A multilevel-based study of school policy for tobacco control in relation to cigarette smoking among children in elementary schools: gender differences

Abstract

The aim was to comprehensively examine school-based tobacco policy status, implementation and students' perceived smoking at school in regard to gender-specific differences in smoking behavior. We conducted a multilevel-based study to assess two-level effects for smoking among 2350 grades three to six students in 26 randomly selected elementary schools in southern Taiwan. A series of multilevel models were analyzed separately for male and female students. The school-level variables appear to be related to smoking behavior in male students. Among males, the risk of ever-smoking was significantly associated with those schools without antitobacco health education activities or curricula [adjusted odds ratio (aOR) = 6.23, 95% confidence interval (CI): 2.55-15.24], with a high perceived smoking rate (aOR = 3.08, 95% CI: 1.41-6.72) and located in a mountainous region (aOR = 2.53, 95% CI: 1.15-5.58). The risk of ever-smoking among females was significantly associated with those schools without antitobacco activities or curricula (aOR = 3.10, 95% CI: 1.27-7.55). As compared with female counterparts, the specific school that the male students attended had a positive significant effect on the risk of being ever-smokers. The findings suggest that effective tobacco policy implementation should be considered in elementary schools that are currently putting children at the greatest risk for cigarette smoking, especially in regard to male students.

Peer Pressure and Smoking Behavior in Elementary School Students

“…Forty students (97.6%) out of 41 students who never experienced peer pressure reported as never smoked. The percentage of ever smoking students in male elementary school students in Jatinangor district was high if compared with a study conducted by Huang et al 7 in southern Taiwan. The study conducted by Huang et al 7 shows that the percentage of ever smokers in elementary school students is 13.7% in which 9.23% of them are male and 4.47% are female.…”

“…The percentage of ever smoking students in male elementary school students in Jatinangor district was high if compared with a study conducted by Huang et al 7 in southern Taiwan. The study conducted by Huang et al 7 shows that the percentage of ever smokers in elementary school students is 13.7% in which 9.23% of them are male and 4.47% are female. From the total of 1,213 male students who participated in the study, 217 students (17.9%) are ever smokers and 996 students (82.1%) are never smokers.…”

Anti-tobacco policy in schools: upcoming preventive strategy or prevention myth? A review of 31 studies

“…Five of these studies16 24 30 35 37 suggested a 20% to 60% decreased probability of tobacco use among students in schools with strict bans, supported by three studies that presented an increased risk with more liberal attitudes, especially concerning smoking by teachers 11 19 40. However, other studies failed to detect clear relationships between smoking bans per se and students’ behaviour,12 18 32 38 while one study suggested an association in the opposite direction (higher likelihood of smoking progression) if the students perceived the presence of strict bans 36…”

“…While written dissemination was linked to lower probability of smoking, the opposite association was found between formal policy and students smoking, but this was no longer observed after adjustment for individual-level variables. However, some studies failed to detect any association between formal or clearly stated school policies and students’ behaviour 17 18 34. Similarly, studies where the presence of clearly stated anti-smoking rules was self-reported by students yielded mixed results, as some found associations in the hypothesised direction26 31 37 while others did not 28 33…”

“…Five studies indicated that policies including prevention and education components were associated with lower prevalence of smoking,17 18 23 30 35 but two studies did not detect an association 22 34. Two studies compared schools including anti-smoking educational or cessation components programmes, schools introducing policy measures only, or a combination of the two 26 27.…”