School Smoking Policies Research Articles

Meta Analysis: Effects of Peer, Family, and School Environment on Smoking Behavior in Adolescents

Background: Smoking behavior is a behavior that is harmful to health, but there are still many people who do smoking activities, even someone starts smoking starting as a teenager. This study aimed to estimate the influence of peers, family, school on smoking behavior in adolescents through a meta-analysis of primary studies conducted by previous authors. Subjects and Method: This was a systematic review and meta-analysis conducted following the PRISMA diagram and the PICO format. Population: Teenagers. Intervention: Smokers' peers, smokers' family members, schools apply smoking rules. Comparison: Peers don't smoke, family members don't smoke, schools don't enforce smoking rules. Outcome: Smoking. The online databases used are Google Scholar, Science Direct, and ProQuest with the words ''Smoking peers'' AND ''Smoking parents'' AND ''Smoking policy school'' AND ''smoking'' AND behavior AND adolescents AND ''cross sectional'' AND aOR. There were 16 cross-sectional studies published in 2013-2023 that met the inclusion criteria. Analysis was performed with RevMan 5.3. Results: The meta-analysis included 16 cross-sectional studies from India, Korea, China, Hong Kong, Taiwan, South Africa, America, Chile, Denmark, Saudi Arabia and, Turkey. The total sample was 191,101. Smoking behavior increased with smoker peers (aOR= 5.04; 95% CI = 3.23 to 7.87; p< 0.001), smoker family members (aOR=2.04; 95% CI= 1.45 to 2.87; p< 0.001), and low smoking policy in school (aOR= 1.00; 95% CI= 0.65 to 1.54; p< 0.001). Conclusion: There is influence of smoking peers, smoking families, smoking policies in schools with smoking behavior in adolescents. Keywords: adolescents, peers of smokers, families of smokers, smoking policies.

Reducing smoking in youth by a smoke-free school environment: A stratified cluster randomized controlled trial of Focus, a multicomponent program for alternative high schools.

Youth smoking remains a major challenge for public health. Socioeconomic position influences the initiation and maintenance of smoking, and alternative high school students are at particularly high risk. The school environment is an important setting to promote health, however there is a lack of evidence-based school intervention programs. This article presents the Focus study, which aims to test the implementation and effectiveness of a school-based intervention integrating1 a comprehensive school smoking policy [i.e. smoke-free school hours (SFSH)]2, a course for school staff in short motivational conversations3, school class-based teaching material4, an edutainment session5, a class-based competition, and6 access to smoking cessation support. Together these intervention components address students’ acceptability of smoking, social influences, attitudes, motivation, and opportunities for smoking. The setting is alternative high schools across Denmark, and the evaluation design is based on a stratified cluster randomized controlled trial comparing the intervention group to a control group. Outcome data is collected at baseline, midway, and at the end of the intervention period. Moreover, a detailed process evaluation, using qualitative and quantitative methods, is conducted among students, teachers, and school principals. The results from this trial will provide important knowledge on the effectiveness of a smoke-free school environment. The findings will lead to a better understanding of which policies, environments, and cognitions, contribute to preventing and reducing cigarette use among young people in a diverse and high-risk school setting, and illuminate which complementary factors are significant to achieve success when implementing SFSH.

School Smoking Policies and Health Science Students' Use of Cigarettes, Shisha, and Dipping Tombak in Sudan.

The relationship between school smoking policies and students' tobacco use is ambiguous, and little is known about the effect of these policies in low- and middle-income countries. This study was designed to assess the effects of schools' smoking policies and the exposure to residential smoking on cigarette smoking and the use of different kinds of tobacco products by Health Science students. Self-reports of cigarette smoking, use of shisha (smoking of fruits-mixed tobacco using a bowl and a connected hose); dipping tombak (local smokeless tobacco that users usually place inside oral cavity in the groove behind the lower lip), and tobacco use on school premises are analyzed. A cross-sectional survey was carried out using a modified self-report questionnaire, originally developed by WHO, among a representative sample of 1,590 third-year HSS from 25 schools drawn from 13 universities, using a multi-stages sampling technique. The response rate was 100% for schools and 68% for students. A multilevel analysis was performed by nesting student-level in school-level variables. Results from the adjusted models revealed that, when students reported awareness of smoking restriction, they were more likely to be current smokers (OR = 2.91; 95% CI: 1.68–5.02; p = 0.021) and shisha users (OR = 2.17; 95% CI: 1.54–3.06; p = 0.021). Results from additional analysis performed among tobacco users only, showed increased risk of smokers and tombak dippers who smoked or dipped on school premises (OR = 2.38; 95% CI: 1.34–4.25; p = 0.003, OR = 2.60; 95% CI: 1.22–5.56; p = 0.013, respectively). Current smokers (OR = 3.12; 95% CI: 1.98–4.92; p = ≤ 0.001), ever smokers (OR = 1.66; 95% CI: 1.31–2.10; p = ≤ 0.001) and shisha users (OR = 1.73; 95% CI: 1.36–2.21; p = ≤ 0.001) were exposed to residential smoking on one or more days during the previous 7 days. High percentages of those who used any kind of tobacco products reported being aware of school smoking policies, indicating no clear evidence that school smoking policies had an effect on use of any of the mentioned tobacco products. The lack of compliance with school policies shows the need for further policy enforcement and sustainability, taking into account the effect of residential smoking and social influences.

Results of outdoor smoking bans at secondary schools on adolescents smoking behaviour: a quasi-experimental study.

Research on the effectiveness of school smoking policies on adolescents' smoking behaviour remain inconclusive. This study evaluates the results of an outdoor school ground smoking ban at secondary schools on adolescents smoking behaviour, taking individual characteristics into account. Data on 2684 adolescents from 18 Dutch secondary schools (nine with and nine without an outdoor smoking ban) were obtained at two moments. Associations between outdoor school ground smoking bans, individual characteristics, and smoking prevalence and frequency were measured. Multilevel logistic regression analyses were used. At schools with a ban implementation fidelity was checked. Although smoking prevalence and frequency appeared to make a slower increase at schools with an outdoor smoking ban compared with schools without an outdoor smoking ban, the differences were not significant. Differences between schools in the prevalence of smoking behaviour of students could mainly be explained by individual characteristics. Smoking prevalence and frequency were higher among adolescents with a positive attitude towards smoking and when significant others were more positive about smoking. Smoking prevalence and frequency were significantly lower when adolescents perceived it as easy not to smoke. Implementation fidelity was good at schools with a ban. No short-term effects were found of an outdoor smoking ban. A longer follow-up time than 6 months is needed. In addition, future research should investigate effectiveness in relation to the enforcement of the ban, comprehensiveness of the ban and when it is prohibited to leave school grounds, as smoking behavior might be transferred off school grounds.

Relationship among School Connectedness, Smoking Policy, and Smoking Behavior in Finnish Vocational Schools

Relationship among School Connectedness, Smoking Policy, and Smoking Behavior in Finnish Vocational Schools

Do stronger school smoking policies make a difference? Analysis of the health behaviour in school-aged children survey.

Background: Associations of the strength of school smoking policies with cigarette, e-cigarette and cannabis use in Wales were examined. Methods: Nationally representative cross-sectional survey of pupils aged 11–16 years (N=7376) in Wales. Senior management team members from 67 schools completed questionnaires about school smoking policies, substance use education and tobacco cessation initiatives. Multi-level, logistic regression analyses investigated self-reported cigarette, e-cigarette and cannabis use, for all students and those aged 15–16 years. Results: Prevalence of current smoking, e-cigarette use and cannabis use in the past month were 5.3%, 11.5% and 2.9%, respectively. Of schools that provided details about smoking policies (66/67), 39.4% were strong (written policy applied to everyone in all locations), 43.9% were moderate (written policy not applied to everyone in all locations) and 16.7% had no written policy. There was no evidence of an association of school smoking policies with pupils’ tobacco or e-cigarette use. However, students from schools with a moderate policy [OR = 0.47; 95% (confidence interval) CI: 0.26–0.84] were less likely to have used cannabis in the past month compared to schools with no written policy. This trend was stronger for students aged 15–16 years (moderate policy: OR = 0.42; 95% CI: 0.22–0.80; strong policy: OR = 0.45; 95% CI: 0.23–0.87). Conclusions: School smoking policies may exert less influence on young people’s smoking behaviours than they did during times of higher adolescent smoking prevalence. Longitudinal studies are needed to examine the potential influence of school smoking policies on cannabis use and mechanisms explaining this association.

School smoking policies and educational inequalities in smoking behaviour of adolescents aged 14–17 years in Europe

BackgroundStudies on the effects of school smoking policies are inconclusive and there is no research on whether the effects of school policies vary by educational level. We examined the association...

Entwicklung einer Checkliste zur Erfassung der schulischen Tabakpolitik

The school system is an established setting for behavioural and environmental tobacco prevention activities. Most research on the effectiveness of tobacco prevention has been conducted with regard to behavioural approaches, knowledge about school smoking policy is lacking. This research project aimed at developing a psychometrically sound instrument to assess school smoking policy. The checklist presented here contains five scales with a total of 15 items. Its reliability was tested with 42 Bavarian schools and 607 schools from Hesse. The checklist allows to measure school smoking policy in a reliable and action-oriented manner.

The role of tobacco promoting and restraining factors in smoking intentions among Ghanaian youth

BackgroundIn Western countries, the relationship between smoking intentions and smoking behaviour is well established. However, youth smoking intentions and associated factors in developing countries are largely unexplored and the former may occur for a variety of reasons. We investigated youth smoking intentions in Ghana with regard to several tobacco promoting and restraining factors, including environmental, familial, attitudinal and knowledge measures.MethodsA school-based survey of a representative sample of 12-20-year-olds was conducted in 2008 in Ghana (N = 1338, response rate 89.7%).ResultsIn a bivariate model, both among ever and never smokers, allowing smoking on school compound, exposure to tobacco advertisement and parental smoking were associated with future intention to smoke. Compared to those who agreed that smoking is harmful to health, smoking is difficult to quit and that tobacco should not be sold to minors, those who disagreed or were not sure were more likely to have an intention to smoke. In the multivariate analyses, these associations persisted, except that the attitude measures concerning the difficulty of quitting smoking once started and tobacco sales ban were no longer significantly associated with smoking intentions.ConclusionsThese findings underscore the importance of school smoking policy, parental smoking behaviour and knowledge of the harmful effects of tobacco use in determining Ghanaian youths’ future smoking intentions. Because current high percentages of smoking intentions may turn into high smoking rates in the future, the introduction of effective tobacco control measures at all levels of society to prevent youth smoking in Ghana may be essential.

The influence of school policies on smoking prevalence among students in grades 5-9, Canada, 2004-2005.

School characteristics may account for some of the variation in smoking prevalence among schools. The purpose of this study was to investigate the relationships between characteristics of school tobacco policies and school smoking prevalence. We also examined the relationship between these characteristics and individual smoking status. Tobacco policy data were collected from schools in 10 Canadian provinces during the 2004-2005 school year. Written tobacco policies were collected from each school to examine policy intent, and school administrators were surveyed to assess policy enforcement. Students in grades 5 through 9 completed the Youth Smoking Survey to assess smoking behaviors and attitudes. We used negative binomial regression and multilevel logistic regression to predict the influence of school policies on smoking behavior at the school and student levels. School policies that explicitly stated purpose and goals predicted lower prevalence of smoking at the school and individual levels. Policies that prohibited smoking on school grounds at all times predicted lower smoking prevalence at the school level but not at the individual level. For maximum effectiveness, school smoking policies should clearly state a purpose and goals and should emphasize smoking prohibition. These policies can help reduce smoking prevalence among youths and are part of a comprehensive school approach to tobacco control.

Do students’ perceptions of school smoking policies influence where students smoke?: Canada’s Youth Smoking Survey

The objective of this study was to explore students' perceptions of school policy characteristics that influence the location of smoking while at school. Data were collected from a nationally representative sample of Canadian youth in grades 7-12 as part of the 2006-2007 Youth Smoking Survey. We used multilevel logistic regression to examine how students' perceptions of school policies predicted smoking behavior on and off school grounds in 11,881 students who had ever smoked. Separate analyses were conducted for grades 7-9 and 10-12. In both grades 7-9 and 10-12, perceiving clear rules about smoking decreased the likelihood that a student would smoke on school grounds, while perceiving that a high percentage of peers smoke, that there are school rules about smoking, that students obey the rules, and that students can be fined for smoking increased the likelihood that a student would smoke off school grounds. Clearly perceived rules about smoking encourage students not to smoke on school grounds; however, perceptions of rules, along with strong enforcement, may displace behavior off of school grounds. Non-smoking policies should be part of a comprehensive approach, that supports cessation.

Brief report: Multilevel analysis of school smoking policy and pupil smoking behaviour in Wales

A multilevel analysis of cross-sectional data from a survey involving 1941 pupils (in grades 10 and 11) and policy indicators developed from interviews with staff from 45 secondary schools in Wales examined the hypotheses that pupil smoking prevalence would be associated with: restrictive staff and pupil smoking policies; dissemination of school smoking policies; and implementation of smoking policies in the context of a health promoting whole school environment. The only statistically significant association found was that pupils attending schools that did not disseminate pupil smoking policy in a written document had a greater tendency (OR = 2.16, 95% CI 1.13–4.10) to smoke daily on school premises than those who attended schools that disseminated policy through a written document. This association was not significant ( p < 0.05) when pupil level covariates were included. Further research is required to identify the effectiveness and optimal content, enforcement and support of school smoking policies.

School Smoking Policy Characteristics and Individual Perceptions of the School Tobacco Context: Are They Linked to Students’ Smoking Status?

The purpose of this study was to explore individual- and school-level policy characteristics on student smoking behavior using an ecological perspective. Participants were 24,213 (51% female) Grade 10–11 students from 81 schools in five Canadian provinces. Data were collected using student self-report surveys, written policies collected from schools, interviews with school administrators, and school property observations to assess multiple dimensions of the school tobacco policy. The multi-level modeling results revealed that the school a student attended was associated with his/her smoking behavior. Individual-level variables that were associated with student smoking included lower school connectedness, a greater number of family and friends who smoked, higher perceptions of student smoking prevalence, lower perceptions of student smoking frequency, and stronger perceptions of the school tobacco context. School-level variables associated with student smoking included weaker policy intention indicating prohibition and assistance to overcome tobacco addiction, weaker policy implementation involving strategies for enforcement, and a higher number of students smoking on school property. These findings suggest that the school environment is important to tobacco control strategies, and that various policy dimensions have unique relationships to student smoking. School tobacco policies should be part of a comprehensive approach to adolescent tobacco use.

School Context Variables and Students’ Smoking

Background/Aims: This study applied a multilevel approach to examine the associations between school smoking policy and student smoking. It was tested whether individual characteristics are mediators of school policy effects. Methods: On the basis of cross-sectional data from 3,364 students and school principals from 40 schools in Germany, two multilevel nonlinear regression models were computed for current smoking. Results: In the first model, controlling for individual factors not influenced by school, smoking bans for students and evidence-based prevention activities were negatively associated with smoking prevalence. The second model included student characteristics potentially influenced by school (e.g. school engagement, peer smoking). As school variables remained significant, these characteristics obviously do not mediate school context effects. Conclusion: School context variables influence students’ smoking independent of individual factors. The data suggest that individual variables rather mediate family influences.

School smoking bans: do they help/do they harm?

The international evidence about the effectiveness of school smoking bans on youth smoking initiation is equivocal. The purpose of the present study was to examine the association between school smoking bans and smoking initiation as a health outcome as well as academic achievement as an educational outcome, taking into account socio-economic status. This multi-level study was based on a cross-sectional self-reported anonymous data from 12,990 students who participated in the 2002 Student Drug Use Survey in the Atlantic Provinces. The main outcomes were having smoked a first whole cigarette in the year prior to the survey, and academic performance. The main independent variable at the individual- and school-levels was a school rule against smoking on school property or at school events, as reported by students. Smoking initiation was predicted by individual-level demographic factors and by the contextual factor of attending a school with a high prevalence of established smoking, but failed to be predicted by a school smoking ban. The academic performance of students who indicated there was no school smoking ban was found to worsen as an increasing proportion of the student body indicated that such a rule existed. Lower socio-economic status was found to be an independent predictor of smoking initiation and poorer academic performance. A school ban against smoking, in addition to not being clearly effective, might also not be entirely benign. School smoking policy should be monitored as to educational outcomes and the impact of policy on groups vulnerable to smoking.

Social contexts in adolescent smoking: does school policy matter?

According to an ecological perspective in psychology and in line with social cognitive theory, smoking behaviour is determined by different social contexts (for example, peers, family and school) providing adolescents with important role models. This paper investigates the effects of personal characteristics as well as family, peer and school context variables on youth smoking behaviour. We hypothesize that school smoking policy variables predict adolescents' smoking in addition to other context variables. Data were obtained from a self-report survey administered to 3364 students in 40 secondary schools in Bavaria, Germany. For both younger (10-15 years) and older (16-21 years) students, strong associations were found between smoking behaviour and (i) smoking best friends and friends in general, (ii) other substance use and (iii) school performance. In the younger age group, the non-existence of smoking bans for students was associated with an increased risk of being smoker. For the older students, a positive association was found between the presence of smoking teachers on school grounds and smoking behaviour. Results are discussed considering methodological aspects and public health concerns.

The Influence of School Smoking Policies on Student Tobacco Use

To investigate the association between smoking behavior among secondary school students and school smoking policies. Cross-sectional provincially representative study. Quebec secondary schools. Complete data were available for 763 of 1058 students aged 13 years in 50 schools and for 768 of 1160 students aged 16 years in 57 schools. School principals provided data on school smoking policies. Main Exposure School smoking policies. Outcome Measure Student tobacco use. Of students aged 13 years, 3.8% of boys and 7.1% of girls smoked daily; 21.0% of boys and 25.2% of girls aged 16 years smoked daily. Of schools, 28.0% permitted staff to smoke indoors, 84.1% permitted staff to smoke outdoors on school grounds, and 83.2% permitted students to smoke outdoors on school grounds. Daily smoking was not associated with policies targeting student smoking or those targeting indoor smoking by staff. In multilevel analyses, girls aged 13 years were almost 5 times more likely to be daily smokers if they attended schools at which staff were permitted to smoke outdoors. Younger girls may be more susceptible to social influences at school related to tobacco use. School policies banning smoking by teachers and other school personnel within and outside the school should be an important component of comprehensive adolescent smoking prevention programs.

The relationship between school-based smoking policies and prevention programs on smoking behavior among grade 12 students in Prince Edward Island: A multilevel analysis

Purpose To examine how school-based smoking policies and prevention programs are associated with occasional and regular smoking among a cohort of grade 12 students in Prince Edward Island, Canada, between 1999 and 2001. Methods Data from the Tobacco Module of the School Health Action, Planning and Evaluation System (SHAPES) collected from 3,965 grade 12 students in 10 high schools were examined using multi-level regression analysis. Results Attending a school with smoking prevention programming was associated with a decreased risk of being an occasional smoker (OR 0.42, 95% CI: 0.18, 0.97). School-based policies banning smoking on school property were associated with a small increased risk of occasional smoking (OR 1.06, 95% CI: 0.67, 1.68) among some students. The combination of both policies and programs was not associated with either occasional or regular smoking. Conclusion This preliminary evidence suggests that tailored school-based prevention programming may be effective at reducing smoking uptake; however, school smoking policies and the combination of programs and policies were relatively ineffective. These findings suggest that a new approach to school-based tobacco use prevention may be required.

The impact of school smoking policies and student perceptions of enforcement on school smoking prevalence and location of smoking

The purpose of this study was to comprehensively assess the impact of school tobacco policy intention, implementation and students' perceptions of policy enforcement on smoking rates and location of tobacco use during the school day. Data were obtained from all students in Grades 10-11 (n = 22,318) in 81 randomly selected schools from five Canadian provinces. Policy intention was assessed by coding written school tobacco policies. School administrators most familiar with the tobacco policy completed a survey to assess policy implementation. Results revealed policy intention and implementation subscales did not significantly predict school smoking prevalence but resulted in moderate prediction of tobacco use on school property (R(2) = 0.21-0.27). Students' perceptions of policy enforcement significantly predicted school smoking prevalence (R(2) = 0.36) and location of tobacco use (R(2) = 0.23-0.63). The research findings emphasize: (i) the need to consider both written policy intention and actual policy implementation and (ii) the existence of a policy is not effective in controlling tobacco use unless the policy is implemented and is perceived to be strongly enforced.

Empowering Youth for Tobacco Control

To investigate common youth group activities and how they relate to young people's attitudes of empowerment around tobacco control. A mailed survey was administered to 940 Minnesota youth involved in locally organized tobacco prevention groups. By multivariate linear regression, participation in eight tobacco-related activities and selected personal characteristics were examined in relation to youths'perceived influence on youth smoking. Two activities--developing materials with antismoking messages and taking action to change school smoking policies--were associated with significantly higher perceived influence scores for the youth involved (p < .05). Youth in groups who had worked to raise awareness of how the tobacco industry targets teens also had significantly higher influence scores (p < .001). Associated personal factors included high involvement in extracurricular activities (p < .001), having never experimented with smoking (p < .01), leadership experience (p < .001), and being white (p < .01). Some youth group activities and strategies may be particularly effective at instilling attitudes of empowerment for tobacco control among youth.