REDUCING UNDERAGE SMOKING HEALTH POLICY 1

Reducing Underage Smoking Through Health Policy

Theresa Joyce

College of Nursing, University of South Florida

REDUCING UNDERAGE SMOKING HEALTH POLICY 2

Reducing Underage Smoking Through Health Policy

Hillsborough County, located in the western aspect of central Florida, is an urban area

with a diverse population. Just like any community, this county can improve its facets of health,

including its high rate of underage smoking. Though health concerns may be the result of social

conditions, primary prevention measures can be put into place with the support of an overarching

health policy in order to preserve the health of the constituents.

Identification of a Population-Specific Priority Health Concern

One major health concern that requires improvement in Hillsborough County is the

elevated rates of underage smoking, particularly with electronic-vapor (e-vape) usage. For

instance, the percentage of students that have used an e-vape product by the time they reach

twelfth grade is higher (47.2%) compared to the rate in Florida (45.4%) (Florida Department of

Health [FDH], 2022b). With this rate equating to nearly half of all students, the goal of Healthy

People 2030 to decrease respiratory diseases including asthma and COPD would be negatively

affected (U.S. Department of Health and Human Services, 2022).

Population Diagnosis

Hillsborough county youth, especially middle through high school students, are at risk of

respiratory diseases due to the high rates of e-vape use.

Impact of Community Health Models

Many community health models can assist with understanding why health is impacted in

a positive or negative way within a particular location of focus. For instance, the Social

Determinants of Health Model (SDOH) refers to the social conditions that affect people’s daily

lives and, therefore, health (Office of Disease Prevention and Health Promotion, 2022). In

Hillsborough County, the main SDOHs include high rates of poverty, low percentages of high
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school graduates, and unsafe levels of crime (FDH, 2022a) (Crime Grade, 2021); each of these

factors contribute to elevated stress in the community, which could be a causative factor in

underage smoking. In addition, it is important to acknowledge the strengths of a community.

Three strengths include lower excessive alcohol drinking, decreased deaths by drug overdose,

and a higher availability of mental health providers compared to the state of Florida (FDH,

2022c) (University of Wisconsin Population Health Institute, 2021). By understanding these

conditions, interventions and policies can be put in place that are sensitive to the people that

these statistics represent.

Primary Level of Prevention

The most important part of prevention begins at the primary level by stopping negative

actions that affect health before they occur. Adult cigarette smoking rates and student electronic

vapor (e-vapor) usage with marijuana oil were higher in the county than the state (FDH, 2022b).

In addition, because much of Hillsborough’s youth (15.6%) is unaware that e-vapes can cause

addiction, an essential intervention is school-based educational programs on smoking and

tobacco (FDH, 2022b). Botvin Lifeskills Training (LST) is an example that has been effective in

reducing tobacco use by up to 90% in locations worldwide by functioning at the community

level (National Institute of Justice, 2015). This program works by facilitating education to

students about tobacco abuse, anti-drug thinking, self-control, and resistance training. It is the

role of the public health nurse (PHN) to advocate for these types of programs in schools and

even be the educators that run them. Stakeholders for this intervention include public health

offices, law enforcement agencies, educational facilities, and substance abuse and recovery

providers (Office of Substance Abuse and Mental Health, 2018).

REDUCING UNDERAGE SMOKING HEALTH POLICY 4

Development of Health Policy

In order to resolve the negative health outcomes in a particular area, it is important for the

community to establish health policies. Effective health policies have the potential to drive

adequate funding to support the implementation of successful interventions, as well as guide the

objectives and actions that will yield the intended outcomes. Likewise, Hillsborough County

needs a policy that will assist in reducing the rates of underage smoking.

Policy Proposal

Healthy People 2030 has identified a priority goal of reducing sickness, disability, and

mortality related to tobacco use and secondhand smoke. One objective to meet this goal is

decreasing the current e-cigarette use in adolescents, particularly middle through high school

students (Office of Disease Prevention and Health Promotion, 2022). In order to fulfill this

objective, a proposed policy suggests primary prevention strategies including education or brief

counseling with the use of direct or telephone interaction, printed materials, and online

applications in order to prevent the initiation of tobacco use (U.S. Preventative Services

Taskforce, 2020). By achieving this outcome, fewer of these adolescents will grow up to become

part of the adult population that deals with the consequences of long-term smoking, such as

airway irritation, mucus hypersecretion, and inflammatory responses, which can lead to

additional problems such as asthma and COPD (Thirión-Romero, 2019). As stated previously,

evidence shows that school-based educational programs such as Botvin LST are effective in

reducing underage smoking rates and can be utilized to reach this objective.

Policy and Program Implementation

The program being implemented will be similar to Botvin LST in educational

information but will additionally have printed materials and computer applications for the target
REDUCING UNDERAGE SMOKING HEALTH POLICY 5

population—students in middle through high school—and will be applied at the community level

in schools. To start, public officials and legislators would be approached with presentations on

the efficacy of the policy involved to obtain stakeholders and secure funding. The next step

would include finding health care providers and nurses willing to be the educators in the

program. Funding would need to cover labor costs as well as materials; sources to help cover the

cost would include the Tobacco Free Partnership of Hillsborough County and community

donations (Florida Health, 2022). Potential supporters of the program would include parents and

families of the students involved as well as health care professionals and rehabilitation centers

that see what the damages of smoking can do to children. Possible opposition may come from

the students themselves, which strongly suggests that the program must be catered to the children

in a fun and interactive way to create a positive experience. This may mean changing the

materials and communication skills used based on what grade the students are in.

Conclusion

It is important for the entire community to become involved in preserving the health of

the population, especially in areas that require improvement. Successfully achieving this requires

knowledge of the strengths and weaknesses in an area in addition to the SDOHs that affect the

constituents. Hillsborough County’s health would largely benefit from the implementation of a

policy that requires a school-based education program for middle and high school students that

focused on the prevention of tobacco use, especially e-vapes.

Personal Relevance

In my future career as a nurse, I will be working with the adult population that is heavily

affected by nicotine addiction and will have a much more challenging time achieving cessation.

Though the focus of this three-paper series was adolescents, I feel that preventing this harmful
REDUCING UNDERAGE SMOKING HEALTH POLICY 6

lifestyle behavior at a young age will largely prevent the associated consequences that the current

adult generation bears. Regardless of clinical setting, knowing how to conduct research on

interventions and the community and having the ability to apply that to policy and program has

the potential to tremendously benefit the future patients in my care.

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References

Crime Grade. (2021). Hillsborough County, FL Violent Crime Rates and Maps. Retrieved

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Florida Department of Health. (2022a). Florida Access and Functional Needs Profile. FL Health

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rdReport=ChartsProfiles.AccessAndFunctionalNeeds&uid=ee2c4e2e-7f57-42b8-8391-

ca477546df8f

Florida Department of Health. (2022b). Florida Youth Tobacco Indicators Data viewer.

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nicotine-use-prevention-in-children-and-adolescents-primary-care-interventions