The San Francisco Unified School District’s successful legal fight against tobacco giant Altria is paying big dividends for its fiscal health and will help Superintendent Maria Su close the school district’s persistent budget gap. Meanwhile, school nurses — intended recipients of the $24.65 million settlement fund — are waging a battle to remain in schools. For the second year in a row, the school district may be using more of its e-cigarette money for purposes other than what its leaders pledged to spend it on, namely, “to provide additional resources to address youth vaping and youth nicotine use in SFUSD.”
While the school district needs money everywhere, school nurses have recently criticized the new school site staffing plan set to go into effect in the fall as forcing them to travel and short changing the needs of students on campuses across the district. While school district officials may be able to cite national data showing drops in youth tobacco use and less need for the health program, shifting the funds deserves scrutiny by the school board and answers to students, parents, and the nurses themselves.
The school district’s initiative to take tobacco companies to court for targeting the youth vaping market in 2019 was a litigation success in marked contrast to its frequently criticized penchant for adopting novel teaching methods, creating its own curriculum or using one-of-a-kind payroll processes. Responding to a youth vaping craze that produced a dramatic rise in use of vaping pens from seven percent of San Francisco students in 2017 to 16 percent in 2019, the school district joined other school districts and local governments suing Altria for injuries to its students and educational costs and was the first to go to trial. Judicial rulings against tobacco industry defenses led to settlements totaling over $1.2 billion for thousands of school districts and local governments nationally. In March 2024, the school district received its $24.65 million share.
When announcing the settlement, the school district stated the funds would pay for a targeted educational campaign to combat student tobacco use and to bolster student health. Then Superintendent Matt Wayne stated the settlement “will amplify the efforts of our health education staff and benefit SFUSD’s students by helping to reduce and deter youth nicotine use.” Then school board President Jenny Lam echoed that it would “advance SFUSD’s established health education work by providing meaningful resources to support prevention efforts and education around youth e-cigarette use.” She enumerated three sets of employees who carried out the health initiatives: health educators, youth outreach workers, and school nurses.
According to data provided by the school district, $10.9 million in settlement funds are being used this academic year to pay 76 salaries, including 44 high school counselors, 12 nurse positions, 17 community health outreach workers, and three central office positions, including two in the office of equity. Almost twice as many nurses (23.5 full-time equivalents) are paid by the mayor’s wellness program or the school district’s nonprofit partner known as SPARK. Health educators are also paid from SPARK or other funds unrelated to the tobacco settlement.
While vaping and tobacco use have dropped since the inception and settlement of the lawsuit, they consistently have been two to four times more prevalent at the high school level than among middle school students. Yet, the settlement fund is not being used for any high school nurses and only a share of middle school nurses. And, notwithstanding the 2022 press release, it does not pay health educator salaries. While vaping has an impact on student classroom attendance, compared to these colleagues, counselors are far less likely to engage with students on tobacco-related health outcomes.
Currently, school nurses are assigned to one or two schools each to provide general and emergency care. Under a new staffing plan designed to save money, they will be “cohorted” to cover and travel to multiple schools primarily performing specialized and required medical and related services for individual students designated based on particular needs. The school district now hires nurses from medical staffing agencies for these services and intends to reduce their role.
School district officials face tough choices on the road to emerge from the fiscal crisis. With the influx of the settlement funds, the school district moved existing funds away from health-related positions in order to subsidize other needs. This year, the school district is spending health-related funds on school counselors and has obtained other funds to pay for nurses and health outreach workers. In the coming year, the school district is asking the original intended beneficiaries of the settlement funds to stretch their positions to do more even though it still has $14 million it could use to pay for nurses without a change.
The school district still has work ahead to find a solution that advances, and does not compromise, both student physical health and district fiscal health.
