Smoke-free community assessment

Smoke-Free Community Assessment Tool (SFCAT)

This assessment is for communities that want to increase smoke-free environments in schools, college campuses, multi-unit housing facilities,
outdoor venues and other localities. The purpose of this assessment is to determine the smoke-free policy status of any Michigan community,
including municipalities (cities, villages, townships), schools, multi-unit housing facilities, outdoor environments, and support for smoke-free
environments by local public officials. A college campus assessment is included if a local university/college campus is located in the community.
Depending on what type of smoke-free policy a community is interested in, and who they want to target, a community can use this entire
assessment as a comprehensive tool or use individual sections included in the assessment, if they are only interested in assessing one entity,
such as surveying local outdoor venues about whether they have smoke-free policies. There is evidence that the implementation of smoke-free
policies at schools and other public places can prevent youth from starting to smoke and motivate smokers to quit.
Communities should start with the Municipalities section to define the municipality (ies) they are assessing and for which they are collecting data.
Communities are advised to complete the Treatment Services section in conjunction with other sections that users choose to work with or before –
this section helps identify the tobacco use and dependence treatment services that exist before the implementation of local smoke-free policies, so
that you can direct community entities (such as schools, colleges, outdoor venues) to resources that can help their students and employees with
smoking cessation.
Local tobacco reduction coalitions across the State of Michigan are also involved in conducting these assessments. Community organizations and
individuals will be encouraged to collaborate with a local tobacco reduction coalition or another type of community health coalition to complete this
assessment. The Michigan Department of Community Health, Tobacco Section, at 517-335-8376, will serve as the contact point for a listing of
local tobacco reduction coalitions and assistance.

SFCAT-Tobacco Use & Dependence Treatment– Print Version Tobacco Use & Dependence Treatment Services
Tobacco use and dependence treatment services are a variety of program and services to help people quit tobacco, such as individual
or group counseling, support groups, quit kits, online programs, telephone quit lines, treatment aids (e.g., nicotine replacement
products, Chantix™, and Zyban®) or any other type of method that’s available in the community to help people quit. Local services to
help people quit tobacco must go hand-in-hand with the implementation of local smoke-free policies. Smoke-free policies can actually
prevent youth from smoking and can assist smokers in quitting; therefore, there needs to be services available to help people quit
smoking as policies are passed. As community organizations assess and increase the number of local smoke-free environments, they
also need to identify what local services are available to help residents quit tobacco. Assessing what tobacco use & dependence
treatment services are available can help community organizations refer individuals to the appropriate services, and can help
community organizations determine what type of treatment services are needed.

If you are interested in more information about tobacco use & dependence treatment services, how to assess local services, form a community tobacco use &
dependence treatment network, and offer referrals, contact Karen Brown, Michigan Department of Community Health, Tobacco Section at 517-335-8803.

You can complete an assessment for as many treatment services as you wish and you can return and edit information on any service as often as
you wish. Please print or copy a new form for each tobacco use & dependence treatment service.

1. Name of Organization/Professional _______________________

2. Street Address ______________________________

3. City _____________________________ 4. Zipcode ____________

5. Phone Number _________________________________ 6. Fax Number ___________________________________
7. Email Address _________________________________ 8. Website Address _______________________________

SFCAT-Tobacco Use & Dependence Treatment– Print Version 9. Check all the tobacco use & dependence treatments offered by this organization/professional by clicking the box next to the type of
treatment. For each checked treatment, provide details about duration and cost of treatment plus any additional notes.

Type of Tobacco Use &
Duration of Treatment (# and
Additional Notes (use this space for any
Dependence Treatment
other relevant information describing the aids (for example, nicotine patch, nicotine gum, Chantix™, Zyban®) as laser treatments, acupuncture, or hypnosis SFCAT-Tobacco Use & Dependence Treatment– Print Version 10. Notes: (Use this area for other notes related to this organization and the tobacco use & dependent treatment it provides.)

Date Started:

Last Updated on:
SFCAT-Tobacco Use & Dependence Treatment– Print Version


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