Tobacco Free Broward Comprehensive Approach

State: FL Type: Model Practice Year: 2020


Brief description of LHD-location, demographic of the population served in your community.

The Tobacco Prevention Program of Broward is administered locally at the Florida Department of Health in Broward County (DOH-Broward). The program focuses on improving the health of Broward County residents through policy and systems change. Broward County has a population of 1.9 million and the breakdown of the population by the age group is as follows: 13-17 years 6.1%, 18-29 years 14.9% and 30-44 years 20%. Broward County Public Schools (BCPS) is the sixth largest public school system in the nation.  BCPS had 271,517 students enrolled during the 2017-2018 calendar year, which is the primary population served by the Tobacco Prevention Program of Broward.

Describe the public health issue?

According to the Centers for Disease Control and Prevention (CDC), tobacco use is the leading cause of preventable disease, disability, and death in the United States. Nearly 40 million adults are current smokers and 4.7 million middle and high school students have utilized at least one tobacco product. Tobacco related illness takes the lives of 500,000 Americans each year. For every person that dies due to smoking; at least 30 people live with smoking related illness such as cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD). Due to exposure to second-hand smoke, 41,000 deaths occur among non-smoking adults and 400 infants annually. In addition, $170 million in direct medical cost could be saved each year if initiation of smoking among youth could be prevented or if needed help is provided to quit to every person who smokes. In the United States, tobacco companies spent $9.36 billion in promotion and advertising tobacco products during the year 2017.  Tobacco company's marketing campaigns are targeted towards youth/young adults and certain racial/ethnic minorities. Scientific evidence shows that young people are greatly influenced by these advertising and promotions resulting in the initiation of smoking. The 2018 Florida Behavioral Risk Factor Surveillance Survey report indicates that 14.5% of adults are current smokers and 5.9% of adults are e-cigarette smokers.

Goal and objectives of the proposed practice

The goal of the Tobacco Prevention Program is to improve the health of community residents through policy and systems implementation under four main objectives:

1) Prevent Initiation of Tobacco Products Among Youth and Young Adults

2) Eliminate Secondhand Smoke Exposure

3) Maintain Infrastructure of Students Working Against Tobacco (SWAT) and the Tobacco Free Partnership of Broward County

4) Promote Cessation from Tobacco Use

How was the practice implemented?

The DOH-Broward Tobacco Prevention Program operates in partnership with community agencies. The cessation services are promoted through Nova Southeastern University Area Health Education Center (NSU AHEC) and the Florida Quit line.  DOH-Broward also coordinates Students Working Against Tobacco (SWAT) clubs in middle and high schools and community-based sites. SWAT is a statewide youth organization that mobilizes, educates, and equips Florida youth to de-glamorize Big Tobacco”. Further, DOH-Broward is the lead agency charged with sustaining the Tobacco Free Partnership of Broward County, providing meeting locations, staff-led policy trainings and leadership on the policy subcommittees. 30% of the Broward County Schools (BCPS) were educated on Point-of Sale utilizing the mass media campaign. The education efforts were directed towards youth programs that directly educate them, their families, and communities. In addition, DOH-Broward worked with Broward College (BC) and Florida Atlantic University (FAU) to facilitate the adoption of comprehensive tobacco-free campus policies by educating decision-makers on the benefits of policy change. Efforts were also in place to implement tobacco control policies in recreational and entertainment venues through direct solicitation of the venues and education. Further, DOH-Broward facilitated the implementation of tobacco-free policies in various multiunit housing properties and worksites.


The comprehensive tobacco prevention initiatives in Broward County helped to reduce the prevalence of adult and youth smokers and decreased the current prevalence of tobacco use by 3%. Utilizing the mass media campaign, 30% of Broward County Public Schools were educated on Point-of-Sale. A comprehensive tobacco-free campus policy was implemented at Broward College and Florida Atlantic University. In addition, tobacco control policies were implemented at nine local recreation and entertainment venues that are frequented by young adults. Policies focusing on secondhand smoke reduction in multiunit housing were implemented in 21 multiunit housing properties. Tobacco control policies were implemented in 21 large employers, ultimately providing a tobacco-free environment and encouraging healthier lifestyles among more than 27,000 employees. Also, DOH-Broward recruited and maintained SWAT clubs in at least 29% of the 78 middle and high schools that are part of the BCPS District. SWAT clubs were also established within various community-based organizations.


Responsiveness and Innovation

Statement of the problem/public health issue?

The 2016 Behavioral Risk Factor Surveillance System (BRFSS) survey indicates that 11.5% of adults in Broward County are current smokers. 2.4 % of high school students and 1.0% of Middle School students reported smoking in the past 30 days. Adult and youth tobacco use has declined since 2012, however, the use of hookah and electronic vaping has been on the rise (Florida Youth Tobacco Survey, Broward County (FYTS). Attitudes and behaviors towards tobacco in Broward County are shifting in youth and young adults. In 2016, 9.1% of youth reported currently using electronic vaping compared to 4.4% in 2014.  11.6% of youth are current users of cigarettes, cigars, smokeless tobacco, hookah, or electronic vaping. Data from the 2016 FYTS shows that 32.3% of youth are exposed to secondhand smoke compared to 31.9% in 2014. Secondhand smoke exposure causes serious health threats to children and adults. It can be a major concern for the multi-unit housing as it can migrate from other units to common areas. The harmful effects of secondhand smoke exposure can only be prevented through eliminating indoor smoking. According to Florida Health CHARTS data (, the age-adjusted death rate for lung cancer in Broward County is 31.5 and it is comparatively lower to the statewide rate of 38.6. In 2017, the top five leading causes of death for Broward County residents were heart disease, cancer, stroke, unintentional injuries and chronic lower respiratory disease.

What is the target population size?

The program targets the more than 1.9 million Broward County residents. Program activities are aimed to reduce the prevalence of adult and youth smokers and decrease the current prevalence of tobacco use by 3% in Broward County.

What has been done in the past to address the problem?

DOH- Broward has implemented programs such as Not a Replacement and Not a Lab Rat campaigns to counter tobacco marketing to youth, Students Working Against Tobacco (SWAT) and promoted tobacco cessation services at the Nova Southeastern University Area Health Education Center and the Florida Quit Your Way Program for the past 30 years. In addition, DOH-Broward has been the lead agency charged with sustaining the Tobacco Free Partnership of Broward County providing meeting locations, staff led policy trainings and leadership on policy committees. DOH-Broward provided leadership in assisting BCPS to adopt a comprehensive tobacco free school policy. Additionally, DOH-Broward staff has formed a relationship with the Southeastern Florida Apartment Association resulting in free membership to DOH-Broward, Miami-Dade, Monroe and Palm Beach counties.  Membership permits access to over 316,300 apartment communities and their decision makers. This relationship has yielded numerous meetings, survey events, and smoke free multiunit housing policies across county lines. DOH-Broward has also collaborated with various large and small employers to implement the tobacco free worksite policy and to increase the utilization of tobacco cessation services from the Area Health Education Center and Florida's Quit Your Way program.

Why is current/proposed practice better?

The comprehensive tobacco prevention initiative funded by the Bureau of Tobacco Free Florida was implemented from 2015-2021. Mass media campaigns were utilized to educate Broward County Middle and High school students and their parents. Advertisements that depict a tobacco prevention message were placed on the storefronts of 25 tobacco retailers in targeted neighborhoods within .5 miles of middle and high schools in Broward County. The four-month campaign had 1.5 million impressions (views, read, and listening points) at the local stores. iHeart Media-Clear Channel Media, an alternative electronic media campaign captured non-traditional media, was developed at the local level to include streaming radio ads and banner ads to communicate that Broward County K-12 schools are tobacco free. Additionally, the campaign included advertisements on the Total Traffic Network, a leading provider of traffic, transit and weather information in the United States. These advertisements were aired during the weekdays, reaching parents driving their children to and from school. The campaign had over 4 million impressions. In addition, the program sponsored various high school events where the Tobacco Free Florida website, SWAT and the Tobacco Free Partnerships of Broward County was promoted. To promote the multiunit housing smoke free policy, ads were strategically placed on radio stations (talk radio, news, sports and adult contemporary stations) which have an audience of adults aged 18-50 and over 50 who own/rent multiunit dwellings in Broward County. The commercial resulted in 1,079,273 impressions among Broward County residents over the age of 18 who own or rent. Billboard and Transit shelter advertisements were also placed, and an estimated 4 million impressions were generated. Broward College has an estimated student population of 65,000 and consists of 14 college campuses throughout Broward County. DOH-Broward facilitated the adoption of a comprehensive tobacco free campus policy at all campuses by working with the president of the college and the senior management team to educate on the benefits of the policy change. Although efforts were in place to implement tobacco control policies at nine local recreation and entertainment venues, only one venue accepted the assistance from DOH-Broward for policy writing, communication plans, implementation and maintenance. Through community education and awareness presentations to local management companies, stakeholder and community organizations, DOH-Broward assisted in the adoption of 30 smoke free multi housing unit policies. Broward County businesses consists of various entities that employ hundreds of people and generate millions of dollars that is progressively moving to become tobacco-free. DOH-Broward assisted 14 large employers to implement tobacco control policies. The practice created a positive impact not only on employees, but visitors to these businesses as well as it encouraged the initiation of tobacco-free lifestyles among the worksite. Further, it assisted Program's goal of decreasing secondhand smoke exposure. The goal of SWAT clubs is to educate on the dangers of tobacco and nicotine and raise awareness within the community about the misleading information provided by tobacco companies and to promote tobacco free lifestyles in Broward County. DOH-Broward recruited and/or maintained the SWAT clubs in 29% of 78 middle and high schools that are part of the BCPS District. Although the program employs existing tools from the Bureau of Tobacco Free Florida, it is evident that a implementing a comprehensive tobacco prevention program is ideal for addressing the prevalence of tobacco use and secondhand exposure to smoke to improve the health of community residents through policy and systems implementation.

LHD and Community Collaboration

Goal(s) and objectives of practice

The goal of the Tobacco Prevention Program is to improve the health of the Broward County residents by decreasing the prevalence of smoking and exposure to secondhand smoke through policy and system implementation. The objectives are 1) prevent initiation of tobacco products among youth and young adults, 2) eliminate secondhand smoke exposure, 3) maintain infrastructure of Students Working Against Tobacco (SWAT) and the Tobacco Free Partnership of Broward County, 4) promote tobacco cessation from tobacco use.

What did you do to achieve the goal?

A Point-of-Sale (POS) media campaign was developed in collaboration with the Tobacco-Free Partnership of Broward County to inform and educate the community on Tobacco Point of Sale which encourage customers to make last-minute tobacco purchases. The campaign focused on communities of color and lower income neighborhoods, which are disproportionally targeted by tobacco companies. As per the Bureau of Tobacco Free Florida County Profile, the rates of tobacco use for those who earn less than $2,500/year are higher in Broward County than the state of Florida. Media included posters at convenience stores, print media and/or radio buys that served specific minority audiences. Spaces were leased from retail partners at their stores for poster campaigns and local media outlets that serve the target audience.

In addition, Take-A-Penny” trays were provided to retailers to promote cessation with Florida's Quit Your Way Program messages. Training opportunities were provided to 10 community and faith-based organizations that trained youth/parents groups in tobacco point-of-sale. Partners included the YMCA of Broward County, Boys and Girls club, and Memorial Healthcare-Community Services.

DOH-Broward worked with Broward College to implement a comprehensive tobacco-free campus policy at 14 college campuses throughout Broward County. To achieve policy adoption, DOH-Broward pursued partnerships with the president of the Broward college and the Senior Management Team to educate these decision makers on the benefits of the policy change. The Tobacco Free Partnership of Broward County also hosted campus events such as Butts Clean-Ups and tobacco observance festivities to increase the support from students and stakeholders. DOH-Broward also partnered with the Tobacco Free Program members from Florida Atlantic University (FAU) to assist and guide decision makers through the process as FAU was amid the implementation of a tobacco free policy.

As a result of the efforts to implement tobacco control policies at recreation and entertainment venues, program goals were achieved by partnering with the business owner and providing education on the need for policy changes and implementation. Assistance from current tobacco free venues were attained to explain the process and discredit myths about decreasing revenues due to tobacco free policies to these venues. A needs assessment survey and strategic plan for the adoption and implementation of the policy were developed in partnership with Tobacco Free Partnership.

DOH-Broward assisted in establishing 30 smoke free multiunit housing policies. DOH- Broward, in partnership with the American Lung Association (ALA) and the School of Public Health at Nova Southeastern University (NSU) targeted properties with 40 or more units. Policy changes were sustained by the properties through house rules and leasing agreements. Also, through the membership in the South East Florida Apartment Association (SEFAA), DOH-Broward had the opportunity to meet with 316,300 properties located in the tri-county area (Palm Beach, Broward and Miami-Dade). Properties were surveyed to establish resident sentiment and readiness for policy adoption. Once the results were received, DOH-Broward and ALA met with the decision makers to ascertain readiness for tobacco-free policy implementation. In addition, DOH-Broward participated in three community-wide smoke free multiunit housing seminars where relevant information regarding the issue of secondhand smoke and the benefits of adopting smoke free policies were provided to the community.

To date, DOH-Broward has assisted 14 large employers with the adoption of tobacco free worksite policies. Efforts to implement the tobacco free worksite policies were implemented by coordinating with the targeted organization's management teams, human resource departments, and health and wellness liaisons. The Florida Tobacco Cessation Alliance's Worksite Wellness Award was promoted to targeted employers. Bureau of Tobacco Free Florida cessation toolkits were provided to the employers that expressed interest in formulation tobacco free environments. DOH-Broward assisted in policy writing, communication plans, implementation, and continuance. Collaborative partners included Nova South Eastern University Area Health Education Center (NSU AHEC) and the Tobacco Free Partnership of Broward County. Relationships with new partners were developed by attending strategic community meetings such as various chambers of commerce, worksite wellness coalitions and human resources association in Broward County.

The Tobacco Free Partnership (TFP) played an integral part in the adoption of most tobacco polices received in Broward County. DOH-Broward has been the champion in the sustainability of TFP.  DOH-Broward hosts monthly partnership meetings and assists the Executive Committee in maintaining accurate meeting records and membership directory. Additionally, DOH-Broward staff conduct member training sessions, advise members on current tobacco issues and serve as subject matter experts to the TFP.

DOH-Broward establishes and maintains one county-wide SWAT chapter and 23 local SWAT clubs and oversees coordination annually. The county SWAT chapter consists of all Presidents and Vice Presidents from local SWAT clubs. Individual SWAT clubs consist of youth members that attend BCPS. DOH-Broward consistently maintained 23 SWAT clubs and is always working to increase the number of SWOT clubs in schools. In addition, DOH-Broward sponsored and attended various community-wide events to promote SWAT as well as resetting the social norm for tobacco use and initiation. The events aided in raising awareness and in promoting tobacco free policies that ultimately promoted positive behavior changes surrounding tobacco use and addiction. Each school year, SWAT youth participate in the Above the Influence Teen Rally that celebrates students making the decision to resist peer pressure, steer clear of violence, and remain tobacco-, alcohol- and drug-free. Each year, the event attracts over 5,000 youth in grades K-12 in addition to parents and other family members. The program also reached over 5,000 school-aged youths through partnerships and sponsorships.


What did you find out?

The program succeeded in meeting the set target in all areas of the comprehensive tobacco prevention program. The objectives are: 1) prevent initiation of tobacco products among youth and young adults, 2) eliminate secondhand smoke exposure, 3) maintain infrastructure of Students Working Against Tobacco (SWAT) and the Tobacco Free Partnership of Broward County, and, 4) promote cessation from tobacco use. The program successfully implemented 30 multiunit tobacco-free housing policies, 14 tobacco-free worksite polices, a tobacco-free campus policy, a tobacco control policy for an entertainment and recreation venue and consistently maintained 23 SWAT clubs during the 5-year period. The percent of high school students smoking cigarettes in the past 30 days decreased from 3.9 (2014) to 2.0 (2018) (FL Health CHARTS). Adults who reported as current smokers decreased from 12.1% (2013) to 11.5% (2018). Furthermore, the percentage of youth (ages 11-17), exposed to secondhand smoke decreased to 23.8% in 2018 compared to 31.9% in 2014. The Automated Tobacco Activity Collection System (ATACS) by the Bureau of Tobacco Free Florida was utilized to capture the progress of program activities. The Program is funded through the Bureau of Tobacco Free Florida and meeting quarterly deliverables is a part of the grant requirement. The progress of the program is also monitored at monthly agency-wide business review meetings utilizing the performance management system; Active Strategy. Underperforming metrics are discussed among agency leaders and corresponding action plans are developed to ensure metrics are attained in future months. DOH-Broward was recognized as a NACCHO Model Practice in 2016 for its Active Strategy system.


Lessons learned in relation to practice

Promotion of a statewide recognition program as an incentive provided an increased receptibility to policy change with local worksites and multifamily communities.  A collaboration with the Florida Apartment Association (FAA) provided program staff with tools to promote the program during meetings with stakeholders to garner support of the implementation of smoke free policies in apartment and condominium communities. The FAA partnered with DOH-Broward to promote smoke free multiunit housing to apartments and condominiums throughout the state of Florida. As a result, the FAA launched a smoke free multiunit housing certification program, and this has resulted in favorable decisions to implement smoke free policies within local communities. The Florida Tobacco Cessation Alliance (FTCA) Worksite Wellness Award was established to recognize and to set standards for businesses that provide comprehensive tobacco cessation services to their employees. Program staff have been able to efficiently utilize this as an incentive to assist employers with the transition to creating tobacco free worksites. 

Since 2015, the SWAT program was designed to provide SWAT youth with opportunities to collaborate with local community partners and other SWAT youth throughout Broward County through the formulation of quarterly Tobacco Free Youth Workshops. DOH-Broward program staff organized and hosted meetings between the Tobacco Free Partnership of Broward County and local SWAT members to provide opportunities for collaboration on current tobacco control projects at the local level. As a result, SWAT youth were able to participate in various tobacco prevention and education outreach activities such as local commission meetings, school board meetings, Relay for Life, the Above the Influence Teen Rally, Tobacco Free Art Exhibit, Tobacco Free Youth and Young Adult essay contest, and the Fort Lauderdale Beach Sweep.

Lessons learned in relation to partner collaboration

Today, DOH-Broward continues to maintain partnerships with local partners and stakeholders in tobacco prevention and control. Those partnerships include the Tobacco Free Partnership of Broward County, Nova Southeastern University Area Health Education Center (NSU AHEC), Broward Regional Health Planning Council (BRHPC), American Lung Association (ALA), Broward College (BC), Southeast Florida Apartment Association (SEFAA), United Way of Broward County, and YMCA. Partnerships with these local organizations assisted with different aspects of the tobacco prevention program and were instrumental in influencing policy change in multiple areas. Program staff work closely with NSU AHEC to promote the use of tobacco cessation services and have assisted the establishment and maintenance of tobacco policies within worksites. Strong partnerships with the ALA and SEFAA have garnered support of local property managers, condominium board members, and agency administrators for the establishment of smoke free multiunit housing policies within local market rate, condominium, and public housing authority communities. The local TFP and BC have been pivotal in establishing tobacco free campus policies with all local colleges and universities in Broward County. 

BCPS and its Office of Diversity, Prevention, and Intervention continues to be a leading partner with the SWAT component of the Tobacco Prevention program. Since 2015, SWAT was successfully implemented in approximately 29% of BCPS middle and high schools. 

Additionally, due to the program's success and positive response in the community, supplemental grant funds was awarded from the Health Foundation of South Florida and Broward Regional Health Planning Council to further expand the efforts of SWAT and smoke-free multiunit housing. 

Did you do a cost/benefit analysis? A cost/benefit analysis was not conducted.

Is there a sufficient stakeholder commitment to sustain the practice?

The Tobacco Free Partnership of Broward County was designed with sustainability in mind. The TFP of Broward County is comprised of local community partners that have a vested interest in tobacco prevention and control efforts. The TFP of Broward has strong membership from organizations such as American Lung Association, Broward County Public Schools, United Way of Broward County, American Cancer Society, Nova Southeastern University, Florida Atlantic University, Broward Regional Health Planning Council, and Concerned Citizens.

TFP members receive training from DOH-Broward program staff on a continual basis to remain current on trends and concepts in tobacco prevention and control. Members of the established partnership are committed to sustaining practices that will prevent or reduce the health risk associated with tobacco use through community engagement and education.

Describe the sustainability plans 

Local community partners were inspired by the accomplishments of the tobacco prevention program which resulted in an increase in funding of $363,960 which has been utilized to increase tobacco prevention efforts. DOH-Broward was awarded supplemental grant funds from the Health Foundation of South Florida and the Broward Regional Health Planning Council to expand the efforts of SWAT and smoke free multiunit housing. 

Due to the success of the Tobacco Prevention Program, the Bureau of Tobacco Free Florida renewed the Community-Based Tobacco Interventions grant for another cycle through 2021. DOH-Broward will receive an additional $376,100 per year during the 2019-2021 grant cycle.

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