Problem/Objective: National and state efforts that encourage adoption and enforcement of 100% tobacco-free policies in schools (TFS) can lead to significant reductions of youth tobacco use. North Carolina has a partial tobacco-free law in schools that prohibits the use of tobacco products in enclosed school buildings during school hours, but allows individual school districts to pass more comprehensive policies.

Methods: Over 100 key informants from 46 districts that passed 100% TFS policies between 2003 and early August of 2005 were interviewed to see what factors were important in policy passage.

Results: Several themes related to policy adoption emerged, including the importance of local and state leadership, grassroots organizing, and optimal communication strategies. Peer pressure from other school districts, and the idea of a statewide trend of policy adoption, also helped some districts pass 100% TFS policies. Interviewees indicated that 100% TFS policies in NC are perceived as effective and that policy implementation fears have remained mostly unfounded. Policy adoption has now occurred in school districts with historic or current strong economic ties to tobacco.

Conclusions: These themes suggest recommendations that would help all remaining school districts in the state, as well as school districts in other states, that have not yet passed 100% TFS policies to adopt them.