Exposure to teachers smoking and adolescent smoking behaviour: analysis of cross sectional data from Denmark

Adolescent Health and Parents' and Teachers' Beliefs about Smoking: A Cross-Sectional Study

BACKGROUND

The acquisition of healthy lifestyle habits by adolescents is largely influenced by close interpersonal relationships including their parents and teachers.

METHODS

A cross-sectional survey regarding tobacco use was conducted among 304 parents and 41 teachers of secondary school adolescents (12-17 years of age) enrolled in the first, second, and third grades of compulsory secondary education at the largest high school in Sueca, Valencia, Spain.

RESULTS

The prevalence of smoking was 36.2% among parents (occasional smokers 75.4%) and 19.5% among teachers (occasional smokers 62.5%). Most parents (89.8%) did not believe that their child smoked and 95.7% viewed it negatively if they did. Also, 75.2% of parents agreed that tobacco consumption encourages adolescents to use cannabis or other drugs. Friends who smoke and additives added to cigarettes were considered very influential factors for starting smoking. Most teachers (90.2%) reported having given a recommendation to their students to quit smoking. Cannabis and cigarette smoking were rated as harmful to health. Most respondents believed that cigarette smoking may favor the consumption of cannabis.

CONCLUSIONS

The use of e-cigarettes was also considered a risk factor for starting smoking. It would be advantageous incorporating parents and teachers as role models in multidisciplinary interventions addressing smoking behavior in secondary school students.

Outdoor smoke-free policies at sports clubs across Europe: Current status, recent evidence, and future challenges

OBJECTIVE

This commentary emphasizes the importance of implementing outdoor smoke-free policies at sports clubs, particularly highlighting their limited adoption across Europe. The primary aim was to assess the progress made in the Netherlands, explore the strategies employed, and outline future challenges.

METHODS

Our methodology involved an examination of national regulations and the voluntary adoption of smoke-free policies at sports clubs throughout Europe. We also assessed the adoption and implementation of these policies using recent evidence, leading to the identification of impending challenges in their implementation across Europe.

RESULTS

While only a few European countries currently have national legislation prohibiting outdoor smoking at sports clubs, voluntary initiatives promoting such policies have emerged in various nations. Experiences from the Netherlands have demonstrated the feasibility of implementing outdoor smoke-free policies at sports clubs. To expand these policies across Europe, five key challenges need to be addressed: 1) encouraging smoke-free policies at sports clubs that are less inclined to adopt them, 2) ensuring consistent compliance and enforcement of outdoor smoke-free policies, 3) preventing smoking just outside the sports club, 4) garnering support from various stakeholders to ensure widespread adoption of smoke-free sports clubs, and 5) establishing monitoring and evaluation mechanisms for policy implementation.

CONCLUSION

The Dutch experiences serve as a testimony to the feasibility of outdoor smoke-free policies at sports clubs. By addressing the remaining challenges, we can create healthier sports environments for children and take substantial steps towards realizing a smoke-free Europe.

Stress and Well-Being of Greek Primary School Educators: A Cross-Sectional Study

The teaching profession has always been challenging, while for various reasons the magnitude of observed stress in teachers has been continually growing over time. This study was conducted to demonstrate the relevance of stress in this professional group and to generate evidence for the benefit of primary school teachers and, indirectly, their pupils. To this end, we examined a large number of school teachers in a descriptive cross-sectional study. The survey comprised 786 primary school instructors aged 21 to 65 years, 646 women (82.2%) and 140 males (17.8%), and was performed from March to October 2022. Participants were asked about their gender, age, marital status, place of domicile, satisfaction with their income, whether their income met their needs, number of children, whether they cared for a person with a disability, work experience, alcohol use, eating patterns, and their height and weight for computation of their Body Mass Index (BMI). The survey included the Teacher Subjective Well-being Questionnaire (TSWQ), the Perceived Stress Scale (PSS), the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ), and the Pittsburgh Sleep Quality Index (PSQI). The results showed that there were significant differences between the two sexes in age, marital status, work experience, smoking, alcohol use, and eating breakfast. Furthermore, there were significant differences between the two sexes in BMI, PSS Total, Dietary Health Choice, Harm Avoidance and Total HLPCQ. The variance of PSS Total was predicted by Sex, Teacher Efficacy, Total PSQI, Dietary Health Choice, organized physical exercise, social support and mental control, and Total HLPCQ. Between teacher efficacy, school connectedness, teacher well-being, organized physical exercise, social support and mental control, Total HLPCQ and PSS Total, the correlation coefficients were negative and significant at the <0.05 level. Between Total PSQI and PSS Total, the correlation coefficient was positive and significant at the <0.05 level. Between teacher efficacy, school connectedness and teacher well-being, organized physical exercise, social support and mental control, Total HLPCQ and Total PSQI, the correlation coefficients were negative and significant at the <0.05 level. In summary, we demonstrated that Greek primary school teachers experience significant stress, which is intertwined with their way of life, and reflected in significant decreases in their sense of well-being, quality of sleep, and overall life satisfaction, as well as in their standards of teaching.

From a teacher and school leader perspective: What happened with smoking rules and practices during a three-year smoking preventive intervention? - Findings from the X:IT II study

BACKGROUND

School-based smoking preventive interventions are most effective if they consist of multiple components; one of them being strict anti-smoking rules, i.e., no smoking by anyone at any location during school hours. However, there is a lack of in-depth knowledge about how smoking practices and rules about smoking actually change over time. Therefore, the purpose of this study was to examine how smoking practices changed during a three-year period in which a smoking preventive intervention with strict anti-smoking rules was implemented at schools.

METHODS

We used data from 46 Danish schools that were enrolled in the evaluation of the X:IT II study - a smoking preventive intervention with three main components: one of them being strict anti-smoking rules. We collected questionnaire data among school employees at four timepoints from the autumn of 2017 until April 2020. The questionnaire covered topics regarding students' and employees' tobacco patterns at the school, control with smoking, and aspects of the intervention delivery.

RESULTS

Over time, student smoking rules got stricter; from three out of four at baseline to almost all schools having rules about no student smoking during school hours three years later. Employee smoking rules also changed, although not as much as student rules. Overall, smoking at school grounds seemed to decline - however, student smoking at other locations increased, hence, violating the rule about no smoking during school hours. Enforcement of smoking rules also increased over time.

CONCLUSION

Although implementing and enforcing new rules in a school setting may be difficult, it seemed that most schools in the X:IT II study changed their rules and smoking practices for both students and employees over the three-year intervention period. It seemed, however, that students relocated their smoking to other places than the school or just outside school grounds. Implications of these findings are important to consider in future interventions, i.e., students leaving school during school hours to smoke and the physical separation between those who smoke and those who do not.

Retailer's Density and Single Stick Cigarette's Accessibility among School-Age Children in Indonesia

OBJECTIVE

The density of single-stick cigarette sales is related to the increase in tobacco epidemic-related diseases. This study aims to provide evidence of retailers' density and radius around the school location, accessibility of single-stick cigarette selling among school-age children, and retailers' response regarding the restriction policy options in urban areas in Indonesia.

METHODS

It is a cross-sectional study. The retailers' spatial density and the radius around schools in Daerah Khusus Ibukota (DKI) Jakarta Province were investigated using Google Maps and Google Street View (GSV). The coordinates of retailers and schools were geo-coded to Kernel Density Map. The accessibility of single-stick cigarettes among children and restriction policy options for cigarette selling were derived from random sampling using surveys of 64 retailers based on Google Data results.

RESULT

Virtually walking using google maps and GSV found 8,371 retailers in DKI Jakarta. There were ± 15 cigarette retailers every 1 km2, and an average of ± one cigarette retailer in every 1,000 residents. There were 456 (21.67%) retailers with a radius ≤ 100 meters around elementary schools, even an increase around junior high school locations of 167 (26.05%) retailers. The accessibility of cigarettes among children is easy because the price is relatively low, at Rp1,500/ $0.11 per stick. In addition, 58.1% of retailers allowed customers to buy on debt. Eleven percent of cigarette retailers intended to reduce the sale of cigarettes if the prohibition of single-stick cigarette sales were applied.

CONCLUSION

Cigarette retailers were very dense and single-stick cigarettes were still accessible to children in Indonesia. The implementation of the prohibition on single-stick cigarette sales should be added for future tobacco control in developing countries such as Indonesia.

Academic Performance and Peer or Parental Tobacco Use among Non-Smoking Adolescents: Influence of Smoking Interactions on Intention to Smoke

BACKGROUND

Intention to smoke is an important predictor of future smoking among adolescents. The purpose of our study was to examine the interaction between academic performance and parents/peer tobacco use on adolescents' intention to smoke.

METHODS

A multi-stage stratified sampling was used to select participants, involving 9394 students aged between 9-16 years in Changchun city, northeastern China. Multiple logistic regression analyses were conducted to examine the individual effect of academic performance and peer/parental smoking behavior. Stratified logistic regressions were conducted to examine the protective effect of academic performance based on peer or parental smoking. Interaction effects of academic performance × peer/parental smoking on adolescents' intention to smoke were tested.

RESULTS

Of all the non-smoking students sampled, 11.9% intended to smoke within the next five years. The individual effect of academic performance and peer/parental smoking was significant. The protective effect of academic performance on the intention to smoke was significant regardless of whether peers smoked or not. However, the protective effect was not significant among adolescents with only maternal smoking and both parental smoking. The current study found the significant interaction effects of academic performance × peer smoking and the academic performance × both parents' smoking. Students with poor academic performance were more likely to intend to smoke if their peers or both parents smoked.

CONCLUSION

These preliminary results suggest that peer smoking or smoking by both parents reinforces the association between low academic performance and the intention to smoke among adolescents. Enhancing school engagement, focusing on social interaction among adolescents with low academic performance, and building smoke-free families may reduce adolescents' intention to smoke.

The impact of smoke-free policies on smoking at outdoor sports clubs: a qualitative study

OBJECTIVES

Smoking may still occur at sports clubs with an outdoor smoke-free policy (SFP). This study aims to map the occurrence of smoking at various sports clubs in the Netherlands and to understand why smoking occurs at some clubs but not at others.

STUDY DESIGN

This was a qualitative design in the form of semistructured interviews.

METHODS

Semistructured interviews (n = 34) were held online with smoking and non-smoking members of 17 Dutch outdoor sports clubs (in field hockey, korfball, football, and tennis) with an outdoor SFP. Data were analyzed using content analysis.

RESULTS

We identified four situations where smoking still occurred: (1) directly at the entrance, (2) at some distance from the entrance, (3) in particular places on the premises, and (4) in various places or on occasions when alcohol is consumed. Smoking directly at the entrance was most often perceived as a bothersome situation that was difficult to avoid. The occurrence of these situations differed per sports club depending on the scope of the SFP (the comprehensiveness of the SFP and the presence or absence of a smoking area) and factors influencing policy compliance (physical characteristics of the sports club's premises, the presence or absence of children, and several enforcement difficulties).

CONCLUSION

In some sports clubs, smoking remained common on the premises despite an outdoor SFP. Exposure to second-hand smoke might be reduced by formulating a comprehensive SFP, improving policy compliance also in situations where children are absent, and organizing the enforcement of the policy.

Development and Validation of a Comic Tool: An Innovative Approach to Raise Awareness about Tobacco Control among School Teachers

Background

National legislation (COTPA) in India has focused on school children with dedicated section (6a and 6b) for tobacco control at Educational Institutions. Innovative mediums like Comic offer unique and engaging medium for dissemination of health information. However, its true potential remains unexplored in tobacco control. The study was conducted to develop and validate Comic for promotion of tobacco control laws in school settings.

Materials and Methods

The present cross-sectional study was conducted among school teachers in Delhi in three phases: (1) need assessment, (2) development of Comic, and (3) validation (face/content validity by experts in public health/tobacco control, and construct validity by school teachers). Ethical clearance was obtained from Institutional Ethical Review Board. Prevalidated, structured, close-ended, and self-administered Questionnaire was used for the data collection. SPSS version 21 was used for descriptive and inferential results.

Results

Phase 1 showed, out of 150 school teachers, 121 participated (80.66%). Mean age and teaching experience was 41.85 ± 9.76 years and 10.35 ± 6.53 years, respectively. Overall awareness about COTPA was 47.9% (n = 58) and COTPA sections 4 and 6 were 37.2% (n = 45). Majority 59.5% (n = 72) reported lack of access to training material. Phase 2 and 3 showed overall content validity index (CVI) score of 0.84. Construct validity evaluation from pre-postintervention yield mean ± SD scores of 3.94 ± 0.99 and 7.97 ± 1.17, respectively, (P < 0.001).

Conclusion

Comic was developed on sound theoretical basis with satisfactory face, content and construct validity, to raise awareness about tobacco control among school children, and teachers to promote tobacco-free school.

Social determinants of smoking among school adolescents in Beijing, China

INTRODUCTION

Understanding the social determinants that influence adolescent smoking behavior has a meaningful impact on adolescent health. Few studies have simultaneously analyzed the impact of teacher smoking and peer smoking on adolescent smoking. Therefore, the present study aims to investigate the impact of teacher smoking, peer smoking, and other social factors, on adolescent smoking.

METHODS

The participants were drawn from schools in Beijing, China, in 2011, 2013, and 2015, using a multi-stage random group sampling method. The number of schools selected for each year was 160. The study participants were 57240 adolescents aged 8-19 years. The generalized linear model with a binomial distribution and logarithmic link function was used to estimate the influence of social determinants on adolescent smoking behavior.

RESULTS

The results show that both teacher smoking and peer smoking were significantly associated with adolescent smoking. Compared to adolescents whose teachers did not smoke, the prevalence ratio (PR) was 1.28 for adolescents with one teacher who smoked and 1.34 for adolescents with two or more teachers who smoked (95% CI: 1.16-1.41/1.23-1.46, p<0.001/0.001, respectively). Compared to adolescents whose peers did not smoke, the prevalence ratio (PR) was 3.73 for adolescents with one peer who smoked and 8.52 for adolescents with two or more peers who smoked (95% CI: 3.20-4.35/7.48-9.69, p<0.001/0.001, respectively).

CONCLUSIONS

Teacher smoking and peer smoking are significant social determinants of adolescent smoking. Prevention programs should concurrently target peer groups, school settings, and individual students.

Socioeconomic Differences in Cigarette Smoking and Alternative Tobacco Product Use Among Adolescents in a School-Based Smoking Preventive Intervention: Findings From the Second Year of the X:IT II Study

Background

Health interventions may differently impact adolescents from diverse backgrounds. This study examined whether a smoking preventive intervention was equally effective in preventing cigarette smoking and use of alternative tobacco products (ATPs, i.e., snus, e-cigarettes, and waterpipe) among students from different socioeconomic backgrounds, i.e., occupational social classes (OSC).

Methods

Data was from the school-based intervention X:IT II targeting 13- to 15-year-olds Danes. The intervention focused on three main components: smoke-free school time, smoke-free curriculum, and parental involvement. In total, 46 schools were included at baseline (N = 2,307, response rate = 86.3%). Using a difference-in-differences approach, changes in current smoking and ever use of ATPs were estimated among students in high versus low OSC at second follow-up. Analyses were based on available cases (N = 826) and multiple imputations of missing data at the second follow-up (N = 1,965).

Results

At baseline (age 13), 1.0% of students from high OSC and 4.8% from low OSC currently smoked cigarettes, while this was the case among 24.5 and 25.6%, respectively, at the second follow-up (age 15). Estimates indicated that social inequalities in current smoking diminished over time (p < 0.001). Regarding ATPs, 10.0% of high OSC students and 13.9% of low OSC students had ever used ATPs at baseline, while at second follow-up, 46.8 and 60.8%, respectively, had ever used ATPs. Estimates indicated that social inequalities in ever use of ATPs widened over time (p < 0.001).

Conclusions

The X:IT II intervention seemed to diminish socioeconomic disparities in smoking over the study period. Meanwhile, social inequalities in ever use of ATPs increased. Therefore, besides focusing on narrowing the social disparities in cigarette smoking, future efforts may, to a larger extent, focus on adolescents' use of ATPs.

Health behaviours of teachers and other education professionals in France: can we do better?

Education professionals play a critical role in health education, both as knowledge providers and as role-models. Drawing on the CONSTANCES French cohort (baseline 2012-19) and adjusting for important confounders, we compared education professionals (n = 14 730) with a random sample of non-education sector employees (n = 34 244) on three indicators of high-risk behaviour (at-risk drinking, current smoking, past-year cannabis use) and three indicators of unhealthy lifestyle (low physical activity, poor adherence to nutritional guidelines, overweight/obesity). Among education professionals, we distinguished between teachers (n = 12 820), school principals (n = 372), senior education advisers (n = 189), school health professionals (n = 128) and school service staff (n = 1221). Compared with non-education sector employees with similar demographic and socioeconomic profiles, teachers were less likely to be at-risk drinkers, to smoke, to have used cannabis in the past year and to be overweight/obese. Other non-teaching education professionals were also less involved in high-risk behaviours than non-education employees, but results were more mixed concerning some lifestyle indicators, with certain non-teaching education professional groups showing a higher likelihood of being physically inactive or overweight/obese. In this nationwide French study, our results suggest a window of opportunity to promote school staff health but also indirectly, that of the youth with whom they interact daily. We suggest that school staff should be supported in health matters not only through the provision of health information but also most importantly, through the development of a favourable and supportive environment enabling them to put health knowledge into practice.

Secondhand smoke presence in outdoor areas in 12 European countries

INTRODUCTION

Secondhand smoke (SHS) causes morbidity and mortality among non-smokers.

OBJECTIVES

To investigate SHS presence in outdoor areas from 12 European countries and its association with country-level characteristics.

METHODS

Cross-sectional study performed in 2017-2018 within the TackSHS project. We conducted a face-to-face survey on a representative sample of the population aged 15 years and older from 12 European countries: Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain. Out of 11,902 participants, 8,562 were non-smokers. SHS presence was assessed in selected outdoor areas and defined as respondents viewing someone smoking the last time they visited each setting within the last 6 months. A ranking score for outdoor SHS presence was assigned to each country based on the SHS presence in each setting. We used Spearman's correlation (r) and the Chi-squared tests to assess the relationship between SHS presence and country-level characteristics.

RESULTS

Except for children's playgrounds (39.5%; 95% confidence interval, CI: 37.6%-41.3%), more than half of non-smokers reported SHS presence in outdoor areas: schools (52.0%; 95%CI: 50.2%-53.7%), stadia (57.4%; 95%CI: 55.4%-59.4%), parks (67.3%; 95%CI: 66.0%-68.5%), hospitals (67.3%; 95%CI: 65.8%-68.7%), public transport stops (69.9%; 95%CI: 68.6%-71.2%), bar/restaurant terraces (71.4%; 95%CI: 70.2%-72.6%), and beaches (72.8%; 95%CI: 71.4%-74.1%). Residents in Latvia showed the highest overall outdoor SHS presence rank, followed by Greece, and Portugal. Outdoor SHS presence was directly correlated to the country's smoking prevalence (r = 0.64), and inversely correlated to the Tobacco Control Scale 2016 overall score (r = -0.62), the socio-demographic index 2017 (r = -0.56), and Gross Domestic Product per capita 2018 (r = -0.47) (p < 0.001).

CONCLUSIONS

SHS presence is high in most outdoor areas in Europe, especially in countries with higher smoking prevalence and lower tobacco control performance. To address outdoor SHS exposure, our findings require considering smoking bans along with other strategies to reduce smoking prevalence.

Key Drivers to Implement an Evidence-based Tobacco Control Programme in Schools of India: A Mixed-Methods Study

Background:

Adolescence is an influential stage in students’ lives when lifelong behaviours such as tobacco use are formed. During these years, school teachers are important role models for tobacco control among students. A study was conducted among school personnel and administrators to understand the key drivers for implementing an evidence-based school tobacco control program.

Methodology:

A cross-sectional, mixed-method study was conducted in five districts of Assam, India. The quantitative study was conducted among 565 school personnel across 40 Government-aided schools. Data was collected by means of an anonymous, self-administered questionnaire. Qualitative data was generated from 15 focus group discussions (FGDs) among 146 participants - District Program Officers, Block Education Officers, Cluster Coordinators, Headmasters and Teachers.

Results:

While the prevalence of smoked tobacco was low (3%), the use of smokeless tobacco was higher (40%), and the prevalence of use of areca nut without tobacco (65%) was still higher among school personnel. They were aware of the school policies prohibiting the use of tobacco among students within or outside school buildings or during school-sponsored activities (81%); they had rather limited knowledge about policy for themselves (58%). There was lack of access to training materials about prevention of tobacco use among youth. The FGDs amongst school personnel resulted in several constructive suggestions on tobacco control in schools mainly in training school teachers, monitoring the program and incentives for execution of the program. However, there was a reluctance to implement a smokeless tobacco control programme since many were current users of smokeless tobacco and areca nut.

Conclusion:

Tobacco control policies as well as training school personnel in schools need to improve and further measures must be taken to prohibit use of areca nut, which contains carcinogens. The existing system of the education department can be utilised to implement tobacco control programmes effectively.

Secondhand smoke exposure and other signs of tobacco consumption at outdoor entrances of primary schools in 11 European countries

INTRODUCTION

Although smoking restrictions at child-related settings are progressively being adopted, school outdoor entrances are neglected in most smoke-free policies across Europe.

OBJECTIVES

To describe secondhand smoke (SHS) exposure and tobacco-related signs in outdoor entrances of primary schools in Europe according to area-level socioeconomic status (SES), smoke-free policy, national smoking prevalence, and geographical region.

METHODS

In this cross-sectional study we monitored vapor-phase nicotine concentrations at 220 school outdoor entrances in 11 European countries (March 2017-October 2018). To account for nicotine presence, we used the laboratory's limit of quantification of 0.06 μg/m³ as point threshold. We also recorded the presence of smell of smoke, people smoking, cigarette butts, and ashtrays. Half of the schools were in deprived areas. We grouped countries according to their Tobacco Control Scale (TCS) score, smoking prevalence (2017-2018), and United Nations M49 geographical region.

RESULTS

There were detectable levels of nicotine in 45.9% of the outdoor entrances, in 29.1% smell of smoke, in 43.2% people smoking, in 75.0% discarded butts, and in 14.6% ashtrays. Median nicotine concentration was below the laboratory's limit of quantification <0.06 μg/m³ (Interquartile range:<0.06-0.119). We found higher SHS levels in countries with lower TCS scores, higher national smoking prevalence, and in the Southern and Eastern European regions. People smoking were more common in schools from lower area-level SES and in countries with lower TCS scores (p<0.05).

CONCLUSIONS

Smoking at school outdoor entrances is a source of SHS exposure in Europe. These findings support the extension of smoking bans with a clear perimeter to the outdoor entrances of schools.

A qualitative study of the views about smoking, licensed cessation aids and e-cigarettes in people with schizophrenia spectrum disorders

Smoking prevalence remains high among people with a mental health condition compared to those without. Understanding people's motivation to quit and their views of smoking cessation support may help to develop future interventions. We conducted a qualitative study to explore the perceptions of 30 people with schizophrenia spectrum disorders who were current smokers, about smoking traditional cigarettes, the appeal of licensed medicines and e-cigarettes for smoking cessation or smoking reduction. The experiences of participants who were motivated to quit were compared with those who were not motivated to quit. Findings suggest traditional cigarettes were pleasurable and licensed cessation aids and e-cigarettes unappealing to participants who were unmotivated to quit. Whereas nicotine replacement products and e-cigarettes may be an appealing smoking cessation or reduction strategy for those motivated to quit. There is a need to find ways of making traditional cigarettes less appealing and alternative less harmful nicotine products (licensed and unlicensed) more appealing and accessible to this group of high risk smokers.

Individual and joint association of adulthood experiences and parental or teacher smoking with adolescent cigarette smoking

INTRODUCTION

One limitation of the minimum legal age (MLA) law, the primary strategy for curbing youth smoking, is the rite-of-passage effect. Adulthood experiences and the behavior of surrounding adults help build ‘adult identity’ among adolescents. We examined the individual association of adulthood experience and joint association with significant adults who smoke with adolescent cigarette smoking.

METHODS

A nationally representative cross-sectional sample of 138542 South Korean adolescents aged 12–18 years (mean: 15 years) from the 2014 and 2015 Korea Youth Risk Behavior Survey was used. Adulthood markers used were tall stature, precocious sexual development, independent living, and job experience. Parents and teachers were considered significant adults. Logistic regression analyses and relative risk due to interaction (RERI) calculations were conducted.

RESULTS

Tall stature (OR=1.19; 95% CI: 1.08–1.31), precocious sexual development (OR=1.51; 95% CI: 1.36–1.69), independent living (OR=1.24; 95% CI: 1.08– 1.43), and job experience (OR=4.38; 95% CI: 4.14–4.64) were associated with cigarette smoking among study participants. Statistically significant additive interactions were found for parental smoking and job experience (RERI=0.41; 95% CI: 0.06–0.76), teacher smoking and precocious development (RERI=0.71; 95% CI: 0.28–1.15), teacher smoking and independent living (RERI=0.68; 95% CI: 0.11–1.24), teacher smoking, and job experience (RERI=2.12; 95% CI: 1.66– 2.58).

CONCLUSIONS

The association between adulthood experience and adolescent cigarette smoking suggests the rite-of-passage effect, which may be strengthened by the MLA law. Raising the MLA to an age much higher than the normative age of adulthood initiation is required. Additionally, targeted intervention for adolescents with both adulthood experience and exposure close to adult smoking are required to curb youth smoking.

Tobacco smoking, related harm and motivation to quit smoking in people with schizophrenia spectrum disorders

This narrative review focuses on the topic of tobacco smoking amongst people with schizophrenia spectrum disorders. We searched PubMed, PsycInfo and Scopus databases for schizophrenia spectrum disorders and smoking and included articles about the epidemiology of tobacco smoking in people with schizophrenia spectrum disorders, examining the relationship between smoking and mental health. This narrative review describes that a higher prevalence, frequency and impact of both high nicotine dependence and its harmful effects in patients with schizophrenia spectrum disorders compared with those in the general population. Despite several existent theories, the reasons for high smoking rates, the high dependence on nicotine and severity of nicotine withdrawal symptoms are not fully understood. The main aim of this paper is to inform mental health personnel and particularly clinical and health psychologists about the impact and role of tobacco smoking for smokers with schizophrenia spectrum disorders.

The visibility of smoking in Europe and its relationship with youth's positive beliefs about smoking

Objectives

To determine adolescent-reported visibility of smoking in different public and private spaces in Europe and associations between smoking visibility and beliefs about the benefits of smoking.

Methods

We used SILNE-R cross-sectional survey data (2016/2017) of 10,798 14–16-year-old students from 55 secondary schools in seven European cities. Respondents reported for private and public spaces whether they had seen others smoke there in the last 6 months. Beliefs about the benefits of smoking were measured on a 7-item scale; higher scores indicated more positive beliefs. Multilevel linear regression analyses determined associations while controlling for potential confounders and stratifying by smoking status.

Results

Most students reported observing others smoke in public spaces, especially at train/bus stations (84%). Positive beliefs about smoking of never smokers were positively associated with seeing others smoke in train/bus stations and leisure/sports facilities, but not at home, a friend’s home, restaurants or bars, when fully adjusted. Associations were of similar magnitude for ever smokers.

Conclusions

Smoking in several public places is highly visible to adolescents. Reducing this visibility might weaken positive beliefs that adolescents have about smoking.

Electronic supplementary material

The online version of this article (10.1007/s00038-019-01288-z) contains supplementary material, which is available to authorized users.

Conventional Cigarette and E-Cigarette Smoking among School Personnel in Shanghai, China: Prevalence and Determinants

Smoking cigarettes and e-cigarettes is widely popular among Chinese students. Considering that school personnel are considered role models in the student community, we investigated the prevalence and determinants of such behavior among high school personnel in China so as to provide references for future related intervention measures. We used a stratified cluster sampling design on a total number of 3311 school employees recruited from 33 representative schools. Complex sampling analysis and logistic regressions were used for univariate and multivariate analyses. Among 3194 participants that met the study criteria, 7.4% were cigarette users, and 3.6% e-cigarette consumers. For conventional cigarette smokers, certain characteristics, such as being older and male, attaining less education, and having been exposed to secondhand smoke, were associated with heavier smoking. Nevertheless, e-cigarette users were predominantly male and of younger age. Those who understood the hazards of conventional cigarette smoking had less inclination to smoke but were at a higher risk of e-cigarette use. Our analysis suggests that it is necessary to target different populations for monitoring and controlling conventional cigarette smoking and e-cigarette use respectively among school personnel. In addition, China is in need of more relevant and strict anti-smoking regulations.

Current Cigarette Smoking and Its Predictors among School-Going Adolescents in East Africa: A Systematic Review and Meta-Analysis

BACKGROUND

In developing countries, tobacco smoking has its own contribution to the burden of noncommunicable causes of morbidity and mortality. Studies estimated the burden of cigarette smoking among school-going adolescents in different geographical areas of East Africa. However, due to discrepancies found among those different findings, there is no representative data about the burden of smoking in the continent.

OBJECTIVES

This systematic review and meta-analysis aimed to assess the pooled prevalence of current cigarette smoking and its associated factors among school-going adolescents in East Africa.

METHODS

PubMed, Google Scholar, and the Web of Science Library were searched to access included articles. A weighted inverse-variance random-effects model was used to estimate the prevalence of current cigarette smoking. Variations in the pooled estimates of the prevalence were adjusted through subgroup analysis according to the specific country, where the study was conducted. Funnel plot and Egger's regression test were used to check publication bias. STATA version 14 statistical software was used for meta-analysis.

RESULTS

A total of 26,875 school-going adolescents were included. The pooled prevalence of current cigarette smoking among school-going adolescents in East Africa was found to be 9.02% (95%CI: 6.34-11.70). Based on the subgroup analysis, current cigarette smoking among school-going adolescents was estimated at 9.8% in Kenya, 7.72% in Ethiopia, 10.83% in Uganda, 13.6% in Sudan, and 4% in Tanzania.

CONCLUSIONS

This meta-analysis revealed that the prevalence of current cigarette smoking is increasing among school-going adolescents in East Africa. Therefore, countries have to realize sale prevention policies, establishing and/or strengthening antismoking campaigners designed for school-going adolescents, and providing training for teachers to be antismoking campaigners.

Study protocol of the X:IT II - a school-based smoking preventive intervention

BACKGROUND

The X:IT intervention, conducted in 2010 to 2013, showed overall smoking preventive effect. However, parts of the intervention appeared less appealing to children from families with lower socioeconomic backgrounds. Therefore, the intervention components were modified and an evaluation of the amended intervention X:IT II is needed to show the effect of this revised intervention and whether children from different social backgrounds benefits equally from the current intervention.

METHODS

Main intervention components are smoke free schools, a curricular component, and parental involvement (smoke free agreements and talks about tobacco). Components have been revised from the first version; 1) previously, schools should be smoke free on the school ground and were encouraged to hide smoking so that it wasn't visible to pupils from the school ground. Now they are encouraged to tighten the rules so that no pupils or teachers smoke during the school day, no matter where they are; 2) the specifically developed educational material (Up in Smoke) has been revised so that all materials are online and all texts has a ARI; 3) the parental involvement is now targeted multiple groups of parents, e.g. parents that are smokers, and parents of children that smoke. Language used is simpler and the website for parents presents very specific examples. X:IT is implemented in 46 Danish public schools from fall 2017 until summer 2020. Data is collected through electronic questionnaires to students and coordinators four times (fall 2017, spring/summer 2018, 2019 and 2020). Further, qualitative interviews and observations are conducted.

DISCUSSION

Prevalence of smoking among Danish adolescents is high compared to other Nordic countries and there is social inequality in smoking, leaving individuals from the lowest social backgrounds at higher risk. Although there has been an overall decline in smoking among Danish adolescents over the last decades, a recent levelling of this development indicates an urgent need for smoking prevention in Denmark. The X:IT intervention has the potential to prevent uptake of smoking among adolescents. However, there is a particular need for evaluating the effectiveness of the revised X:IT intervention, X:IT II, with focus on the effect across socioeconomic groups of adolescents.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN31292019 , date of registration 24/10/2017. Retrospectively registered.

Implementation fidelity and adolescent smoking: The X:IT study-A school randomized smoking prevention trial

BACKGROUND

Assessing the actual implementation of multi-component interventions can provide important knowledge for future interventions. Intervention components may be implemented differently, knowledge about this can provide an understanding of which components are essential and therefore must be included. The aim of this study was to examine the implementation of one, two, or all three main intervention components at the individual level and to assess the association to current smoking among 13 year-olds in the X:IT study.

METHODS

Data stems from a cluster-randomized controlled trial in 94 Danish elementary schools (51 intervention; 43 control schools). Implementation was measured by aspects of adherence, dose, quality of delivery, and participant responsiveness based on questionnaire data from 4161 pupils at baseline (mean-age: 12.5 years) and 3764 pupils at first follow-up eight months later. Coordinator responses from 49 intervention schools were also included. Associations between individual level implementation of the three main components and pupil smoking were examined through a 3-level logistic regression model.

RESULTS

Although implementation fidelity for the three main intervention components was good, only one third (38.8%) of pupils in intervention schools were exposed to full implementation of the intervention. Among these pupils odds ratio for smoking was 0.25 (95% CI: 0.15 - 0.42).

CONCLUSIONS

School-based programs can be very effective if carefully implemented. Future school-based smoking preventive initiatives should include multiple components, and seek to enhance implementation quality of all components.

Visibility of smoking among school-teachers in Spain and associations with student smoking: a cross-sectional study

OBJECTIVE

Limited research has examined the association between smoking among schoolteachers and student smoking. This paper seeks to assess whether smoking visibility on school grounds among schoolteachers is associated with student smoking. We examine both smoking behaviour and the number of cigarettes consumed.

METHODS

We use a school-based cross-sectional survey carried out by the Spanish Government's Delegation for the National Plan on Drugs. A total of 27 503 students between 14 and 18 years of age completed an anonymous survey in 2013. Count data regressions were used to assess the association between observed teacher smoking and adolescent smoking behaviour.

RESULTS

High levels of visibility of teacher smoking on school grounds increased the odds of being a smoker among students (OR=2.09 and OR=1.64, for the highest levels of visibility), but the impact on the quantity of cigarettes smoked, although positive, was not significant.

CONCLUSION

Teacher smoking on school grounds is associated with student smoking behaviour. Consequently, smoking policies designed to prevent adolescent smoking should address this important social environment.

Link between perceived smoking behaviour at school and students smoking status: a large survey among Italian adolescents

OBJECTIVES

To investigate a possible link between sociodemographic factors, the perception of smoking habits at school and smoking status of Italian adolescents attending secondary school.

STUDY DESIGN

The study was a cross-sectional study.

METHODS

An anonymous online survey was employed to gather information on age, gender, smoking status and to examine the perception of smoking behaviour on the school premises. Chi-squared and Kruskal-Wallis tests were performed for the univariate analysis and logistic and multinomial regressions for the multivariate analysis.

RESULTS

The statistical analyses included 1889 students. Univariate analysis showed significant differences concerning knowledge between smoker and non-smoker concerning the harmfulness of smoking (P < 0.001). According to the multivariate analysis smokers had a higher perception of teacher, principal or janitor smoking at school (odds ratio: 1.54 [95% confidence interval 1.26-1.89]). Students older than 19 years most often begin smoking because their friends smoke compared with younger students (adjusted odds ratio: 1.18 [95% confidence interval 0.48-2.89]).

CONCLUSION

School environment and behaviour of role models play a crucial part in student smoking. To prevent and reduce youth tobacco smoking, not merely the presence of preventive measures is important but greater attention needs to be placed on the enforcement of smoking policies.

Tobacco use patterns, knowledge, attitudes towards tobacco and availability of tobacco control training among school personnel from a rural area in Poland

Background

Tobacco-free school environment as well as non-smoking teachers and school personnel provide positive role models for children and young people. In Poland, smoking should be banned in colleges, schools, educational establishments and educational care facilities. However, for the existing law to be effective, awareness of all people in school curriculum and enforcement of the law are crucial. The aim of the study was to evaluate tobacco use patterns, knowledge and attitudes towards tobacco as well as availability of tobacco control training among school personnel in a rural area in Poland. Moreover, compliance with tobacco control policies and their enforcement were assessed.

Methods

The study was carried out in Piotrkowski district between November 2014 and May 2015 in accordance with the Global School Personnel Survey (GSPS) methodology. Sixty schools participated in the survey (92% of the schools from the region) with involvement of 1044 teachers and 500 non-teaching staff (the response rate – 83.1%). The multivariate linear regression analyses were applied to study factors linked to the need for anti-tobacco training dedicated to the youth and teachers’ knowledge as well as activities to educate the students about tobacco use and its prevention.

Results

About 24% of the school personnel were current and 9% were ex-smokers. Significantly more teachers than the non-teaching staff indicated that the schools had a policy prohibiting tobacco use among students. In addition, 6% of the study participants indicated everyday violations of the tobacco control policy by the school personnel. More than 80% of the teaching personnel indicated the need for training dedicated to the youth to prevent their tobacco use. In the multivariate linear regression model, longer duration of working experience predicted higher levels of knowledge and more activities performed to teach the youth about tobacco use and its prevention. The smokers comparing to the non–smokers perceived the need for anti- tobacco training among the youth less strongly.

Conclusions

In order to make it possible for the inhabitants of Piotrkowski district to work and learn in tobacco smoke free environment there is an urgent need for taking actions aiming at increasing effectiveness of enforcing applicable tobacco control regulations in educational units. The necessity for systematic training dedicated to the youth to prevent their tobacco use, including accurate preparation of teachers, also needs to be highlighted.

Electronic supplementary material

The online version of this article (doi:10.1186/s12971-016-0110-y) contains supplementary material, which is available to authorized users.

Impact of advertisements promoting candy-like flavoured e-cigarettes on appeal of tobacco smoking among children: an experimental study

BACKGROUND

There are concerns that the marketing of e-cigarettes may increase the appeal of tobacco smoking in children. We examined this concern by assessing the impact on appeal of tobacco smoking after exposure to advertisements for e-cigarettes with and without candy-like flavours, such as, bubble gum and milk chocolate.

METHODS

We assigned 598 English school children (aged 11-16 years) to 1 of 3 different conditions corresponding to the adverts to which they were exposed: adverts for flavoured e-cigarettes, adverts for non-flavoured e-cigarettes or a control condition in which no adverts were shown. The primary endpoint was appeal of tobacco smoking. Secondary endpoints were: appeal of using e-cigarettes, susceptibility to tobacco smoking, perceived harm of tobacco, appeal of e-cigarette adverts and interest in buying and trying e-cigarettes.

RESULTS

Tobacco smokers and e-cigarette users were excluded from analyses (final sample=471). Exposure to either set of adverts did not increase the appeal of tobacco smoking, the appeal of using e-cigarettes, or susceptibility to tobacco smoking. Also, it did not reduce the perceived harm of tobacco smoking, which was high. Flavoured e-cigarette adverts were, however, more appealing than adverts for non-flavoured e-cigarettes and elicited greater interest in buying and trying e-cigarettes.

CONCLUSIONS

Exposure to adverts for e-cigarettes does not seem to increase the appeal of tobacco smoking in children. Flavoured, compared with non-flavoured, e-cigarette adverts did, however, elicit greater appeal and interest in buying and trying e-cigarettes. Further studies extending the current research are needed to elucidate the impact of flavoured and non-flavoured e-cigarette adverts.

The impact of anti-smoking laws on high school students in Ankara, Turkey

OBJECTIVE

To determine the factors affecting the smoking habits of high school students, their thoughts about changes resulting from anti-smoking laws, and how they are affected by those laws.

METHODS

In this cross-sectional study, 11th-grade students at eight high schools in Ankara, Turkey, were invited to complete a questionnaire.

RESULTS

A total of 1,199 students completed the questionnaire satisfactorily. The mean age of the respondents was 17.0  0.6 years; 56.1% were female, of whom 15.3% were smokers; and 43.9% were male, of whom 43.7% were smokers (p < 0.001). The independent risk factors for smoking were male gender, attending a vocational school, having a sibling who smokes, having a friend who smokes, and poor academic performance. Of the respondents, 74.7% were aware of the content of anti-smoking laws; 81.8% approved of the restrictions and fines; and 8.1% had quit smoking because of those laws. According to the respondents, the interventions that were most effective were the (television) broadcast of films about the hazards of smoking and the ban on cigarette sales to minors. The prevalence of smoking was highest (31.5%) among students attending vocational high schools but lowest (7.5%) among those attending medical vocational high schools. Although 57.1% of the smokers were aware of the existence of a smoking cessation helpline, only 3.7% had called, none of whom had made any attempt to quit smoking.

CONCLUSIONS

Although most of the students evaluated were aware of the harmful effects of smoking and approved of the anti-smoking laws, only a minority of those who smoked sought professional help to quit.

Adolescent Perception on School Environment and Smoking Behavior: Analysis of Isfahan Tobacco use Prevention Program

Background:

School provides a set of condition which is very important determinant for student smoking behavior. This study aims at exploring the association of the school environment on Iranian middle and high school students smoking.

Methods:

A self-administered anonymous questionnaire was circulated among 5500 randomly selected students with 98.3% response rate. The questionnaire asked on demographic information, student smoking status, and their perception on the school environment. School environment factor was consist of teacher smoking, implementation of smoke-free policy at school, student adherence to this policy, student perception of school personnel attitude and attention on smoking and finally receiving information on smoke-related issues via teachers. Analyses were performed with SPSS software using Chi-square and multiple logistic regression.

Results:

Boys with higher level of witness to teachers smoking had higher odds of being smoking (odds ratio [OR] =1.62, 95% confidence interval [CI] =1.17, 2.25); significant relationship was seen between boy's perception regarding school anti-smoking rules and their smoking (OR = 1.40, 98% CI 1.12, 1.75); fewer concern of school personnel on student smoking behavior was correlated to boys smoking behavior (OR = 1.31, 98% CI 1.06–1.63). Among girls, only higher perceived teacher smoking (OR = 2.59, 95% CI = 1.04, 6.44) was associated with their smoking.

Conclusions:

Teachers have a crucial role in student smoking; therefore, they strategies must be taken to persuade the student, school staff, and students to adhere free-smoking policies in and out of school.

Impact of school staff health on work productivity in secondary schools in Massachusetts

BACKGROUND

Healthy, productive employees are an integral part of school health programs. There have been few assessments of work productivity among secondary school staff. This study describes the frequency of 3 common health risk factors--obesity, depressive symptoms, and smoking--and their impact on work productivity in secondary school employees.

METHODS

Employees of secondary schools in Massachusetts (N = 630) participated in a longitudinal weight gain prevention intervention study. Assessment completed at baseline, 1-year and 2-year follow-up included survey assessments of health risk factors as well as measurements for height, weight, and body mass index (BMI). The survey also included a depression inventory and Work Limitations Questionnaire. Data analysis included multivariate mixed effect models to identify productivity differences in relation to BMI, depressive symptoms, and smoking in this population stratified by position type (teacher and other school staff).

RESULTS

The sample included 361 teachers and 269 other school staff. Obesity, depressive symptoms, and smoking were significantly associated with work productivity, including workdays missed because of health concerns (absenteeism) and decreases in on-the-job productivity because of health concerns (presenteeism).

CONCLUSIONS

Three common health conditions, namely obesity, depressive symptoms, and smoking, adversely affect the productivity of high school employees.

Smoking in school-aged adolescents: design of a social network survey in six European countries

BACKGROUND

In Western countries, smoking accounts for a large share of socio-economic inequalities in health. As smoking initiation occurs around the age of 13, it is likely that school context and social networks at school play a role in the origin of such inequalities. So far, there has been little generic explanation of how social ties at school contribute to socio-economic inequalities in smoking. The SILNE (Smoking Inequalities - Learning from Natural Experiments) survey was designed to test the hypothesis that a combination of peer effect, homophilous social ties, and school context may explain how smoking inequalities are magnified at school - a theory known as network-induced inequality. In this paper, the survey theory and design are presented.

FINDINGS

The social network survey was carried out in 2013 in six medium-sized European cities with average incomes similar to the national average: Namur (Belgium), Tampere (Finland), Hannover (Germany), Latina (Italy), Amersfoort (The Netherlands), and Coimbra (Portugal). In each city, 6 to 8 schools were selected in a stratified sampling procedure. In each school, two grades in secondary education, corresponding to 14-16-year-olds, were selected. All adolescents in these two grades were invited to participate in the survey. Social ties were reported using the roster approach, in which each adolescent had to nominate up to 5 friends from a directory. The survey collected information from 11,015 adolescents in 50 schools, out of a total of 13,870 registered adolescents, yielding a participation rate of 79%. The SILNE survey yielded 57,094 social ties, 86.7% of which referred to friends who also participated in the survey.

DISCUSSION

The SILNE survey was designed to measure the association between adolescents' social ties at school, their socio-economic background, and their smoking behaviour. Two difficulties were encountered, however: legal privacy constraints made it impossible to apply the same parental consent procedure in all countries, leading to somewhat lower participation rates in two cities: Hannover and Latina. It was also difficult to match the 6 cities in terms of both age and type of education. The SILNE survey provided a comparable database for the study of smoking inequalities across European cities from a social network perspective.

School policies for preventing smoking among young people

BACKGROUND

School tobacco policies (STPs) might prove to be a promising strategy to prevent smoking initiation among adolescents, as there is evidence that the school environment can influence young people to smoke. STPs are cheap, relatively easy to implement and have a wide reach, but it is not clear whether this approach is effective in preventing smoking uptake.

OBJECTIVES

To assess the effectiveness of policies aiming to prevent smoking initiation among students by regulating smoking in schools.

SEARCH METHODS

We searched seven electronic bibliographic databases, including the Cochrane Tobacco Addiction Group specialized register, MEDLINE, EMBASE, PsycINFO and ERIC. We also searched the grey literature and ongoing trials resources. The most recent search was performed in May 2014.

SELECTION CRITERIA

We included cluster-randomised controlled trials (c-RCTs) in which primary and secondary schools were randomised to receive different levels of smoking policy or no intervention. Non-randomised controlled trials, interrupted time series and controlled before-after studies would also have been eligible. Cross-sectional studies were not formally included but we describe their findings and use them to generate hypotheses to inform future research.

DATA COLLECTION AND ANALYSIS

We independently assessed studies for inclusion in the review, and present a narrative synthesis, as the studies are too limited in quality to undertake a formal meta-analysis.

MAIN RESULTS

We found only one study which was eligible for inclusion in the review. It was judged to be at high risk of bias. The study compared two 'middle schools' from two different regions in China. The experimental conditions included the introduction of a tobacco policy, environmental changes, and communication activities, while the control condition was no intervention. After a year's follow-up the study found no differences in smoking prevalence between intervention and control schools. We also described 24 observational studies, the results of which we considered for hypothesis generation. In these, policy exposure was mainly described using face-to-face interviews with school staff members, and the outcome evaluation was performed using self-administered questionnaires. Most studies reported no differences in students' smoking prevalence between schools with formal STPs when compared with schools without policies. In the majority of studies in schools with highly enforced policies, smoking bans extended to outdoor spaces, involving teachers and including sanctions for transgressions, with assistance to quit for smokers plus support by prevention programmes, there was no significant difference in smoking prevalence when compared to schools adopting weaker or no policies.

AUTHORS' CONCLUSIONS

Despite a comprehensive literature search, and rigorous evaluation of studies, we found no evidence to support STPs. The absence of reliable evidence for the effectiveness of STPs is a concern in public health. We need well-designed randomised controlled trials or quasi-experimental studies to evaluate the effectiveness of school tobacco policies.

Process evaluation of a national school-based iron supplementation program for adolescent girls in Iran

Background

Iron deficiency anemia remains as one of the most common nutritional problems in Iran, especially in women and girls. A process evaluation study of the national iron supplementation program targeting girls attending high schools was conducted to examine degree of exposure and satisfaction of the targets with the intervention components, and to assess the delivery (quantity), fidelity (quality), and environmental mediators of the intervention.

Methods

Three assessment tools were developed and used for the process evaluation. A total of 8 schools were selected using a simple randomization method. Data were collected from students (n = 658 of 661 participants), teachers (n = 80), and school principals (n = 7 of 8). For the qualitative measures semi-structured interviews were conducted with the three study groups.

Results

Mean continuous compliance was 62.3%. Intolerance to pills and no water supply in classrooms accounted for 47.72% and 36.21% of the refusals, respectively. The refusal rate was significantly correlated (p < 0.001) with the absence of a classroom water supply, and with each student’s knowledge of iron deficiency issues (p < 0.05). The odds of refusal in the absence of a classroom water supply were 2.02 (95% CI 1 · 044 to 3 · 900) times greater than for those classrooms with a water supply. Student exposure to the program’s goal was satisfactory; however, delivery and fidelity of educational materials and training sessions were inadequate.

Conclusions

The findings suggest that the methods of delivery and the fidelity of the program components, education materials and training sessions were insufficient and need to be improved. Additionally, specific attention has to be given to contextual factors to ensure the success of the program.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-959) contains supplementary material, which is available to authorized users.

Design of a school-based randomized trial to reduce smoking among 13 to 15-year olds, the X:IT study

BACKGROUND

Adolescent smoking is still highly prevalent in Denmark. One in four 13-year olds indicates that they have tried to smoke, and one in four 15-year olds answer that they smoke regularly. Smoking is more prevalent in socioeconomically disadvantaged populations in Denmark as well as in most Western countries. Previous school-based programs to prevent smoking have shown contrasting results internationally. In Denmark, previous programs have shown limited or no effect. This indicates a need for developing a well-designed, comprehensive, and multi-component intervention aimed at Danish schools with careful implementation and thorough evaluation.This paper describes X:IT, a study including 1) the development of a 3-year school-based multi-component intervention and 2) the randomized trial investigating the effect of the intervention. The study aims at reducing the prevalence of smoking among 13 to 15-year olds by 25%.

METHODS/DESIGN

The X:IT study is based on the Theory of Triadic Influences. The theory organizes factors influencing adolescent smoking into three streams: cultural environment, social situation, and personal factors. We added a fourth stream, the community aspects. The X:IT program comprises three main components: 1) smoke-free school premises, 2) parental involvement including smoke-free dialogues and smoke-free contracts between students and parents, and 3) a curricular component. The study encompasses process- and effect-evaluations as well as health economic analyses. Ninety-four schools in 17 municipalities were randomly allocated to the intervention (51 schools) or control (43 schools) group. At baseline in September 2010, 4,468 year 7 students were eligible of which 4,167 answered the baseline questionnaire (response rate = 93.3%).

DISCUSSION

The X:IT study is a large, randomized controlled trial evaluating the effect of an intervention, based on components proven to be efficient in other Nordic settings. The X:IT study directs students, their parents, and smoking prevention policies at the schools. These elements have proven to be effective tools in preventing smoking among adolescents. Program implementation is thoroughly evaluated to be able to add to the current knowledge of the importance of implementation. X:IT creates the basis for thorough effect and process evaluation, focusing on various social groups.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN77415416.

A influência dos amigos no consumo de drogas entre adolescentes

Objetivou-se avaliar a relação entre variáveis associadas aos amigos e o uso de álcool, tabaco e drogas ilícitas em 965 adolescentes de 50 escolas públicas de Jacareí e Diadema, São Paulo, Brasil. Foi utilizado o Drug Use Screening Inventory para a coleta de dados. Ter amigos que usam substâncias, que têm problemas com a lei, que roubaram/danificaram algo, que vendem drogas, que levam drogas a festas e que ficam entediados quando não bebem em festas aumentou progressivamente o risco de os adolescentes usarem álcool, tabaco e drogas ilícitas. Esse resultado mostra a importância de se avaliar o consumo dessas substâncias separadamente, já que o consumo concomitante de álcool e de tabaco parece ser mais grave do que o consumo isolado de um deles.

Factors affecting cigarette smoking based on health-belief model structures in pre-university students in Isfahan, Iran

INTRODUCTION

The goal of this study was to determine the association between constructs of the Health Belief Model (HBM) (i.e., perceived susceptibility to health-related problems due to smoking, perceived barriers to non-smoking, perceived benefits of non-smoking, perceived self-efficacy to non-smoking, and cues to action of non-smoking) and cigarette smoking among male pre-college students.

MATERIALS AND METHODS

A cross-sectional survey of 382 pre-college students was conducted in Isfahan, in 2010. The method of sampling was systematic randomized and students were selected from eight schools. The instrument was developed by the researchers based on the Health Belief Model. Statistical analyses were carried out using SPSS.V.18, Chi-square, and independent t-tests.

RESULTS

The mean age of the students was 17.72 ± 0.62 years. Overall 7.2% of the subjects reported having smoked in the past 30 days and 32.7% % of the samples reported ever having smoked in their life time. Results of the t-test showed that there were significant differences in knowledge, perceived susceptibility (P =0.03), benefits (t (246) = -2.51, P =0.01), self-efficacy (P < 0.001), and cues to action (P = 0.007), between smokers and non-smokers.

CONCLUSION

These results suggested that the constructs of HBM can be incorporated when examining the predictors of cigarette smoking and developing smoking prevention programs among pre-college students. Furthermore, with a better understanding of the factors affecting this complex behavior (cigarette smoking), it can be a useful step to reduce the rate of death, costs, and also improve the community health outcomes.

Clarifying the Role of Schools in Tendency or Lack of Tendency Toward Smoking among Teenage Boys (11-14) in Mashhad, Iran

Background:

Recent studies show that the prevalence of tobacco use among teens and students is increasing, and the initiation age of tobacco use has decreased.

Objectives:

The current research aimed to signify the role of schools in the process in which student teenage boys became smokers in 2012 in Mashhad.

Materials and Methods:

The current study was part of a qualitative research conducted by content analysis method and purposive sampling, performing 35 in-depth interviews, and 2 focused group discussions. The participants in this research included teenagers, teachers, students` parents , psychologists, and experts in the field of fighting against tobacco use, those who either had the experience of exposure to cigarettes at school, or were well-informed persons about tobacco use.After performing each interview, the interview was transcribed, and analyzed before the next interview. The data were under continuous consideration and comparative analysis in order to achieve data saturation.

Results:

After analysis and codification of data, four concept categories were achieved to clarify the role of schools in student smoking: 1) School purity or impurity to high-risk behaviors; 2) Directive or nondirective schools for controlling tobacco; 3) Preventive or predisposing schools for smoking behavior, and 4) Perceived positive outcomes from smoking at school. Each main category was divided into three subordinate themes.

Conclusions:

With regard to decrease of cigarette use initiation age and the great influence of schools on teenagers’ behavior, it is recommended to perform special screening programs based on the achieved themes in this research to reduce tobacco use. It is also suggested that school staff pay more attention to students’ communication networks and pressures that are imposed on a student for smoking cigarettes during the school time.

Why do smokers start?

Most studies investigating the reasons for smoking initiation are based on adolescents or young individuals. We considered the issue in a large dataset on the general Italian population. Six population-based surveys on smoking were conducted annually from 2005 to 2010 on representative samples of Italian individuals aged 15 years or over, involving more than 3000 individuals each year. A specific question on the main reason to start smoking was asked to 7469 ever smokers. Overall, 59.9% of ever smokers started smoking before 18 years of age and 33.6% started smoking before 16 years of age. Among ever smokers, 61.1% reported having started smoking because of the influence of friends, 15.6% for enjoyment and satisfaction, 9.0% to feel mature and independent, 6.6% because of the influence of partner/family, 2.5% because of stress, 1.9% to feel more secure and 1.8% for curiosity. The finding that the majority of Italian men and women - particularly those who started smoking at a young age - started smoking because of the influence of friends suggests that antismoking campaigns should consider social influence, resistance and the dimension of self-esteem. An improvement in the legislation prohibiting the purchase of tobacco products by minors aged less than 18 years and a smoking ban in school courtyards are urgently required in Italy.

Smoking experimentation among elementary school students in China: influences from peers, families, and the school environment

The aim of this study was to investigate experimentation with smoking among primary school students in China. Data were acquired from a recent survey of 4,073 students in grades 4 to 6 (ages 9–12) in 11 primary schools of Ningbo City. The questions were adapted from the Global Youth Tobacco Survey (GYTS). Results suggest that although the Chinese Ministry of Education (MOE) encourages smoke-free schools, experimentation with cigarettes remains a serious problem among primary school students in China. Peers, family members, and the school environment play important roles in influencing smoking experimentation among students. Having a friend who smoked, seeing a family member smoke, and observing a teacher smoking on campus predicted a higher risk of experimentation with smoking; the exposure to anti-tobacco materials at school predicted a lower risk of experimentation with smoking. The evidence suggests that public health practitioners and policymakers should seek to ensure the implementation of smoke-free policies and that intervention should target young people, families, and communities to curb the commencement of smoking among children and adolescents in China.

Cigarette smoking, knowledge, attitude and prediction of smoking between male students, teachers and clergymen in tehran, iran, 2009

BACKGROUND

Students, clergymen and teachers as role models can be very important in encouragement or prevention of cigarette smoking in young people. The aim of this study was to compare prevalence of smoking in 3 male groups of teachers, clergymen and university students. Also, study their knowledge and attitude towards it and the prediction of their future consumption.

METHODS

In a cross sectional study in 2009 in Tehran, Iran, 1,271 male students, 549 clergymen and 551 teachers were randomly enrolled. Each participant completed the global adult tobacco survey questionnaire. Knowledge, attitude and prediction of smoking for the next 5 years were questioned in these 3 groups. Chi-squared test and logistic regression were used for analysis. P < 0.05 was considered significant.

RESULTS

Prevalence of cigarette smoking was 31.1%, 21.9% and 27.2% among students, clergymen and teachers, respectively. Smoking in students was not associated with poor knowledge but were in teachers and clergymen. The odds ratio of smoking in students, clergymen and teachers was higher among those with having inappropriate attitude towards it (OR = 1.6, 6.1 and 4.5). Those with poor knowledge had an inappropriate attitude and predicted higher chance of cigarette consumption in the next 5 years (P < 0.0001). Inappropriate attitude in all 3 groups resulted in higher prediction of future smoking (P = 0.008).

CONCLUSIONS

This study revealed that the prevalence of smoking among male students and teachers was higher than general population and clergymen who equally smoked. Also, level of knowledge and attitude of students were lower than teachers and clergymen.

Significant others, knowledge, and belief on smoking as factors associated with tobacco use in italian adolescents

Tobacco use is dramatically increasing among youth. Growing attention has been addressed towards possible predictors of smoking in such a population. We evaluated a sample of Italian adolescents to verify whether adults and peers might influence their smoking status. Cross-sectional study was conducted in 16 schools of North Italy. Data were collected from 2001 to 2010 by means of a self-administered questionnaire on sociodemographic data and individual/social possible predictors of smoking. 2,444 students (56.7% boys; 43.3% girls; mean = 14.32 ± 1.384 years) were analysed. 607 (24.8%) were current smokers; 1,837 (75.2%) were nonsmokers. The presence of smokers in the family, seeing teachers who smoke, the influence of friends, and the feeling of inferiority were predictors of youth smoking as well as unawareness of nicotine dangerous action to health. Running the logistic multivariate analysis with all the variables listed above in the same model, the strongest predictors of smoking were as follows: being unaware that pipe/cigar is harmful to health as cigarettes; not knowing that passive smoking is harmful to the growth of children; having seen teachers smoking. The present findings help to identify the variables that might favour smoking in youth. Such variables should become the target of prevention programs.

Setting a good example? Changes in smoking prevalence among key occupational groups in New Zealand: evidence from the 1981 and 2006 censuses

INTRODUCTION

Role modeling by smokers may influence smoking among children and young adults. Most work on smoking by occupation has focused on health workers. A unique opportunity to explore smoking by occupation is presented in New Zealand (NZ) due to inclusion of a smoking status question in most national censuses since 1976. Our aim was to assess trends in smoking prevalence among potential role model occupational groups in NZ.

METHODS

Adult smoking status by occupation was obtained from the 1981 census (N = 1,321,323) and 2006 census (N = 1,744,479). Subjects were aggregated into 5 broad groups of potential role-model occupations: teachers, uniformed services, health-related occupations, public figures, and sportspeople/entertainers. Age and sex-standardized current smoking prevalences were calculated using the 2006 NZ employed population as the reference standard.

RESULTS

Standardized smoking prevalence among the employed population was 34.5% in 1981 and had declined 37% in relative terms and 12.8% in absolute terms to 21.7% in 2006. Relative declines in smoking prevalence between 1981 and 2006 ranged from 35% to 60% among the role model occupational groups and absolute declines from 8.3% to 19.9%. Māori had higher smoking prevalence and lower relative declines in prevalence in each occupational group from 1981 to 2006, compared with non-Māori. Specific occupations mostly had low smoking prevalences--particularly doctors and teachers. But some role model occupations had high crude smoking prevalences in 2006 (up to 47%).

CONCLUSIONS

Persisting high smoking prevalence among some occupational groups suggest that additional targeted smoking cessation support for role model occupational groups may be justified.

Community-level determinants of tobacco use disparities in lesbian, gay, and bisexual youth: results from a population-based study

OBJECTIVE

To determine whether characteristics of the social environment surrounding lesbian, gay, and bisexual (LGB) youth contribute to their rates of tobacco use after controlling for established community-level risk factors.

DESIGN

Cross-sectional.

SETTING

Population-based study of youth.

PARTICIPANTS

A total of 31,852 eleventh-grade students (1413 LGB individuals [4.44%]) in Oregon completed the Oregon Healthy Teens survey in 2006-2008.

MAIN EXPOSURES

We created a composite index of the social environment in 34 Oregon counties. This measure included the proportion of same-sex couples, the presence of gay-straight alliances in schools, and school policies (nondiscrimination and antibullying) that specifically protected LGB students.

MAIN OUTCOME MEASURES

Any tobacco use in the past 30 days.

RESULTS

A more supportive social environment for LGB youth was significantly associated with reduced tobacco use (odds ratio, 0.92; 95% confidence interval, 0.90-0.94). This effect remained robust after controlling for sociodemographic variables and multiple community-level risk factors for tobacco use, including median county-level income, exposure to cigarette advertisements, exposure to teacher and peer smoking in schools, and school smoking rules.

CONCLUSION

This study documents an association between an objective measure of the social environment and sexual orientation-related disparities in tobacco use. These results highlight the need for structural-level interventions that reduce smoking behaviors in LGB youth.