Changing the Smoking Trajectory: Evaluating the Impact of School-Based Tobacco Interventions on Changes to Susceptibility to Future Smoking.

Adam Cole,Scott T Leatherdale,Wei Qian

doi:10.3390/ijerph14101182

Adam Cole, Scott T Leatherdale + Show 1 more

Open Access

https://doi.org/10.3390/ijerph14101182

Copy DOI

Abstract

School-based programs and policies can reduce student smoking rates. However, their impact on never-smoking students has not been investigated despite the clear transition between non-susceptible, susceptible, and ever tried smoking statuses. The objective of this paper was to examine the longitudinal student-level impact of six changes in school-based tobacco control programs and policies on student transitions in susceptibility to smoking over one year. Two multinomial logistic regression models identified the relative risk of a change in self-reported susceptibility to smoking or in trying a cigarette among never-smoking students in each of the six intervention schools compared to the relative risk among never-smoking students in control schools. Model 1 identified the relative risk of a change in smoking susceptibility status among baseline non-susceptible never smoking students, while Model 2 identified the relative risk of a change in smoking susceptibility status among baseline susceptible never smoking students. Students at some intervention schools were at increased risk of becoming susceptible to or trying a cigarette at one year follow-up. Intervention studies should examine changes to susceptibility to future smoking when evaluating impact to ensure that school-based tobacco control programs and policies do not negatively change the risk status of never-smoking students.

Highlights

Youth smoking rates within Canada have decreased substantially such that, by 2014/2015, only 9.7% of adolescents aged 15–17 years reported being current smokers; almost one-third of youth remained at risk of future smoking [1]
The current analyses focused on identifying the relative risk of a change in self-reported susceptibility to smoking or in trying a cigarette among never-smoking students between baseline and follow-up in each of the six intervention schools compared to the relative risk of a change to self-reported susceptibility to smoking or in trying a cigarette among never-smoking students in control schools (n = 26); 11 schools made a change to their tobacco control program or policy environment between baseline and follow-up that did not result in a significant school-level change in the prevalence of susceptible never smokers and were excluded from these analyses
Previous cross-sectional evidence suggests that consistent policy enforcement is important for reducing the number of students that smoke at school [10,11,12,13], and our previous school-level analysis indicated that these types of interventions reduced the prevalence of current smokers at schools [15], the longitudinal student-level data suggest that there may be unintended consequences for never-smokers

Summary

Introduction

Youth smoking rates within Canada have decreased substantially such that, by 2014/2015, only 9.7% of adolescents aged 15–17 years reported being current smokers; almost one-third of youth remained at risk of (i.e., susceptible to) future smoking [1]. As described by Pierce and colleagues [2,3], susceptibility to future smoking is determined by three questions used to identify a student’s intention to smoke cigarettes in the future; among never smoking students, susceptible never-smokers are at the highest risk of initiating cigarette smoking in the future [2,3]. School-based interventions affect all students, regardless of their smoking status (i.e., susceptible never smokers and current smokers). Identifying how school-based tobacco control interventions impact non-susceptible and susceptible never smoking students is important for understanding the

Objectives

Methods

Discussion

Conclusion