Associations between schools' tobacco restrictions and adolescents' use of tobacco

Abstract

Schools are an important arena for smoking prevention. In many countries, smoking rates have been reduced among adolescents, but the use of smokeless tobacco is on the rise in some of these countries. We aimed to study the associations between schools' restrictions on smoking and snus and on the use of these tobacco products among students in upper secondary school. We employed data from a national representative study of 1444 Norwegian students, aged 16-20 years. Respondents were asked about their schools' restrictions on snus and smoking and own use of these products. We examined associations between restrictions and the use, controlling for age, gender, type of school and regional differences. We found clear consistent associations between schools' restrictions on tobacco use and less use of these products. More explicit pervasive restrictions were strongly associated with the prevalence of use. This first study on the associations between schools' restrictions on snus and the prevalence of snus use corroborate what has been found in many studies on smoking restrictions and smoking. Strict school tobacco policies may be an important tool if health authorities are interested in implementing measures to limit or reduce snus use among adolescents.

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…”

“…Concerning the modality of assessment of STPs, studies could be divided into 2 groups: 9 studies where the assessment was based exclusively on students’ subjective perception of rules and of their enforcement in school,20 21 28 31–33 36 37 40 and the remaining 22 where the assessment was performed exclusively or also through interviews or surveys of the school administrators.…”

“…All studies included some measure of smoking by students, and two studies included measures of smokeless tobacco use 35 40. Broadly speaking, outcomes related to tobacco use were conceptualised either with reference to lifetime experience (eg, ever smoking) or to current/recent use (eg, current smoking).…”

“…However, substantial variations could be observed between operational definitions of these two timeframes as well as of behavioural frequency (see online supplementary table S1). For instance, of 25 studies examining current/recent tobacco use as main or secondary outcome about half referred to any use in the past 30 day for the definition of current behaviour, but in 12 studies other definitions were adopted, such as weekly smoking,28 having smoked from a cigarette during 2 of the past 30 days,22 or various combinations of self-reported daily or occasional smoking investigated with different questions 13 37 38 40…”

“…STP variables were exclusively based on students’ perception in nine studies 20 21 28 31–33 36 37 40. In 5 studies14 22 26 34 39 policy information was collected from students and from staff, while in the remaining 17 studies the policy variables were assessed through interviews with staff only.…”