The Association Between School Tobacco Control Policies and Youth Smoking Behavior

BACKGROUND

While U.S. tobacco control policy has focused mainly on tobacco excise taxes, product advertising bans, and state tobacco control policies such as indoor/outdoor smoking bans, little attention has been paid to school tobacco control policies and their impact on youth smoking behavior. Thus, the objective of this study is to examine the impact of school tobacco control policies on smoking behavior among teenagers and young adults in the USA.

METHODS

Using logistic regression approach, this study examines the effect of school tobacco control policies on individuals ever trying smoking and ever being a regular smoker using data from waves I, II, and III of the National Longitudinal Study of Adolescent Health.

RESULTS

Findings indicate that school tobacco control policies targeting both students and employees of the school are associated with a reduced odds of smoking initiation among youth, but do not have much effect on youth becoming regular smokers.

CONCLUSIONS

If implemented properly, school tobacco control policies could play a vital role in preventing youth smoking and help reduce youth smoking rates in the country, addressing a key public health issue.

Results of outdoor smoking bans at secondary schools on adolescents smoking behaviour: a quasi-experimental study

BACKGROUND

Research on the effectiveness of school smoking policies on adolescents' smoking behaviour remain inconclusive. This study evaluates the results of an outdoor school ground smoking ban at secondary schools on adolescents smoking behaviour, taking individual characteristics into account.

METHODS

Data on 2684 adolescents from 18 Dutch secondary schools (nine with and nine without an outdoor smoking ban) were obtained at two moments. Associations between outdoor school ground smoking bans, individual characteristics, and smoking prevalence and frequency were measured. Multilevel logistic regression analyses were used. At schools with a ban implementation fidelity was checked.

RESULTS

Although smoking prevalence and frequency appeared to make a slower increase at schools with an outdoor smoking ban compared with schools without an outdoor smoking ban, the differences were not significant. Differences between schools in the prevalence of smoking behaviour of students could mainly be explained by individual characteristics. Smoking prevalence and frequency were higher among adolescents with a positive attitude towards smoking and when significant others were more positive about smoking. Smoking prevalence and frequency were significantly lower when adolescents perceived it as easy not to smoke. Implementation fidelity was good at schools with a ban.

CONCLUSIONS

No short-term effects were found of an outdoor smoking ban. A longer follow-up time than 6 months is needed. In addition, future research should investigate effectiveness in relation to the enforcement of the ban, comprehensiveness of the ban and when it is prohibited to leave school grounds, as smoking behavior might be transferred off school grounds.

Predictors of the occurrence of smoking discontinuation in novice adolescent smokers

BACKGROUND

While long-term cessation is an outcome of interest in adult smokers, little is known about discontinuing smoking in adolescent smokers. The objective was to identify the predictors of the occurrence of smoking discontinuation in novice smokers.

METHODS

Data were available for 620 adolescent smokers participating in a longitudinal study on the natural course of nicotine dependence. Data on smoking discontinuation (i.e., stopping smoking for ≥12 consecutive months) were collected in 20 cycles over five years from grade 7 to 11 (1999-2005). Data on 37 potential predictors representing a wide range of demographic, psychosocial, health, lifestyle, smoking-related, and context-related characteristics were collected once, 2 to 3 times, or 20 times. Pooled logistic regression was used to test the association between each potential predictor and smoking discontinuation, adjusting for potential confounders.

RESULTS

Forty percent of 620 participants discontinued smoking during follow up. Male sex [OR (95% confidence interval), 1.8 (1.3-2.4)], age [1.3 (1.1-1.5)], cigarette package warnings [0.6 (0.5-0.9)], team sports participation [1.4 (1.1-1.9)], family stress [0.7 (0.6-1.0)], worrying about weight [0.6 (0.5-0.9)], overweight [0.7 (0.5-1.0)], illicit drugs use [0.5 (0.4-0.7)], tolerance [0.6 (0.4-1.0)], and other nicotine dependence symptoms [1.0 (0.9-1.0)] were statistically significantly associated with smoking discontinuation.

CONCLUSIONS

Both individual and context-level factors were associated with smoking discontinuation.

IMPACT

Programs and policy targeting novice adolescent smokers may be more effective if factors associated with long-term smoking discontinuation are taken into consideration. In particular, young smokers may need help with dependence symptoms, body weight issues, family functioning, and polysubstance use. Cigarette package warnings may be effective in helping adolescents discontinue smoking. Cancer Epidemiol Biomarkers Prev; 23(6); 1090-101. ©2014 AACR.

Widening educational inequalities in adolescent smoking following national tobacco control policies in the Netherlands in 2003: a time-series analysis

BACKGROUND AND AIMS

In 2003, the Netherlands introduced tobacco control policies, including bans on tobacco sales to minors, advertising and sponsoring and tobacco sales in government institutions. We examined the extent to which these policies were associated with a change in educational inequalities in adolescent smoking.

DESIGN

Repeated cross-sectional survey.

SETTING

The Netherlands, 1992-2011.

PARTICIPANTS

A total of 43 527 14-19-year-old adolescents.

MEASUREMENTS

Data were obtained from the national Youth Smoking Monitor. We used logistic regression analyses to model the immediate change in daily smoking prevalence in 2003, the trends and the changes in trends. Models included interactions between educational level (high versus low, based on the educational track of the respondent) and, respectively, period (after versus before 2003), time and time × period.

FINDINGS

Before 2003 the smoking trend declined slightly, and the decline was comparable for students of both high and low educational levels. Immediately after tobacco policies were introduced, daily smoking prevalence dropped for the total population [regression coefficient (β) = -0.340, 95% confidence interval (CI) = -0.445; -0.236]. This drop was larger for high educational level compared to low educational level (β interaction = -0.400, 95% CI = -0.623; -0.176). After 2003, trends in educational inequalities in smoking stabilized.

CONCLUSIONS

Following the introduction of new tobacco control policies in the Netherlands in 2003, smoking prevalence rates decreased among adolescents of both higher and lower educational levels. However, socio-economic inequalities in adolescent smoking increased.

A systematic review of store audit methods for assessing tobacco marketing and products at the point of sale

OBJECTIVE

Over four-fifths of reported expenditures for marketing tobacco products occur at the retail point of sale (POS). To date, no systematic review has synthesised the methods used for surveillance of POS marketing. This review sought to describe the audit objectives, methods and measures used to study retail tobacco environments.

METHODS

We systematically searched 11 academic databases for papers indexed on or before 14 March 2012, identifying 2906 papers. Two coders independently reviewed each abstract or full text to identify papers with the following criteria: (1) data collectors visited and assessed (2) retail environments using (3) a data collection instrument for (4) tobacco products or marketing. We excluded papers where limited measures of products and/or marketing were incidental. Two abstractors independently coded included papers for research aims, locale, methods, measures used and measurement properties. We calculated descriptive statistics regarding the use of four P's of marketing (product, price, placement, promotion) and for measures of study design, sampling strategy and sample size.

RESULTS

We identified 88 store audit studies. Most studies focus on enumerating the number of signs or other promotions. Several strengths, particularly in sampling, are noted, but substantial improvements are indicated in the reporting of reliability, validity and audit procedures.

CONCLUSIONS

Audits of POS tobacco marketing have made important contributions to understanding industry behaviour, the uses of marketing and resulting health behaviours. Increased emphasis on standardisation and the use of theory are needed in the field. We propose key components of audit methodology that should be routinely reported.

Smoking initiation associated with specific periods in the life course from birth to young adulthood: data from the National Longitudinal Survey of Youth 1997

OBJECTIVES

Guided by the life-course perspective, we examined whether there were subgroups with different likelihood curves of smoking onset associated with specific developmental periods.

METHODS

Using 12 waves of panel data from 4088 participants in the National Longitudinal Survey of Youth 1997, we detected subgroups with distinctive risk patterns by employing developmental trajectory modeling analysis.

RESULTS

From birth to age 29 years, 72% of female and 74% of US males initiated smoking. We detected 4 exclusive groups with distinctive risk patterns for both genders: the Pre-Teen Risk Group initiated smoking by age 12 years, the Teenage Risk Group initiated smoking by age 18 years, the Young Adult Risk Group initiated smoking by age 25 years, and the Low Risk Group experienced little or no risk over time. Groups differed on several etiological and outcome variables.

CONCLUSIONS

The process of smoking initiation from birth to young adulthood is nonhomogeneous, with distinct subgroups whose risk of smoking onset is linked to specific stages in the life course.

Incidence and determinants of cigarette smoking initiation in young adults

PURPOSE

To describe the incidence and identify predictors of smoking initiation in young adults.

METHODS

Data were collected in self-report questionnaires in 22 cycles over 13 years in a prospective cohort investigation of 1,293 students recruited in 1999-2000 from all grade 7 classes in a convenience sample of 10 high schools in Montreal, Canada. Participants were 12.7 years of age on average at cohort inception and 24.0 years of age in cycle 22. Independent predictors of smoking initiation in young adulthood (post-high school) were identified in multivariable logistic regression analysis using generalized estimating equations.

RESULTS

Of 1,293 participants, 75% initiated smoking by cycle 22. Of these, 44%, 43%, and 14% initiated before high school, during high school, and in the 6 years after high school, respectively. The incidence density rate of initiation was .33, .13, .14, .11, and .12 initiation events per person-year in grade 7, 8, 9, 10, and 11, respectively, and .05 post-high school. Independent predictors of smoking initiation in young adults included alcohol use, higher impulsivity, and poor academic performance.

CONCLUSIONS

A total of 14% of smokers who initiated smoking before age 24 years did so after high school. The predictors of initiation in young adults may provide direction for relevant preventive interventions.