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Schreuders M, Linnansaari A, Lindfors P, van den Putte B, Kunst AE. Why staff at European schools abstain from enforcing smoke-free policies on persistent violators. Health Promot Int 2021; 35:1106-1115. [PMID: 31652317 PMCID: PMC7585527 DOI: 10.1093/heapro/daz111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Michael Schreuders
- Department of Public Health, Amsterdam Public Health Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anu Linnansaari
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland
| | - Pirjo Lindfors
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland
| | - Bas van den Putte
- Department of Communication, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam Public Health 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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Schreuders M, Nuyts PA, van den Putte B, Kunst AE. Understanding the impact of school tobacco policies on adolescent smoking behaviour: A realist review. Soc Sci Med 2017; 183:19-27. [DOI: 10.1016/j.socscimed.2017.04.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 04/03/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
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Risk factors for adolescent smoking: parental smoking and the mediating role of nicotine dependence. Drug Alcohol Depend 2012; 124:311-8. [PMID: 22365898 PMCID: PMC3372645 DOI: 10.1016/j.drugalcdep.2012.02.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 01/12/2012] [Accepted: 02/01/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Parental smoking and early-emerging nicotine dependence symptoms are well-documented risk factors for adolescent smoking. However, very little is known about the mediating pathways through which these risk factors may act, or whether parental smoking may cause or signal early-emerging nicotine dependence symptoms. METHODS Data were drawn from the longitudinal Social and Emotional Contexts of Adolescent Smoking Patterns Study. Adolescents who had smoked under 100 cigarettes in their lifetime (n=594; low-exposure group) and adolescents who had smoked over 100 cigarettes, but fewer than 5 cigarettes per day (n=152) were included in the analyses. Path analysis was performed on longitudinal data to investigate the association between parental smoking and smoking frequency at the 48 months follow-up, both directly and through mediating variables of smoking frequency, smoking quantity, and nicotine dependence. RESULTS Father's smoking was associated with higher adolescent nicotine dependence scores at the baseline assessment wave. Structural equation modeling revealed that mother's smoking at baseline was associated with adolescent's smoking frequency at the 48-month follow-up, and its effect was partially mediated by both smoking frequency and nicotine dependence among low-exposure adolescent smokers. CONCLUSIONS Parental smoking is a risk factor for future smoking in low-exposure adolescent smokers, above and beyond the risks posed by smoking behavior and nicotine dependence. Moreover, parental smoking is associated with early-onset nicotine dependence in low-exposure adolescent smokers. As an easily measureable risk factor, parent smoking status can be used to identify and intervene with novice adolescent smokers who are at high risk for chronic smoking behavior.
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Schepis TS, Rao U. Smoking cessation for adolescents: a review of pharmacological and psychosocial treatments. ACTA ACUST UNITED AC 2009; 1:142-55. [PMID: 19630713 DOI: 10.2174/1874473710801020142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Unlike the vast literature on smoking cessation in adults, research in adolescents has gained significant attention only within the last decade. Even with this increase in focus, research into pharmacological aids for smoking cessation in adolescents (e.g., nicotine replacement therapy, bupropion) is a more recent phenomenon and has produced only modest results. While more extensive, much of the research on behaviorally- or psychosocially-based adolescent smoking cessation interventions has been limited by a lack of control for contact time, biochemical verification of self-reported abstinence, and/or a theoretical focus for the interventions. The MEDLINE, PubMed, PSYCInfo, EMBASE, ERIC, CINHAL, Cochrane CENTRAL and Systematic Review databases were searched for articles relevant to adolescent smoking cessation treatment. After briefly examining the adolescent smoking cessation research prior to 2000, more recent developments in pharmacological aids and psychological treatment will be reviewed. Investigations have made progress in elucidating efficacious treatments for adolescent smokers, but much work remains to be done in both pharmacological and non-pharmacological areas of treatment. With the current state of the literature as a guide, future directions for research into smoking cessation for adolescents will be proposed.
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Affiliation(s)
- Ty S Schepis
- Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9101, USA
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Lu CC, Lin HH, Chen CJ, Huang CL. Psychometric testing of the Chinese version of the Dimensions of Tobacco Dependence Scale. J Clin Nurs 2009; 18:2470-7. [PMID: 19619205 DOI: 10.1111/j.1365-2702.2009.02827.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS This paper reports on a study to establish the psychometric properties of the Chinese version of the dimensions of Tobacco Dependence Scale as these apply in Taiwan. BACKGROUND The instruments for measuring cigarette dependence among adolescent smokers are not available in Taiwan. Therefore, it has not so far been possible to assess such dependence. DESIGN Survey. METHOD A sample comprising 293 adolescent smokers was recruited. They were drawn from nine senior high schools in middle and southern Taiwan. The Dimensions of Tobacco Dependence Scale and the Fagerstrom Test of nicotine dependence were administered, with saliva being subjected to salivary cotinine analysis using competitive enzyme immunoassay kits. RESULTS The internal structure of the Dimensions of Tobacco Dependence Scale (DTDS) was first examined using exploratory factor analysis with promax rotation. By applying the parallel test as the means of selection, four criteria emerged from the factor analysis that accounted for 47.7% of the variance. Concerning criterion validity, the DTDS was found to have a positive and significant association with the Fagerstrom test of nicotine dependence scores (r = 0.58; p < 0.01) and with saliva cotinine levels (r = 0.30; p < 0.01). Cronbach's alpha values for the DTDS were 0.94. CONCLUSIONS The study confirmed that the Chinese version of the DTDS is similar to the English version in that it is multidimensional and has consistent factor structures. And, as a result of the study, it was established that the Chinese version of the Dimensions of Tobacco Dependence Scale is a reliable and valid measure of tobacco dependence among adolescents in Taiwan. RELEVANCE TO CLINICAL PRACTICE The DTDS can provide health professionals with a reference measure for assessing adolescents' tobacco dependence when applied in the context of a smoking cessation programme.
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Affiliation(s)
- Chia-Chen Lu
- Department of Family Medicine, Changhua Christian Hospital Erlin Branch, 396 Sec. 1, Chang Jung Road, Kway Jen, Tainan 71101, Taiwan.
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Stolberg VB. Lack of Gender Differences in Lifetime Substance Use Reported Among African-American Urban Community College Students. J Ethn Subst Abuse 2009; 8:70-98. [DOI: 10.1080/15332640802683466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
The purpose of this study was to examine coping strategies used by teens as they attempted to quit smoking. The teens were attending a school-based cessation program titled Quit 2 Win that was offered in four high schools. This study examined situations in which teens were tempted to smoke. The study compares coping strategies teens reported in resisting smoking with situations where they reported lapsing. Participants were interviewed the week of their quit date and asked about their state of mind, the availability of cigarettes, and coping strategies used to resist smoking. By identifying coping strategies, school nurses can develop new interventions for teen smoking cessation.
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Affiliation(s)
- Laura Jannone
- Monmouth University, Marjorie K. Unterberg School of Nursing, NJ, USA
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Prokhorov AV, Hudmon KS, Cinciripini PM, Marani S. "Withdrawal symptoms" in adolescents: a comparison of former smokers and never-smokers. Nicotine Tob Res 2006; 7:909-13. [PMID: 16298726 DOI: 10.1080/14622200500266114] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Since the early 1980s, investigators have been reporting that adolescent smokers felt "dependent" on cigarettes and that adolescents trying to quit smoking experienced the same withdrawal symptoms observed in adult quitters, including restlessness, insomnia, increased appetite and weight gain, irritability or anger, depression, craving for cigarettes, and trouble concentrating. We hypothesized that most of these symptoms might be attributed to adolescence itself. To investigate this hypothesis, we examined the prevalence of these seven "adult" withdrawal symptoms in a population of adolescent former smokers and never-smokers. Participants were high school students in Houston, Texas, participating in a nested, group-randomized control group study designed to estimate the impact of a CD-ROM intervention for smoking prevention and cessation. We measured differences in symptoms frequency between never-smokers and former smokers, matched in a 2:1 ratio on sex and race/ethnicity, and differences in symptoms among former smokers as a function of time since final quit attempt and prior level of smoking. Only former heavy smokers have shown significantly higher prevalence of withdrawal symptoms compared with never-smokers. Of the seven symptoms assessed, only craving incrementally increased with the intensity of smoking. Overall the individual withdrawal symptoms did not effectively differentiate between 112 never-smokers and 34 former lighter smokers (persons who used to smoke less than "a few cigarettes on most days"). Withdrawal symptoms can reliably differentiate former heavy smokers from light smokers and never-smokers, among adolescents. Because most adolescents tend to be lighter smokers, future tobacco use and cessation studies should interpret adult withdrawal symptoms among adolescents with caution.
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Affiliation(s)
- Alexander V Prokhorov
- Department of Behavioral Science, Division of Cancer Prevention, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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