The first step is to assess community interest in regulation that prohibits smoking in outdoor public spaces where children play, such as playgrounds, fields, and parks. To determine the community's readiness to participate in the initiative and persuade municipalities to participate, some form of survey or focus group should be conducted. The Community Survey has been conducted annually since 2001 via telephone by the Rockland County Department of Health using CATI (Computer Aided Technology, Inc, Buffalo Grove, Illinois) to track attitudes, knowledge, and smoking behaviors. The interviews last approximately 11 minutes and are conducted in English and Spanish. A cross-section sample of 1000 households in Rockland County, New York, is generated using a random-digit–dial method, and participants are interviewed by members of a professional survey research and marketing company.  The results of the Community Survey conducted in 2006 suggested that the majority of county residents were in favor of outdoor smoking bans, particularly in places where children play (8). Selected data from the survey showed that

The second step of implementing the program is to invite policy makers to participate and to provide education about the harmful effects of smoking in places where children play. Attending a town or village board meeting would be helpful, as would providing decision makers with a sample tobacco-free park resolution (9). Educate decision makers about the negative effects of adults smoking in places where children play, and let them know that

Invitational materials should also describe the other benefits municipalities would receive by participating in the program. These materials include educational brochures, free signage to let residents know about the tobacco-free play areas, and public recognition through the media. For people interested in promoting the tobacco-free areas, staff from the health department can provide a community awareness event for residents.

Step three of the process is to develop signs to be posted in the tobacco-free areas and pilot test them with community leaders. The signs are made of metal, are weather-resistant, measure 12 in by 18 in, and are in full color. The signs were created around a graphic of a girl on a swing developed by the Tobacco Control Section of the California Department of Health Services (10). Each municipality can customize the signs by including a town or village logo and can request as many signs as needed. Funds for sign production (approximately $20 per sign) were contributed by the POW'R (Putnam, Orange, Westchester, and Rockland counties) Against Tobacco Coalition. The artwork and graphics can be used by other communities replicating the Young Lungs at Play campaign. (Credit for the artwork should be given to the Tobacco Control Section of the California Department of Health Services and the Rockland County Department of Health.)

The next step is to determine places that are ready to pass a resolution and invite these community members to a kick-off event with local media and officials at which they will receive the signs to post in their areas. The campaign had its first success in November 2005 when the county of Rockland passed a resolution to create a tobacco-free playground area at Haverstraw Bay Park, the most used of the county's park facilities and the only county park with a playground. In partnership with the county of Rockland's Office of the County Executive, the Rockland County Department of Health, the Rockland County Division of Environmental Resources, and the POW'R Against Tobacco Coalition, all municipalities in Rockland were invited in the spring of 2006 to join the county of Rockland in the Young Lungs at Play campaign. Of the five towns and 19 villages in Rockland County, five municipalities (i.e., the towns of Orangetown and Stony Point and the villages of Nyack, Pomona, and Sloatsburg) adopted a resolution in support of Young Lungs at Play. 

The next step in the process is to contact other municipalities, inform them of the successes of these early adopters, and encourage them to pass their own resolutions. After the kick-off event, other municipalities were again invited to participate in the program and offered assistance. In addition, an ongoing "Join Us" postcard campaign, in which county residents encourage their local municipalities to adopt Young Lungs at Play, is in place. As a result, an additional seven municipalities (i.e., the towns of Clarkstown, Haverstraw, and Ramapo and the villages of Haverstraw, Montebello, Suffern, and Wesley Hills) have joined the campaign.

The program was expanded to include other organizations with outdoor pools or play areas. To date, 15 childcare centers, 11 apartment and condominium complexes, a day camp, and a church have joined the campaign. As a direct result of the program's implementation, three school districts in Rockland County (with a total of 27 elementary schools and one middle school) and three additional elementary schools are posting the signs, increasing the visibility of antismoking messages in the county.

The next step is to promote the efforts of the participating communities using, for example, an advertisement in the local newspaper or other media outlet. To recognize communities that adopted resolutions in support of tobacco-free outdoor play areas, "thank-you" advertisements have been placed in four print media outlets. An ongoing campaign in which residents sign "thank-you" postcards that are sent to the town or village board is under way. These efforts are done both to educate the community about the initiatives and the areas affected and to promote the communities that have taken a step toward protecting children from the harmful effects of tobacco.

Finally, continuing to promote the campaign and offering materials and support to interested communities or organizations is important to the continued success of the program. In addition to encouraging municipalities and housing complexes to create tobacco-free play areas, the campaign is now being promoted to day camps in the county. The focus of this initiative is expanding to include not only outdoor play spaces but also other outdoor spaces such as bus shelters.

The campaign is being implemented in three other counties in New York State: Broome, Chatauqua, and Jefferson. These counties are diverse in geography and population and have been successful in promoting the Young Lungs at Play campaign, despite higher smoking rates (Broome County, 24.3%; Chatauqua County, 23.6%; Jefferson County, 22.4%) (6). Although these counties are in the beginning stages of implementing the campaign, they have created many tobacco-free play areas and continue to recruit municipalities and organizations within their communities.