Why Secondary Schools Do Not Implement Far-Reaching Smoke-Free Policies: Exploring Deep Core, Policy Core, and Secondary Beliefs of School Staff in the Netherlands

Assessing the Policy of Non-Smoking Areas in Schools in Indonesia: A Mixed Methods Study

BACKGROUND

Regulations in the form of Regional Regulations on Non-Smoking Areas are efforts to prevent smoking in schools. We will show qualitatively and quantitatively whether the policy can control smoke-free schools since 2015 in Muaro Jambi Regency. However, the implementation is still not optimal, even almost not implemented following the mandate of government regulation Number 109 of 2012 and regional regulation Number 5 of 2018. This study aims to evaluate the implementation of the smoke-free area policy in schools in Muaro Jambi Regency.

METHOD

Research using mixed method study employing quantitative through distribution survey of smoke-free zones and qualitative by interviewing 31 schools of informants and observing 499 points of educational institutions. Selection of informants by considering the criteria of adequacy and suitability of data analysis with content analysis.

RESULTS

The cause of the non-implementation of the smoke-free area policy is the lack of socialization of local regulations. The regulation of non-smoking area bylaws has not been made, implementing rules with the decree of the law. Schools do not run areas without cigarettes because they do not fully understand the rules, namely that they are not allowed to smoke in all school environments and health facilities. Oversight of the no-smoking area policy has not been carried out due to the lack of policy support from policymakers and sources of funds for monitoring the no-smoking area.

CONCLUSION

No smoking area policy is meaningless if there is neglect in its implementation so that it does not impact the compliance of smoking behavior following the No Smoking Area policy. The need for the commitment of school leaders in implementing and operational rules from the regional regulations in the implementation of smoke-free areas.

Context matters in smoking prevention: evaluating smoke-free school hours in Danish vocational schools

Youth is a crucial period for smoking preventive interventions. School-based interventions targeting the policy level and the sociocultural processes of smoking show promising effects in reducing smoking uptake and prevalence. This study presents findings from the qualitative process evaluation of a smoking preventive intervention, Focus, in the vocational school (VET) setting. Specifically, the study focused on contextual factors affecting the implementation of smoke-free school hours (SFSH). Participant observations and focus groups were conducted in four VETs during the implementation period October-December 2018. The data encompass participant observation field notes (n = 21 school days), student focus groups (n = 8) (aged 16-20), teacher focus groups (n = 5) and semi-structured individual interviews with VET leaders (n = 3). The study found that SFSH was not clearly communicated to students due to the educational structure and chaotic rhythm of the school days, ambivalent attitudes among teachers toward enforcement of smoking rules and lack of clear managerial support. The interplay of these factors counteracted the implementation of SFSH in the VET context. The presented contextual factors are important when interpreting the effectiveness of the Focus intervention and for informing future preventive efforts aiming to reduce smoking among youth in high risk of smoking cigarettes.

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

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

Are Danish vocational schools ready to implement "smoke-free school hours"? A qualitative study informed by the theory of organizational readiness for change

BACKGROUND

The smoking prevalence is high among students enrolled in vocational education and training, which is considered a lower level of education. The school tobacco policy regarding smoke-free school hours stipulates that students and staff are not allowed to smoke during school hours-inside or outside school premises-and it might be an effective intervention for reducing smoking in vocational schools. For school tobacco policies to be effective, they must be appropriately implemented. A primary predictor for successful implementation is organizational readiness for change. This study seeks to identify and understand the barriers to and facilitators for developing organizational readiness to implement smoke-free school hours in Danish vocational schools.

METHODS

Semi-structured interviews and focus groups were carried out with managers and teachers (n = 22 participants) from six vocational schools. The interview guides were informed by "A theory of organizational readiness for change" developed by Weiner, which was also used as a framework to analyze the data.

RESULTS

We identified 13 facilitators and barriers. Nine factors acted as facilitators, including the following: believing that health promotion is a school role and duty; believing that society and workplaces are becoming more smoke-free, and believing that smoke-free school hours is a beneficial strategy to achieve fewer educational interruptions. Additional facilitators include establishing clear rules for sanctioning and enforcement, developing a joint understanding about smoke-free school hours, developing skills to deal with student responses to smoke-free school hours, establishing social alternatives to smoking, offering smoking cessation help, and mandating smoke-free school hours by law. Four organizational norms, practices, or discourses acted as barriers: believing that smoke-free school hours violate personal freedom, believing that students have more important problems than smoking, believing that it is difficult to administer the level of enforcement, and believing that the enforcement of smoke-free school hours negatively influences student-teacher relations.

DISCUSSION

Our results suggest that developing organizational readiness before adopting a comprehensive tobacco policy such as smoke-free school hours is important for successful implementation. Further research should investigate how to strengthen the facilitators for and counter the barriers to developing readiness for implementing smoke-free school hours.

Evaluation of the Implementation of a 25-Year Outdoor School Ground Smoking Ban: A Qualitative Interview Study With Implications for Prevention Practise

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.

Programme theory and realist evaluation of the 'Smoke-Free Vocational Schools' research and intervention project: a study protocol

INTRODUCTION

Smoke-free school hours (SFSHs) entails a smoking ban during school hours and might be an effective intervention to reduce the high smoking prevalence in vocational schools. For SFSH to be effective, the policy must be adequately implemented and enforced; this challenge for schools constitutes a research gap. The 'Smoke-Free Vocational Schools' research and intervention project has been developed to facilitate schools' implementation of SFSH. It is scheduled to run from 2018 to 2022, with SFSH being implemented in 11 Danish vocational schools. This study protocol describes the intervention project and evaluation design of the research and intervention project.

METHODS AND ANALYSIS

The intervention project aims to develop an evidence-based model for implementing SFSH in vocational schools and similar settings. The project is developed in a collaboration between research and practice. Two public health NGOs are responsible for delivering the intervention activities in schools, while the research partner evaluates what works, for whom, and under what circumstances. The intervention lasts one year per school, targeting different socioecological levels. During the first 6 months, activities are delivered to stimulate organisational readiness to implement SFSH. Then, SFSH is established, and during the next 6 months, activities are delivered to stimulate implementation of SFSH into routine practice. The epistemological foundation is realistic evaluation. The evaluation focuses on both implementation and outcomes. Process evaluation will determine the level of implementation and explore what hinders or enables SFSH becoming part of routine practice using qualitative and quantitative methods. Outcomes evaluation will quantitively assess the intervention's effectiveness, with the primary outcome measure being changes in smoking during school hours.

ETHICS AND DISSEMINATION

Informed consent will be obtained from study participants according to the General Data Protection Regulation (GDPR) and Danish data protection law. The study adheres to Danish ethics procedures. Study findings will be disseminated at conferences and further published in open-access peer-reviewed journals.

[The association between school tobacco policies and the perceived smoking prevalence of adolescents]

BACKGROUND

In the German context, there is hardly any quantitative data about the implementation of school tobacco polices that include the perspective of both teachers and students. The aim of the study is to investigate the associations between implemented school tobacco policies and the perceived prevalence of smoking at the level of school staff and adolescents.

METHODS

The repeated cross-sectional study (2013 and 2017) is based on pooled responses of 13- to 17-year-old adolescents (N = 2393) and school staff (N = 85) from 25 schools located in the West German metropolitan region of Hanover. In linear regression models, average marginal effects (AMEs) with 95% confidence intervals (CI95%) and robust standard errors for perceived tobacco prevalence are reported separately for school tobacco policies assessed by teachers and students (scale 0-6). All models were controlled for sociodemographic, school-, and smoking-specific covariates.

RESULTS

On average, adolescents perceive a smoking prevalence of 30% ([Formula: see text]; s: 24.0) for their school. A comprehensive school tobacco policy is consistently associated with lower school smoking prevalence both from the point of view of teachers (AME: -3.54 CI95% -6.49 to -0.58) and students (AME: -1.69 CI95% -2.52 to -0.86). The number of smoking friends (e.g., "most of them are smokers" +14%: AME: 14.13 CI95% 10.46 to 17.80) and the type of school are the most relevant determinants of a high school smoking prevalence. School types with a nonacademic track report a 15% (AME: 15.03 CI95% 10.13 to 19.93) higher prevalence compared to grammar schools.

DISCUSSION

Progressive school tobacco control policies should focus more on school types with nonacademic tracks, certain groups at risk, and those schools that do not strictly enforce school tobacco policies.

Smoke-free school policies in Europe: Challenges for the future

Scholars commonly plea for the development and evaluation of new tobacco control interventions to further decrease smoking and exposure to second-hand smoke. We, in addition, emphasize there is still much that can be done to improve the impact of current tobacco control interventions. This commentary makes a specific case for improving the implementation of smoke-free school policies across Europe.