Problem/Objective: In 1999, only 9 of North Carolina's 115 school districts prohibited outdoor tobacco use on school grounds by students, faculty and staff. By 2005, 64 districts had adopted policies requiring 100% tobacco-free schools (TFS). We used survey data from 1999, 2003 and 2005 to examine changes in tobacco use by high school students following adoption of TFS policies.

Methods: The North Carolina Youth Tobacco Survey was administered to a statewide, representative sample of high school students in the fall of 1999 (n=6,560), 2003 (n=3,124) and 2005 (n=3,261). Current tobacco use was defined as use of any form of tobacco within the past 30 days. School districts were grouped by the date they adopted TFS policies: before the 1999 survey, between the 1999 and 2003 surveys, and between the 2003 and 2005 surveys.

Results: In general, current tobacco use showed significant declines in the survey immediately following adoption of a TFS policy. In districts that adopted TFS policies between the 1999 and 2003 surveys, prevalence declined from 38.7% in 1999 (baseline) to 28.0% in 2003 and 27.1% in 2005. In districts that adopted TFS policies between the 2003 and 2005 surveys, the prevalence remained steady before adoption (40.8% in 1999 and 39.6% in 2003), but declined to 25.7% in 2005. Tobacco use in districts that had not passed a TFS policy before the 2005 survey showed no significant declines during this time.

Conclusions: Current tobacco use among high school students declined in school districts after TFS policies were adopted.