Milwaukee Tobacco-Free Sports Program

State: WI Type: Model Practice Year: 2004

A collaborative community partnership is the key element in the Milwaukee Tobacco-Free Sports (T-FS) Program design, implementation, and evaluation. The following agencies contribute technical assistance, materials, and in-kind resources toward program development and sustainability: City of Milwaukee Health Department, Wisconsin Division of Public Health – Southeast Region, Milwaukee Public Schools - Department of Recreation & Community Services, American Cancer Society - Midwest Division, and American Lung Association of Wisconsin. T-FS is implemented as a youth-led, adult-guided initiative within the Milwaukee Public Schools (MPS) Department of Recreation & Community Services Sports Programs. Program objectives are to: Plan and conduct five sets of interactive tobacco prevention mini-sessions for youth and parents in multiple school-linked settings.  Plan and implement one annual media advocacy event coordinated with the national Campaign for Tobacco-Free Kids.  Plan and conduct tobacco educational outreach and implementation guidance for coaches and athletic staff. Teen Presenters deliver tobacco prevention mini-sessions to younger children, grades 1-6. The following public health best practices are incorporated into the program methodology: peer education, health promotion, health policy, systems integration, data collection, and evaluation. The focus of this approach is in direct alignment with the Centers for Disease Control and Prevention's (CDC) 2010 objective to reduce the morbidity and mortality associated with tobacco use.
Tobacco use is the single most preventable cause of disease and death in the United States. It is widely known and accepted that a majority of smokers begin smoking before adulthood. According to the CDC, tobacco use prevention education must be provided in elementary school and continued through the middle and high school years because many youth begin using tobacco before high school and impressions about tobacco use are formed even earlier. Thus a program such as Tobacco-Free Sports, which educates elementary age youth and positively engages high school youth as mentors, is an effective and necessary part of the solution. Tobacco-Free Sports works to involve as many positive role models as possible in delivering and reinforcing a tobacco-free message. By involving parents, coaches and older peers in prevention efforts, the tobacco-free message is reinforced three times. Youth who focus on sports, freedom from tobacco and other healthy lifestyle habits are more likely to become healthy, tobacco-free adults. Since September 2000, the Program has been conducted during fall, winter, and spring youth sports recreation sessions and at several community-learning sites. Agency partners and Teen Presenters have progressively developed a three-pronged program approach: Tobacco prevention mini-sessions for youth and parents include interactive components and/or activities;  Annual media anti-tobacco event coordinated with the national Campaign for Tobacco-Free Kids “Kick Butts Day"; and  Educational outreach and activity packet for Coaches and Athletic Staff to integrate a tobacco-free message into their weekly team practices. Since the program’s inception, Tobacco-Free Sports has never been static. The themes and session outlines have been refined throughout the life of the program with significant input from youth. Input from the participating youth has helped to ensure that the interactive messages and activities resonate with a young audience and yield positive, lifelong healthy outcomes.
Agency Community Roles In partnership with the WI Division of Public Health – Southeast Region (DPH), the City of Milwaukee Health Department (MHD) is currently the fiscal agent for the T-FS Program. This collaboration between State and City Public Health has also helped to coordinate the multiple resources necessary to effectively deliver and promote tobacco prevention education as a primary health care message and promote the development of a strong and ongoing community partnership. This collaborative partnership has been in place since the inception of the program in 2000 and includes: DPH, MHD, Milwaukee Public Schools Department of Recreation and Community Services, Milwaukee Students (MPS), the American Cancer Society, Midwest Division (ACS), and the American Lung Association of WI (ALA). This partnership is the key element in program design, implementation, and evaluation. In addition, the partnership contributes technical assistance, materials, and in-kind resources toward program development and sustainability. This sustained collaboration is grounded in not only its commitment to young people in Milwaukee but also in its commitment to fostering a positive environment for a youth-led tobacco-education program within a sports and community recreation venue. Costs and Expenditures The initial Smoke-Free Sports Program was funded under a special tobacco-free sports grant issued by the CDC. With that CDC funding, the Milwaukee “Smoke-Free Sports” Program was designed and implemented as a youth-led, adult-guided program within the Milwaukee Public Schools (MPS) Department of Recreation & Community Services Sports Programs. In 2004, MHD’s Tobacco Control Program assumed the fiscal accountability for the youth-led, adult-guided program. Annual T-FS program costs are approximately $22,000. This total cost includes, training materials, youth stipends, lunches, transportation, program materials, annual media event, incentives for the over 6,000 participating youth, and contributes to the T-FS coordinator’s salary. In addition, DPH, MHD, MPS, ACS, and ALA provide in-kind services and other valuable resources throughout the year. Implementation A Tobacco-Free Sports Coordinator manages the implementation and evaluation of program activities. Teens are recruited as Teen Presenters to conduct anti-tobacco education and prevention lessons to younger children who participate in the MPS Department of Recreation and Community Services sports teams. The Program utilizes a three-pronged approach to address tobacco control and prevention: five brief, interactive sessions targeting youth and their parents/guardians; tobacco prevention trainings for sports program coaches, officials, and athletic staff; and a targeted media advocacy anti-tobacco event. Outreach and educational efforts are conducted for coaches, officials, and athletic staff prior to each sport’s season. Letters are sent to coaches describing Tobacco-Free Sports Program and requesting their support for both the program content and for the Teen Presenters. In addition, the Tobacco-Free Sports Coordinator provides the athletic staff with information on second hand smoke, current youth smoking rates, and the dangers of tobacco use. Coaches are encouraged to include a tobacco-free message in each of their team practice sessions. Throughout the implementation of the program, coaches and athletic staff are requested to provide feedback to the Coordinator to improve the program and to make it more user-friendly. An annual Tobacco-Free Sports media event is organized to highlight the program and the Teen Presenters in the community. This event is planned and coordinated around the national Kick Butts Day, a national day to promote smoking awareness among kids ( This targeted media event outreaches to all local media markets with event information and details. Press releases and a media kit are sent to local media outlets, including, print, radio, and television. Media resources include a national press release citing Wisconsin data on youth smoking rates and feature stories. This concentrated media focus serves to not only increase the community’s knowledge about state and national tobacco control efforts, but also to highlight Milwaukee’s tobacco program initiatives.
The Milwaukee T-FS Program evaluation component includes tracking and analyzing outcomes for key indicators to assess knowledge, exposure to secondhand smoke, and program support. Those key indicators include tracking the number of participating youth and adults; post-evaluation knowledge survey for youth, adults, and teen presenters; assessment of exposure to secondhand smoke in the home; perceived effectiveness of program; and impact of annual media event. As a result of participation in T-FS youth will understand and demonstrate knowledge of the health risks associated with tobacco use and secondhand smoke, the tobacco industry marketing tactics, and health choices for lifelong wellness. Adults such as coaches, athletic staff and parents will understand how to support and promote tobacco-free lifestyles. Informal evaluation results indicate that coaches are supportive of the program and parents value the importance of Coaches providing tobacco prevention messages. Teen presenters provide ongoing program evaluation relative to session topics, logistics, and ease of implementation. The Program utilizes pre/post quizzes, evaluations and surveys as an important part of Tobacco-Free Sports. They are crucial in order to complete the picture of the programs’ success by documenting the impact of the program on participants. These tools allow for the evaluation and improvement of the program on an ongoing basis. The data gained can be instrumental in effectively articulating the success of Tobacco-Free Sports and in securing future funding. To date, collated evaluation summary results indicates: 87% (youth) and 98% (adults) find the Tobacco-Free Sports Program useful  93% (youth) believe that smoking affects sports performance  98% (adults) believe that second hand smoke affects children  54% (youth) and 42% (adults) have reported exposure to second hand smoke at home  70% (adults) report a desire to quit smoking
Sustainability Program sustainability is promoted through the collaborative partnership and the life-long skills developed in the young people participating in T-FS. In addition, in December 2003, the Milwaukee Health Department collated and printed the first edition of the Tobacco-Free Sports Implementation Guide and Tool Kit. In sharing the curriculum, the Milwaukee Partnership hopes that others will creatively adapt and use the curriculum to prevent tobacco initiation and tobacco use within their communities. The guidelines in this curriculum are meant to serve as a template of how Tobacco-Free Sports may be implemented. Tobacco-Free Sports was initially implemented within the Milwaukee Public Schools Department of Recreation and Community Services. Due to its solid foundation, the content is easily used in other settings that require a brief interactive tobacco prevention message or it can be adapted for longer presentations. After the preliminary success of the program, Tobacco-Free Sports has been used as a template for other youth-led, adult-guided program presentations. Examples include local community center basketball games, cultural center music and dance programs and within school classroom settings. It is expected that the information would be tailored to best suit each specific community or organization’s needs. Key Elements Replication In addition, the collaborative team considers the following useful to share with others in any youth-led, adult-guided initiative: Information needs to focus on accuracy; therefore, the adult (adult-guided component) should always generate a draft document for the young people. All final edit(s) or fine-tuning of “language” should be interjected by the teen presenters (youth-led component). Engage Coaches and Staff Support. Active involvement of coaches and support staff is critical to the program’s acceptance by the team members and their families. Encourage Parental Support (both the non-smoker and smoker). Parental support helps to instill a consistent message for the participating youth. Provide Incentives. They DO Work! They are the initial “hook” to engage students. Update and monitor Teen Presenters for accuracy of message on an ongoing basis.