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Mylocopos G, Wennberg E, Reiter A, Hébert-Losier A, Filion KB, Windle SB, Gore G, O'Loughlin JL, Grad R, Eisenberg MJ. Interventions for Preventing E-Cigarette Use Among Children and Youth: A Systematic Review. Am J Prev Med 2024; 66:351-370. [PMID: 37802308 DOI: 10.1016/j.amepre.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Many nonregulatory interventions targeting children and youth have been implemented at three levels: directed at the individual (e.g., interactive video games), delivered to students at school (e.g., campus bans), and launched in the community (e.g., mass media campaigns). This systematic review aims to synthesize the evidence on the effectiveness of interventions aimed at preventing e-cigarette initiation among children and youth. METHODS MEDLINE, CINAHL, Embase, APA PsycINFO, and Web of Science Core Collection were searched for papers published between January 1, 2004 and September 1, 2022 that reported more than one outcome on vaping prevention among individuals aged less than 21-years-old: vaping prevalence/incidence, initiation intentions, knowledge/attitudes, and other tobacco product use prevalence/initiation intentions. Interventions were at the individual, school, or community level. The risk of bias was assessed using ROBINS-I and RoB 1. RESULTS Thirty-nine publications met the eligibility criteria. Fourteen individually-based (4 parental monitoring, 3 video games, 2 text messages, 3 graphic message themes, 2 healthcare), 19 school-based (14 educational and skill interventions, 5 vape-free policies/bans), and 6 community-based (3 social media, 3 mass media campaigns) interventions were reported. E-cigarette initiation prevention was observed with high perceived parental monitoring; however, the cross-sectional study designs precluded causal claims. There was promising but limited evidence that social-emotional skills curricula and peer leader programming prevented vaping initiation. DISCUSSION Some individual- and school-based interventions showed promise for preventing e-cigarette initiation among children and youth.
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Affiliation(s)
- Genevieve Mylocopos
- Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada; Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Erica Wennberg
- Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anna Reiter
- Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada; Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Andréa Hébert-Losier
- Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Kristian B Filion
- Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada; Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Sarah B Windle
- Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada
| | - Jennifer L O'Loughlin
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Roland Grad
- Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada; Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Mark J Eisenberg
- Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada; Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada.
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Linnansaari A, Schreuders M, Kunst AE, Lindfors P. Facilitating conditions for staff's confidence to enforce school tobacco policies: qualitative analysis from seven European cities. Implement Sci Commun 2022; 3:113. [PMID: 36273225 PMCID: PMC9588223 DOI: 10.1186/s43058-022-00362-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
Abstract
Background School staff members’ consistent enforcement of school tobacco policies (STPs) is needed to decrease adolescent smoking and exposure to tobacco smoke. Staff’s confidence, indicating their perceived ability to cope with students’ negative responses, explains variations in staff’s STPs enforcement, yet understanding of the determinants for confidence is lacking. We analyzed the conditions in which the staff feel confident in addressing students who violate STPs to support staff’s enforcement. Methods Data consists of 81 semi-structured interviews with the staff members from 26 secondary schools in seven European cities in Belgium, Finland, Germany, Ireland, Italy, The Netherlands, and Portugal. In every city, 3–4 staff members (senior management, teachers, supportive staff) in 3–4 schools (academic–vocational, high–low SES area) were interviewed. Transcripts were analyzed with thematic analysis. Results When staff felt confident in their ability to prevent, diminish, or handle students’ negative responses, they were more likely to address students on STP violations. The staff was more confident (1) when consistent policy enforcement within school and regarding the wider society ensured staff legitimacy for STPs enforcement, (2) when dialog and mutual familiarity with students allowed the staff to facilitate constructive interaction with STP violators, and (3) when organizational backup structures provided staff collegial support to overcome challenges in the enforcement. These conditions would support consistent enforcement, especially with persistent misbehavers and among the more uncertain staff members. Conclusions Our study stresses the need to implement strategies at multiple levels to strengthen staff’s confidence for STP enforcement. To support staff’s legitimacy for enforcement, we suggest reinforcing structures and practices that facilitate consistency in STP enforcement; to support staff’s ability for constructive interaction with STP violators, we suggest strengthening staff’s social and emotional learning; and to support staff’s experience of collegial support, we suggest reinforcing staff’s collective ability to cope with students’ negative responses. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00362-7.
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Affiliation(s)
- Anu Linnansaari
- grid.502801.e0000 0001 2314 6254Faculty of Social Sciences, Unit of Health Sciences, Tampere University, P.O. Box 100, 33014 Tampere, Finland
| | - Michael Schreuders
- grid.6906.90000000092621349Department of Public Administration and Sociology, Erasmus School of Behavioral and Social Sciences, Erasmus University Rotterdam, 3000 Rotterdam, DR The Netherlands ,grid.7177.60000000084992262Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Anton E. Kunst
- grid.7177.60000000084992262Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | | | - Pirjo Lindfors
- grid.502801.e0000 0001 2314 6254Faculty of Social Sciences, Unit of Health Sciences, Tampere University, P.O. Box 100, 33014 Tampere, Finland
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Hjort AV, Kuipers MAG, Stage M, Pisinger C, Klinker CD. Intervention Activities Associated with the Implementation of a Comprehensive School Tobacco Policy at Danish Vocational Schools: A Repeated Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12489. [PMID: 36231788 PMCID: PMC9565121 DOI: 10.3390/ijerph191912489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
School tobacco policies are often poorly implemented, which may explain their limited effectiveness. Further, constructs to measure implementation outcomes of school tobacco policies are missing. The Smoke-Free Vocational Schools intervention was designed to stimulate the implementation of a comprehensive school tobacco policy into routine practice. This study (1) developed implementation fidelity outcomes measures for the school tobacco policy and (2) examined associations between intervention activities and implementation fidelity at two time points. We applied a repeated cross-sectional survey study design across seven schools: the first time point was >5 months after the policy was established and the second time point > 14 months after policy establishment. The dependent/outcome variables were four binary fidelity domains as well as a total score across domains. A total of six intervention activities were measured among either students (e.g., new school-break facilities) or staff/managers (e.g., a joint workshop before policy implementation). Associations were analyzed separately for students and staff/managers using generalized linear mixed models, adjusted for confounders. A total of n = 2674 students and n = 871 staff/managers participated. The total implementation fidelity scores increased over time among both students and staff/managers. Three intervention activities were consistently associated with the total implementation fidelity score, including: new school-break facilities (BT1 = 0.08, 95% CI = 0.03; 0.12; BT2 = 0.07, 95% CI = 0.04-0.50), the joint workshop before policy implementation (BT1 = 0.13, 95% CI = 0.02; 0.25; BT2 = 0.13, 95% CI = 0.004; 0.24), and internalization of fixed procedures for enforcement (BT1 = 0.19, 95% CI = 0.13-0.26; BT2 = 0.16, 95% CI = 0.13-0.26). These findings can be applied by schools and other actors in practice. The developed implementation fidelity outcomes measures can be applied in future research on school tobacco policies.
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Affiliation(s)
- Anneke Vang Hjort
- Health Promotion Research, Steno Diabetes Center Copenhagen—Copenhagen University Hospital, 2730 Herlev, Denmark
- National Institute of Public Health, University of Southern Denmark, 5230 Odense, Denmark
| | - Mirte A. G. Kuipers
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Health Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, 1081 BT Amsterdam, The Netherlands
| | - Maria Stage
- The Danish Cancer Society, 2100 Copenhagen, Denmark
| | - Charlotta Pisinger
- Center for Clinical Research and Prevention, Capital Region, 2000 Frederiksberg, Denmark
- The Danish Heart Foundation, 1120 Copenhagen, Denmark
| | - Charlotte Demant Klinker
- Health Promotion Research, Steno Diabetes Center Copenhagen—Copenhagen University Hospital, 2730 Herlev, Denmark
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Longitudinal Associations of Substance Use Risk Profiles with the Use of Alternative Tobacco Products and Conventional Smoking among Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413248. [PMID: 34948856 PMCID: PMC8701906 DOI: 10.3390/ijerph182413248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 11/16/2022]
Abstract
Although personality is associated with the onset of substance use (i.e., conventional smoking, alcohol use, and cannabis use) during adolescence, it is unclear whether personality traits are also associated with the onset of use of alternative tobacco products (ATPs), i.e., electronic cigarettes, shisha-pens, and water pipes. This study examines whether personality traits are associated with the onset of use of both conventional cigarettes and ATPs. Longitudinal data (baseline and 18-month follow-up) were used. The sample consisted of 1114 non-user adolescents (mean age = 13.36, SD = 0.93, 56% female) at baseline. To measure personality traits, the Substance Use Risk Profile Scale was used with four subscales: anxiety sensitivity, hopelessness, sensation seeking, and impulsivity. Structural equation models were conducted using Mplus 7.3. Results showed that both hopelessness and sensation seeking were associated with the onset of use of e-cigarettes and conventional cigarettes. Further, sensation seeking and impulsivity were associated with the onset of use of shisha-pens and water pipes. In conclusion, to prevent adolescents from using ATPs and/or conventional cigarettes, it is important to take their personality traits into account. More research on other (shared) risk factors and on more advanced stages of ATP use is needed before effective prevention strategies can be developed.
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Mathijssen J, Rozema A, Hiemstra M, Jansen M, van Oers J. Stability of and change in substance use risk personality: Gender differences and smoking cigarettes among early adolescents. Addict Behav Rep 2021; 14:100360. [PMID: 34159249 PMCID: PMC8196044 DOI: 10.1016/j.abrep.2021.100360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 03/17/2021] [Accepted: 06/01/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Adolescents show a steadily increasing inclination toward health risk behaviors, including smoking cigarettes. There is ample evidence that personality traits are related to smoking behavior. However, less is known about the stability of and change in these personality traits during early adolescence and whether smoking behavior affects the developmental trajectories. Moreover, less is known about the influence of gender on the course of personality. METHOD Longitudinal data of three waves were used from 1121 early adolescents. To measure personality, the Substance Use Risk Profile Scale was used. Individual growth curve models were conducted to measure the stability, mean-level change and individual differences in change for personality. RESULTS Stability of personality was moderate for boys and ranged from moderate to high for girls. On average early adolescents became more impulsive and more sensation seeking over a period of 18 months. Furthermore, hopelessness for girls increased and the increase in sensation seeking was higher for girls than for boys. Third, smoking behavior was related to all personality traits, indicating that smoking adolescents are more anxious, hopeless, impulsive and sensation seeking than non-smoking adolescents. CONCLUSIONS Our results are in line with the disruption hypothesis, i.e., during early adolescence there is a dip in personality maturity. There are clear differences between girls and boys in stability of and change in personality traits. Besides, although smoking behavior is related to personality, the change in personality is probably related to other variables.
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Affiliation(s)
- J.J.P Mathijssen
- Tilburg School of Social and Behavioral Sciences, Department Tranzo, Tilburg University, the Netherlands
| | - A.D. Rozema
- Tilburg School of Social and Behavioral Sciences, Department Tranzo, Tilburg University, the Netherlands
| | - M. Hiemstra
- Tilburg School of Social and Behavioral Sciences, Department Tranzo, Tilburg University, the Netherlands
| | - M.W.J. Jansen
- Academic Collaborative Centre for Public Health Limburg, Public Health Service South Limburg (GGD ZL), Heerlen, the Netherlands
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - J.A.M. van Oers
- Tilburg School of Social and Behavioral Sciences, Department Tranzo, Tilburg University, the Netherlands
- Ministry of Health and Welfare, Den Haag, the Netherlands
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Garritsen HH, da Costa Senior YY, Rozema AD, Kunst AE, Kuipers MAG. Association between smoke-free legislation in hospitality venues and smoking behavior of young people: a systematic review. Nicotine Tob Res 2021; 24:807-812. [PMID: 34132801 DOI: 10.1093/ntr/ntab129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 06/15/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION While evaluations of indoor smoke-free legislation have demonstrated major public health benefits among adults, their impact on smoking behavior of young people remains unclear. Therefore, we performed a systematic review of the association between smoke-free legislation in hospitality venues and smoking behavior of young people. METHODS A systematic search was conducted in PubMed, Scopus, and Embase in June 2020. We searched for studies that assessed the association of any form of smoke-free legislation in any hospitality venue (e.g. bar, restaurant) with a smoking behavior outcome (e.g. initiation, current smoking) among young people (aged 10-24 years). RESULTS Our search yielded 572 articles of which 31 were screened based on full-text and 9 were included in the analysis. All studies were published between 2005 and 2016. The majority of studies used a quasi-experimental design. Four studies evaluated smoke-free legislation in hospitality venues specifically. Two studies reported that comprehensive, but not weaker, smoke-free legislation decrease progression to established smoking. Two other studies provided mixed results on which level of comprehensiveness of legislation would be effective, and which smoking outcomes would be affected. Five studies evaluated legislation that also included other workplaces. Out of these five studies, three studies found significant decreases in current smoking, smoking frequency, and/or smoking quantity, while two other studies did not. CONCLUSION Most studies found that smoke-free legislation in hospitality venues is associated with a decrease in smoking behavior among young people. Their results indicate the need for comprehensive smoke-free legislation without exemptions. IMPLICATIONS This is the first systematic review to provide insight in the relationship between smoke-free legislation in hospitality venues and smoking behavior of young people. Our findings show that there is a need for comprehensive smoke-free legislation without exemptions (such as designated smoking areas).
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Affiliation(s)
- Heike H Garritsen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Yoël Y da Costa Senior
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Andrea D Rozema
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Anton E Kunst
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mirte A G Kuipers
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Kvillemo P, Feltmann K, Elgán TH, Gripenberg J. Evaluation of the Implementation of a 25-Year Outdoor School Ground Smoking Ban: A Qualitative Interview Study With Implications for Prevention Practise. Front Public Health 2021; 9:628748. [PMID: 33869127 PMCID: PMC8046920 DOI: 10.3389/fpubh.2021.628748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/03/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: Tobacco use, often initiated in younger ages, is a serious health challenge worldwide. In Sweden, smoking has been prohibited on school grounds since 1994. Municipal environmental and health inspectors control the compliance of the ban. Nevertheless, the enforcement and maintenance of the ban are inadequate. The aim of the current study was to identify facilitators, barriers, and the potential for improved implementation of a 25-year outdoor school ground smoking ban in upper secondary schools. Materials and Methods: A process evaluation was conducted using semi-structured interviews with principals in upper secondary schools, local environmental and health inspectors, and local politicians (n = 30) in Stockholm County, with purposive sampling for informant recruitment. A qualitative content analysis of the transcribed interviews was performed. Results: Three main categories and 10 subcategories were generated from the interviews, revealing facilitators, barriers, and the potential for improvement of the implementation of the ban. A prominent facilitator of the ban was informed and engaged principals and inspectors. Prominent barriers were conflicting goals governing the schools, which reduce staffs' motivation to maintain the ban, unclear school ground boundaries, and lack of resources. Potential for improvement was found in a new tobacco act with an extended ban on smoking at school entrances, extended support for schools and staff to strictly enforce the ban, and a continued denormalisation of smoking in society. Conclusion: To achieve effective implementation of outdoor school ground smoking bans in upper secondary schools, authorities need to address conflicts between different goals governing the schools and give necessary support to the staff to strictly enforce the ban. Policies on smoke-free working hours in the municipalities along with tobacco restrictive policies in the surrounding society may increase the possibility to maintain the smoking ban in upper secondary school grounds.
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Affiliation(s)
- Pia Kvillemo
- Stockholm Prevents Alcohol and Drug Problems, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kristin Feltmann
- Stockholm Prevents Alcohol and Drug Problems, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Tobias H Elgán
- Stockholm Prevents Alcohol and Drug Problems, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Johanna Gripenberg
- Stockholm Prevents Alcohol and Drug Problems, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Babaie J, Ahmadi A, Abdollahi G, Doshmangir L. Preventing and controlling water pipe smoking: a systematic review of management interventions. BMC Public Health 2021; 21:344. [PMID: 33632181 PMCID: PMC7908788 DOI: 10.1186/s12889-021-10306-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/21/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Water pipe smoking (WPS) is re-gaining widespread use and popularity among various groups of people, especially adolescents. Despite different adverse health effects of WPS, many of the WPS interventions have failed to control this type of tobacco smoking. This study was conducted to identify experienced management interventions in preventing and controlling WPS worldwide. METHODS A systematic literature review was conducted. Electronic databases were searched for recordes which were published from beginning 1990 to August 2018. Studies aiming at evaluating, at least, one intervention in preventing and controlling WPS were included in this review, followed by performing the quality assessment and data extraction of eligible studies by two independent investigators. Finally, interventions that were identified from the content analysis process were discussed and classified into relevant categories. RESULTS After deleting duplications, 2228 out of 4343 retrieved records remained and 38 studies were selected as the main corpus of the present study. Then, the identified 27 interventions were grouped into four main categories including preventive (5, 18.51%) and control (8, 29.62%) interventions, as well as the enactment and implementation of legislations and policies for controlling WPS at national (7, 25.92%) and international (7, 25.92%) levels. CONCLUSION The current enforced legislations for preventing and controlling WPS are not supported by rigorous evidence. Informed school-based interventions, especially among adolescents can lead to promising results in preventing and controlling WPS and decreasing the effects of this important social and health crisis in the global arena.
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Affiliation(s)
- Javad Babaie
- Department of Health Policy& Management, Tabriz Health Services Management Research Centre, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ayat Ahmadi
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Abdollahi
- Department of Health Policy& Management, Tabriz Health Services Management Research Centre, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Doshmangir
- Department of Health Policy& Management, Tabriz Health Services Management Research Centre, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Garritsen HH, Rozema AD, Am van de Goor I, Kunst AE. Implementation of an outdoor smoke-free policy at sports clubs: Critical situations and determinants influencing implementation. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:103129. [PMID: 33486332 DOI: 10.1016/j.drugpo.2021.103129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/21/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Outdoor smoke-free policies (SFPs) at sports clubs have significant potential to reduce adolescent smoking. However, the realization of this potential may be strongly dependent on how these policies are implemented in practice. The aim of this study is to explore the perceptions of key stakeholders at different sports clubs in the Netherlands concerning how outdoor SFPs are implemented in practice and which determinants influence implementation. METHODS Semi-structured interviews were held with 46 key stakeholders at eight Dutch sports clubs (i.e., field hockey, soccer, tennis, korfball) with an outdoor SFP. A thematic approach was used for the analysis of the transcripts. RESULTS Overall, respondents perceived the implementation of an outdoor SFP at sports clubs as feasible. The SFP is often enforced, people who smoke react positively when they are approached, the SFP has led to less (visible) smoking at the venue, and a nonsmoking norm is reinforced. However, we identified three 'critical situations' in which implementation is less than optimal: 1) when children are not present at the sports club, 2) when alcohol is involved, and 3) when people who smoke relocate to the entrance of the sports club. Several determinants influenced implementation in those critical situations: 1) determinants related to individual smokers and club members (i.e., support, communication towards people who smoke), 2) determinants related to the SFP itself (i.e., clarity of the policy), 3) determinants related to the sports club (i.e., communication of the policy, characteristics of the sports club), and 4) determinants related to the wider community (i.e., change of social norm with regard to smoking, support from local and national organizations). CONCLUSION Implementation of an outdoor SFP at sports clubs is feasible because there is a high level of support and experiences are mainly positive. Nevertheless, some situations present challenges to compliance and enforcement. We identified a number of determinants that may facilitate implementation of an outdoor SFP at sports clubs.
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Affiliation(s)
- Heike H Garritsen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Andrea D Rozema
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Ien Am van de Goor
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Anton E Kunst
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Mélard N, Grard A, Robert PO, Kuipers MAG, Schreuders M, Rimpelä AH, Leão T, Hoffmann L, Richter M, Kunst AE, Lorant V. School tobacco policies and adolescent smoking in six European cities in 2013 and 2016: A school-level longitudinal study. Prev Med 2020; 138:106142. [PMID: 32450162 DOI: 10.1016/j.ypmed.2020.106142] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/19/2022]
Abstract
Assessment of the effectiveness of school tobacco policies (STPs) in reducing adolescent smoking remains inconclusive. Previous studies took insufficient account of different dimensions of STPs, the different views of students and staff, and policy changes over time. This study assessed how a multidimensional STP, as perceived by students and staff, was associated with adolescent smoking over time in six European cities. The SILNE and SILNE-R surveys were conducted among students (n = 18,502) and staff (n = 438) in 38 schools in 2013 and 2016. Three dimensions (comprehensiveness, enforcement, and communication) were assessed and we calculated total STP scores. Multilevel logistic regressions estimated associations of STPs with adolescent smoking on and just outside school premises and with weekly smoking. Further analyses estimated associations between 2013 and 2016 STP changes and smoking outcomes in 2016, controlling for STP and smoking prevalence in 2013. On average, there were few increases in STP scores over time. Greater STP enforcement, as perceived by students, was associated with lower odds of weekly smoking (OR:0.93, 95%CI:0.89-0.97) and of smoking on school premises (OR:0.80, 95%CI:0.72-0.90). Higher total STP scores were associated with lower odds of smoking on school premises (OR:0.76, 95%CI:0.67-0.86), but not of smoking just outside premises or smoking weekly. Greater increases in STP scores over time were associated with lower odds of smoking on school premises in 2016 (OR:0.65, 95%CI:0.47-0.89). Well-enforced STPs may help reduce adolescent smoking at school. Schools should be supported in adopting comprehensive policies that also extend to the surroundings of their premises.
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Affiliation(s)
- Nora Mélard
- Institute of Health and Society (IRSS), Université catholique de Louvain, Belgium.
| | - Adeline Grard
- Institute of Health and Society (IRSS), Université catholique de Louvain, Belgium
| | | | - Mirte A G Kuipers
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Michael Schreuders
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Arja H Rimpelä
- Faculty of Social Sciences (SOC), Unit of Health Sciences, Tampere University, Finland; Tampere University Hospital, Department of Adolescent Psychiatry, Nokia. Finland
| | - Teresa Leão
- EpiUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Laura Hoffmann
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-, Wittenberg, Germany
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-, Wittenberg, Germany
| | - Anton E Kunst
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Vincent Lorant
- Institute of Health and Society (IRSS), Université catholique de Louvain, Belgium
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Andersen S, Pisinger V, Rod MH, Tolstrup J. Associations of school tobacco policies and legislation with youth smoking: a cross-sectional study of Danish vocational high schools. BMJ Open 2019; 9:e028357. [PMID: 31345969 PMCID: PMC6661684 DOI: 10.1136/bmjopen-2018-028357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In vocational high schools, the prevalence of smoking is high (nearly 40% daily smoking in Danish vocational high schools). Schools are increasingly adopting school tobacco policies (STPs) and a national law on smoke-free school grounds has been implemented. Our objective was to explore the extent of STPs in vocational schools and examine the association of STPs and smoke-free school grounds legislation with student smoking. METHODS We used data from the cross-sectional Danish National Youth Study 2014, including 5013 vocational high school students (76% male) at 40 campuses. Implementation of STPs was measured by questionnaires to principals and field observations of smoking practices were conducted. Logistic regression models assessed whether STP characteristics were associated with students' current smoking (ie, daily and occasional) compared with non-current smoking. Negative binominal regression models assessed cigarettes per day among daily smokers. RESULTS Schools covered by the national law on smoke-free school ground had more comprehensive STPs than schools not covered by the law. Student smoking was observed on 78% of campuses, with less visibility of smoking in schools covered by the national law (69% vs 83%). Current smoking was lower for students attending a school covered by the national law (OR=0.86, 95% CI 0.75 to 0.97). Students who attended schools that allowed teacher-student smoking were more likely to smoke (OR=1.13, 95% CI 1.01 to 1.27). CONCLUSIONS A law on smoke-free school grounds was associated with less current smoking in vocational high schools, while school norms that are supportive of teacher-student smoking were associated with greater odds of current smoking. Visibility of student smoking was less prevalent at schools covered by the law on smoke-free school grounds; nevertheless, the visibility of smoking was high. Better enforcement or an extension of the current law on smoke-free school grounds is recommended.
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Affiliation(s)
- Susan Andersen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Veronica Pisinger
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Morten Hulvej Rod
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Janne Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Why Are New Tobacco Control Interventions Needed? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040658. [PMID: 29614798 PMCID: PMC5923700 DOI: 10.3390/ijerph15040658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/17/2022]
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