargeable batteries and refillable cartridges, that a user fills with e-liquid, often containing nicotine or THC (cannabis/marijuana).

• Mods and tanks are the largest devices. These devices are refillable.

• Pod-based systems are smaller and can often look like a USB. Pod-based systems consist of two main parts- a battery and a pod. The pod is filled with e-juice and they are either closed or open systems. Closed systems, such as Juul, come prefilled and open systems allow the used to refill the pod.

7

California Youth Advocacy Network, May 2020, www.cyanonline.org

• •

Disposable pod devices are designed for singled use, come fully charged, and pre-filled. Once the e-juice is gone, the device is thrown away.

Pod flavor add-ons are pre-filled, no nicotine flavor attachments that can be used with multi-use and disposable pod devices. They are designed to add flavor to vaping devices.

When heated, the e-juice in an e-cigarette becomes an aerosol that users breathe from the device and exhale. E-cigarette aerosol can contain harmful and potentially harmful substances, including nicotine, ultrafine particles that can be inhaled deep into the lungs, and heavy metals such as nickel, tin, and lead.8 Key concerns regarding adolescent use: • Adolescent use of e-cigarettes has surpassed combustible tobacco products.9 • Most e-cigarettes contain nicotine, a highly addictive neurotoxin. Exposure to nicotine during adolescence can harm brain development. Young people who are first-time e-cigarette users are four times more likely to smoke combustible cigarettes within one year.10 • While we are still learning about the long-term health effects, we do know that ecigarettes emit an aerosol, not water vapor. Mainstream and secondhand ecigarette aerosol has been found to contain at least ten chemicals that are on the California’s Proposition 65 list of chemicals known to cause cancer, birth defects, or other reproductive harm.

Ever Used Tobacco, Contra Costa 2017-2019 CHKS Data 47%

50% 40%

32%

30% 16%

20% 10%

28%

1% 1%

6%

3% 2%

6% 4%

9%

0%

Grade 7

Cigarettes

Grade 9

Smokeless Tobacco

Grade 11

Non-Traditional

E-Cigarettes/Vape Pens

CDC https://www.cdc.gov/tobacco/basic_information/e-cigarettes/index.htm National Institute on Drug Abuse https://www.drugabuse.gov/related-topics/trends-statistics/infographics/teens-e-cigarettes 10 BMJ Journals http://tobaccocontrol.bmj.com/content/early/2017/01/04/tobaccocontrol-2016-053291 8 9

THE FDA HAS NOT APPROVED ANY E-CIGARETTE/VAPE PEN/POD-BASED SYSTEM AS A SMOKING CESSATION AID. -

U.S. FOOD & DRUG ADMINISTRATION (2017)

Key talking points for students: •

•

•

•

•

•

E-cigarettes are battery operated devices that deliver nicotine and other chemicals to the user.

E-cigarettes have many names, such as vape pens, e-hookah, and mods. They also include pod-based systems such as Juul and Puff Bar. Like alcohol, cannabis, and other tobacco products, it is illegal to sell e-cigarettes/vape pens to anyone under the age of 21.

While e-cigarettes don’t contain tobacco, most contain nicotine and nicotine harms the brain and heart. Nicotine is also very addictive. Once someone starts using nicotine, it can be very hard to stop.

The tobacco industry is known for trying to make their product seem fun and harmless, including enticing flavors and targeted marketing.

However, we know that these products are in fact harmful, especially for children and teens.

The best way to avoid tobacco-related health problems, including nicotine addiction, is to never start.

California Department of Public Health “Still Blowing Smoke” Campaign

Click on an image below to access more information and resources from Stanford University’s Tobacco Prevention Toolkit and Cannabis Awareness & Prevention Toolkit.

While not as widely used, smokeless/chew tobacco and hookah are also tobacco products that we also see used by young people.

Smokeless/Chew Smokeless tobacco refers to tobacco products that are used without smoking, such as chew tobacco.

Products also include those which are placed between the lip and the gum or sniffed.

Smokeless tobacco is harmful. Overall, people who dip or chew get about the same amount of nicotine as regular smokers. They also get at least 30 chemicals that are known to cause cancer.11

Example of smokeless tobacco

Hookah Hookahs are water pipes, used to smoke a specific type of tobacco that comes in many flavors. While hookahs vary in shape and size, they typically include a water bowl with a flexible hose and mouthpiece.

Hookah use is often done in groups, with people sharing the same mouthpiece. The tobacco is heated with charcoal. While some think that hookah is less harmful than other tobacco products, hookah has many of the same health risks.12 Emerging Products

Example of a hookah water pipe

New tobacco and nicotine products are regularly introduced in the U.S. market.

Additionally, some products that have been around for centuries are increasing in popularity and use.13 We regularly check for updated information and resources on new and emerging tobacco and nicotine products and share this information with the field. If you ever have any questions, or have observed an emerging trend in adolescent tobacco use, don’t hesitate to contact the County Office TUPE team.

American Cancer Society https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/smokeless-tobacco.html CDC https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/index.htm 13 California Youth Advocacy Network https://cyanonline.org/resources/topic-areas/new-and-emerging-products/ 11 12

Tobacco is a Social Justice Issue Tobacco is not an equal opportunity killer.

For decades, African Americans, lowincome neighborhoods, LGBTQ+ communities and those with mental illness have been disproportionately affected by tobacco use—a result of profiling by the tobacco industry.14

“While there has been progress, there is still a long way to go. Especially in communities that are disproportionally impacted by tobacco. Programs like TUPE, that empower community members to take a stand against Big Tobacco, not only educate the community, but also help teenagers find their voice.�

- Contra Costa Tobacco Prevention Survey (Adult)

The tobacco industry has a history of heavily targeting all these groups and, therefore, these groups are those with higher adult smoking rates, and those who suffer from higher rates of tobacco-related illness.

14

Truth Initiative https://truthinitiative.org/news/tobacco-is-a-social-justice-issue

The tobacco industry aggressively markets their products in order to reach those they refer to as “replacement smokers,” new users the industry needs to replace current users who die or quit.

Tobacco Use Disparities (Statewide): Ø Among California adults, smoking prevalence is higher in the African American population (20%) than in the general population (11.6%).15 Ø Three times as many Contra Costa Hispanic/Latinx young people report current cigarette use, as compared to their Asian peers.16 Locally, 650% more non-traditional school (continuation/alternative) students report current cigarette use and 500% more report current smokeless tobacco use, as compared to the general 11th grade population.16 While cigarette and smokeless tobacco use rates continue to decrease, they are decreasing at a slower rate among non-traditional students.

Our non-traditional school students also report much higher levels of e-cigarette use, use of tobacco/e-cigarettes on school property, and lower disapproval of cigarette use.16

Current Tobacco Use - Contra Costa 2017-2019 CHKS Data 25%

21%

20%

16%

15%

13%

Grade 9

10% 5%

8% 5% 1%

1%

2%

0%

Cigarettes

Grade 7

0%

1%

1%

Smokeless

3%

Grade 11 Non-Traditional

E-Cig/Vape Pens

A promising data finding is that our non-traditional school students in our current TUPE consortium districts report higher rates of quit attempts, which speaks to the success of our TUPE intervention and cessation support provided within these school communities.16 15 16

California Health Interview Survey, California Department of Public Health California Healthy Kids Survey (CHKS), Contra Costa County Secondary Report, 2015-16

Consistent with state and national data, Contra Costa young people who identify as lesbian, gay, and bisexual are more than three times as likely to be current cigarette users than their peers who identify as heterosexual. The rates of use for students who identify as transgender is even more alarming, with six times the rate of current cigarette use, as compared to their peers who identify as cisgender.17

Current Cigarette Use - Contra Costa 2015-16 CHKS Data 35%

31%

30% 25% 20% 15%

12%

10%

7%

5% 0%

12%

3% 0%

Middle School Heterosexual

2%

High School Lesbian/Gay/Bisexual

Non-Traditional Transgender

We remain committed to addressing tobacco use as a social justice issue and continue to work to counter the tobacco industry’s predatory marketing tactics to try to hook new users.

We ensure that all students are reached directly through classroom-based prevention programs, intervention and cessation services, and engaged in anti-tobacco youth development opportunities. We also develop additional activities and resources to further address the needs of those most impacted by tobacco use.

Despite past and present challenges, we have the people, programs, supports, and partnerships in place to continue to meet our goal of reducing tobacco use. Our efforts thus far have proven to be successful and there is still more work to be done.

17

California Healthy Kids Survey (CHKS), Contra Costa County Secondary Report, 2015-16

Funding All funding for our local TUPE work comes from the California Department of Education, Tobacco Use Prevention Education Office (TUPEO), and these resources are secured through a competitive grant application process. TUPE is funded through California Propositions 99 and 56.

California Proposition 99, the Tobacco Tax and Health Protection Act, was passed by voters in 1988. Prop 99 imposed a 25-cent per pack state excise tax on the sale of tobacco cigarettes, with equivalent taxes on the sale of other tobacco products, such as cigars and chew tobacco. Prop 99 also included a ban on cigarette vending machines and the sale of single cigarettes, often referred to as “loosies.” A portion of the revenue generated from Prop 99 supports various tobacco prevention efforts, including TUPE in grades six through twelve, the California Public Health Department’s Tobacco Control Program, and tobacco research.

California Proposition 56, the Tobacco Tax Increase Initiative, was on the ballot in 2016 and was approved by voters. (64.4% of voters voted yes.) Prop 56 increased the cigarette tax by an additional $2.00 per pack, with equivalent increases on other tobacco products, including e-cigarettes. A portion of the revenue from Prop 56 also goes to tobacco prevention. Addressing health-related disparities is required for recipients of Prop 56 funding.

County Offices: Every County Office of Education in the state is eligible to receive County Technical Assistance and Leadership Funds (CTALF). These funds allow us to provide ongoing technical assistance and training for all our local school districts, as well as our direct-funded charter schools.

Districts: In Contra Costa County, 16 of our 18 districts currently receive funds to support tobacco prevention efforts. Funding is made available through a competitive grant process with the California Department of Education, Tobacco Use Prevention Education Office (TUPEO). Half of our districts receive funding that provides the resources to implement comprehensive tobacco-use prevention education programs in grades six through twelve, known as Tier 2. The other half receive minimal funds to administer the California Healthy Kids Survey (CHKS) and maintain tobacco-free school policy, known as Tier 1. Current funding is secured through June 2020 (Tier 2) and June 2021 (Tier 1).

Tobacco Industry Funding Prohibition: TUPE grantees, including all participating districts in the case of a consortium, are prohibited from accepting any funding, educational

materials, or services from the tobacco industry, including e-cigarette/vape pen companies, or from any agency which has received funding from the tobacco industry.

Acceptance of such items will result in termination of the grant and a request for the return of all advanced grant funds.

Contra Costa County TUPE Collaborative

Contra Costa County TUPE Collaborative

Our Contra Costa TUPE Collaborative reviews, develops, implements, and evaluates all aspects of our countywide tobacco prevention work. TUPE Collaborative members include County Office staff, district staff, and community partners, including Contra Costa Health Services, Tobacco Prevention Project, and community-based non-profit organizations.

We meet quarterly and utilize the existing resources in our communities to most effectively and efficiently meet the tobacco-prevention, intervention, and cessation needs of our students.

Student Services Districts

County Office

County Health Services

Community-Based Organizations

Guiding Principles Our TUPE Collaborative is grounded in the following statements and professional practices:

Curriculum & Instruction TUPE Staff Tobacco Prevention Project Alcohol and Other Drug Services Center for Human Development Rainbow Community Center Students

Individuals

Teachers/School Staff Parents

v Tobacco is a social justice issue. v There is no safe level of tobacco use or exposure. v Young people have the power and capacity to educate others and positively impact their entire school communities. v We strive to be as effective as possible, making data-driven decisions and evaluating our efforts to determine what works. v We partner across systems and sustain a broad collaborative, including young people, to meet the needs of students most impacted by tobacco use. v We focus on strategies proven to reduce tobacco use, while leaving room for innovation and connecting our work to what is happening in students’ lives. v We treat current users with respect, suspend judgment, and provide the resources to support users to cut back or quit. v We provide valuable, high quality professional development.

Participating Districts & Schools

Tier 1 Districts

Tier 2 Districts

COE Schools

The County Office offers ongoing technical assistance and training for all Local Education Agencies (LEAs).

Tier 1 Consortium: Funding for CA Healthy Kids Survey administration

Tier 2 Consortium: Comprehensive program.

Participating LEAs: • Lafayette School District • Moraga School District • Orinda Union School District • Walnut Creek School District

Participating LEAs:

Youth Engagement to Address Tobacco-Related Health Disparities County Office of Education schools: • Golden Gate Community School • Mt. McKinley (Court Schools)

• • • • • • • • • • • •

Acalanes Union High School District Antioch Unified School District Brentwood Union School District County Office of Education (Golden Gate, Marchus, & Mt. McKinley) John Swett Unified School District Knightsen Elementary School District Liberty Union High School District Martinez Unified School District Mt. Diablo Unified School District Oakley Union Elementary School District Pittsburg Unified School District San Ramon Valley Unified School District

TUPE Tier 2 County, District, and School Partners

It takes a lot of people working together to ensure that all students are equipped with the information and skills they need to remain tobacco-free. County Office TUPE staff work directly with district and school staff to ensure successful implementation of TUPE programs and services.

Primary roles and responsibilities of individuals/groups within our TUPE Collaborative: County Office • Provide overall project management • Secure funding • Convene Countywide Collaborative meetings • Coordinate programs and services • Provide professional development and ongoing support

Districts • Act as a liaison between County Office of Education and school sites • Administer the California Healthy Kids Survey (CHKS) • Maintain tobaccofree school policy • Provide ongoing support

Sites • Provide on-site program coordination (site coordinators) • Implement programs and services (site coordinators, peer educators, and other school staff and community partners)

Community Partners • Active members of TUPE Collaborative • Provide ongoing training and technical assistance, as well as direct services, as needed • Co-coordinate CourAGE Youth Health Coalition

What Works: Our Comprehensive Program

Staff Professional Development

Family & Community Engagement

Student Services

TUPE programs include multiple student services, including classroom-based substance abuse prevention programs, intervention and cessation services, and youth development activities, such as peer education, as well as family and community engagement, and staff professional development.

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•

•

Classroom-Based Prevention Programs: Project ALERT (middle school) is a research-validated drug prevention program and proven to reduce the experimental and continued use of drugs. The Stanford Tobacco Prevention Toolkit (high school) is a theory-based and evidence-informed educational resource created by educators and researchers aimed at preventing middle and high school students’ use of tobacco and nicotine products.

Alternatives to Suspension Intervention Model: Our model consists of three key programs that provide options along a continuum, to best meet the needs of students currently using tobacco products. For small group intervention, we utilize the Stanford Tobacco Prevention Toolkit’s Healthy Futures program, for one-onone support we utilize the Brief Intervention program, and we are also piloting a peer-to-peer intervention program.

Youth Development: Teams of students from every middle school, high school, and non-traditional (continuation/alternative) school are trained as TUPE Peer Educators each year. These students deliver anti-tobacco messages at their

•

•

school through classroom presentations and school-wide events. In addition, the County Office also co-coordinates a countywide Youth Health Coalition, CourAGE. CourAGE members represent schools/districts from throughout the county.

Family & Community Engagement: Also a multi-strategy approach, our family and community engagement work includes virtual, countywide parent education events, as well as on-site family engagement through community-specific parent education events and existing events such as Back-to-School Night, Open House, sporting events, and awards nights.

Staff Professional Development: We provide valuable, high quality professional development that aligns with local needs and supports TUPE programs and services.

While the primary focus of the program is tobacco prevention, our strategies are comprehensive and include information on alcohol, marijuana, and other drugs.

Students are also building a wide variety of important and relevant skills including communication, planning, public speaking, and decision making.

nt s St u de Fe w nt s St u de m e So

*Cessation

Current Users/Voluntary

*Intervention

Current Users/Involuntary

*Peer Educators Selected Students

*Classroom-Based Prevention Programs

Al

lS

tu de

nt s

Selected Grade Levels

*School-Wide Events/Anti-Tobacco Advocacy *Family & Community Engagement *Staff Professional Development *Tobacco-Free Schools Policy, Education, & Enforcement

Tiered approach to Tobacco-Use Prevention Education

Classroom-Based Prevention Programs – Project ALERT & Stanford Tobacco Prevention Toolkit (TPT) Middle school teachers have implemented Project ALERT, a research-validated prevention program, since our first TUPE consortium grant began in 2011, and many districts were implementing this or similar programs for many years prior. One of the newest prevention programs available, is the Stanford Tobacco Prevention Toolkit (TPT), which we implement at the high school level.

During a student focus group at Excelsior Middle School in Byron, we asked students where they are able to find accurate information about tobacco and e-cigarettes and one student immediately responded, “My science teacher… we had Project ALERT last year and it taught us about some of the dangers of different drugs.”

While alcohol, tobacco, marijuana, and other drug prevention is a topic that requires ongoing program adaptation to respond to current needs, both Project ALERT and the TPT are grounded in instructional strategies that have been proven effective to prevent and reduce drug use.

At the middle school level, Project ALERT focuses on increasing students’ understanding of the dangers of drug use while building their skills to make healthy decisions regarding their own drug use. Project ALERT materials are all available online at no cost, and they regularly issue updates to provide recommendations for integrating new issues, such as e-cigarette/vape pen use, into existing lessons.

The Stanford Tobacco Prevention Toolkit is a new, theory-based and evidence-informed educational resource created by educators and researchers aimed at preventing middle and high school students’ use of cigarettes, cigars/cigarillos, chew, hookah, and electronic cigarettes.

The TTPT includes modules focused on:

• • • •

Nicotine addiction; E-cigarettes/vape pens/pod-based systems; Information and resources concerning positive youth development; and School policies that provide information about school tobacco policies and tobacco control efforts.

Teachers lead lessons from the TPT with grade 9 or 10 students and all non-traditional school students, equipping them with the knowledge and skills to make decisions that best support their healthy brain development and reduce the likelihood that they will engage in tobacco use.

Classroom-Based Prevention Programs At-a-Glance

Overview

Target Audience Lessons Topics Covered

Project ALERT – Middle School

Tobacco Prevention Toolkit – High School

Classroom-based substance abuse prevention program that motivates students against drug use, cultivates new nonuse attitudes, and equips students with the skills they will use to resist drugs.

All students in grades 7 and 8

Classroom-based substance abuse prevention program aimed at preventing students’ use of tobacco and nicotine products, as well as supporting healthy brain development.

11, 45- to 60-minute lessons (grade 7), min once per week. 3 booster lessons (grade 8).

Consequences of alcohol, tobacco, marijuana, and other drug use.

5, 50- to 60-minute lessons, typically implemented daily over the course of a week.

Adolescent brain development and how drugs impact the brain, nicotine addiction, history of tobacco in the United States and tobacco marketing strategies, and e-cigarettes.

Benefits of nonuse and how to identify and resist pro-drug pressures.

Small-group activities, roleInstruction playing, and rehearsal of new Strategies skills.

Effectiveness Proven to reduce the experimental and continued use of drugs.

Teacher or other trained health Provider Qualifications educator.

In-person and/or online Training www.projectalert.com Website

All students in grade 9 or 10 and attending non-traditional schools

Full and small group discussion.

Interactive activities. Lecture.

Theory-based and evidenceinformed.

Teacher or other trained health educator.

In-person and/or online http://tnd.usc.edu/

Both Project ALERT and TPT align with the California Health Education Content Standards.

California Health Education Content Standards Standard 1: Essential Health Concepts •All students will comprehend essential concepts related to enhancing health.

Standard 2: Analyzing Health Influences •All students will demonstrate the ability to analyze internal and external influences that affect health.

Standard 3: Accessing Valid Health Information •All students will demonstrate the ability to access and analyze health information, products, and services.

Standard 4: Interpersonal Communication •All students will demonstrate the ability to use interpersonal communication skills to enhance health.

Standard 5: Decision Making •All students will demonstrate the ability to use decision-making skills to enhance health.

Standard 6: Goal Setting •All students will demonstrate the ability to use goal-setting skills to enhance health.

Standard 7: Practicing Health-Enhancing Behaviors •All students will demonstrate the ability to practice behaviors that reduce risk and promote health.

Standard 8: Health Promotion •All students will demonstrate the ability to promote and support personal, family, and community health.

More information about the California Health Education Standards is available on the California Department of Education’s website: https://www.cde.ca.gov/ci/he/

Project ALERT/TPT Teacher Support & Incentives County Office staff provide ongoing support for teachers and other staff implementing classroom-based prevention programs.

No-Cost Training

• One-day, in-person or virtual training • Self-guided online training (Project ALERT only) • On-site training

Ongoing Support

• Implementation check-in webinars • Online resources • Phone/e-mail/in-person support

Materials

• Teacher manual • Student materials, including Project ALERT posters.

• Additional materials, as needed

Annual Stipend Project ALERT & TPT instructors are eligible to receive a $250 stipend. *

Teachers/staff are eligible to receive a stipend incentive upon completion of the following: Training or New educators attend a countywide training, online training, Returning Teacher and/or receive on-site training. Returning educators are Check-in welcome to attend trainings as a refresher.

Documentation & Provide teacher/staff information and implementation plan Implementation Documentation: Completed independent consultant Plan (pre) documentation (hard copy) and implementation plan (online).

Implementation Provide implementation dates (range), total students, any major Log (post) adaptations, and brief reflection. (online) Student Surveys Post-survey. Completed online. Hard copies of surveys are available upon request. *All stipends are paid at the end of the school year, upon completion of training/checkin, pre- and post-implementation log, and submission of student surveys.

For more information, contact Tiffani Mason: (925) 942-5315 or tmason@cccoe.k12.ca.us

Intervention & Cessation Support “Punishing students when they are caught just isn’t enough.”

- High School Student

The goal of intervention and cessation strategies is to boost the number and frequency of quit attempts among young people. When a student is caught with tobacco products on campus, this is an opportunity to provide necessary support through our alternatives to suspension intervention model.

Healthy Futures is a small group, educational intervention program. Healthy Futures was developed by the Stanford Tobacco Prevention Toolkit Team, in response to the increased need for intervention supports and services. Students who are caught on campus with tobacco products are referred to the Healthy Futures program, which is facilitated by a teacher, site coordinator, or other trained school or community-based organization staff member. There are 1-hour, 2-hour, and 4-hour options available, meeting the varying logistical needs of our districts and schools.

The Healthy Futures program covers critical content and resources, including opportunities to explore health problems associated with e-cigarette/vape pen and other tobacco use. Participating students also have the opportunity to develop an individualized plan for setting goals related to their tobacco use and learn how to access resources to quit tobacco use.

Brief Intervention for Substance Using Adolescents (BI) is a short-term, one-on-one intervention that consists of 2-3 sessions for young people who use tobacco and/or other drugs. BI utilizes motivational interviewing, cognitive behavior therapy, and the stages of change model to meet the needs of adolescents.

For the purposes of TUPE, we utilize BI for tobacco use, however this strategy can be used to address other behaviors, including marijuana/cannabis use.

Brief Intervention provides young people with: • A forum to talk about their drug use, • Accurate information about their drug of choice, • Support in identifying drug use related issues that impact them, • Goal setting support, and

•

Assistance in accessing other services.

Brief Intervention is best suited for young people who: • Are experiencing few problems with their drug use, • Have low levels of dependence, • Have a short history of drug use, • Have stable backgrounds, and • Are unsure about changing their drug use.

“When a student gets caught on campus, they are referred to us and then we schedule to check-in with them to see if BI is a good fit, or if they need other services. It’s a great opportunity for collaboration with our school administrative team and, most importantly, it engages students in services.”

– TUPE Site Coordinator

Provider trainings are provided at no-cost. Trainings are open to any interested school staff.

Cessation/Quit Resources Approximately half of all adolescents who currently smoke tried to quit in the previous 12 months.18 Only 12% succeed. Teens double their chance of success by participating in a cessation program.

Our TUPE Collaborative is committed to ensuring that cessation referrals and support are communicated and accessible within every school site. While most students are not current tobacco users, we know that everyone is impacted by tobacco use in some way.

We work to make sure that all students, staff, and parents/families know where to go to access no-cost cessation resources.

Cessation Fast Facts According to the 2015-16 Healthy Kids Survey…

2% of Contra Costa 9th graders, 3% of 11th graders, and 11% of nontraditional school students tried to quit or stop using cigarettes in the last year.

Objectives of Cessation efforts: • Boost the quit attempt rate – the more often people try to quit, the more likely they are to succeed!

• Increase the desirability of quitting and the motivation to try quitting.

• Normalize quitting.

• Increase the sense of urgency to quit earlier in life.

• Encourage youth to access health care providers that spur pediatric patients to try quitting.

18

CDC https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2015/ss6506_updated.pdf

We promote tobacco cessation in multiple ways, including: • School-wide “Cessation Campaigns,” particularly during the month of November and in alignment with the National Great American Smokeout.

• Provide all students, staff, and parents/guardians with cessation information and resources • Refer current users to voluntary Brief Intervention sessions or cessation/quit group

“The best way to avoid addiction is to never start… but we’re not fixing the issue if we’re just focused on preventing it.”

- Student, Grade 12

School-wide Cessation/Quit Campaigns: Cessation Campaigns ensure that everyone within a school community – students, staff, and even parents/guardians – are aware of resources available. These campaigns can be planned and led by teams of Peer Educators and are an opportunity to encourage current tobacco users to use the date to make a plan to quit or quit that day.

Check out this short video with strategies for young people to stay tobacco-free.

There is also an accompanying, interactive student worksheet and parent letter. These resources are available in English and Spanish.

For more information about cessation resources available, visit our TUPE webpage or contact a member of the Contra Costa County Office of Education TUPE team.

Tobacco Cessation/Quit Resources In Contra Costa, call 2-1-1 or text zip code to TXT211 (898211) for direct cessation referrals.

Free services for teens and adults that include self-help materials and one-on-one counseling.

Services are available in multiple languages. www.nobutts.org Vape quit support at www.novapes.org Contra Costa County folks can dial 2-1-1 or text TXT211 (898211) for direct referrals. • •

English: 1-800-NO BUTTS (1-800-662-8887) Spanish: 1-800-45 NO FUME (1-800-4566386)

Tips for Supporting Someone Trying to Quit Someone who feels supported is more likely to quit tobacco use for good. That’s why friends and family members can play a big part in helping a person become tobaccofree.19 If someone you care about is quitting tobacco, it can be difficult to know what to say and do. Here are some tips for supporting a current tobacco user in their quit efforts.

Respond positively when someone says they are thinking about quitting tobacco use.

“I’m so proud of you for trying to quit smoking. I’ll help with whatever you need to make it happen.”

“You’re not in this alone. Even if it gets tough, I’ll be here for you.”

Ask open-ended questions to help you understand what a tobacco user who is quitting is going through.

Offer distractions by helping them plan healthy, tobacco-free activities, such as going to a movie, taking a walk, etc.

Be patient and don’t give up on them.

The withdrawal that can come from quitting may make a person irritable.

Avoid taking their mood personally and check-in regularly.

“Quitting tobacco will be hard, but I know you can do it. Have you set a quit date?”

“What things make you crave a cigarette/vape pen? What made you decide to quit?

What could I do to help make quitting easier for you?”

“Quitting isn’t easy and many people need several tries before they quit for good. You’ve got this, and I’m here for you.”

Don’t be too hard on them if they slip up at some point.

19

National Institutes of Health https://smoke-free.gov/help-others-quit/family-friends/how-support-your-quitter

Youth Development We have adopted a mission of developing the next generation of tobacco-free advocates and are committed to implementing strategies that provide young people with opportunities to experiences first-hand the role of envisioning and creating schools and communities free from tobacco use and the harms caused by tobacco.

Commitment to Youth-Adult Partnerships CCCOE TUPE staff work in partnership with young people in a way that establishes and sustains intergenerational equity between young people and adults.

Countywide Youth Health Coalition – CourAGE Our TUPE Collaborative is dedicated to the continued inclusion of students as active and meaningful partners in our prevention work. We established the Contra Costa Youth Health Coalition in 2013 to ensure ongoing student involvement and leadership at the countywide level. The group is named CourAGE, which stands for See (C) Our Advocacy, Generation, and Education (AGE). CourAGE is supported by a partnership with Center for Human Development’s (CHD) Contra Costa Friday Night Live (FNL) program.

CourAGE Youth Health Coalition members, 2019-20

Grounded in positive youth development and youth-adult partnership principles, the CYHC is youth-centered and –directed and plays a leadership role in addressing tobacco-related issues. CYHC members are in grades 8-12 and represent multiple schools from across our county. CYHC members develop skills that empower them to create healthy environments through anti-tobacco awareness and advocacy projects.

Current CourAGE projects include: Ø Run annual countywide video PSA Contest & Film Festival Ø Plan and host student-led Youth Symposium & Facilitate middle school workshops Ø Attend and support community-based events Ø Present to local decision-makers, including County Board of Supervisors

Peer Educators Teams of students from every middle school, high school, and non-traditional (continuation) school are trained as TUPE Peer Educators each year.

These students deliver anti-tobacco messages at their school, primarily through classroom presentations and school-wide events.

The primary role of our Peer Educators is to provide tobacco-prevention information, resources, and support to their peers, as well as inspire all members of the school community by modeling healthy choices and leadership.

The goals of all Peer Educators are to: • Teach new information about tobacco/ecigarettes.

• Encourage non-tobacco users to stay tobacco free.

• Encourage current tobacco users to cut back or quit. (Share resources.)

• Have fun!

Peer Ed Fast Facts During the 2018-19 school year…

576 students were trained as TUPE Peer Educators.

36,368 middle and high school students were reached through antitobacco school-wide events and classroom presentations.

269 TUPE Peer Educators attended the Teens Tackle Tobacco Conference at UC Berkeley.

Recruitment/Selection Each school site determines the best strategies to recruit Peer Educators. Some sites utilize existing groups of students, such as Leadership. While engaging Leadership students has its strengths, TUPE Peer Education is also an opportunity to engage students who may not already be in leadership roles on campus.

Youth and/or adult-led recruitment strategies include: • Classroom presentations • Lunchtime tabling • School-wide announcements • Posters/flyers

El Cerrito High School Peer Educators, West Contra Costa Unified

• • •

Teacher and other school staff recommendations Peer recommendations List of incoming 9th graders from feeder middle school(s)

“I want to influence others. I want to educate them and if they are thinking about using, to encourage them not to. If they say something that is incorrect, then I could correct them… in a nice way.”

For continuing sites, we highly recommend starting with returning Peer Educators and work together to implement new member recruitment and selection.

- TUPE Peer Educator, Middle School

While we do not require that each site establish an application process and/or interviews, this can add a level of professionalism and send a message that what students are signing up for is important. We have provided sample Peer Educator applications in the online Site Coordinator resources.

Peer Educator Selection While any young person can potentially be a Peer Educator, you may want to consider the following questions when selecting students: • • • • • •

Do they care about the issue of tobacco prevention?

Are they eager to learn more about the issue of tobacco?

Do they care about the health and wellbeing of their peers?

Do they have an interest in building leadership skills?

Do they have time to participate?

Are they excited about this opportunity?

“This was very different from any

TUPE Tip: For continuing sites with returning Peer Educators, think about the strengths and gaps of your current membership to do more targeted recruitment. For example, is your group all 8th or 12th graders? Consider focusing on recruiting younger students.

other extracurricular activity I had done before, and I am glad I got to participate in such a unique experience.”

- TUPE Peer Educator, High School

Peer Educator Training Once you have established your group, they need training!

Annual District-Level Training: Each site is invited to bring 10 students to attend a oneday Peer Educator Training. The Peer Educator trainings are district-wide, so students can connect and learn alongside other middle or high school students from nearby schools.

“I became more comfortable with public speaking and I also developed a greater understanding of curriculum development and the dynamics of teaching in a classroom. Overall, my experience as a Peer Educator has had an incredibly positive impact on me!”

- TUPE Peer Educator, High School

The goals of the Peer Educator training are to: • Equip students with new information about tobacco, including e-cigarettes.

• Demonstrate activities that can be used and adapted to educate their peers about tobacco/e-cigarettes.

• Model that learning about tobacco can be fun.

Additional On-Site Training: Most sites are able to bring teams of students to the districtlevel training, however, if a site is unable to attend, or if a site would like additional training for students who were unable to attend, on-site training is available. County TUPE staff are available to provide half- or full-day trainings, as well as ongoing, on-site training and support. For example, most district-level trainings happen in September and October. A site may not schedule classroom presentations until weeks or months later and County TUPE staff are happy to attend a Peer Educator meeting, or longer, to help them plan and prepare for classroom presentations and other tobacco prevention activities they want to implement on campus.

Peer Educator Retention Once you have your group established, it is important to Antioch Unified Middle School Peer Educator Training think about ways to retain active members. You may also want to conduct ongoing recruitment throughout the school year, as needed.

A good place to start is to understand why each person chose to be a Peer Educator and what they hope to gain as part of their involvement.

Two of the main reasons that people don’t remain involved in a program are that they don’t feel like they are a part of the group and/or they get bored. Of course, there are many other things that may impact a young person’s ability to be an active member of the group, however, many of those are things outside of our direct control.

Here are some ideas for how to recognize and retain student members: • Respect their efforts and their time.

• Meet consistently. For example, lunch meetings every “TUPE Tuesday.”

• Listen to their ideas and allow them to make decisions.

• Transfer leadership of meeting facilitation and activity planning.

• Provide incentives, such as our Peer Educator t-shirts, backsacks, and lanyards, as well as certificates of appreciation and letters of recommendation.

• Share Peer Educators’ names with teachers and other adults on campus and encourage the adults to acknowledge students for their important work.

• Provide adequate training and support as they build the skills necessary to do classroom presentations and plan school-wide events.

• If possible, provide off-campus learning opportunities, such as the district-level Peer Educator training, regional Teens Tackle Tobacco Conference, etc.

• Celebrate accomplishments both small “The majority of the students who become Peer Educators officially and big.

Peer Educator Meetings We highly recommend scheduling regular meetings with your team of Peer Educators, with the first meeting within a week or two of attending a Peer Educator training. A consistent meeting schedule can greatly increase member retention.

commit to the program for one year, but we have found that they often return for a second, and third, year. To have the privilege of seeing their growth over the course of 2-3 years is nothing short of amazing.”

- TUPE Site Coordinator, High School

If you would like additional support at an upcoming meeting, someone from our TUPE team would be happy to attend a meeting at your site!

All TUPE sites plan and implement tobacco prevention activities throughout each school year. In this section are ideas for reaching students within the classroom setting and through school-wide events.

Keep in mind that there is no “one size fits all” and each site should determine what activities will work best based on their student population, existing events, level of administrator and colleague support, etc.

We also have our TUPE Monthly Themes, if you are interested in using those to guide your messaging and activities throughout the year. Consider all of these to be suggestions and feel free to mix-and-match themes and specific activities. For example, you do not need to do e-cigarettes/vape pens prevention only in September and a Take Down Tobacco (formerly Kick Butts! Day) event can be held on any day that works for your school community.

We also recommend considering existing events on campus that could benefit from a dose of TUPE information and inspiration – a TUPE Table at Back-to-School Night and/or Open House, airing studentdeveloped anti-tobacco PSAs before a music or theater performance, a TUPEthemed obstacle course at a school-wide Club or Health Fair… get creative!

Antioch High School TUPE Peer Educators, after presenting at our countywide site coordinator training

Student-Led Advocacy In addition to anti-tobacco advocacy work within their school communities, TUPE Peer Educators have the opportunity to join our CourAGE Youth Health Coalition in community-level advocacy.

Adlvolcate noun: a person who works for a cause verb: publicly support

Community-Level Advocacy CCCOE TUPE partners with Contra Costa Health Services Department Tobacco Prevention Project staff and is an active member of the Contra Costa Tobacco Prevention Coalition (TPC). Tobacco Prevention Project staff are also active members of our countywide TUPE Collaborative.

The goal of TPC activities is to: 1. Eliminate tobacco use in Contra CourAGE Youth Health Coalition members prepare to speak Costa County; at the Contra Costa Board of Supervisors meeting. June 2017 2. Eliminate youth access to tobacco; 3. Counter pro-tobacco influences; and 4. Eliminate exposure to environmental tobacco smoke.

The current TPC goals and objectives include: 1. Reduce access to tobacco products through tobacco retailer licensing policy prohibiting the sale of flavored tobacco products, including menthol cigarettes and electronic smoking devices, and a minimum pack size for little cigars and cigarillos.

2. Reduce Exposure to Secondhand Smoke through jurisdictions adopting 100% smoke-free multi-unit housing policy.

3. Build Community Capacity to Address Tobacco Prevention Issues The activities are grounded in a social justice framework and the TPC goals align perfectly with our primary TUPE goal of reducing tobacco-use among young people.

Examples of Community-Level Advocacy Opportunities: Ăž Community Walk-Arounds 12 De Anza High School (West Contra Costa Unified) TUPE Peer Educators were trained on assessing tobacco influences in the retail environment and conducted store surveys. Ăž Tobacco-Free Schools Excelsior Middle School (Byron Union School District) Peer Educators presented to their school board, sharing their concerns regarding e-cigarette use and policy revision recommendations. Ăž Flavored Tobacco/Menthol CourAGE members reviewed state and local data on tobacco influences near schools and presented their findings and recommendations to the Contra Costa Board of Supervisors. Thanks to their and other advocates testimony, in July 2017 the Board voted to prohibit the sale of flavored tobacco products, including menthol cigarettes, within 1000 feet of schools, parks, playgrounds and libraries!

Pregnant Minors and Minor Parent Services The following services are available to every pregnant minor and minor parent enrolled in districts throughout the county.

These services include: 1) Referral to perinatal and related support services; 2) Outreach services and assessment of smoking status; 3) Individualized counseling and advocacy services; 4) Motivational messages; 5) Cessation services, if appropriate; 6) Incentives to maintain a healthy lifestyle; 7) Follow-up assessment; 8) Maintenance and relapse prevention services.

Pregnant minors and minor parents should have access to all TUPE information, programs, and intervention and cessation services.

Family & Community Engagement Despite the impact of movies, advertising, the internet, and peers, parents can still be the greatest influence in their children’s lives, including their decision to remain tobacco-free. Also, with the changing landscape of tobacco use among young people, we are receiving increased requests to ensure that parents and other adults have access to the information and resources to support tobacco prevention.

Parent Education 6

Number of presentation requests

14

185

Parents reached

462

0

50

100

150

2017-18

200

250

300

350

400

450

500

2018-19

Before being interrupted by shelter-in-place in March, our team had already completed eight (8) parent education presentations during the 2019-20 school year, engaging 141 parents and other adults.

“Lots of good info and great presenters...clear and knowledgeable. I felt it was very professional. Much better than most parent ed presentations I’ve seen.”

Examples of family and community engagement at the site, district, and county level: þ Board Presentations þ Parent Education Nights þ TUPE Table at Registration/Back-toSchool Night/Open House þ Virtual family and community engagement events (webinars)

“Lots of good information and great presenters… clear and knowledgeable.

I felt it was very professional. Much better than most parent ed presentations I’ve seen.”

- Parent Attendee, Virtual Event, September 2020

TUPE Tip: • Where we have seen the greatest success is when we reach parents and other adults where they are – TUPE tables at school registration, Back-to-School Night, Open House, sporting events, award nights, and other school events engage parents/guardians who are already attending these events.

Key Messages for Parents/Guardians: • Tobacco remains the number one cause of preventable death in the United States, with over 440,000 people dying from tobacco-related causes each year.20 • Most adult tobacco users began under the age of 18.

• In California, the legal age to purchase any tobacco products, including ecigarettes/vape pens, is 21.

• The tobacco industry has a long history of predatory marketing practices, aimed towards those who they consider “replacement smokers” – young people.

• Adolescent use of e-cigarettes, including vape pens and pod-based systems such as Juul and Puff Bar, has surpassed combustible tobacco products.21 • Most e-cigarettes contain nicotine, a highly addictive neurotoxin. Exposure to nicotine during adolescence can harm brain development.

• Young people who are first-time e-cigarette users are four times more likely to smoke combustible cigarettes within one year.22 • The best way for young people to avoid a lifelong addiction to nicotine, and other tobacco-related health issues, is to never start.

Parents/Guardians are often looking for ideas on how to talk to their children and/or other young people in their lives regarding tobacco. We suggest the following tips for parents/guardians.

TUPE Tips for Parents/Guardians: v Start with “I care about you…” o One of our TUPE peer educators pointed out, during a parent education event co-led by staff and students, that while parents and other family member may clearly express how much they care about the children in their life, it is still a good idea to remind them often. v Make sure you have access to credible information.

CDC https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm National Institute on Drug Abuse https://www.drugabuse.gov/related-topics/trends-statistics/infographics/teens-e-cigarettes 22 BMJ Journals http://tobaccocontrol.bmj.com/content/early/2017/01/04/tobaccocontrol-2016-053291 20 21

v

v

v

v

v

o Know the facts and know where you can go to get information you can trust, such as the Center for Disease Control and Prevention, the U.S. Surgeon General, the California Department of Public Health, etc.

Be patient and ready to listen. o Ask your child what they think about tobacco use, or a situation you experience together, such as seeing someone using an e-cigarette/vape pen in the car next to you.

Have a conversation, not a confrontation. Avoid criticism and encourage an open dialogue. o This is an opportunity to have a conversation, not provide a lecture. o Answer questions honestly. If you don’t know the answer to something, say so, “I don’t know… why don’t we try to find out the answer together?”

Set a positive example by remaining tobacco-free. o Current adult tobacco users often struggle with how to speak to young people about this issue. Stay focused on the fact that most adult tobacco users wish they had never started and have tried to quit. The best way to avoid a lifelong addiction to nicotine is to never start. o If you use tobacco, it is never too late to quit. For free help, go to www.nobutts.org or, in Contra Costa County, call 2-1-1 or text zip code to TXT211 (898211) for direct cessation referrals.

Keep the conversation going. o The issue of tobacco is an evolving one, and so it is important to consider any discussion part of an ongoing dialogue regarding tobacco and healthrelated decisions. o Suggest that your child/teen talk to other trusted adults, such as teachers, faith leaders, coaches, etc. These other supportive adults can help reinforce pro-health messages.

Reach out for support. o It is important to connect with others around you, who you can go to with questions and concerns.

Staff Professional Development Annual professional development for Contra Costa educators includes TUPE site coordinator training, classroom-based prevention program trainings, intervention trainings, and workshops on various topics of interest. In addition, our team is as active member of our regional TUPE network and sit on the planning team for the annual Northern California Safe & Healthy Schools Conference.

In addition, our TUPE sites work to educate district and school staff, as well as community partners.

Something as simple as an e-mail or sharing a recent news article can help to raise awareness among adults on campus, particularly with regards to the changing landscape of tobacco use and resources available.

Presentations, even brief ones at Local educators participate in a collaborative activity during the 2019 TUPE site coordinator training. a regularly scheduled staff meeting, are also a great way to raise awareness regarding your TUPE-related efforts, as well as an excellent skill-development opportunity for peer educators.

Examples of past presentations: þ Three TUPE Site Coordinators, representing a middle school, a high school, and a non-traditional school, prepared a presentation for their district’s School Board, highlighting district-wide TUPE-related accomplishments including number of active student peer educators and reductions in past 30-day tobacco use as evidenced by district California Healthy Kids Survey data, etc. þ A team of Peer Educators presented at their school’s staff meeting on current trends in e-cigarette/vape pen use among their peers, and what classroom presentations and school-wide events they have planned to address the issue.

While we strive to provide a selection of professional development events that fully meet the needs of local educators, we also accept presentation and training requests.

Request a Presentation or Training

Telling Our Story – Activity Logs, Surveys, Reporting, & Outcomes We know that there are incredible tobacco prevention efforts happening across our TUPE Consortium school sites, and these efforts are having a real, positive and life-saving impact.

Each year we gather the information necessary to share these stories with our broader community, as well as with our funder.

What positive impact has the TUPE program had for my students and within my school community?

In order to gather the most meaningful information about current program and services, and utilize our findings for ongoing program improvement, we follow a continuous data gathering, analysis, and feedback cycle.

Site coordinators and other TUPE program providers document all TUPE-related activities in an online site activity log.

County TUPE Staff complete all required grant reports and submit reports to the California Department of Education (CDE).

County TUPE staff share reports and related findings with our TUPE Collaborative members and site coordinators.

Site coordinators and other TUPE program providers assist with adminstering student surveys for all TUPE programs and services.

County TUPE staff review reports, identify strengths and areas for growth, and create reports.

Contra Costa TUPE’s continuous data gathering, analysis, and feedback cycle.

TUPE Site Activity Logs (Sites/CCCOE) All sites have an online activity log to track all TUPE-related activities. At the end of each year, this information is compiled and submitted to the California Department of Education to report on all grant-funded program activities.

The following information is collected from all TUPE sites: • Number of students who participated in… o Project ALERT/TPT o Classroom Presentations o School-wide Events o Peer Educators Program o Intervention (referred/served) o Cessation (referred/served) • Number of parenting and/or pregnant minors… o Identified o Served in school-based programs o Referred to county programs • Number of parents who received general TUPE information • Number of certificated and classified staff who received general TUPE information Additional narrative information regarding strengths and challenges with program implementation allows our County Office TUPE Team to better support sites with program implementation.

Most activity log updates are the responsibility of the TUPE site coordinator(s), although County Office staff update information related to any direct service that they provide, such as a staff presentation, and/or information that is gathered from other teachers/staff implementing TUPE program strategies, such as an educator teaching Project ALERT or TPT on campus.

County Office TUPE staff keep detailed records for professional development, including registrations and actual attendance. We survey everyone who attends TUPE-related events and family and community engagement events, to gather feedback for continuous quality improvement.

Program Surveys (Sites/CCCOE) Program participant surveys act as back-up documentation to support implementation, as well as provide valuable feedback on specific activities. The specific program surveys include: • • • • • •

Project ALERT/TPT Healthy Futures Brief Intervention Classroom Presentation School-wide Event Peer Educator Training

All student surveys are available in an online format.

If a site is unable to gather feedback electronically, hard copies of each survey are available upon request. We can provide copies of surveys, if needed.

Site Coordinator and Peer Educator Surveys (Sites/CCCOE) We invite TUPE site coordinators to respond to mid-year and end-of-year surveys to provide constructive feedback on the TUPE program and the training and other support they receive. We also survey student peer educators Required Surveys (Districts/Sites) All participating Tier 2 districts are required to conduct the California Healthy Kids Survey (CHKS) Core Module with students in grades six, seven, nine, and eleven at a minimum of once every two years. The CHKS is part of the larger California School Climate, Health, and Learning Survey (Cal-SCHLS) system and is the largest statewide survey of resiliency, protective factors, risk behaviors, and school climate in the nation.

Additionally, randomly selected schools must participate in the California Student

Tobacco Survey (CSTS). Students in grades six, eight, ten, and twelve, as well as school and district TUPE Program administrators, are among the participants of this evaluation.

Annual On-Line Report (CCCOE/CDE) This report, completed and submitted by the Contra Costa County Office of Education, is required of all TUPE Tier 2 grantees. The primary use of the data is to report to the Tobacco Education and Research Oversight Committee (TEROC) on the number of students receiving services and the number of parents and teachers reached with inservice or workshops. Duerr Evaluation performs the collection of this data on behalf of the CDE. TUPE Annual Progress Report (CCCOE/CDE) This report is also required of all TUPE grantees and is completed and submitted by the Contra Costa County Office of Education on behalf of our Tier 2 districts. The report is used by the California Department of Education’s TUPE Office to monitor the implementation of activities and strategies approved in the grant application.

Measuring Success – Program Evaluation Outcomes We track and analyze both process data – how we are doing with regards to program implementation – as well as outcome data – how effective we are in reducing tobacco use and empowering the next generation of anti-tobacco advocates.

“How many times do I have to teach you… just because something works doesn’t mean it can’t be improved.”

– Shuri, Black Panther

Using Data for Program Improvement We are committed to continuous program improvement. We utilize all survey results to provide feedback and guidance in how we can be the most relevant and effective.

A few countywide highlights from 2018-19 include: • Teachers/Educators reached nearly 5,000 students through classroom-based substance use prevention programs (Project ALERT/TND).

• We trained 576 TUPE Peer Educators, who reached 36,368 of their peers through anti-tobacco classroom presentations and school-wide events.

• We supported 157 current tobacco users through one-on-one Brief Intervention and another 22 students participated in voluntary cessation/quit groups.

Overall, we have seen great success in decreasing cigarette use rate in our county.

Current Cigarette Use - Decreases from 2011 to 2019 40%

38%

35% 30% 25% 20%

16%

15% 10% 5%

13%

12% 8% 4%

2%

1%

3%

1%

1%

2%

0%

2009-2011

2015-2016 Grade 7

Grade 9

Grade 11

2017-2019 Non-Traditional

With that said, the increase in e-cigarette/vape pen use, as well as continued tobaccorelated health disparities, means that our prevention, intervention, and youth development efforts are still incredibly important and needed.

Current Tobacco Use - Contra Costa 2017-2019 CHKS Data 25%

21%

20%

16%

15%

13%

Grade 9

10% 5%

8% 5% 1%

1%

2%

0%

Cigarettes

Grade 7

0%

1%

1%

Smokeless

3%

E-Cig/Vape Pens

Grade 11 Non-Traditional

Contact Information Tobacco Use Prevention Education (TUPE) Contra Costa County Office of Education TUPE Website www.cocoschools.org/TUPE E-mail tupe@cccoe.k12.ca.us The Contra Costa County Office of Education provides technical assistance to school districts to develop and implement effective, comprehensive tobacco education programs. Training and technical assistance provided includes: • • • • • • •

Tobacco-free school certification Annual county-wide TUPE Site Coordinator training California Healthy Kids Survey (CHKS) administration and data sharing training Alcohol, tobacco and other drug (ATOD) curriculum trainings for teachers Grant writing support Quarterly district and community partner networking meetings Current research on adolescent ATOD use, as well as effective prevention and intervention strategies

Contra Costa County Office of Education TUPE Staff: Emily Justice, Manager ejustice@cccoe.k12.ca.us (925) 942-5328

Tiffani Mason, M.A.T., Curriculum Specialist tmason@cccoe.k12.ca.us (925) 942-5315

Marissa Frias, Intervention Specialist mfrias@cccoe.k12.ca.us (925) 942-5337

Leslie Holst, Administrative Assistant lholst@cccoe.k12.ca.us (925) 942-3370

Derrick Kirk, Youth Development Specialist dkirk@cccoe.k12.ca.us (925) 942-5318

Chelsea Nakatani, Administrative Assistant cnakatani@cccoe.k12.ca.us (925) 942-5320

Nicole Square, Youth Development Specialist nsquare@cccoe.k12.ca.us (925) 942-5317