Center for Tobacco Control Research and Education

In 2007, although Tennessee was (and still is) the third largest tobacco¬producing state, it enacted the Non¬Smoker Protection Act (NSPA), making most enclosed public and workplaces, and restaurants 100% smoke-free. This study triangulates archival documents with interviews, legislative debates and quantitative data for a stakeholder analysis of why and how the diverse interests in the state collaborated to develop the policy and identifies areas and opportunities for improvement. The study utilizes the policy cycle and stages of policy development approach and three public policy models – garbage can or multiple streams, policy networks, and socio¬economic influences – to give us understanding of the phases of the development of the NSPA – agenda-setting, legislative development, and implementation. While the dominant thesis for the origin of this smoke¬free policy (SFP) was government¬centered, the activities of non¬governmental actors, such as efforts by students of University of Tennessee in Knoxville to have smoke¬free domitories and that of Campaign for Healthy and Responsible Tennessee (CHART) to repeal preemption (nongovernmental¬centered thesis), and societal changes (bubble¬up thesis) contributed to its emergence. The SFP entered the state’s policy agenda when the problem of tobacco use in the state (health consequences and costs) and policy solutions (including SFP) became coupled with favorable political circumstances involving Governor Phil Bredesen’s unexpected announcement of support for a statewide SFP during smoke¬free state buildings bill signing ceremony in June 2006. This announcement created a window of opportunity for SFP change, which was seized by a change agent in the state, CHART. In February 2007, the Governor included SFP in the administration's legislative package for the 105th Legislative Session. Additionally, SFP bills were sponsored in both houses of the Legislature to make SFP a priority item on the state’s policy agenda. The development of the NSPA was facilitated by factors, such as the administration’s continuous support for the SFP, activities of CHART, public support for the SFP, U¬turn in the position of Tennessee Restaurant Association (now Tennessee Hospitality Association) to support 100% SFP and limited opposition from tobacco interests in the state. Although implementation of the NSPA has generally proceeded smoothly, about half of the stakeholders prefer that the exemptions are repealed, particularly those for age¬restricted venues, non¬enclosed areas of public places and private businesses with three or fewer employees. This study suggests that there is high level of knowledge on tobacco use (the problem) and control (policy solutions) in policy circles and the key remaining factors for policy change are favorable political environment and a change agent. The development of the NSPA suggests that proponents for policy change should know and understand their policy and political environment and be alert for any change that will facilitate the development of an SFP.

The Florida Department of Health (FDOH) initiated a tobacco prevention program in 1989 when it received federal funding to implement tobacco prevention and control activities. By 1997, the State of Florida successfully settled with the tobacco industry for $11.3 billion to recoup Medicaid costs incurred by smokers. As part of the settlement agreement, the FDOH launched the Tobacco Pilot Program targeting tobacco use among underage youth.

The Florida Youth Tobacco Survey (FYTS), which was originally part of the Tobacco Pilot Program, is a statewide, school-based anonymous survey that has been conducted annually since 1998. The FYTS collects information regarding the prevalence of tobacco use, attitudes, and related behaviors among middle and high school students throughout Florida and tracks those behaviors over time. The FYTS has been administered to a state-level sample annually since 1998, with county-level surveys being conducted in 2000, 2002, 2006, and 2008.

In 2000, the FDOH worked with other state agencies to coordinate school-based surveys to reduce the burden on schools, teachers, and students. The FYTS became part of a multi-agency joint survey effort that also includes the Florida Youth Substance Abuse Survey (FYSAS), the Youth Physical Activity and Nutrition Survey (YPANS), and the Youth Risk Behavior Survey (YRBS).

The 2008 FYTS was based on a two-stage cluster probability sample design. First, a random sample of public middle schools and high schools was selected for participation in the survey. Then, within each selected school, a random sample of classrooms was selected, and all students in that class were invited to participate in the survey. To be able to generalize the data to all of Florida, the survey data were statistically weighted. Weighting is a procedure that adjusts for oversampling and for any discrepancies between the sample and the entire population from which the sample is drawn. The weighted responses of the survey participants that are presented in this report were calculated to reflect the prevalence of tobacco usage and related indicators among all Florida public middle and high school students within each county and for Florida as a whole.

The 2008 county-level FYTS was implemented in the spring of 2008. Sixty-six of the 67 Florida counties participated in this survey. The survey was administered to 38,510 middle school students (grades six to eight) and 40,283 high school students (grades nine to twelve) in 744 public schools throughout the state. The survey response rate for middle school students was 79% and the survey response rate for high school students was 73%. Sarasota County did not participate in the 2008 Florida Youth Survey and, therefore, has been omitted from this report. In addition, no middle school students from Gilchrist County participated in the survey so results for Gilchrist County are presented at the high school level only.

In this report, county values are presented for key indicators with maps for both middle and high school students, followed by detailed tables listing the prevalence by county. On each map, counties have been split into four groups: (1) counties with rates higher than the state rate and statistically significant; (2) counties with rates higher than the state rate, but not statistically significant; (3) counties with rates lower than the state rate, but not statistically significant; and (4) counties with rates lower than the state rate and statistically significant. Confidence intervals (C.I.s) were used to determine significance. A 95% C.I. is a range in which the “true” rate will fall 95% of the time. The tables in this document show the total percentage for the county, as well as the breakdown by gender for each county, including 95% C.I.s. These maps and tables will allow readers to view their county in comparison to other counties, as well as to the State of Florida. Results were omitted if there were less than 30 respondents for a specific indicator.

Introduction The Florida Youth Tobacco Survey (FYTS) was administered in the spring of 2008 to 38,510 middle school students and 40,283 high school students in 744 public schools throughout the state. The survey response rate for middle schools was 79%, and the survey response rate for high schools was 73%. The FYTS has been conducted annually since 1998. The data presented in this fact sheet are weighted to represent the entire population of public middle and high school students in Florida.

Introduction The Florida Youth Tobacco Survey (FYTS) was administered in the spring of 2008 to 38,510 middle school students and 40,283 high school students in 744 public schools throughout the state. The survey response rate for middle schools was 79%, and the survey response rate for high schools was 73%. The FYTS has been conducted annually since 1998. The data presented in this fact sheet are weighted to represent the entire population of public middle and high school students in Florida.

The Florida Youth Tobacco Survey (FYTS) was administered in the spring of 2008 to 38,510 middle school students and 40,283 high school students in 744 public schools throughout the state. The survey response rate for middle schools was 79%, and the survey response rate for high schools was 73%. The FYTS has been conducted annually since 1998. The data presented in this fact sheet are weighted to represent the entire population of public middle and high school students in Florida.

Introduction The Florida Youth Tobacco Survey (FYTS) was administered in the spring of 2008 to 38,510 middle school students and 40,283 high school students in 744 public schools throughout the state. The survey response rate for middle schools was 79%, and the survey response rate for high schools was 73%. The FYTS has been conducted annually since 1998. The data presented in this fact sheet are weighted to represent the entire population of public middle and high school students in Florida.