Adolescent Health, Annual Report FY 2020

 

Priority: Reduce barriers, improve access, and increase the availability of health services for all populations

NPM 10: Percent of Adolescents, ages 12 through 17 with a preventive medical visit in the past year.

• According to the National Survey of Children’s Health, Ohio increased from 78.1% in 2016 to 79.1% in 2017. In State Fiscal Year (SFY) 2019, 48% of Ohio’s eligible Medicaid youth, ages 12-17, received a well-care visit. This figure was 44.4% in SFY 2020.

 

ESM 10.1: Number of clinical providers in Ohio trained on Bright Futures clinical recommendations.

• From FY 16-18, 267 providers were trained through webinars and trainings, including those provided through contact with Ohio American Academy of Pediatrics (Ohio AAP). In FY 19, ODH did not renew the contract with Ohio AAP and instead collaborated with Ohio AAP on webinars and a statewide conference to train 100 clinical providers on Bright Futures clinical recommendations, and in FY 20 an additional 80 clinical providers were trained.

 

Adolescence is a unique developmental time that is characterized by distinct and dramatic developmental, physical, social, emotional, and intellectual changes. Many lifestyle behaviors that contribute to or reduce risk for chronic disease and disability in adulthood are developed in adolescence. Adolescence is defined as ages 10-24, including young adults due to the finalization of frontal lobe development that impact decision-making skills. This transition into young adulthood is important to recognize as youth shift from child serving agencies into adult focused systems. Development within this age range varies by the individual and is much more complex than chronical age. Certain subgroups of adolescents may experience development tasks of adolescents in different ways, such as those with special health care needs, chronic physical or mental health conditions, or disabilities. Adverse childhood and adolescent experiences may also impact or delay development and maturity. Other subgroups of adolescents may be more vulnerable to risk factors and poor health outcomes such as those living in poverty, foster care, juvenile justice, homelessness, racial or ethnic minority youth, and youth identifying with sexual or gender minority.

 

Health outcomes among adolescents reflect the disparities in the larger population. Lack of access to health care, safe housing, transportation, and lower educational attainment disproportionally impact minority adolescents and young adults, which impact overall health outcomes. In Ohio, approximately 20% of the population is between the ages of 10 and 24 (U.S. Census Bureau, population Division).

 

Ohio Title V recognizes the need to improve areas of preconception health and understanding of health literacy and engagement with the medical field during adolescence for improved maternal and infant health outcomes. Particular areas of concern are Ohio’s adolescent overweight, obesity, vaping prevalence, and lack of physical activity. Ohio is the only state in the country without Health Education Standards which prevents the assessment and improvement of quality health education skills development.

 

Despite the deficits, Ohio Title V staff have strong partnerships with entities that aim to improve adolescent health outcomes. The following will describe some the partnerships and strategies implemented during FY 20. It should be noted that Ohio’s Adolescent Health Coordinator position was vacant for a majority of FY 20.

 

In the last Needs Assessment process, Ohio selected National Performance Measure (NPM) 10, Percent of adolescents, 12-17 years, with a preventive medical visit in the past year. According to the National Survey of Children’s Health, Ohio increased from 78.1% in 2016 to 79.1% in 2017. In SFY 2020, 44.4% of Ohio’s eligible Medicaid youth, ages 12-17, received a well-care visit. This figure had continued to improve each year from 2016 to 2019, but showed an expected drop during 2020 due to COVID-19 (SFY 2016 42.6%, SFY 2017 43.9%, SFY 2018 44.3%, SFY19 48.0%). Despite the challenges of COVID-19 the 2020 rate was still higher than in the rates seen 2016-2018.

 

Over the past five years of the Title V adolescent health action plan, Ohio has developed an advisory committee, assessed the status of well visits, conducted assessments regarding needs for improvement from a parent, practitioner, public health, and insurance perspective. Ohio has continued to provide professional development to practitioners serving adolescents on strategies to increase and improve adolescent well visits and Bright Futures recommendations and health topics. Education and support were provided through webinars and quality improvement practices. Within the assessments and feedback from QI, adolescents, and families, recommendations for Ohio to improve policy, process, and practices have become evident such as providing improvement strategies for the following:

• Quality measures and improvement activities related to:
  • Improving access to care
  • Issues related to claims data
  • Issues related to performance metrics and incentives
  • Considerations for confidentiality, privacy, EMR and patient portal access
• Screening and referral needs and issues for relevant adolescent health issues addressed in well-care visit
• Transition strategies for healthy health care consumerism as adolescents mature
• Conversion of sports physicals to comprehensive well visits
• Adolescent and family voice

 

In FY 19, Ohio released a Request for Proposal (RFP) asking for a vendor to create a recommendation brief on policies and strategies to increase well visits, including the above topics. The brief would include the status of well visits including national and state-specific data, recommended best practice strategies, current activities, barriers and successes, and proposed policy improvements impacting practice and reimbursement. In addition, the brief would include needs of adolescents, parents, and practitioners to increase and improve visit outcomes. Ohio did not receive a valid response for either of two RFP rounds.

 

After the solicitation timeframes, attempts were made to receive feedback from perspective vendors as to why they did not respond. Timing and partnership needs were the two largest barriers. It was noted that the experts in adolescent well visits and health outcomes are not the policy and brief development experts. Therefore, more relationship building is necessary to bring together the two types of expertise to successfully implement the deliverables.

 

Since the fall of 2018, the Title V program has been in conversations with the Ohio Department of Education (ODE) and Nationwide Children’s Hospital (NCH) regarding the topics from the proposed brief and leveraging school-based health care (SBHC) in providing services to adolescents. Over the past few years, ODE has increased their level of technical assistance and guidance to school districts in developing SBHC, including publishing a toolkit and providing webinars. The ODH Title V Director participated in development of the toolkit. NCH is a provider of SBHC to districts in Central Ohio; has an adolescent medicine department consisting of board-certified Adolescent Medicine physicians, advanced practice nurses, social workers, and nutritionists; and has developed a state-of-the-art behavioral health center. Both ODE and NCH, are interested in creating systemic changes to improve practices related to sport physicals that would provide opportunities to more comprehensively assess adolescent’s health.

 

ODE and NCH are also lead entities in a school-based health center COIIN that has worked to develop PDSA opportunities for SBHC’s that are associated with NCH. The COIIN plans to explore opportunities to expand the initiative to a more statewide approach. Due to ODH staff vacancies, there was not ODH representation on the COINN in FY 20, but ODH continues to get updated on the work and plans to continue SBHC collaborative work with state and local partners. In addition, the ODH School Nursing program is a participant in Ohio’s team in the National Center for School Mental Health (NCSMH) 12-month Collaborative Improvement and Innovation Network to focus on making measurable improvements in students’’ mental health (including social, emotional, behavioral health, and substance use). Ohio is one of five states participating.

 

During FY 19, Ohio Title V and ODE became involved in the Midwest Adolescent Health Project, which is a HRSA funded project to build capacity for adolescent centered care in rural and underserved communities in Region V. Two Ohio-based entities were selected to participate in activities during FY 20: Cleveland Clinic Children's Hospital and Rock Hill Family Medical Center. Both provide school-based health services and adolescent well visits. Due to the COVID-19 pandemic, the timeline for the round 1 sites was adjusted, with the kick-off occurring in September 2020, instead of March 2020 as previously planned. During FY 20, an RFP was distributed to recruit sites to participate in round 2 of the project. One entity was selected from Ohio to participate: Lower Lights Christian Health Centers. The kick-off for round 2 will occur in March 2021, with further updates on both rounds to be provided in the FY 21 report.

 

The ODE also released $675 million, through HB 166 released in July 2019, to Ohio school districts to support student’s academic achievement through mental health counseling, wrap around services, mentoring, and after-school programs. School districts are to work with local organizations, such as local health departments and mental health agencies, to determine community needs and resources. Title V staff are on a committee to assist ODE with these student wellness initiatives, as well as on a Prevention and Harm Reduction team. Districts are required to partner with local organizations such as local health departments and local mental health agencies. In late 2019, ODE released a survey asking districts about their current level of collaboration with community agencies and needed support. The data collection from this survey was extended, and results are expected to be available in early 2021. ODH Title V staff will provide assistance, as needed, based upon results.

 

Further connection to Title V within ODE is the Anti-Intimidation Harassment and Bullying (Anti-HIB) Initiative that focuses on bullying reduction through Positive Behavior Intervention Supports (PBIS) and local district policy, training, and curriculum support. ODH staff funded through Title V and CDC participate in the work group led by ODE. Risk topics include harassment, intimidation, bullying, teen dating violence, suicide, cyber-bullying, and human trafficking. During FY 20, the group spent time compiling a suite of Anti-HIB resources. In addition, considering the swift transition to remote learning across the state during the COVID-19 pandemic, the group focused on creating a cyberbullying prevention toolkit. The toolkit was created to provide resources to support staff, students and families identify, respond and report cyber bullying.

In addition, School Nursing program staff participate in the ODE Trauma Informed Schools Committee which, among other activities, hosted a virtual Trauma Conference with over 3,000 attendees.

 

Also supporting behavioral health, Title V adolescent health has served on the Ohio Interagency Council for Youth (OICY) which supports the creation and maintenance of a comprehensive continuum of care to facilitate timely access to appropriate services among youth with behavioral health needs. OYIC’s purpose is to make recommendations to state and local entities to increase access to behavioral services for children and youth and to reduce behavioral health disparities. Committees focus on trauma-informed care, state and local policies and regulations, funding and resources, workforce development, and youth and family engagement. Youth and family with lived experience are present and involved at each meeting. OYIC was created by the OhioMHAS through funding from SAMSHA. Current initiatives align goals from multiple grants across cabinet-level agencies, including ODE, OhioMHAS, Ohio Medicaid, Ohio Department of Job and Family Services, ODH (Title V and Health Care Shortage funding goals), Ohio Department of Youth Services, and Ohio Department of Developmental Disabilities. The ODE’s Office of Workforce Transformation recently accepted the group’s application for a new industry credential for a Mental Health Technician. Youth will be able to enroll in courses beginning in the 2021 school year and graduate from high school with this credential. The process has strengthened the relationship across all state agencies in better understanding workforce development needs and how to develop successful applications that can impact multiple medical and public health employment services.

 

Title V has supported the Ohio Adolescent Health Partnership through leadership and facilitation. Over 100 agencies with expertise in adolescent health and wellness are members. The group provides professional development and networking, focusing on the needs of the whole adolescent. The aim is to reduce silos and build the capacity of agencies to more effectively and positively serve adolescents. Topic addressed during FY 20 meetings (prior to COVID-19) focused on adolescent vaping and EVALI and results from the 2019 Ohio Youth Risk Behavior Survey. During the COVID-19 pandemic, meetings were transitioned to a virtual platform. Much of the meeting content after March focused on resources available during COVID-19 and impact the pandemic had on the work of the member agencies.

 

In FY 20 a research article was published in the journal Health and Social Care in the Community on the infant mortality and positive youth development project funded by Title V in 2018 (https://doi.org/10.1111/hsc.13158). The research project was designed to identify the root causes, structural and individual factors associated with the health and well-being of adolescent girls within the communities with the highest infant mortality rates. Guided by the SWOT framework findings were organized by strengths, opportunities, weaknesses, and threats to explore links between access to positive youth development programming, community supports, and maternal, adolescent and infant health outcomes. The results have implications for community-based efforts that can leverage positive youth development contexts (e.g., school, afterschool, youth sports) to improve maternal health, prevent infant mortality and

promote positive health and well-being for adolescent girls.

 

The above initiatives and partnerships support National Outcome Measures (NOMs) associated with tooth decay, child and adolescent mortality, adolescent suicide, needs of students with special health care needs, mental health treatment, obesity, vaccination, teen births, and, ultimately infant mortality. And, NPMs related to physical activity, bullying, well visits, transition, medical home, and oral health may also be impacted.

 

Maternal and Child Health Program- Adolescent Resiliency (MP Subsidy)

The Maternal and Child Health Program (MP Subsidy), fully funded by Title V, administers funds to counties across the state to improve MCH outcomes and started a new component for FY 19-21 related to adolescents. The Adolescent Health Evidence-Based Resiliency component was designed to support the identification and implementation of evidence-based projects related to physical activity, prevention activities (vaping, tobacco, illicit drugs, mental health, and/or healthy eating), or staff capacity training for community based organizations (trauma informed, implicit bias, suicide prevention, drug abuse prevention, effective communication with English language learners, ACES, violence prevention/Safe Space, nutrition, and/or physical activity).

 

The MP Subsidy engaged 20 subgrantees in FY 19 to complete an assessment on the engagement of adolescents using community resources to inform future adolescent resiliency efforts. Subgrantees submitted final assessment reports with needs including transportation, expanding programs, parent partnership, youth voice in programming, among others. Subsequent MP Subsidy funding years include a strategy to create an implementation plan that addresses the needs and recommendations from the FY 19 assessment report.

 

In FY 20 MP Subsidy engaged 19 subgrantees to support the development of an Implementation Plan that will improve physical activity of adolescents (ages 11-14) to at least 60 minutes per day, decrease the prevalence of overweight and obese adolescents, and/or improve the overall health of adolescents to good or excellent health. Activities that were proposed for implementation included: Community gardens, life skills, cooking matters, physical activity, violence prevention, trauma informed and ACES programming, library connections, family engagement, transportation support, mindfulness skill building, mental health education, and resiliency programming. The subgrantees will use FY 21 funds to implement the Adolescent Resiliency programs.

 

School Nursing

The Ohio Department of Health School Nursing program provides support for a number of MCH priorities, including:

• Increase prevalence of children receiving integrated physical, behavioral, mental, and developmental services
• Reduce the rate of childhood obesity
• Reduce barriers, improve access, and increase the availability of health services for all populations
• Increase access to care via Patient Centered Medical Home (PCMH) for children and youth with special healthcare needs (CYSHCN)

 

Ohio has almost 1.7 million preschool-12th grade public school students. Fifty percent of these students are classified as economically disadvantaged, while 15% are students with disabilities (http://www.ohiobythenumbers.com/). In addition, almost 22 % of Ohio children have special health care needs (https://www.childhealthdata.org/browse/survey) such as asthma, allergies, seizure disorders, and diabetes. Most of these children spend their days in the school setting. Schools rank the following chronic health conditions as most difficult to manage: diabetes, mental health issues, allergies, and asthma (https://odh.ohio.gov/wps/wcm/connect/gov/bf86c00c-1003-4c77-85fc-fbefc48500d9/2017+ODH+Health+Services+Survey+webFINAL.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=ROOTWORKSPACE.Z18_M1HGGIK0N0JO00QO9DDDDM3000-bf86c00c-1003-4c77-85fc-fbefc48500d9-mMqOoKq). A large number of medications are administered in Ohio schools on a daily and as needed basis. While the person most likely to administer the medication is an RN, more than 40% of medications are administered by unlicensed school staff such as secretaries and school administrators; these unlicensed staff must all be trained for this task by a licensed health professional. Many of these data are from the ODH Survey of Health Services in Ohio Schools. The next iteration of that survey was planned to be in the field in spring 2020 but had to be postponed because of pandemic restrictions.

 

While the descriptions of activities are those that typically occur in school, the pandemic created dramatic change in the schools. In March 2020 schools were closed and had to transition to a remote learning environment within a matter of days. With so little known or understood about COVID-19 at that time, there were widespread fears about handling student papers completed at home and submitted to the school. There were disruptions in services provided to CYSHCN, food meal services, and other activities typically held at school. During the summer both ODH (https://coronavirus.ohio.gov/wps/portal/gov/covid-19/responsible-restart-ohio/Sector-Specific-Operating-Requirements--see Schools) and ODE (http://education.ohio.gov/Topics/Reset-and-Restart) provided guidance to schools for the 2020-21 school year, but there has continued to be wide variation of school services (see map at ODE link above).

 

Despite the challenges of the pandemic, school nurses continue providing care to children with special healthcare needs, conduct COVID-safe health screenings, health education, in-service education to other school staff, and acute injury and illness care for all students. As needed, they refer children and families to medical homes or other community resources (including Medicaid if appropriate) for healthcare services. These school nurse activities address these four MCH priorities.

 

The ODH School Nursing program activities include professional/workforce development, provision of technical assistance, resource development, and data collection. Professional development is provided in both face-to-face conferences as well as online independent study opportunities. Topics for professional development are determined by requests of school nurses on conference evaluations, trending topics in technical assistance requests, and emerging issues. Annually, program convenes a focus group of practicing school nurses to identify the topics for the upcoming year and which should be shared as conferences or online independent studies. These Public Health Strategies (PHS) are designed to support school nurses in providing direct (D) and enabling (E) services to students and school communities. Title V funds, with a smaller amount of GRF dollars, pays for the School Nursing program staff, venues, and speakers for conferences if needed.

 

Professional/Workforce Development

In a typical year, the School Nursing program hosts a three-day in person orientation for new school nurses, three regional school nurse conferences on a variety of topics, and a summer conference where an entire day is devoted to a specific topic. Continuing nursing education (CNE) contact hours are provided for all professional development.

 

Due to the pandemic, only one of the regular Regional School Nurse Conferences was held in the spring, providing 6.25 CNEs for topics including Leadership, Self-Harm/Cutting, Tick- and Mosquito-Borne Diseases, Psychogenic Seizures, and Social Media to 185 nurses. One was completely cancelled, and one was transitioned to a virtual conference within the week for 130 nurses. All of these topics support MCH goals of integrative services, reducing barriers/improving access, and care of CYSHCN. Summative evaluations for the conference were excellent.

 

The conference in the summer of 2020 addressed homeless and was also transitioned to a virtual platform; 60 nurses attended, earning 5.25 CNEs. Summative evaluations for the conference were excellent.

 

For the new school nurse orientation in August, the conference was transitioned to three successive Friday virtual conference days, rather than three successive face to face conference days. Registration for this virtual format was higher than previous years with 141 nurses.

earning 17.8 CNEs. While all of the topics support the health of children in the school setting, the agenda specifically included presentations on BMI-for-Age screening (obesity prevention); MSP and MAC (Medicaid reimbursement for CYSHCN, medical home, reducing barriers/improving access); chronic disease management, autism, special education services, vision and hearing screening, management of food allergies, and more topics (CYSHCN, integrated services). Summative evaluations for the conference were excellent.

 

As previously mentioned, professional development is also offered through online independent study opportunities. The School Nursing program has developed a library of more than 40 online independent study courses. A minimum of four new courses are added each year. Courses are revised and updated or discontinued as necessary to ensure continuing relevance. Depending on the topic, trainings range from one-hour trainings on a single topic to Blended Learning Series that provide more than five hours of CNEs. In the past year, 1,651 nurses took courses from the library and earned up to 20.7 CNEs. A wide variety of topics are included in the library, including many that specifically address MCH goals. These include allergies, anxiety disorders, autism, bleeding disorders, special education law, individualized healthcare plans and other topics related to providing care for CYSHCN, removing barriers/improving access, and integrating services. BMI-for-Age training supports obesity prevention. Summative evaluations for the studies were excellent.

 

Technical Assistance, Resource Development, Data Collection

The School Nursing program is home to the State School Nurse Consultants for Ohio. These consultants responded to more than 1,000 requests for technical assistance during the year, providing support to school nurses, school administrators, parents, and others with an interest in school health.

 

School Nursing program staff create resources for use by those interested in school health. In addition to the usual development of resources for schools such as the revision of the Emergency Guidelines for Schools, School Nursing program staff participated on interdisciplinary, interagency work groups to develop pandemic guidance for schools and school nurses. School Nurse FAQs, Resources, Don/Doff Facemask handouts and videos were also created and posted on the ODH coronavirus.oho.gov website.

 

Another resource in the electronic School Nurse Bulletin Board. This is a one-way communication system from ODH to school nurses on the Constant Contact platform. More than 1,330 school nurses are enrolled in the Bulletin Board; 59 messages were sent this year to school nurses alone, with an additional 53 sent to both the School Nursing and Early Childhood Health Bulletin Boards jointly. The School Nursing messages showed a 59.9% open rated and 18.35% click rate—both above industry average. The average number of messages were up from 9 messages per month last year to 11.75 per month this year; 66 of these messages were pandemic-related, 46% of all messaging this year.

 

The School Nursing program periodically conducts a survey of health services in Ohio schools. While this year was not a data collecting year, the results from the previous year were compiled, analyzed and published on the ODH website. While there had been plans to be in the field in spring 2020 for data collection, they were deferred due to the pandemic.

 

Stakeholders and Partnerships

The State School Nurse Consultants in the School Nursing program participate and share their expertise in numerous state level and national committees such as the Ohio Violence and Injury Prevention Program, the Ohio Association of School Nurses, and the Ohio Adolescent Health Partnership, and the National Association of State School Nurse Consultants.

 

The ODH School Nursing program has partnered with the Ohio AAP, Ohio EMS, and others to create the Emergency Guidelines for Schools book. Historically, this book has been printed and disseminated to schools, and is available online. It has been adapted for use in numerous states and jurisdictions across the country. It was last revised in 2007, so the program has pulled together an interdisciplinary team to revise the document. While the goal was to have the revisions completed by next year competing priorities related to the pandemic have delayed the final formatting and production of this resource.

 

Next Steps

In addition to continuing to offer professional development, the School Nursing program expects to be in the field with the next Survey of Health Services in Ohio Schools in 2021. Title V funding will be used to contract for statistical services to draw a weighted sample and clean and weight the data after collection.

 

A new project that will be undertaken is that the program will contract with an external evaluator to develop a comprehensive evaluation plan for the School Nursing program. In development of this proposal, it was found that no other state has done this kind of evaluation planning for their school nursing program, so this will be the first of its kind in the country. Title V funding is being used to contract with this external evaluator. Work began in October 2020.

 

Youth Survey Work

Ohio achieved weighted data on the 2019 Youth Risk Behavior Survey/ Youth Tobacco Survey, which was the first time in six years this was accomplished. One barrier to getting school participation in recent years was an abundance of state and local surveys occurring simultaneously, adding pressure to schools to participate in multiple. ODH staff, including YRBS Coordinator and Data and Surveillance Manager, convened a workgroup of multiple state agencies, including the Ohio Departments of Education, Mental Health and Addictions Services and Medicaid, to discuss coordination of survey efforts. The group was facilitated by staff from the Ohio University, who walked through a process to identify shared goals and work towards a system of surveys for the state.

 

 

 

Youth Homelessness

State Fiscal Year 2020 marked the first time ODH received funds in the General Revenue Fund (state budget, GRF) to address youth homelessness. Former Director of Health, Dr. Amy Acton, actively lobbied that homelessness is a public health issue. The budget line item was specific to addressing homelessness in individuals aged 14-24, with particular emphasis on homeless youth who are pregnant. ODH awarded 7 subgrantees a total of $1,800,000 in grant funds in SFY 20, and to an additional 6 subgrantees for a total of 13 subgrantees that were awarded a total of $2,200,000 in SFY 21.

 

ODH’s funding for this initiative enabled local agencies that serve homeless youth to implement innovative strategies to reach and assist this difficult and vulnerable population. The funding is able to be used for services not typically covered by traditional federal funding for homelessness. Strategies implemented by the subrecipients included expanding/enhancing COVID-safe/socially distanced “drop in” centers for youth; purchasing bicycles to assist with transportation to school/work; purchasing cleaning supplies for housing; supporting the costs of cell phone minutes in order to keep youth connected to case managers, appointments, job/school, etc. Additionally, the funding provided support to smaller agencies that provide specific core services to youth who are homeless (such as education/employment training, or behavioral/substance use counseling/treatment), as well as to larger agencies to expand their comprehensive services for homeless youth.

 

COVID-19 restrictions in Ohio created barriers in getting this initiative up and running at the local level, which began in February 2020. Many of the grant funded agencies experienced delays in getting their initiatives implemented fully until recently, due to not being able to host face-to-face services. ODH anticipates this initiative will continue to grow as we work through the pandemic. Title V MCH funds support the ODH personnel who administer this GRF funded grant.

 

Tobacco Use Prevention and Control Program

ODH Title V partners with other funded areas of the agency to improve adolescent health outcomes. Regarding tobacco and e-cigarettes, the CDC funded Tobacco Use Prevention and Control Program (TUPCP) aims to reduce youth use. They fund 30 communities for youth work which includes formation and implementation of counter-marketing campaigns, point-of-sale audits and compliance checks, promotion of point-of-sale policies that limit the availability and accessibility of tobacco to youth, and work with community leaders to increase awareness of the need for policy change. The grant encourages youth involvement in counter-marketing activities and in activities that promote adoption of laws or policies that restrict youth access to and availability of tobacco. Ohio has collected and continues to collect point-of-sale marketing information about tobacco in local retail environments. Youth and public health officials use these data and data gathered from compliance checks and other community assessments to educate community members and decision makers about the impact of tobacco on youth. Between 7/1/19 to 6/30/20, 495 retail compliance checks were conducted with a 73% compliance rate, a decrease of 12% from the previous year. This decrease in compliance rate was anticipated with the adoption and implementation of Ohio’s statewide Tobacco 21 law which raised the legal age to buy tobacco from 18 to 21. The advent of the pandemic also most likely impacted the functioning of retail establishments that sell tobacco.

 

Another grantee activity is store audits. Findings are used to promote awareness among decision-makers and community members and to promote policy change to reduce exposure to tobacco marketing and price discounting. A total of 495 store audits were also completed and these results were much more promising indicating a decrease in community marketing affecting youth including decreases in price promotions for little cigars (from 69% to 49.5% of stores audited), e-cigarettes (from 64.7% to 45.1%) and Juul pods (from 52.4% to 40.7%). Community grantees with ODH tobacco prevention and control grants continue to work to promote point-of-sale policies that would restrict or eliminate price discounting, would restrict overall marketing on windows in convenience stores, would decrease the availability of flavors, or that would restrict the density of tobacco retailers in a community or limit their proximity to schools or parks where youth spend time.

 

With the dramatic rise in youth nicotine use, largely through vaping, TUPCP added a vaping deliverable to the local tobacco grant program in November 2019 which continued through 6/30/20 and which will be included in following project periods of the local tobacco prevention and control grant. Objectives related to raising community awareness of youth, parents, school personnel, and healthcare professionals about the dangers of vaping. Additionally, grantees continue working with established task forces to implement community centered objectives to address the vaping epidemic and to promote the My Life, My Quit program, a youth cessation program associated with the Ohio Tobacco Quit Line.

 

Increasing the number of 100% Tobacco-Free School Districts is an ODH Directive and an indicator in Ohio’s State Health Improvement Plan. During the reporting period the total number of school districts that have a 100% tobacco free policy rose from 183 to 285. These districts include an additional 529 schools, protecting an additional 192,642 students.

 

While the TUPCP is funded by CDC, the Title V program collaborates with and benefits from their strategies and objectives. By decreasing the availability and initiation of nicotine product use, preconception health indicators will improve in addition to overall adolescent health. Title V continues this partnership with the Tobacco Use Prevention and Cessation Program on tobacco issues that impact youth, such as 100% Free School Policies, Tobacco 21 law, and adolescent development and e-cigarette use and cessation efforts.