1. An Analysis of Youth Tobacco Use and Social Norms in Rural Clay and Richland Counties, Illinois Jackson D. Ward, B.S. Public Health Associate, Clay County Health Department Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention PHAP Class of 2015 Summer Seminar 5/17/2016 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

2. Presentation Overview  Significance to Public Health  Background and Objectives  Methods  Results  Conclusions, Implications, Future Direction

3. Significance to Public Health  Cigarette smoking is the leading cause of preventable death in the United States  Tobacco use among rural populations is higher than in urban communities, among both adult and youth populations  Rural youth are less likely to see or hear media campaigns about the dangers of tobacco use Zollinger TW, Saywell RM Jr, Overgaard AD, Przybylski MJ, Dutta-Bergman M. Antitobacco Media Awareness of Rural Youth Compared to Suburban Youth in Indiana. Journal of Rural Health, Spring 2006;22(2):119-23.

4. Background and Objectives  Perform a comprehensive Youth Tobacco Survey for Clay and Richland County (CRC) youth grades 6 through 12 as part of a Social Norms Marketing Campaign  Examine prevalence and perception  CDC’s National Youth Tobacco Survey ( 2014 NYTS) and Illinois State Youth Tobacco Survey (2013 YTS) served as baseline data

5. 2010 U.S. Census Data  Population: 30,048  Clay: 13,815  Richland: 16,233  Population Density:  Clay: 29.5 inhabitants/sq. mile  Richland 45.1 inhabitants/sq. mile  97.5% White  Median household income:  Clay: $38,016  Richland: $41,917 Clay and Richland Counties, Illinois

6. Clay County Health Department Youth Tobacco Survey (Methods)  29-question cross-sectional survey  Based on CDC’s NYTS and Illinois’ YTS  Survey distributed to all 8 public middle and high schools in Clay and Richland Counties Online and in-person sampling methods

7. Tobacco-Related Indicators 1. Tobacco use by students, friends, & family 2. Exposure to secondhand smoke 3. School curriculum 4. Minor’s ability to purchase or obtain tobacco products 5. Knowledge and attitudes about tobacco

8. CCHD Youth Survey High School Smoking Rates vs. State and National Averages  Tried cigarettes ( lifetime)  CRC – 43.4%  IL – 40.4%  USA – 46.0%  Current Users (past 30 days)  CRC – 20.6%  IL – 12.9%  USA – 9.2%  Current frequent users (20 days of last 30)  CRC – 10.2%  IL – 4.6%

9. CCHD Youth Survey Middle School Smoking Rates vs. State and National Averages  Tried cigarettes (lifetime)  CRC – 13.7%  IL – 12.8%  USA – 17.7%  Current Users (past 30 days)  CRC – 3.7%  IL – 2.6%  USA – 2.5%

10. Distribution of Age When First Tried Smoking (n=308; Smokers only)

11. Electronic Cigarette Statistics  45% of high school students have tried an electronic cigarette  Most popular product county-wide

12. 40% Percent of students exposed to secondhand smoke on a weekly basis 25% Percent of students exposed to secondhand smoke on a daily basis Secondhand Smoke Statistics

13. Social Norms Smoking Statistics 400% Percent increase in student smoking rates if at least one of student’s four closest friends smokes

14. Conclusions, Implications, Future Direction for Our Social Norms Marketing Campaign  Earlier tobacco prevention and health hazard education  D.A.R.E. presentations in 4 th grade classrooms  Electronic cigarette education  Delivered brochures and teaching materials to schools  Adding topic to D.A.R.E. school program  Marketing campaign  Reinforcement of positive social norms

15. Acknowledgements  Clay County Health Department Staff  Amber Wille, Host Site Supervisor  Brian Lane  Katelyn Brown  Deena Mosbarger  PHAP  Denise Freeman, CDC Supervisor  Emily Anderson, CCHD, PHAP 2014  Sarah Mixson, PHAP 2015

16. For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: OSTLTSfeedback@cdc.govWeb: http://www.cdc.gov/stltpublichealthOSTLTSfeedback@cdc.govhttp://www.cdc.gov/stltpublichealth The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Thank you! Jackson D. Ward kzo4@cdc.gov Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support