Understanding the impact of school tobacco policies on adolescent smoking behaviour: A realist review

Schreuders, Michael; Nuyts, Paulien A W; Putte, Bas van den; Kunst, Anton E.

doi:10.1016/j.socscimed.2017.04.031

Cited by 58 publications

(72 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…During this process, we attended to evidence supporting these theory areas alongside contradictory examples and unintended consequences. 44 We discussed areas of uncertainty within the final synthesis with stakeholders, and where helpful we conducted additional searches to refine the synthesis further.…”

Section: Analysis and Synthesismentioning

confidence: 99%

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

Brighton

Evans

Man

et al. 2020

COPD

View full text Add to dashboard Cite

Background: People living with both chronic obstructive pulmonary disease (COPD) and frailty have high potential to benefit from exercise-based interventions, including pulmonary rehabilitation, but face challenges completing them. Research to understand ways to optimise exercise-based interventions in this group is lacking. We aimed to understand how exercisebased interventions might improve outcomes for people living with both COPD and frailty. Methods: This realist review used database searches and handsearching until October 2019 to identify articles of relevance to exercise-based interventions for people living with COPD and frailty. A scoping search explored what is important about the context of living with COPD and frailty, and what mechanisms might be important in how exercise-based interventions result in their intended outcomes. Through discussion with stakeholders, the review scope was refined to areas deemed pertinent to improving care. We retained articles within this refined scope and identified additional articles through targeted handsearching. Data were extracted and synthesised in a narrative, prioritised by relevance and rigour. Results: Of 344 records identified, 35 were included in the review and 20 informed the final synthesis. Important contextual factors to consider included: negative beliefs about themselves and exercise-based interventions; heterogenous presentation and comorbidities; decreased reserves and multidimensional loss; and experiencing unpredictable health and disruptions. In these circumstances, mechanisms that may help maximise outcomes from exercise-based interventions included: trusting relationships; creating a shared understanding of needs; having the capacity to address multidimensional concerns; being able to individualise approaches to needs and priorities; and flexible approaches to intervention delivery. Mixed-methods research and explicit theorising were often absent. Conclusion: Building trusting relationships, understanding priorities, using individualised and multidisciplinary approaches, and flexible service delivery can improve the value of exercise-based interventions for people living with both COPD and frailty. Development and evaluation of new and adapted interventions should consider these principles.

show abstract

Section: Analysis and Synthesismentioning

confidence: 99%

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

Brighton

Evans

Man

et al. 2020

COPD

View full text Add to dashboard Cite

show abstract

“…Staff, however, seemed to experience a lack of means to effectively deal with persistent violators, because they have no real means to support nicotine-dependent adolescents and cannot override negative parental influence. Scholars in earlier studies propagated that schools should be provided complementary means and receive external support to help staff enforce SFSPs ( Hamilton et al , 2003 ; Soteriades et al , 2003 ; Schreuders et al , 2017 ), such as smoking cessation services.…”

Section: Discussionmentioning

confidence: 99%

“…While the adoption of SFSPs by governments is important ( Rozema et al , 2016 ; Linnansaari et al , 2019 ), such top-down rules only become part of adolescents’ school life if these are consistently enforced by school staff. Consistent enforcement is a crucial requisite for realizing SFSP’s optimum effectiveness on the collective of adolescents ( Wakefield et al , 2000 ; Galanti et al , 2014 ; Schreuders et al , 2017 ), because adolescents may (i) interpret staff’s inconsistent enforcement as a sign that health risks of smoking are not so serious ( Clark et al , 2002 ; Baillie et al , 2007 ), (ii) believe consequences are applied in unfair and biased fashions ( Booth‐Butterfield et al , 2000 ; Gittelsohn et al , 2001 ; Clark et al , 2002 ) and (iii) abuse staff’s leniency in attempts to gradually weaken the rules ( Turner and Gordon, 2004 ). In real life, however, inconsistent enforcement is the rule rather than the exception ( Baillie et al , 2011 ; T. Leão et al , 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Why staff at European schools abstain from enforcing smoke-free policies on persistent violators

Schreuders

Linnansaari

Lindfors

et al. 2019

Health Promotion International

Self Cite

View full text Add to dashboard Cite

Summary Secondary schools in European countries increasingly implement comprehensive smoke-free school policies (SFSPs) that prohibit most or even all adolescents from smoking during school hours. Consistent enforcement of SFSPs is essential for realizing optimum effectiveness. A main challenge represents adolescents who persistently violate the rules. We studied how staff in European countries respond to these persistent violators and why they may turn a blind eye. We used interview transcripts from 69 staff members at 22 schools in 6 European countries to identify cases in which staff turned a blind eye. We then applied thematic analysis for identifying the considerations as to why they turn a blind eye. Turning a blind eye on persistent violators happened among school staff in all six countries. Three considerations were identified. First, staff believe their primary role and duty is to support all adolescents to develop into well-functioning adults, and sometimes it is best to accept smoking. Second, staff expect that applying stricter disciplinary measures will not stop persistent violators and is more likely to create more severe problems. Third, staff do not feel supported by relevant actors in society (e.g. parents) in influencing adolescent smoking. We conclude that staff’s considerations stress the need to support school staff in enforcing the increasingly comprehensive rules on the most persistent smokers.

show abstract

“…The international evidence regarding the effectiveness of outdoor smoking bans remains equivocal and, in line with another study, an outdoor smoking ban might not always protect adolescents from taking up smoking [ 27 ]. Nevertheless, whether or not school smoking policies are effective, depends on whether: (i) the policy is strictly enforced and sanctioned; (ii) adolescents do not feel the pressure to smoke; and (iii) anti-smoking beliefs are internalized so that non-smoking becomes the generally accepted norm [ 36 ]. All these points are important when interpreting the results of the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Second, adolescents still saw others smoking during school hours, since most schools in the experimental condition tolerated smoking off the school grounds. As a result, adolescents might have felt pressure to conform to other smoking behavior [ 36 ]. Actual smoking might have shifted to, for example, off the school grounds.…”

Section: Discussionmentioning

confidence: 99%

Impact of an Outdoor Smoking Ban at Secondary Schools on Cigarettes, E-Cigarettes and Water Pipe Use among Adolescents: An 18-Month Follow-Up

Rozema

Hiemstra

Mathijssen

et al. 2018

IJERPH

View full text Add to dashboard Cite

The effectiveness of outdoor smoking bans on smoking behavior among adolescents remains inconclusive. This study evaluates the long-term impact of outdoor school ground smoking bans among adolescents at secondary schools on the use of conventional cigarettes, e-cigarettes (with/without nicotine) and water pipes. Outdoor smoking bans at 19 Dutch secondary schools were evaluated using a quasi-experimental design. Data on 7733 adolescents were obtained at baseline, and at 6 and 18-month follow-up. The impact of outdoor smoking bans on ‘ever use of conventional cigarettes’, ‘smoking onset’, ‘ever use of e-cigarette with nicotine’, ‘e-cigarette without nicotine’, and ‘water pipe’ was measured. Multilevel logistic regression analysis was used. At schools with a ban, implementation fidelity was checked. At schools where a ban was implemented, at 18-month follow-up more adolescents had started smoking compared to the control condition. No effect of implementation of the ban was found for smoking prevalence, e-cigarettes with/without nicotine, and water pipe use. Implementation fidelity was sufficient. No long-term effects were found of an outdoor smoking ban, except for smoking onset. The ban might cause a reversal effect when schools encounter difficulties with its enforcement or when adolescents still see others smoking. Additional research is required with a longer follow-up than 18 months.

show abstract

Understanding the impact of school tobacco policies on adolescent smoking behaviour: A realist review

Abstract: STPs' impact can be influenced by adequate implementation and embedding them in continuous monitoring and adaptation cycles, so that schools can proactively deal with the cognitive and behavioural responses that lead to suboptimal or adverse outcomes.

Cited by 58 publications

References 60 publications

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

Why staff at European schools abstain from enforcing smoke-free policies on persistent violators

Impact of an Outdoor Smoking Ban at Secondary Schools on Cigarettes, E-Cigarettes and Water Pipe Use among Adolescents: An 18-Month Follow-Up

Contact Info

Product

Resources

About