School Tobacco Research Articles

Comparison of School-Attending Adolescent Areca Nut Users with Tobacco-Only Users and Those Using Both Substances on Demographic Variables and Behavioral Determinants.

Consumption of areca nut and tobacco, often initiated in adolescence, are important causes of oral cancers in India. Areca nut prevention, often subsumed into school tobacco prevention programs, assumes that users are similar. However, differences in gender or age of users could necessitate unique approaches. The study aimed to find if adolescent areca nut-only users are different from tobacco-only users and users of both areca and tobacco. A cross-sectional survey with school-students attending grades 7, 8, 9 was used to compare differences in age, gender, knowledge, and attitudes among areca nut only users, tobacco-only, users of both, and non-users. Of 1909 respondents, 464 (24.3%) used only areca nut, 25 (1.3%) used only tobacco, 177 (9.3%) used both, and 1243 (65.1%) were never-users. Females, overwhelmingly, consumed only areca nut. Users of both substances, in greater proportions, were male, older in age, and more than half believed that tobacco-users had more friends. A third of tobacco-only and users of both substances found it hard to turn down a friend's request to use compared to a fifth of areca-only and non-users. Differences in gender, age, and behavioral determinants such as subjective norms and perceived behavioral control between the different types of users underlines the need for prevention and cessation programs and policies that are specific to and tailored to their unique profiles and needs.

Effectiveness of teacher’s training program for tobacco control in schools of Lucknow: A Quasi-experimental study

Introduction: Teachers play a crucial role in influencing the attitudes and behaviors of their students. Their knowledge, attitude, and practice towards tobacco use, have a direct impact on strict implementation of School Tobacco Control Policies. The present study aimed to assess the effectiveness of the teacher’s training program, Choose Health by Avoiding Tobacco (CHAT) for tobacco control measures in schools of Lucknow. Materials and Methods: The study was a Quasi experimental study conducted among 120 school teachers from six Government High Schools in Lucknow. An interactive training session on various tobacco-related topics was conducted. Knowledge gained was assessed by comparing post-test scores with pre-test scores. McNemar’s test was employed to assess change in knowledge before, after, and after 1 month of the training program. Wilcoxon signed-rank test was used to compare the mean of pre-, post-, and follow-up test scores. Results: The prevalence of tobacco use was 21.7% among the participating school teachers. The female teachers did not consume tobacco in any form. There was a significant improvement in the mean post-test score as compared to the pre-test score (P < 0.001), with no significant attrition of knowledge gained after one month. A 94.2% of the participants reported that the training session conducted has motivated them to quit tobacco use. Evaluation of the six participating schools on their compliance with the “Tobacco Free Educational Institute” (ToFEI) Guidelines, demonstrated some improvement in implementation of these guidelines within two months of the training session as compared to baseline observations. Conclusion: The present study showed that the CHAT interactive educational intervention program was effective in improving knowledge related to tobacco and its laws to protect minors from the tobacco epidemic. The intervention also resulted in a high level of motivation among teachers to choose a tobacco-free life.

The Impact of Implementation Fidelity of a School-Based Multi-Component Smoking Prevention Intervention on Vocational Students’ Smoking Behavior: A Cluster-Randomized Controlled Trial

Preventing young people’s cigarette smoking is a major public health priority, and smoking is especially prevalent in vocational schools. Well-enforced comprehensive school tobacco policies accompanied by preventive efforts show potential to reduce smoking, but the implementation process is crucial to achieve the intended effect. We investigate whether and how implementation fidelity of a multi-component smoking prevention intervention impacted student smoking outcomes after 4–5 months among students in Danish vocational education and training (national age range 15–65 years, mean 25.6) and preparatory basic education (national age range 15–25 years, mean 17.6) institutions using questionnaire data from a cluster-RCT. The intervention included a smoke-free school hours policy, educational curriculum, and class competition. We calculated an overall implementation fidelity measure combining staff-reported school-level delivery (fidelity) and student-reported receipt (participation, responsiveness), and used multilevel regression models to analyze associations with smoking outcomes (smoking daily, regularly, and during school hours). We supplemented the analysis with restricted cubic spline regression. Additionally, we stratified the analyses by school types and analyzed associations between implementation fidelity of the separate intervention components and smoking outcomes. High implementation was associated with lower odds of regular smoking (OR: 0.37, 95% CI: 0.18–0.78) and smoking during school hours, but not daily smoking, and these associations varied between the school settings. When analyzed separately, implementation fidelity of the components did not affect the outcomes significantly. Our findings underline the need to support the implementation process of school tobacco policy interventions to ensure the intended effects of reducing students’ smoking.

Exploring the cross-sectional association between the strength of school vaping policies and student vaping behaviours using data from the 2021-2022 COMPASS Study.

Youth vaping is a concern in Canada. While school-level policies influence student behaviours, few studies have investigated the association between school vaping policies and student vaping. This study reviewed and scored the comprehensiveness of school vaping policies and investigated the association between school vaping policy scores and student vaping. Online policy documents from n = 39 schools in Ontario, Alberta, and British Columbia, Canada, participating in the 2021-2022 wave of the COMPASS study were collected, reviewed, and scored for comprehensiveness (/39) using the School Tobacco Policy Index (STPI) rating form. The mean and range of scores for each domain of the STPI were calculated. School policy scores were linked to student vaping data from the COMPASS study. Multilevel logistic regression analyses identified the association between school vaping policy score and student lifetime and current (past 30-day) vaping. The mean total policy score was 10.2/39 (range 0‒24), and 28% of schools scored 0/39. The majority of school policies did not identify enforcement approaches or available preventive or cessation resources. Increasing STPI score was not associated with the odds of student lifetime or current vaping in multilevel logistic regression analyses. The STPI quickly identified components of school vaping policies that were missing. The overall score of most school vaping policies in our sample was low and most school vaping policies lacked many important components. Future studies should explore factors associated with adolescent vaping and identify effective prevention measures.

Factors associated with deaths by tuberculosis in the state of Mato Grosso, 2011-2020: retrospective cohort study.

To investigate factors associated with tuberculosis deaths in Mato Grosso state, Brazil, from 2011 to 2020. Retrospective cohort study with data obtained from the Notifiable Health Conditions Information System and the Mortality Information System. Deaths were qualified using probabilistic linkage and analyzed using Poisson regression. 12,331 cases and 525 deaths were identified over 10 years. The factors associated with death were: age ≥60 years (RR: 7.70; 95%CI 1.91;31.04), incomplete elementary and high school education (RR: 3.66; 95%CI 1.34;9.96), illiteracy (RR: 4.50; 95%CI 1.60;12.66), homeless population (RR: 2.41; 95%CI 1.34;4.35), alcohol use (RR: 1.45; 95%CI 1.04;2.02), male sex (RR: 1.48; 95%CI 1.04;2.09) and tobacco use (RR: 1.32; 95%CI 0.98;1.77). Laboratory confirmation was a protective factor. Risk of death was higher in men over 60 years old, with low education levels, in vulnerable situations, and who used alcohol/tobacco.

Do school-based smoking preventive interventions have unintended effects? Post hoc analysis of the Focus cluster randomised controlled trial

ObjectivesPublic health interventions are designed to improve specific health-related outcomes; however, they may also produce negative side effects, such as substitution use, psychological or social harms. Knowledge about the unintended...

Impact of implementation of a smoking prevention intervention on vocational students’ smoking status

Abstract Introduction Smoking prevalence is high in vocational education across Europe. School-based programs to reduce smoking among older adolescents and young adults are sparse. School tobacco policies are often used though the evidence for their effectiveness is inconclusive. The implementation process of far-reaching smoking prevention initiatives such as tobacco policies can be challenging due to, e.g., nicotine dependency and attitudes towards smoking. We investigated the association between implementation of a smoking prevention intervention and students’ smoking status. Methods The “Focus” intervention combined a comprehensive school tobacco policy with educational activities and access to smoking cessation support. It was tested in a cluster-randomized controlled trial in 14 Danish vocational schools. Based on a conceptual model, we calculated an individual level implementation score for all students in the intervention arm, including schools’ delivery (principal and teacher surveys) and students’ receipt (student surveys) of the intervention components at 4-5 month-follow-up. We compared odds for smoking daily or weekly (regular smoking) for students with low, medium, and high implementation with students in control schools using multilevel logistic regression models (N = 1112). Results Students with high implementation had significantly lower odds for smoking compared to the control group (OR: 0.37, 95% CI: 0.18-0.78) whereas students with medium (OR: 1.72, 95% CI: 0.95-3.12) and low (OR: 1.26, 95% CI: 0.68-2.34) implementation had higher odds, although insignificant. Conclusions High implementation of the “Focus” intervention was associated with less smoking. Tendencies in the opposite direction for lower implementation may indicate a complex, non-linear relationship between implementation level and smoking behavior. This suggests that careful implementation efforts are needed to reduce smoking in older adolescent and young adult school settings. Key messages • Our study suggests that efforts to support implementation of smoking prevention interventions are needed to reduce smoking in vocational education and similar settings. • To capture the complexity of the implementation process, we use an individual level measure of implementation based on a conceptual model and multiple data sources.

Assessment of School Staff Knowledge and Perceptions of Student E-cigarette Use and Resource Needs, and E-cigarettes Confiscated at 12 North Carolina High Schools - 2019.

E-cigarettes are the most commonly used tobacco product among US youth and are regularly used on school grounds. We assessed school staff's awareness of students' e-cigarette use, response by schools, and resources needed to address use, and examined e-cigarettes confiscated by school staff in North Carolina to guide prevention and identify needed resources. In May 2019, staff from a random sample of 25 of 451 North Carolina public and charter high schools were invited to complete an online survey and semistructured interview; 12 schools consented to ≥ 1 component (survey, N = 514; interviews, N = 35). Staff knowledge and perceptions of students' e-cigarette use and school tobacco policies were assessed, including school efforts to address e-cigarette use. E-cigarette products confiscated by nine schools from students during the 2018-2019 school year were collected. Only 12 public high schools participated, and these schools might not be representative of all North Carolina high schools. Quantitative surveys were not collected from all staff at participating schools; however, the response rate was 62% and included different staff positions and both urban and rural schools. Finally, e-cigarette products collected by schools might not be representative of all devices used by students. Among surveyed staff, 33% observed students using e-cigarettes on school grounds; 86% believed e-cigarette use somewhat or largely contributes to learning disruptions. Overall, 94% of respondents knew their school's policy prohibits student e-cigarette use on school grounds, and 57% were not confident their school has resources to help students quit. From 35 interviews, themes included concern that schools' tobacco-free policies do not deter use and additional resources are needed to address e-cigarette use in schools. Of 336 collected devices, there were different e-cigarette types and most (65%) e-liquid bottles were flavored. Efforts are warranted to incorporate evidence-based curricula; educate staff, parents, and youth regarding health risks of e-cigarette use; and help youth quit e-cigarettes.

Assessment of Delivery and Receipt of a Complex School-Based Smoking Intervention: A Systematic Quantitative Process Evaluation

Comprehensive school tobacco policies have the potential to reduce smoking in vocational education where smoking is widespread. Assessment of the implementation process is important to understand whether and how complex interventions work, yet many studies do not measure receipt among the target group. We conducted a quantitative process evaluation of a newly developed smoking intervention in Danish vocational education to (1) operationalize measures of delivery and receipt, (2) investigate the extent to which the intervention was delivered and received, and (3) analyze whether this differed across school settings. We used questionnaire data collected 4–5 months after baseline among students (N = 644), teachers (N = 54), and principals (N = 11) from 8 intervention schools to operationalize implementation at the school level (delivery; content, quality, and fidelity) and student level (receipt; participation, responsiveness, exposure, and individual-level implementation). We calculated means and compared levels across school settings using stratified analysis and mixed models. The total intervention was delivered by a mean of 76% according to how it was intended and received by a mean of 36% across all students. Relatively low means of participation and responsiveness indicated challenges to reach the students with the intervention components, and delivery and receipt varied between school settings. This study highlights the challenge of reaching the intended target group in complex health behavior interventions even when reaching relatively high levels of fidelity. Further studies using the operationalized measures can give insight into the ‘black box’ of the intervention and strengthen future programs targeting smoking in vocational education.

Association between School Achievement and Tobacco Susceptibility among US Adolescents: Ethnic Differences.

Although risky behaviors such as educational problems and tobacco use tend to co-occur, these associations may vary across diverse ethnic groups, in part because ethnic minorities tend to reside in worse neighborhoods and tend to attend worse schools than Non-Latino White adolescents. To compare the association between baseline school achievement (student grades) and subsequent tobacco use susceptibility (openness to smoke in future) by ethnicity, we compared African American, Latino, and Non-Latino White adolescents in the US over a four-year period. This longitudinal study followed 3636 adolescents who were never smokers at baseline for a period of four years. Baseline and four-year data of the Population Assessment of Tobacco and Health (PATH) study were used for this analysis. All participants were 12 to 17 years old at baseline and were either Non-Latino White (Majority), African American (Minority), or Latino (Minority). The outcome was a tobacco use susceptibility score at wave 4 which was defined as openness to use tobacco in the future, measured at year four. The predictor was school achievement at wave 1, measured as grades from F to A+. The moderator was ethnicity (African American, Latino, Non-Latino White), and covariates were age, gender, parental education, and family structure. Our linear regressions in the pooled sample showed an inverse association between baseline school achievement and subsequent tobacco use susceptibility four years later. However, this inverse association was weaker for ethnic minorities than for Non-Latino White adolescents, as documented by interaction effects between ethnic minority status and baseline school grades. Higher educational success better correlates with lower tobacco use susceptibility of non-Latino White than African American and Latino adolescents, which may reflect some tobacco use susceptibility of Latino and African American adolescents with highly educated parents. Future research should investigate how social context such as high-risk school environment, neighborhood risk, peer risk, and other mechanisms increase behavioral risk of educationally successful African American and Latino adolescents.

The Diffusion of Smoking: Association Between School Tobacco Policies and the Diffusion of Adolescent Smoking in 38 Schools in 6 Countries.

Social network research has evidenced the role of peer effects in the adoption of behaviours. Little is known, however, about whether policies affect how behaviours are shared in a network. To contribute to this literature, we apply the concept of diffusion centrality to school tobacco policies and adolescent smoking. Diffusion centrality is a measure of centrality which refers to a person's ability to diffuse a given property-in our case, smoking-related behaviours. We hypothesized that stronger school tobacco policies are associated with less diffusion centrality of smoking on school premises and of smoking in general. A whole network study was carried out in 2013 and 2016 among adolescents (n = 18,805) in 38 schools located in six European cities. Overall, diffusion centrality of smoking in general and of smoking on school premises significantly decreased over time. Diffusion centrality of smoking significantly decreased both in schools where the policy strengthened or softened over time, but for diffusion of smoking on school premises, this decrease was only significant in schools where it strengthened. Finally, stronger school tobacco policies were associated with lower diffusion centrality of smoking on school premises and of smoking in general, though to a lesser extent. With such policies, smoking may, therefore, become less prevalent, less popular, and less clustered, thereby lowering the risk of it spreading within networks in, and even outside the school.

Implementation of an evidence-based tobacco control intervention for school teachers in India: Evaluating the effects of a capacity-building strategy.

Tobacco-Free Teachers, Tobacco-Free Society (TFT-TFS) is an evidence-based intervention that promotes tobacco use cessation among teachers and tobacco control policies among schools in India. This study tested an implementation model to build Bihar Department of Education (DOE) capacity to support and deliver TFT-TFS within schools, leveraging DOE training infrastructure. We used a training-of-trainers (TOT) "cascade" implementation strategy to embed the TFT-TFS program into the Bihar DOE infrastructure. We trained 46 Cluster Coordinators to train and support Headmasters to implement TFT-TFS in their schools over one academic year. We selected three school districts, representing approximately 46 clusters and 219 schools. We used the RE-AIM framework to assess program adoption (Headmaster participation in at least one of six TFT-TFS trainings), implementation (of four core program components), and reach (teachers' participation in three or more group discussions). Using a non-inferiority design, we hypothesized that program adoption, implementation, and reach would not be inferior to the high standards demonstrated when TFT-TFS was originally tested in the Bihar School Teachers Study. We used self-reported checklists to measure outcomes and SPSS Version 25 to analyze data. For adoption, 94% of Headmasters attended the first training, although participation declined by the sixth training. Among the 112 schools out of 219 with complete Headmaster checklist data, all met our minimum criteria for implementing TFT-TFS. Over 99% of schools posted a school tobacco control policy and distributed quit booklets. However, only 69% of schools met our criteria for program reach. This study outlines the processes for taking a tobacco control intervention to scale and implementing it through the Bihar DOE infrastructure. These findings provide a foundation for other Indian states and low- and middle-income countries to implement tobacco control and other health programs for schoolteachers. NCT05346991. Each year in India, more than 1.2 million people die from tobacco-related causes, and India has the world's highest oral cancer burden. The world needs more evidence on how to bring cost-effective tobacco control interventions to scale, especially in low- and middle-income countries (LMICs). To address this gap, from 2017 to 2021, we examined the process of scaling up Tobacco-Free Teachers, Tobacco-Free Society (TFT-TFS), an evidence-based intervention promoting tobacco use cessation among teachers and tobacco control policies in schools. Our study tested an implementation model aimed at building the Bihar State Department of Education (DOE) capacity to support and deliver TFT-TFS. We used a training-of-trainers model to embed TFT-TFS into Bihar DOE infrastructure, training 46 Cluster Coordinators to in turn train and support Headmasters to implement TFT-TFS over one academic year. We hypothesized that program adoption, implementation, and reach would not be inferior to the high standards demonstrated when we originally tested TFT-TFS through the Bihar School Teachers Study (2013-2017). For adoption, 94% of Headmasters attended the first training, although participation declined by the sixth training. Of 112 schools (out of 219 with complete Headmaster checklist data), all met our minimum criteria for implementing TFT-TFS. Over 99% of schools posted a school tobacco control policy and distributed quit booklets. However, only 69% of schools met our criteria for program reach. Study findings offer other Indian states and LMICs lessons to implement tobacco control and other health programs for schoolteachers within educational systems.

Intersectional Disparities in Youth Tobacco Use by Sexual and/or Gender Minority Status and Race and/or Ethnicity.

The current study applied an intersectional lens to examine societal factors, individual psychological outcomes, and youth combustible tobacco and vape use at the intersection of sexual and/or gender minority (SGM) status and race and/or ethnicity. Data were drawn from 133 969 youth respondents surveyed in the 2019-2020 California Student Tobacco Survey, a representative school-based survey of 8th and 10th-grade public school students throughout California. The impact of multiple marginalized group membership using four mutually exclusive intersectional positions (non-SGM white, SGM white, racial minority only, and both SGM and racial minority), in addition to specific differences across ten SGM by race and/or ethnicity groups (e.g. non-SGM black or African American, SGM black or African American, etc.) were assessed. Compared to heterosexual and cisgender white youth, SGM and racial minority adolescents were shown to experience poorer school tobacco education quality and cessation support, lower school and family connectedness, and higher anxiety and depression symptoms. SGM and racial minority youth had a higher prevalence of ever-combustible tobacco use but were less likely to be current vape users compared to non-SGM white respondents. In examining specific group differences, results revealed that SGM teens had the highest risk of ever combustible tobacco use. This disparity was amplified for those belonging to multiple marginalized groups, with black or AA SGM teens evidenced to be at the highest risk of current combustible tobacco. Information from this study has useful implications for SGM measurement in surveillance systems and highlights the usefulness of adopting an intersectional approach to inform equity-driven public health policy and intervention. This representative study of California youth supports that identifying as a sexual and/or gender minority (SGM) is an important risk factor for combustible tobacco use. Particularly, observed SGM disparities were magnified for the youth belonging to marginalized groups, as black or African American SGM teens were shown to be at the highest risk of current combustible tobacco use. Findings support that Intersectionality Theory represents a useful framework for examining tobacco-related disparities and underscores the importance of assessing how the intersection of multiple social categories impacts youth tobacco use.

Symptoms of tobacco dependence among middle and high school tobacco users – Data from the 2019–2020 National Youth Tobacco Survey

IntroductionPrevious studies have indicated that youth who use tobacco products, including cigarettes, cigars, and smokeless tobacco, demonstrate dependence symptoms. However, the tobacco marketplace has expanded dramatically in recent years, and few studies have examined dependence symptoms among youth who use novel products. This study combined 2019–2020 National Youth Tobacco Survey data to report the prevalence and determinants of tobacco dependence symptoms among U.S. middle and high school current (past 30-day) tobacco users. MethodsPrevalence estimates were calculated to examine dependence outcomes and other covariates by user groups (single product users and multiple product users). Multivariable logistic regression analyses were used to identify independent predictors of tobacco dependence among current users of cigarettes, cigars (regular cigars, cigarillos, and little cigars), e-cigarettes, heated tobacco products, hookah, pipe tobacco, bidis, and smokeless tobacco products (chew, snuff, dip, snus, and dissolvables). ResultsAmong current tobacco users, 15.7 % (95 % CI: 14.2–17.3) reported wanting to use tobacco within 30 min of waking and 28.3 % (95 % CI: 26.3–30.5) reported strong cravings for tobacco in the past 30 days. Nearly-two-thirds of current users were single product users, of which 80.5 % reported using e-cigarettes. Reporting of dependence symptoms was generally associated with multiple product use, higher frequency of use, earlier initiation age, and use of flavored products. ConclusionsAmong U.S. adolescents, a considerable amount of current tobacco product users, even infrequent users, reported symptoms of dependence. These findings highlight the continued importance of prevention strategies for youth tobacco experimentation and progression to regular use.

Facilitating conditions for staff’s confidence to enforce school tobacco policies: qualitative analysis from seven European cities

BackgroundSchool staff members’ consistent enforcement of school tobacco policies (STPs) is needed to decrease adolescent smoking and exposure to tobacco smoke. Staff’s confidence, indicating their perceived ability to cope with students’ negative responses, explains variations in staff’s STPs enforcement, yet understanding of the determinants for confidence is lacking. We analyzed the conditions in which the staff feel confident in addressing students who violate STPs to support staff’s enforcement. MethodsData consists of 81 semi-structured interviews with the staff members from 26 secondary schools in seven European cities in Belgium, Finland, Germany, Ireland, Italy, The Netherlands, and Portugal. In every city, 3–4 staff members (senior management, teachers, supportive staff) in 3–4 schools (academic–vocational, high–low SES area) were interviewed. Transcripts were analyzed with thematic analysis.ResultsWhen staff felt confident in their ability to prevent, diminish, or handle students’ negative responses, they were more likely to address students on STP violations. The staff was more confident (1) when consistent policy enforcement within school and regarding the wider society ensured staff legitimacy for STPs enforcement, (2) when dialog and mutual familiarity with students allowed the staff to facilitate constructive interaction with STP violators, and (3) when organizational backup structures provided staff collegial support to overcome challenges in the enforcement. These conditions would support consistent enforcement, especially with persistent misbehavers and among the more uncertain staff members.ConclusionsOur study stresses the need to implement strategies at multiple levels to strengthen staff’s confidence for STP enforcement. To support staff’s legitimacy for enforcement, we suggest reinforcing structures and practices that facilitate consistency in STP enforcement; to support staff’s ability for constructive interaction with STP violators, we suggest strengthening staff’s social and emotional learning; and to support staff’s experience of collegial support, we suggest reinforcing staff’s collective ability to cope with students’ negative responses.

School tobacco policies and social inequalities in adolescent smoking

Abstract Background Adolescents of lower socio-economic status initiate smoking earlier and smoke more frequently than those of higher socio-economic status. Tobacco control policies, such as school tobacco policies, aim to reduce adolescent smoking, but their implementation has been found to vary greatly from one school to another. Such differences in the implementation might therefore contribute to social inequalities in smoking. This study examines whether school tobacco policies are implemented where they are most needed, and how this implementation according to needs has changed over time. Methods Student (n = 18,805) and staff surveys (n = 438) were conducted in 2013 and 2016 in 38 schools from six European cities in six countries. School tobacco policies were measured as a 10-point score taking into account their multidimensionality, and the perceptions of both students and staff. We used concentration curves and indices to measure the inequality in the implementation of these policies depending on the smoking prevalence and on adolescents’ socio-economic status. Results A concentration curve below the perfect equity line indicated a concentration of school tobacco policies where smoking prevalence was lower. Moreover, this inequality was larger in 2016 compared to 2013 (concentration indices of .038 in 2013 and .041 in 2016). On the contrary, a concentration curve overlaying the perfect equity line indicated no inequality in the implementation of these policies depending on adolescents’ socio-economic status (concentration indices of .016 in 2013 and -.013 in 2016). Conclusions School tobacco policies have been developed to reduce adolescent smoking. They, however, seem to be less implemented in schools where they are most needed. This confirms that smoking prevention is still driven by the inverse prevention law. Next to evaluating the impact of such policies on smoking outcomes, research should also focus on their contribution to social inequalities in adolescent smoking. Key messages • School tobacco policies, developed to reduce adolescent smoking, might contribute to social inequalities in smoking. • School tobacco policies are less implemented where they are most needed.

Intervention Activities Associated with the Implementation of a Comprehensive School Tobacco Policy at Danish Vocational Schools: A Repeated Cross-Sectional Study.

School tobacco policies are often poorly implemented, which may explain their limited effectiveness. Further, constructs to measure implementation outcomes of school tobacco policies are missing. The Smoke-Free Vocational Schools intervention was designed to stimulate the implementation of a comprehensive school tobacco policy into routine practice. This study (1) developed implementation fidelity outcomes measures for the school tobacco policy and (2) examined associations between intervention activities and implementation fidelity at two time points. We applied a repeated cross-sectional survey study design across seven schools: the first time point was >5 months after the policy was established and the second time point > 14 months after policy establishment. The dependent/outcome variables were four binary fidelity domains as well as a total score across domains. A total of six intervention activities were measured among either students (e.g., new school-break facilities) or staff/managers (e.g., a joint workshop before policy implementation). Associations were analyzed separately for students and staff/managers using generalized linear mixed models, adjusted for confounders. A total of n = 2674 students and n = 871 staff/managers participated. The total implementation fidelity scores increased over time among both students and staff/managers. Three intervention activities were consistently associated with the total implementation fidelity score, including: new school-break facilities (BT1 = 0.08, 95% CI = 0.03; 0.12; BT2 = 0.07, 95% CI = 0.04–0.50), the joint workshop before policy implementation (BT1 = 0.13, 95% CI = 0.02; 0.25; BT2 = 0.13, 95% CI = 0.004; 0.24), and internalization of fixed procedures for enforcement (BT1 = 0.19, 95% CI = 0.13–0.26; BT2 = 0.16, 95% CI = 0.13–0.26). These findings can be applied by schools and other actors in practice. The developed implementation fidelity outcomes measures can be applied in future research on school tobacco policies.

Awareness of tobacco control policies and anti-tobacco attitudes and behaviors among school personnel.

INTRODUCTIONAdolescent smoking is a serious public health concern, and the role of personnel in reducing students’tobacco use has been proven. Anti-tobacco policies are strong factors for tobacco control but most are newly implemented in China. This study aimed to examine the awareness of anti-tobacco policies among school personnel in a southern city of China, and assess its influence on personnel’s anti-tobacco attitudes and behaviors towards students.METHODSAn online cross-sectional study was conducted between September 2017 and January 2018 in schools of Shanghai, China. A total of 3194 subjects from 33 schools were selected by a two-stage stratified cluster randomized sampling design. Prevalence of anti-tobacco policy awareness is presented. Crude (ORs) and adjusted odds ratios (AORs) and their 95% confidence intervals (CIs) were estimated to assess the association between policy awareness and anti-tobacco attitudes or behaviors.RESULTSIn all, 22.4% of surveyed participants knew four or five polices presented in the survey and 13.0% of personnel knew none of these policies. Most of the participants fully support prohibiting indoor (94.6%) and outdoor (86.3%) smoking in public places, bans on tobacco advertising (90.9%), and printing warning pictures on cigarette boxes (89.5%). Less than half of the personnel had taken action to stop students from smoking (45.7%), encourage students to quit smoking (42.4%) or participated in relevant educational activities held by schools (37.4%) in the previous year. The school personnel’s anti-tobacco attitudes (AOR=1.28; 95% CI: 1.21–1.36) and behaviors (AOR=1.10; 95% CI: 1.03–1.17) were strengthened with increasing level of policy awareness.CONCLUSIONSThe involvement of school personnel can be an important part of intervention to improve anti-tobacco campaigns on campus. The study calls for the implementation of projects or activities to improve anti-tobacco policy awareness in the school environment as part of school tobacco control strategy.

The First State Tobacco Flavor Ban: High School Tobacco Control Needs in a Changing Landscape.

Despite recent tobacco control efforts, adolescent vaping remains an epidemic in the United States. The purpose of our study was to understand high school student vaping behaviors using the perceptions of Massachusetts school personnel during the critical window from when the Massachusetts statewide flavor ban legislation was passed in November 2019 through the first year of the COVID-19 pandemic. High school personnel throughout Massachusetts were invited to complete a cross-sectional survey. Analysis of survey responses was conducted in R. A total of 162 respondents completed the survey representing 137 schools that draw enrollments from 216 (61%) of the 352 cities and towns in Massachusetts. The most popular products that respondents believed their students were using were JUULs (95.7%), other e-cigarettes (85.3%), and disposable vapes (79.6%). Following the flavor ban, the majority (90.7%) did not report an increase in combusted tobacco product use. All participants (100%) reported wanting more access to prevention and treatment resources. Our findings suggest that a comprehensive flavor ban may be an effective tobacco control policy that does not appear to promote student switching from vaping products to combusted tobacco products. These data also indicate that schools report needing additional resources to address the vaping epidemic.

Educational short film versus powerpoint based lecture in school tobacco awareness programs: Study from a tertiary cancer Center, Kerala, India.

Multimedia, being more attention-getting and attention-holding, is a powerful tool for mass awareness creation and is used for intervention among students in many studies. Our aim was to see the effectiveness of an educational short film in tobacco awareness generation and to compare it with the traditional lecture-based awareness. Selected schools were divided into two groups as per convenience. Short film was used as intervention in Group 1 and PowerPoint-based lecture in Group 2. The increase in awareness was assessed by a pre and posttest. On analysis, though both methods increased awareness as given by higher posttest score, it is found that the awareness levels showed a statistically significant difference between educational short film on hazards of tobacco and power point-based lecture using Mann-Whitney test. Our study proves that an educational short film carefully scripted and picturized can be used effectively in imparting awareness in school-based tobacco control programs.