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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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Hjort AV, Christiansen TB, Stage M, Rasmussen KH, Pisinger C, Tjørnhøj-Thomsen T, Klinker CD. Programme theory and realist evaluation of the 'Smoke-Free Vocational Schools' research and intervention project: a study protocol. BMJ Open 2021; 11:e042728. [PMID: 33542044 PMCID: PMC7925872 DOI: 10.1136/bmjopen-2020-042728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
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.
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Affiliation(s)
- Anneke Vang Hjort
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Maria Stage
- Cancer Prevention & Information, Danish Cancer Society, Copenhagen, Denmark
| | | | - Charlotta Pisinger
- Prevention, Danish Heart Foundation, Copenhagen, Denmark
- Center for Clinical Research and Prevention, University of Copenhagen, Frederiksberg, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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3
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Glenstrup S, Bast LS, Danielsen D, Andersen A, Tjørnhøj-Thomsen T. Places to Smoke: Exploring Smoking-Related Practices among Danish Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E386. [PMID: 33419139 PMCID: PMC7825534 DOI: 10.3390/ijerph18020386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/22/2020] [Accepted: 12/25/2020] [Indexed: 11/22/2022]
Abstract
Several established school smoking prevention initiatives involve restrictions on places to smoke. The focus on tobacco control in schools is due to the risk of smoking initiation during adolescence and the perception of this life stage as a period of time when health behavior is established. Hence, this period of time is considered to be ideal for health-promoting initiatives. This paper is part of an ethnographic study on adolescents' perceptions of tobacco use. Focus groups and field observations were used to explore adolescents' smoking-related practices related to smoking bans at schools. The findings show that smoking, as a place-based practice, is influenced by locally embedded rules and carries social implications resulting in a distinction between smokers and non-smokers. The distinction between smokers and non-smokers contributes to the retention of a stereotypical view of smokers and, moreover, stigmatizes smokers. According to this, restrictions on places to smoke within the school should be considered carefully in order to avoid stigma or ethical issues.
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Affiliation(s)
- Stine Glenstrup
- Danish National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark; (L.S.B.); (D.D.); (T.T.-T.)
| | - Lotus Sofie Bast
- Danish National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark; (L.S.B.); (D.D.); (T.T.-T.)
| | - Dina Danielsen
- Danish National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark; (L.S.B.); (D.D.); (T.T.-T.)
| | - Anette Andersen
- Steno Diabetes Center Aarhus, Hedeager 3, 2. sal, 8200 Aarhus, Denmark;
| | - Tine Tjørnhøj-Thomsen
- Danish National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark; (L.S.B.); (D.D.); (T.T.-T.)
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4
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Scalici F, Schulz PJ. School policies and smoking intention in a Swiss sample of adolescents. Health Promot Int 2020; 35:1005-1014. [PMID: 31539024 DOI: 10.1093/heapro/daz095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The majority of today's adult smokers took up the habit during adolescence. The school community and the rules it imposes are important factors that can influence adolescents' smoking intention and behaviour. Research on the effect of school tobacco policies on adolescents' smoking concludes with mixed results. Our study aims to look at the influence of these policies on the intention to smoke and to know if this relation is mediated by individual and environmental factors. The study includes information on social norms, attitude towards smoking and smoking intention from 4515 students of 32 Ticino middle schools and on the tobacco policy implemented in this school. Linear regression indicates a marginal impact of school policy on intention to smoke. Schools that strongly enforce tobacco policy obtain an increase in their students' intention to smoke, while schools that implement assistance programmes to overcome tobacco use decrease intention to smoke. Mediation models show that the influence of some of tobacco policy dimensions on the intention to smoke is mediated by personal attitudes towards smoking, beliefs about health consequences of smoking and perceived peers smoking. Increasing visibility of tobacco policies and having tobacco prevention programmes have stronger positive effects on smoking intention than other policy dimensions, but only through the mediation of individual and environmental factors.
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Affiliation(s)
- Francesca Scalici
- Università della Svizzera italiana, Institute of Communication and Health (ICH), Via Buffi 6, 6900 Lugano, Switzerland
| | - Peter J Schulz
- Università della Svizzera italiana, Institute of Communication and Health (ICH), Via Buffi 6, 6900 Lugano, Switzerland
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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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Butler AE, Qian W, Leatherdale ST. Caffeinated energy drink consumption and predictors of use among secondary school students over time in the COMPASS cohort study. Prev Med Rep 2019; 15:100911. [PMID: 31194103 PMCID: PMC6551549 DOI: 10.1016/j.pmedr.2019.100911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/17/2019] [Accepted: 05/26/2019] [Indexed: 11/30/2022] Open
Abstract
Consumption of caffeinated energy drinks (CED) by youth is a public health priority, given the lack of regulation and evidence for both short and long-term health effects of CED use. Considering the potential risks associated with excessive caffeine consumption, this paper examined CED consumption and predictors of CED use over time in a large sample of Canadian secondary school students participating in the COMPASS study. Using linked longitudinal data (n = 4949) from the first three years of the COMPASS study (2012/13 to 2014/15), three logistic Generalized Estimated Equation models were performed to examine predictors of weekday CED use, weekend CED use, and weekly CED use. The prevalence of weekly CED use remained fairly consistent across the three years of follow-up; 12.5% in year-1, 11.3% in year-2, and 11.4% in year-3. Smokers and marijuana users at follow-up were all at greater odds of weekday or weekly CED use, regardless of baseline use. Binge drinkers at baseline were at greater odds for weekday or weekly CED use, but not if they started binge drinking after their baseline year. Marijuana users at follow-up were all at greater odds of weekend CED use, regardless of baseline marijuana use. >1 in 10 youth reported consuming CEDs one or more times per week, where specific subpopulations of youth, such as marijuana users, appear to be more frequent CED users. Although CED use remained relatively constant over the three-year period examined, prevalence of CED use remains problematic among secondary school students.
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Affiliation(s)
- Alexandra E Butler
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Wei Qian
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
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Perception of health professions students of their role model status in Toombak cessation: A cross-sectional study from Sudan. PLoS One 2019; 14:e0210837. [PMID: 30730905 PMCID: PMC6366877 DOI: 10.1371/journal.pone.0210837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/02/2019] [Indexed: 12/01/2022] Open
Abstract
Introduction Health professionals are to play an essential and effective role in tobacco control. Toombak is a popular form of smokeless tobacco, locally made and used among Sudanese. It is associated with oral and systemic health hazards, particularly oral cancer. This study was set out to assess health professions students’ perception of their status as future role models for their patients and the public regarding Toombak use cessation and to explore socio-cognitive covariates of perceived role model status. Materials and methods A cross-sectional study was conducted in 2013–2014 using a self-administered questionnaire among health professions students enrolled in Medicine, Pharmacy, Dentistry and Nursing colleges in Khartoum state, Sudan. A total of 1530 participants were recruited from colleges using a cluster stratified sampling procedure. Results The majority of the participants (88.2%) were 19–22 year old, females showed predominance (66.1%). Most of the participants (69.7%) scored good knowledge of Toombak-related therapies. The majority (97%) had a positive attitude towards banning Toombak use in public. Half of the participants (50.4%) confirmed availability of Toombak control policy in their college, while 66% reported receiving training in Toombak cessation. Only 9.2% of the participants reported that they have ever used Toombak; among them, 69.5% were current daily users. Less than half (47.8%) reported a positive perception of their status as a role model. Logistic regression model revealed that tobacco cessation training, availability of college policy and positive attitudes towards banning Toombak use in public were strong predictors of with a positive perception of role model status. Conclusion Imposing Toombak control policies within colleges combined with formal training in cessation methods, would reinforce the positive perception of health professions students as a role model, particularly the students themselves seem to be ready for such systematic training.
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Rozema AD, Mathijssen JJP, Jansen MWJ, van Oers JAM. Sustainability of outdoor school ground smoking bans at secondary schools: a mixed-method study. Eur J Public Health 2019; 28:43-49. [PMID: 29016786 PMCID: PMC5881753 DOI: 10.1093/eurpub/ckx099] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Although increasing numbers of countries are implementing outdoor school ground smoking bans at secondary schools, less attention is paid to the post-implementation period even though sustainability of a policy is essential for long-term effectiveness. Therefore, this study assesses the level of sustainability and examines perceived barriers/facilitators related to the sustainability of an outdoor school ground smoking ban at secondary schools. Methods A mixed-method design was used with a sequential explanatory approach. In phase I, 438 online surveys were conducted and in phase II, 15 semi-structured interviews were obtained from directors of relevant schools. ANOVA (phase I) and a thematic approach (phase II) were used to analyze data. Results Level of sustainability of an outdoor school ground smoking ban was high at the 48% Dutch schools with an outdoor smoking ban. Furthermore, school size was significantly associated with sustainability. The perceived barriers/facilitators fell into three categories: (i) smoking ban implementation factors (side-effects, enforcement, communication, guidelines and collaboration), (ii) school factors (physical environment, school culture, education type and school policy) and (iii) community environment factors (legislation and social environment). Conclusions Internationally, the spread of outdoor school ground smoking bans could be further promoted. Once implemented, the ban has become ‘normal’ practice and investments tend to endure. Moreover, involvement of all staff is important for sustainability as they function as role models, have an interrelationship with students, and share responsibility for enforcement. These findings are promising for the sustainability of future tobacco control initiatives to further protect against the morbidity/mortality associated with smoking.
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Affiliation(s)
- A D Rozema
- Department Tranzo, Academic Collaborative Centre for Public Health Brabant, Tilburg University, Tilburg, The Netherlands
| | - J J P Mathijssen
- Department Tranzo, Academic Collaborative Centre for Public Health Brabant, Tilburg University, Tilburg, The Netherlands
| | - M W J Jansen
- Academic Collaborative Centre for Public Health Limburg, Public Health Service South Limburg (GGD ZL), Geleen, The Netherlands.,Department of Health Services Research, School for Public Health and Primary Care CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - J A M van Oers
- Department Tranzo, Academic Collaborative Centre for Public Health Brabant, Tilburg University, Tilburg, The Netherlands.,National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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School Policy, Administrator Perceptions, and Student E-cigarette Use. HEALTH BEHAVIOR AND POLICY REVIEW 2018; 5:72-82. [PMID: 30854404 DOI: 10.14485/hbpr.5.4.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective In this study, we investigated the relationship between school e-cigarette policy and e-cigarette use among students. Secondarily, we examined whether this relationship varied by administrator perceptions about e-cigarette use being "an issue." Methods Data were utilized from written school policies, a school tobacco surveillance study of 2755 students (N = 310,412), and administrator interviews in 54 Texas schools. Results When administrators perceived e-cigarettes as an issue, the odds of ever e-cigarette use, susceptibility to use e-cigarettes, and perceived peer use of e-cigarettes were 0.20-0.54 times lower for students attending schools that had an e-cigarette policy compared to those without a policy (p < .05). Conclusion The impact of school policies on student e-cigarette use behavior is positive if policies are strongly implemented.
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Midgley LS, Murphy S, Moore G, Hewitt G, White J. Multilevel population-based cross-sectional study examining school substance-misuse policy and the use of cannabis, mephedrone and novel psychoactive substances among students aged 11-16 years in schools in Wales. BMJ Open 2018; 8:e020737. [PMID: 29903791 PMCID: PMC6009502 DOI: 10.1136/bmjopen-2017-020737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To examine whether young peoples' risk of cannabis, mephedrone and novel psychoactive substances (NPS) use is associated with school substance-misuse policy. DESIGN A cross-sectional survey of secondary school students combined with a School Environment Questionnaire and independently coded school substance-misuse policies (2015/6). SETTING 66 secondary schools in Wales. PARTICIPANTS Students aged 11-16 years (n=18 939). RESULTS The prevalence of lifetime, past 30-day and daily cannabis use was 4.8%, 2.6% and 0.7%, respectively; lifetime prevalence of mephedrone use was 1.1% and NPS use was 1.5%. Across 66 schools, 95.5% (n=63) reported having a substance-misuse policy, 93.9% (n=62) reported having a referral pathway for drug using students, such that we were insufficiently powered to undertake an analysis. We found little evidence of a beneficial association between lifetime cannabis use and involving students in policy development including student council consultation (OR=1.24, 95% CI 0.89 to 1.73), other student consultation (OR=1.42, 95% CI 0.94 to 2.14) or with the use of isolation (OR=0.98, 95% CI 0.67 to 1.43), with similar results for cannabis use in past 30 days, daily and the lifetime use of mephedrone and NPS. The School Environment Questionnaires found that 39.4% (n=26) schools reported no student involvement in policy development, 42.4% (n=28) reported student council consultation, 18.2% (n=12) used other student consultations and 9.7% (n=3) mentioned isolation. The independently coded content of policies found that no school policy recommended abstinence, one mentioned methods on harm minimisation, 16.1% (n=5) policies mentioned student involvement and 9.7% (n=3) mentioned isolation. CONCLUSIONS Policy development involving students is widely recommended, but we found no beneficial associations between student involvement in policy development and student drug use. This paper has highlighted the need for further contextual understanding around the policy-development process and how schools manage drug misuse.
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Affiliation(s)
- Luke S Midgley
- School of Social Sciences, Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
- School of Medicine, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Simon Murphy
- School of Social Sciences, Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Graham Moore
- School of Social Sciences, Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Gillian Hewitt
- School of Social Sciences, Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - James White
- School of Medicine, Centre for Trials Research, Cardiff University, Cardiff, UK
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11
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Eitle D, Thorsen M, Eitle TM. School Context and American Indian Substance Use. THE SOCIAL SCIENCE JOURNAL 2017; 54:420-429. [PMID: 29225409 PMCID: PMC5716479 DOI: 10.1016/j.soscij.2017.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/11/2017] [Accepted: 07/17/2017] [Indexed: 06/07/2023]
Abstract
The present study extends prior research exploring the role of school contextual factors in predicting individual adolescent substance use by examining how a school's racial composition is associated with American Indian adolescent tobacco and marijuana use. Using a subsample of 523 American Indian students from the restricted use Add Health data, we consider both individual and school contextual factors across 99 schools. Our results suggest that a school's racial composition is associated with individual tobacco and marijuana use among American Indian youth, but in different ways depending upon the substance. Our findings illustrate the importance of extending research on the correlates of substance use for racial and ethnic minorities beyond studies examining African-Americans and/or Hispanics.
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Affiliation(s)
- David Eitle
- Montana State University, Department of Sociology & Anthropology. Wilson 2-130, P.O. Box 172380, Bozeman, MT 59717.
| | - Maggie Thorsen
- Montana State University, Department of Sociology & Anthropology. Wilson 2-130, P.O. Box 172380, Bozeman, MT 59717.
| | - Tamela McNulty Eitle
- Montana State University, Department of Sociology & Anthropology. Wilson 2-130, P.O. Box 172380, Bozeman, MT 59717.
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12
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Moore GF, Evans RE. What theory, for whom and in which context? Reflections on the application of theory in the development and evaluation of complex population health interventions. SSM Popul Health 2017; 3:132-135. [PMID: 29302610 PMCID: PMC5742639 DOI: 10.1016/j.ssmph.2016.12.005] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 09/22/2016] [Accepted: 12/12/2016] [Indexed: 01/10/2023] Open
Abstract
Recent years have seen a growing emphasis on the value of building and testing middle range theory throughout the development and evaluation of complex population health interventions. We agree that a coherent theoretical basis for intervention development, and use of evaluation to test key causal assumptions and build theory, are crucial. However, in this editorial, we argue that such recommendations have often been operationalised in somewhat simplistic terms with potentially perverse consequences, and that an uncritical assumption that an intervention explicitly based on theory is inherently superior carries significant risks. We first argue that the drive for theory-based approaches may have exacerbated a propensity to select ‘off-the-shelf’ theories, leading to the selection of inappropriate theories which distract attention from the mechanisms through which a problem is actually sustained. Second, we discuss a tendency toward over-reliance on individual-level theorising. Finally, we discuss the relatively slow progress of population health intervention research in attending to issues of context, and the ecological fit of interventions with the systems whose functioning they attempt to change. We argue that while researchers should consider a broad range of potential theoretical perspectives on a given population health problem, citing a popular off-the-shelf theory as having informed an intervention and its evaluation does not inherently make for better science. Before identifying or developing a theory of change, researchers should develop a clear understanding of how the problem under consideration is created and sustained in context. A broader conceptualisation of theory that reaches across disciplines is vital if theory is to enhance, rather than constrain, the contribution of intervention research. Finally, intervention researchers need to move away from viewing interventions as discrete packages of components which can be described in isolation from their contexts, and better understand the systems into which change is being introduced.
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Affiliation(s)
- Graham F Moore
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Wales, United Kingdom
| | - Rhiannon E Evans
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Wales, United Kingdom
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13
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Cole AG, Qian W, Leatherdale ST. Changing the Smoking Trajectory: Evaluating the Impact of School-Based Tobacco Interventions on Changes to Susceptibility to Future Smoking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101182. [PMID: 28981472 PMCID: PMC5664683 DOI: 10.3390/ijerph14101182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 11/26/2022]
Abstract
School-based programs and policies can reduce student smoking rates. However, their impact on never-smoking students has not been investigated despite the clear transition between non-susceptible, susceptible, and ever tried smoking statuses. The objective of this paper was to examine the longitudinal student-level impact of six changes in school-based tobacco control programs and policies on student transitions in susceptibility to smoking over one year. Two multinomial logistic regression models identified the relative risk of a change in self-reported susceptibility to smoking or in trying a cigarette among never-smoking students in each of the six intervention schools compared to the relative risk among never-smoking students in control schools. Model 1 identified the relative risk of a change in smoking susceptibility status among baseline non-susceptible never smoking students, while Model 2 identified the relative risk of a change in smoking susceptibility status among baseline susceptible never smoking students. Students at some intervention schools were at increased risk of becoming susceptible to or trying a cigarette at one year follow-up. Intervention studies should examine changes to susceptibility to future smoking when evaluating impact to ensure that school-based tobacco control programs and policies do not negatively change the risk status of never-smoking students.
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Affiliation(s)
- Adam G Cole
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
| | - Wei Qian
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
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Backhaus I, D'Egidio V, Grassucci D, Gelardini M, Ardizzone C, La Torre G. Link between perceived smoking behaviour at school and students smoking status: a large survey among Italian adolescents. Public Health 2017; 151:169-176. [PMID: 28806725 DOI: 10.1016/j.puhe.2017.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/15/2017] [Accepted: 07/07/2017] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- I Backhaus
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy.
| | - V D'Egidio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - D Grassucci
- Skuola Network Srl, Via Taranto 21, 00182 Rome, Italy
| | - M Gelardini
- Skuola Network Srl, Via Taranto 21, 00182 Rome, Italy
| | - C Ardizzone
- Skuola Network Srl, Via Taranto 21, 00182 Rome, Italy
| | - G La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
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Tobacco use patterns, knowledge, attitudes towards tobacco and availability of tobacco control training among school personnel from a rural area in Poland. Tob Induc Dis 2017; 15:3. [PMID: 28096794 PMCID: PMC5225631 DOI: 10.1186/s12971-016-0110-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 12/30/2016] [Indexed: 11/30/2022] Open
Abstract
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.
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Individual and contextual determinants of perceived peer smoking prevalence among adolescents in six European cities. Prev Med 2016; 88:168-75. [PMID: 27103335 DOI: 10.1016/j.ypmed.2016.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 04/13/2016] [Accepted: 04/16/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Young people perceiving a high peer smoking prevalence are more likely to initiate smoking. It is unclear which factors contribute to perceived peer smoking prevalence and if these factors vary according to education. This study aimed to assess the determinants of perceived smoking prevalence and assessed its variation at school and country-level. METHODS Data of 10,283 14-17-year-old students in 50 secondary schools in six European cities were derived from the 2013 SILNE survey. The outcome was the perceived smoking prevalence score among peers at school (0-10 scale, 10 represented 100% smoking prevalence). Multilevel linear regression models estimated the associations of factors with perceived prevalence score and variance at school and country-levels. Analyses were also stratified by academic achievement of the adolescent and parental education. RESULTS Determinants of a higher perceived prevalence score were female sex, ever smoking, having friends who smoke, low academic achievement, low parental educational level, and higher actual prevalence of smoking in the school. The perceived prevalence score was not associated with school policies or with the availability of cigarettes near the school. Determinants were very similar across levels of academic achievement and parental education. Perceived prevalence scores substantially varied between schools and countries: 10% and 11% of total variance was related to schools and countries respectively. CONCLUSION Across educational levels, perceptions of peer smoking are strongly determined by both individual characteristics and school and national contexts. Future studies should assess why perceived smoking prevalence varies between schools and countries and identify modifiable factors.
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Hallingberg B, Fletcher A, Murphy S, Morgan K, Littlecott HJ, Roberts C, Moore GF. Do stronger school smoking policies make a difference? Analysis of the health behaviour in school-aged children survey. Eur J Public Health 2016; 26:964-968. [PMID: 27335332 PMCID: PMC5172489 DOI: 10.1093/eurpub/ckw093] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Associations of the strength of school smoking policies with
cigarette, e-cigarette and cannabis use in Wales were examined. Methods:
Nationally representative cross-sectional survey of pupils aged 11–16 years
(N=7376) in Wales. Senior management team members from 67
schools completed questionnaires about school smoking policies, substance use
education and tobacco cessation initiatives. Multi-level, logistic regression
analyses investigated self-reported cigarette, e-cigarette and cannabis use, for all
students and those aged 15–16 years. Results: Prevalence of
current smoking, e-cigarette use and cannabis use in the past month were 5.3%,
11.5% and 2.9%, respectively. Of schools that provided details about
smoking policies (66/67), 39.4% were strong (written policy applied to
everyone in all locations), 43.9% were moderate (written policy not applied to
everyone in all locations) and 16.7% had no written policy. There was no
evidence of an association of school smoking policies with pupils’ tobacco or
e-cigarette use. However, students from schools with a moderate policy [OR =
0.47; 95% (confidence interval) CI: 0.26–0.84] were less likely to have
used cannabis in the past month compared to schools with no written policy. This
trend was stronger for students aged 15–16 years (moderate policy: OR =
0.42; 95% CI: 0.22–0.80; strong policy: OR = 0.45; 95% CI:
0.23–0.87). Conclusions: School smoking policies may exert less
influence on young people’s smoking behaviours than they did during times of
higher adolescent smoking prevalence. Longitudinal studies are needed to examine the
potential influence of school smoking policies on cannabis use and mechanisms
explaining this association.
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Affiliation(s)
- B Hallingberg
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - A Fletcher
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - S Murphy
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - K Morgan
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - H J Littlecott
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - C Roberts
- Social Research and Information Division, Cathays Park, Cardiff, United Kingdom
| | - G F Moore
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
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Rozema AD, Mathijssen JJP, Jansen MWJ, van Oers JAM. Schools as smoke-free zones? Barriers and facilitators to the adoption of outdoor school ground smoking bans at secondary schools. Tob Induc Dis 2016; 14:10. [PMID: 27030793 PMCID: PMC4812616 DOI: 10.1186/s12971-016-0076-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/22/2016] [Indexed: 11/13/2022] Open
Abstract
Background Whereas smoking bans inside secondary school buildings are relatively widespread, a smoking ban for the outdoor school grounds is less common. Therefore, this study investigates why many secondary schools fail to adopt an outdoor school ground smoking ban. The aim is to elucidate the perceived barriers and facilitators of stakeholders at schools without an outdoor school ground smoking ban. Methods Qualitative data were obtained from 60 respondents of 15 secondary schools. Semi-structured interviews were held with various key stakeholders and a thematic approach was used for analysis of the transcripts. Results The perceived barriers and facilitators of the stakeholders fell into four categories: 1) socio-political characteristics (legislation and social norm), 2) school characteristics (policy, decision process, enforcement, resources, workforce conditions, communication and collaboration), 3) individual characteristics (support, knowledge, and target group), and 4) smoking ban characteristics (environmental factors, guideline recommendations, outcome expectations, and evidence). Conclusions These findings highlight the importance of legislation for outdoor smoking bans. Moreover, collaboration, communication and involving stakeholders during an early stage of the process should be stimulated, as this might increase adoption. These results can be applied in future studies on outdoor tobacco control policies; moreover, they may facilitate tobacco control initiatives leading to more smoke-free environments to further protect youth from the harmful effects of tobacco.
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Affiliation(s)
- A D Rozema
- Department Tranzo, Tilburg University, P.O. Box 90153, Tilburg, 5000 LE The Netherlands
| | - J J P Mathijssen
- Department Tranzo, Tilburg University, P.O. Box 90153, Tilburg, 5000 LE The Netherlands
| | - M W J Jansen
- Academic Collaborative Centre for Public Health Limburg, Public Health Service South Limburg (GGD ZL), Geleen, The Netherlands ; Department of Health Services Research, School for Public Health and Primary Care CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - J A M van Oers
- Department Tranzo, Tilburg University, P.O. Box 90153, Tilburg, 5000 LE The Netherlands ; National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Ribeiro Sarmento D, Yehadji D. An analysis of global youth tobacco survey for developing a comprehensive national smoking policy in Timor-Leste. BMC Public Health 2016; 16:65. [PMID: 26800672 PMCID: PMC4722677 DOI: 10.1186/s12889-016-2742-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 01/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking is a global public health concern. Timor-Leste is facing a rapidly growing epidemic of tobacco use. The trend of smoking in Timor-Leste seems to be increasing and the magnitude of the problem affects people who smoke before reaching adulthood. One of the factors implicated in the continuously rising trend of smoking among young people in Timor-Leste is clearly due to unavailability of restrictive laws and regulations. Therefore, our study sought to analyze available dataset from the Global Youth Tobacco Survey (GYTS) for developing a comprehensive national smoking policy in order to lower smoking risks among young people in Timor-Leste. METHODS We conducted a secondary analysis of the 2009 GYTS in Timor-Leste. The 2009 GYTS assessed 1657 in-school students aged 13-15 years for current smoking prevalence and determinants of tobacco use. We used IBM SPSS version 21 software to analyze the data. Frequency analyses were computed to identify demographic characteristics of study participants. Bivariate logistic regression analysis was performed to examine the association between each demographic characteristic as well as each independent variable and the outcome of being current smokers. RESULTS Out of 1657 in-school students, 51 % were of ages less than 15; 53 % were girls; and 45 % were in grade 2. Prevalence of current cigarette smoking was found to be 51 %. The prevalence of current smoking among in-school students increased with ages (from 46 % in less than 15 to 57 % in 15 plus). Boys were more likely to be smokers than girls (59 % versus 28 %). Significant factors positively associated with current smoking included parental smoking; closed-peer smoking; number of days people smoked in the house; having family discussion about harmful effects of smoking; being smoking in areas such as school, public places and home; and having seen cigarette advertisements on billboard. CONCLUSION Timor-Leste has higher prevalence of cigarette smoking among minors, especially among boys. Our analysis provides evidence-based information for developing comprehensive tobacco control programs - both education and policy interventions to reduce smoking rate among young people in Timor-Leste.
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Affiliation(s)
- Decio Ribeiro Sarmento
- Fulbright SERN Timor-Leste Awardee for School of Public Health, Georgia State University, Atlanta, 30303 Georgia
| | - Degninou Yehadji
- Fulbright Awardee Togo for School of Public Health, Georgia State University, Atlanta, 30303 Georgia
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Correlates of gambling on high-school grounds. Addict Behav 2015; 51:57-64. [PMID: 26232102 DOI: 10.1016/j.addbeh.2015.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/02/2015] [Accepted: 07/16/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study examined adolescent gambling on school grounds (GS+) and how such behavior was associated with gambling-related attitudes. Further, we examined whether GS+ moderated associations between at-risk problem-gambling (ARPG) and gambling behaviors related to gambling partners. METHOD Participants were 1988 high-school students who completed survey materials. Demographic, perceptions, attitudes, and gambling variables were stratified by problem-gambling severity (ARPG versus recreational gambling) and GS+ status. Chi-square and adjusted logistic regression models were used to examine relationships among study variables. RESULTS Nearly 40% (39.58%) of students reported past-year GS+, with 12.91% of GS+ students, relative to 2.63% of those who did not report gambling on school grounds (GS-), meeting DSM-IV criteria for pathological gambling (p<0.0001). In comparison to GS- students, GS+ students were more likely to report poorer academic achievement and more permissive attitudes towards gambling behaviors. Weaker links in GS+ students, in comparison with GS-, students, were observed between problem-gambling severity and gambling with family members (interaction odds ratio (IOR)=0.60; 95% CI=0.39-0.92) and gambling with friends (IOR=0.21; 95% CI=0.11-0.39). CONCLUSIONS GS+ is common and associated with pathological gambling and more permissive attitudes towards gambling. The finding that GS+ (relative to GS-) youth show differences in how problem-gambling is related to gambling partners (friends and family) warrants further investigation regarding whether and how peer and familial interactions might be improved to diminish youth problem-gambling severity. The high frequency of GS+ and its relationship with ARPG highlights a need for school administrators and personnel to consider interventions that target school-based gambling.
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Kuipers MAG, de Korte R, Soto VE, Richter M, Moor I, Rimpelä AH, Perelman J, Federico B, Kunst AE, Lorant V. School smoking policies and educational inequalities in smoking behaviour of adolescents aged 14–17 years in Europe. J Epidemiol Community Health 2015; 70:132-9. [DOI: 10.1136/jech-2015-205831] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 08/09/2015] [Indexed: 11/04/2022]
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State Education Standards for Tobacco Prevention and Classroom Instruction. HEALTH BEHAVIOR AND POLICY REVIEW 2015; 2:352-361. [PMID: 29552575 DOI: 10.14485/hbpr.2.5.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives We examine whether state educational standards regarding tobacco correspond with teacher reports of classroom instruction. Methods We test this relation with data on tobacco use prevention standards, reports of middle and high school teachers from the 2008 and 2010 School Health Profiles study, and logistic regression models. Results State education standards are significantly related to increased likelihood of a lead health education teacher in that state reporting that the specific topic was taught in the school. These relationships are stronger for middle school teachers than for high school teachers. Conclusions Associations between state standards and teacher reports of actual instruction are consistent with education standards influencing the teaching of these health education topics.
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Leatherdale ST, Cole A. Examining the impact of changes in school tobacco control policies and programs on current smoking and susceptibility to future smoking among youth in the first two years of the COMPASS study: looking back to move forward. Tob Induc Dis 2015; 13:8. [PMID: 25834482 PMCID: PMC4381407 DOI: 10.1186/s12971-015-0031-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 03/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND School-based prevention activities continue to be an important tobacco control resource, however there is little guidance for school-based tobacco control programming within Ontario. The objective of this study is to identify real-world changes in school-based tobacco control programs or policies in the COMPASS study and examine of those interventions (natural experiments) had any impact on the school-level prevalence of smoking susceptibility and current smoking over time. METHODS This paper uses longitudinal school-level smoking behaviour data from Year 1 (Y1: 2012-13) and Year 2 (Y2: 2013-14) of the COMPASS study. Changes to school-level tobacco control programs and policies were measured using the COMPASS School Programs and Policies Questionnaire and knowledge broker follow-up interviews. Quasi-experimental tests of proportion and difference-in-difference models were used to evaluate the impact of the interventions identified between Y1 and Y2 on school-level prevalence of smoking susceptibility among never smokers and current smoking. RESULTS Between Y1 and Y2, 17 schools reported a change in their tobacco control programming or policies. In four of the intervention schools, the increase in the within-school prevalence of susceptible never smokers between Y1 and Y2 was significantly greater than the natural change observed in the control schools. In five of the intervention schools, the decrease in the within-school prevalence of current smokers between Y1 and Y2 was significantly greater than the natural change observed in the control schools. Only two of the new interventions evaluated (both focused on policies of progressive punishment for students caught smoking on school property), were associated with significant desirable changes in both smoking susceptibility and current smoking between Y1 and Y2. DISCUSSION Interventions specific to effective and enforced tobacco control were the most common and consistently had the desired impact on the school-level prevalence of smoking susceptibility and current smoking. Due to the variation in the types of interventions implemented and their effectiveness, additional evaluation evidence is necessary to determine the most successful activities and contexts among individual students. The results presented here highlight which of these real-world promising interventions should be further evaluated using the longitudinal individual-level data in COMPASS over time.
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Affiliation(s)
- Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue, Waterloo, ON N2L 3G1 Canada
| | - Adam Cole
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue, Waterloo, ON N2L 3G1 Canada
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Evans-Whipp TJ, Plenty SM, Catalano RF, Herrenkohl TI, Toumbourou JW. Longitudinal effects of school drug policies on student marijuana use in Washington State and Victoria, Australia. Am J Public Health 2015; 105:994-1000. [PMID: 25790384 DOI: 10.2105/ajph.2014.302421] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the longitudinal effect of schools' drug policies on student marijuana use. METHODS We used data from the International Youth Development Study, which surveyed state-representative samples of students from Victoria, Australia, and Washington State. In wave 1 (2002), students in grades 7 and 9 (n = 3264) and a school administrator from each participating school (n = 188) reported on school drug policies. In wave 2 (2003), students reported on their marijuana use. We assessed associations between student-reported and administrator-reported policy and student self-reported marijuana use 1 year later. RESULTS Likelihood of student marijuana use was higher in schools in which administrators reported using out-of-school suspension and students reported low policy enforcement. Student marijuana use was less likely where students reported receiving abstinence messages at school and students violating school policy were counseled about the dangers of marijuana use. CONCLUSIONS Schools may reduce student marijuana use by delivering abstinence messages, enforcing nonuse policies, and adopting a remedial approach to policy violations rather than use of suspensions.
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Affiliation(s)
- Tracy J Evans-Whipp
- Tracy J. Evans-Whipp, Stephanie M. Plenty, and John W. Toumbourou are with the Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia. Tracy J. Evans-Whipp and Stephanie M. Plenty are also with the University of Melbourne Department of Paediatrics, Royal Children's Hospital, Parkville. John W. Toumbourou is also with the Centre for Mental Health and Wellbeing Research and School of Psychology, Deakin University, Geelong, Victoria. Richard F. Catalano and Todd I. Herrenkohl are with the Social Development Research Group, School of Social Work, University of Washington, Seattle
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Gaete J, Montgomery A, Araya R. The Association Between School Bonding and Smoking Amongst Chilean Adolescents. Subst Abus 2015; 36:515-23. [PMID: 25671659 DOI: 10.1080/08897077.2014.991862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The objective of the research was to study the association between school bonding dimensions (school commitment and school attachment) and current adolescent smoking in Chile, controlling for confounding variables using the fifth Chilean School Population National Substance Use Survey, 2003 (CHSS-2003) data set. METHODS The CHSS-2003 is a stratified cross-sectional survey that gathers information about personal, familial, peer, and school factors and cigarette use using a self-reported questionnaire. Complete data from 21,956 adolescent students for all the variables of interest were used in the analyses. An exploratory factor analysis (EFA) was performed in order to explore the construct validity of the questionnaire and create the main exposure and potential confounding variables. Multivariable logistic regression analyses were undertaken to study the association between school bonding and smoking. RESULTS The construct validity of the school attachment and school commitment scales was mainly supported by the EFA. Multivariable analyses showed strong evidence that, after adjusting for factors from different domains, school commitment (student's good grades and school attendance) appears to have a clear inverse association with current smoking (odds ratio [OR]=0.46, 95% confidence interval [CI]: 0.38-0.56). On the other hand, school attachment (their feelings towards their school and their teachers) was not associated with adolescent smoking (OR=1.16, 95% CI: 0.88-1.53). CONCLUSIONS School commitment was strongly associated with current smoking. It is important to further study this variable with the aim of ascertaining whether or not interventions that improve school commitment may prevent or reduce smoking amongst adolescent students.
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Affiliation(s)
- Jorge Gaete
- a School of Psychology , Universidad de los Andes , Santiago , Chile
| | - Alan Montgomery
- b Nottingham Clinical Trials Unit , University of Nottingham , Nottingham , United Kingdom.,c School of Social and Community Medicine , University of Bristol , Bristol , United Kingdom
| | - Ricardo Araya
- d Department of Epidemiology and Population Health , London School of Hygiene and Tropical Medicine , London, United Kingdom
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Coppo A, Galanti MR, Giordano L, Buscemi D, Bremberg S, Faggiano F. School policies for preventing smoking among young people. Cochrane Database Syst Rev 2014; 2014:CD009990. [PMID: 25342250 PMCID: PMC6486025 DOI: 10.1002/14651858.cd009990.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Alessandro Coppo
- Università del Piemonte OrientaleDepartment of Translational MedicineNovaraItaly
| | | | - Livia Giordano
- CPO Piemonte, AOU San Giovanni Battista HospitalCenter for Oncological PreventionVia San Francesco da paola 31TurinPiedmontItaly10123
| | - Daria Buscemi
- Università del Piemonte OrientaleDepartment of Translational MedicineNovaraItaly
| | - Sven Bremberg
- Karolinska InstitutetDepartment of Public Health SciencesStockholmSweden
| | - Fabrizio Faggiano
- Università del Piemonte OrientaleDepartment of Translational MedicineNovaraItaly
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Substance Use Prevalence According to Public High School Types in Istanbul. ADDICTIVE DISORDERS & THEIR TREATMENT 2014. [DOI: 10.1097/adt.0b013e31829111b6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lindström M. Social capital, social class and tobacco smoking. Expert Rev Pharmacoecon Outcomes Res 2014; 8:81-9. [DOI: 10.1586/14737167.8.1.81] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fahrenwald NL, Kerkvliet JL, Carson P, Lammers C, Melstad S, Dugstad D, McCord J. Evaluation of school tobacco-free policies in a rural Northern Plains state. THE JOURNAL OF SCHOOL HEALTH 2013; 83:824-831. [PMID: 24138354 DOI: 10.1111/josh.12100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 10/25/2012] [Indexed: 06/02/2023]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) has called for tobacco-free school (TFS) policies. In South Dakota (SD), a rural state with a large American Indian population, collaboration between state agencies focused on development and dissemination of a model TFS policy in 2008. This study explored the current status of TFS policies in statewide SD school districts. METHODS Tobacco policies were requested from all SD school district administrators. A 26-point checklist based on CDC TFS policy guidelines was used to evaluate policies. Follow-up interviews were conducted with selected superintendents. RESULTS Policies were received from 144 of 217 districts (66% response). Participation was higher for public districts than tribal/Bureau of Indian Education (BIE) districts and nonpublic districts. The overall mean policy score was 11.6 (SD 5.1). Public school districts had the highest mean (12.3) followed by nonpublic (8.9) and tribal/BIE (7.5). In a subset of districts with a large American Indian population (>30%), policy scores were lower for those located on reservation or tribal lands compared with other locations. Barriers to policy development were identified as time and staff expertise. CONCLUSIONS There is a need to improve statewide TFS policies. A district report card with recommendations for improvement and a resource guide were developed and disseminated.
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Affiliation(s)
- Nancy L Fahrenwald
- Dean and Professor , South Dakota State University College of Nursing, Box 2275, Brookings, SD 57007
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Abstract
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.
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O'Loughlin EK, Tremblay M, Dugas EN, Barry AD, O'Loughlin JL. Effect of anti-smoking legislation on school staff smoking may dissipate over time. Eur J Public Health 2013; 23:791-3. [DOI: 10.1093/eurpub/ckt009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Paek HJ, Hove T, Oh HJ. Multilevel analysis of the impact of school-level tobacco policies on adolescent smoking: the case of Michigan. THE JOURNAL OF SCHOOL HEALTH 2013; 83:679-689. [PMID: 24020681 DOI: 10.1111/josh.12081] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 09/07/2012] [Accepted: 10/14/2012] [Indexed: 06/02/2023]
Abstract
BACKGROUND In efforts to curb and prevent youth smoking, school tobacco policies have become an important and effective strategy. This study explores the degrees and types of tobacco-free school policy (TFSP) enforcement that are associated with adolescent smoking. METHODS A multilevel analysis was performed using 983 students who are nested in 14 schools. The individual-level data are drawn from the 2009 Michigan Youth Risk Behavior Survey. The school-level data are drawn from the 2008 School Health Profiles survey. RESULTS Two factors are associated with lower adolescent smoking: greater punishment for TFSP violation and more tobacco control communication efforts. By contrast, the factors associated with higher adolescent smoking are designation of a tobacco-free school zone and school-level smoking. CONCLUSIONS This study theoretically and methodologically guides researchers to test TFSP effectiveness in other states. Three strategic implications emerge: (1) schools should provide a consistent antismoking message in smoke-free environments; (2) schools should integrate TFSP into a comprehensive tobacco control initiative, including community-wide tobacco control programs and messages; and (3) the way a specific TFSP is promoted and communicated could determine how effective it is.
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Affiliation(s)
- Hye-Jin Paek
- Associate Professor, , Department of Advertising & Public Relations, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan, Kyeonggi-do 426-791, South Korea
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Evans-Whipp TJ, Plenty SM, Catalano RF, Herrenkohl TI, Toumbourou JW. The impact of school alcohol policy on student drinking. HEALTH EDUCATION RESEARCH 2013; 28:651-662. [PMID: 23766454 PMCID: PMC3708139 DOI: 10.1093/her/cyt068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 05/08/2013] [Indexed: 06/02/2023]
Abstract
Although it is common for secondary schools to implement alcohol policies to reduce alcohol misuse, there has been little evaluation of the efficacy of these policies. The purpose of this study was to test the impact of the degree and type of alcohol policy enforcement in state representative samples of secondary students in Washington State, USA, and Victoria, Australia (n = 1848). Multivariate logistic regressions were used to examine the prospective association between student reports of school alcohol policy in Grade 8 and self-reported alcohol use in Grade 9, controlling for age, gender, state, family socio-economic status and Grade 8 alcohol use. The likelihood of students drinking on school grounds was increased when students perceived lax policy enforcement. Student perceptions of harm minimization alcohol messages, abstinence alcohol messages and counselling for alcohol policy violators predicted reduced likelihood of binge drinking. Students perceiving harm minimization messages and counselling for alcohol policy violators had a reduced likelihood of experiencing alcohol-related harms. Perceptions of harsh penalties were unrelated to drinking behaviour. These results suggest that perceived policy enforcement may lessen drinking at school 1 year later and that harm minimization messages and counselling approaches may also lessen harmful drinking behaviours as harm minimization advocates suggest.
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Affiliation(s)
- Tracy J Evans-Whipp
- Centre for Adolescent Health, Royal Children's Hospital and Adolescent Health Research, Murdoch Children's Research Institute, The University of Melbourne Department of Paediatrics, Royal Children's Hospital, Parkville, Victoria, 3052, Australia.
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Barbero C, Moreland-Russell S, Bach LE, Cyr J. An evaluation of public school district tobacco policies in St. Louis County, Missouri. THE JOURNAL OF SCHOOL HEALTH 2013; 83:525-532. [PMID: 23834603 DOI: 10.1111/josh.12061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 06/23/2012] [Accepted: 08/02/2012] [Indexed: 06/02/2023]
Abstract
BACKGROUND One way to address tobacco use by youth is for primary and secondary schools to adopt and implement comprehensive tobacco policies. The purpose of this study was to evaluate the comprehensiveness of tobacco policies in St. Louis County, Missouri public school districts. METHODS We evaluated the strength of tobacco policies from all 23 public school districts located in the county using the Center for Tobacco Policy Research's School Tobacco Policy Index, a standardized tool for rating school tobacco policies. RESULTS The districts averaged a score of 24.4 of 40 possible points on the Index. Policies scored highest on the Tobacco-Free Environment domain and lowest on the Enforcement domain. Policies averaged about half of the total possible points for the Prevention and Treatment Services and Policy Organization domains. CONCLUSION Despite more than a decade of efforts by the Centers for Disease Control and Prevention to improve school tobacco policies, this study shows that policies in St. Louis County districts have yet to meet the standard of comprehensiveness. It is recommended that schools adopt policies that are comprehensive and that address all domains of the School Tobacco Policy Index.
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Affiliation(s)
- Colleen Barbero
- Center for Tobacco Policy Research, Washington University in St. Louis, 700 Rosedale Ave, CB 1009, St. Louis, MO 63112, USA.
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Bonell C, Jamal F, Harden A, Wells H, Parry W, Fletcher A, Petticrew M, Thomas J, Whitehead M, Campbell R, Murphy S, Moore L. Systematic review of the effects of schools and school environment interventions on health: evidence mapping and synthesis. PUBLIC HEALTH RESEARCH 2013. [DOI: 10.3310/phr01010] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BackgroundIn contrast to curriculum-based health education interventions in schools, the school environment approach promotes health by modifying schools' physical/social environment. This systematic review reports on the health effects of the school environment and processes by which these might occur. It includes theories, intervention outcome and process evaluations, quantitative studies and qualitative studies.Research questionsResearch question (RQ)1: What theories are used to inform school environment interventions or explain school-level health influences? What testable hypotheses are suggested? RQ2: What are the effects on student health/inequalities of school environment interventions addressing organisation/management; teaching/pastoral care/discipline; and the physical environment? What are the costs? RQ3: How feasible/acceptable and context dependent are such interventions? RQ4: What are the effects on student health/inequalities of school-level measures of organisation/management; teaching/pastoral care/discipline; and the physical environment? RQ5: Through what processes might such influences occur?Data sourcesA total of 16 databases were searched between 30 July 2010 and 23 September 2010 to identify relevant studies, including the British Educational Index, the Cumulative Index to Nursing and Allied Health Literature, the Health Management Information Consortium, EMBASE, MEDLINE and PsycINFO. In addition, references of included studies were checked and authors contacted.Review methodsIn stage 1, we mapped references concerning how the school environment affects health and consulted stakeholders to identify stage 2 priorities. In stage 2, we undertook five reviews corresponding to our RQs.ResultsStage 1: A total of 82,775 references were retrieved and 1144 were descriptively mapped. Stage 2: A total of 24 theories were identified (RQ1). The human functioning and school organisation, social capital and social development theories were judged most useful. Ten outcome evaluations were included (RQ2). Four US randomised controlled trials (RCTs) and one UK quasi-experimental study examined interventions building school community/relationships. Studies reported benefits for some, but not all outcomes (e.g. aggression, conflict resolution, emotional health). Two US RCTs assessed interventions empowering students to contribute to modifying food/physical activity environments, reporting benefits for physical activity but not for diet. Three UK quasi-experimental evaluations examined playground improvements, reporting mixed findings, with benefits being greater for younger children and longer break times. Six process evaluations (RQ3) reported positively. One study suggested that implementation was facilitated when this built on existing ethos and when senior staff were supportive. We reviewed 42 multilevel studies, confining narrative synthesis to 10 that appropriately adjusted for confounders. Four UK/US reports suggested that schools with higher value-added attainment/attendance had lower rates of substance use and fighting. Three reports from different countries examined school policies on smoking/alcohol, with mixed results. One US study found that schools with more unobservable/unsupervised places reported increased substance use. Another US study reported that school size, age structure and staffing ratio did not correlate with student drinking. Twenty-one qualitative reports from different countries (RQ5) suggested that disengagement, lack of safety and lack of participation in decisions may predispose students to engage in health risks.LimitationsWe found no evidence regarding health inequalities or cost, and could not undertake meta-analysis.ConclusionsThere is non-definitive evidence for the feasibility and effectiveness of school environment interventions involving community/relationship building, empowering student participation in modifying schools' food/physical activity environments, and playground improvements. Multilevel studies suggest that schools that add value educationally may promote student health. Qualitative studies suggest pathways underlying these effects. This evidence lends broad support to theories of social development, social capital and human functioning and school organisation. Further trials to examine the effects of school environment modifications on student health are recommended.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- C Bonell
- Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - F Jamal
- Institute for Health and Human Development, University of East London, London, UK
| | - A Harden
- Institute for Health and Human Development, University of East London, London, UK
| | - H Wells
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - W Parry
- Department of Quantitative Social Science, Institute of Education, University of London, London, UK
| | - A Fletcher
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - M Petticrew
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - J Thomas
- Department of Childhood, Families and Health, Institute of Education, University of London, London, UK
| | - M Whitehead
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - R Campbell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - S Murphy
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - L Moore
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
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Galanti MR, Coppo A, Jonsson E, Bremberg S, Faggiano F. Anti-tobacco policy in schools: upcoming preventive strategy or prevention myth? A review of 31 studies. Tob Control 2013; 23:295-301. [DOI: 10.1136/tobaccocontrol-2012-050846] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Effect of a smoking ban and school-based prevention and control policies on adolescent smoking in Spain: a multilevel analysis. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2013; 13:574-83. [PMID: 22918603 DOI: 10.1007/s11121-012-0283-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We evaluated the impact of a smoking ban in schools and of school-based smoking prevention and control policies on adolescent smoking. Annual surveys carried out between 2001 and 2005 that were representative of students in the 4th year of secondary education in the Madrid region, with 203 schools and 9127 students participating. The student questionnaire gathered information about personal and family variables. The contextual factors were: the periods before (years 2001-2002) and after the law; and through a survey of school management boards: compliance with the law, policy reflected in the school regulations, existence of complaints against smoking, and undertaking of educational activities regarding smoking. Multilevel logistic regression models were constructed with two dependent variables: current smoking and the proportion giving up smoking. Smoking declined in 2003, the first year after the law came into force (Odds ratio: 0.80; CI 95%: 0.66-0.96), and this decline was maintained in 2005. By contrast, smoking increased in those schools that did not undertake educational programmes regarding smoking (Odds ratio: 1.34; CI 95%: 1.13-1.59), and in those that received complaints about smoking (Odds ratio: 1.12; CI 95%: 0.96-1.29). This association is partly due to the effect of the increase in giving up smoking. The inclusion of contextual variables into the model with the individual factors reduces the variability of smoking between schools by 32.6%. In summary, the coming into force of a law banning smoking in schools, and the implementing of educational policies for the prevention and control of smoking are related to a lower risk of adolescent smoking.
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Kanda H, Osaki Y, Kaneita Y, Itani O, Ikeda M, Ohida T. Smoking rate trends of male 7th and 11th graders in Japan based on repeated, nationwide, cross-sectional surveys every 4 years from 1996 to 2008. Health (London) 2013. [DOI: 10.4236/health.2013.58168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bonell C, Parry W, Wells H, Jamal F, Fletcher A, Harden A, Thomas J, Campbell R, Petticrew M, Murphy S, Whitehead M, Moore L. The effects of the school environment on student health: a systematic review of multi-level studies. Health Place 2012; 21:180-91. [PMID: 23501377 DOI: 10.1016/j.healthplace.2012.12.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 12/07/2012] [Accepted: 12/10/2012] [Indexed: 12/23/2022]
Abstract
Health outcomes vary between schools and it is theorised that this may be partly attributable to variation in the school environment. Existing systematic reviews have not drawn authoritative conclusions because of methodological limitations in the review or studies available. We identified 42 multi-level studies, ten of which were judged of sufficient quality to narratively synthesize. There was consistent evidence that schools with higher attainment and attendance than would be expected from student intake had lower rates of substance use. Findings on the influence of smoking/alcohol policies were mixed. Three studies examined the health effects variously associated with school campus area and observability, year structure, school size and pupil-to-teacher ratio with mixed findings. The studies reviewed support the potential influence of the school environment on student health.
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Affiliation(s)
- Chris Bonell
- Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, Oxford OX1 2ER, United Kingdom.
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Coppo A, Galanti MR, Buscemi D, Giordano L, Faggiano F. School policies for preventing smoking among young people. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Huang HL, Hsu CC, Peng WD, Yen YY, Chen T, Hu CY, Shi HY, Lee CH, Chen FL, Lin PL. Analysis of influential factors associated with the smoking behavior of aboriginal schoolchildren in remote Taiwanese mountainous areas. THE JOURNAL OF SCHOOL HEALTH 2012; 82:318-327. [PMID: 22671948 DOI: 10.1111/j.1746-1561.2012.00705.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND A disparity in smoking behavior exists between the general and minority populations residing in Taiwan's mountainous areas. This study analyzed individual and environmental factors associated with children's smoking behavior in these areas of Taiwan. METHODS In this school-based study, data on smoking behavior and related factors for mountain-dwelling students were obtained from the 2008 and 2009 Control of School-aged Children Smoking Study surveys. A representative sample (N = 1239) from 26 primary schools was included. The association among 3 groups (never-, former-, and current-smokers) and the potential variables were simultaneously examined using unordered polytomous logistic regression analysis. RESULTS Between 13% and 34% of ever-smokers reported that their first smoking experience was in third grade. More than 70% were found to have bought cigarettes and 87% reported that the tobacco retailers had sold them cigarettes. The significant factors for current-smokers were predisposing factors, ie, attitude toward smoking (adjusted odds ratio [AOR] = 1.21); reinforcing factors, ie, family smoked in front of me (AOR = 2.44), friends smoked in front of me (AOR = 16.24), and school staff smoked in front of me (AOR = 2.98); and enabling factors, ie, cigarette availability and accessibility (AOR = 2.16 and 2.42, respectively). A student's perceived punishment for smoking at school had a positive significant effect on the risk of being former-smokers (AOR = 1.57). CONCLUSION The findings provide a basis for school and community to design and implement effective anti-smoking programs for remote mountain-based students to further reduce youth smoking.
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Affiliation(s)
- Hsiao-Ling Huang
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung City 80708, Taiwan
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Geiger BF, Vaid I, Beeson D, Riddle B. Implementation of school policies to prevent youth tobacco use in Alabama. THE JOURNAL OF SCHOOL HEALTH 2012; 82:277-284. [PMID: 22568463 DOI: 10.1111/j.1746-1561.2012.00698.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Public health professionals must monitor the effectiveness of school policies and programs to prevent youth initiation, promote quitting, and eliminate secondhand smoke. This analysis of school tobacco policies was preliminary to release of a state tobacco prevention and control plan for 2010-2015. METHODS University health educators collaborated with the state health agency to review policies of 33 school systems in 5 Metropolitan Statistical Areas and 9 public health areas. Authors developed a systematic approach of 8 steps useful to rate implementation of school tobacco control and prevention policies and discuss implications for health education program planning. RESULTS Thirty school policies prohibited possession and use of tobacco by students, faculty and campus visitors, and 26 of 33 specified disciplinary measures following violations. Only 4 public education agencies included 3 of the 6 elements of a model tobacco prevention and control policy as suggested by the state public health agency. None featured all 6 elements. None specified establishing school-community partnerships for tobacco prevention and control. CONCLUSIONS Preparing smoke-free youth requires implementing and evaluating tobacco education in grades K-12 including use of model guidelines from federal agencies and professional organizations. Determining the focus of existing school tobacco policies is an initial step to encourage adoption of comprehensive policies to reduce youth use of tobacco. Youth health advocates may act together with school administrators and legislators to strengthen policies to be consistent with model guidelines for tobacco prevention and control.
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Affiliation(s)
- Brian F Geiger
- School of Education & Center for Educational Accountability, University of Alabama at Birmingham College of Arts & Sciences, 1530 3rd Avenue South, Birmingham, AL 35294-1250, USA.
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Jafarabadi MA, Allahverdipour H, Bashirian S, Jannati A. Modeling the Underlying Predicting Factors of Tobacco Smoking among Adolescents. IRANIAN JOURNAL OF PUBLIC HEALTH 2012; 41:46-57. [PMID: 23113177 PMCID: PMC3468991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 02/14/2012] [Indexed: 10/29/2022]
Abstract
BACKGROUND With regard to the willing and starting tobacco smoking among young people in Iran. The aim of the study was to model the underlying factors in predicting the behavior of tobacco smoking among employed youth and students in Iran. METHODS In this analytical cross-sectional study, based on a random cluster sampling were recruited 850 high school students, employed and unemployed youth age ranged between 14 and 19 yr from Iran. The data of demographic and tobacco smoking related variables were acquired via a self-administered questionnaire. A series of univariate and multivariate logistic regressions were performed respectively for computing un-adjusted and adjusted Odds Ratios utilizing SPSS 17 software. RESULTS A number of 189 persons (25.6%) were smoker in the study and the mean smoking initiation age was 13.93 (SD= 2.21). In addition, smoker friend, peer persistence, leaving home, and smoking in one and six month ago were obtained as independent predictors of tobacco smoking. CONCLUSIONS The education programs on resistance skills against the persistence of the peers, improvement in health programs by governmental interference and policy should be implemented.
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Affiliation(s)
- M Asghari Jafarabadi
- Injury Epidemiology and Prevention Research Center, Dept. of Statistics and Epidemiology, Faculty of Health and Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - H Allahverdipour
- Dept. of Health Education and Promotion, Faculty of Health and Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran,Corresponding Author: Tel: 0098411-3357580-2 (383), E-mail address:
| | - S Bashirian
- Dept. of Public Health, Faculty of Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - A Jannati
- Dept. of Health Service Management, Faculty of Health and Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
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Changes in teachers' smoking behaviour following enforcement of a total smoke-free school policy. Public Health 2012; 126:678-81. [PMID: 22621804 DOI: 10.1016/j.puhe.2012.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 11/08/2011] [Accepted: 02/15/2012] [Indexed: 11/24/2022]
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Pabayo R, O'Loughlin J, Barnett TA, Cohen JE, Gauvin L. Does Intolerance of Smoking at School or in Restaurants or Corner Stores Decrease Cigarette Use Initiation in Adolescents? Nicotine Tob Res 2012; 14:1154-60. [DOI: 10.1093/ntr/ntr326] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Plaspohl SS, Parrillo AV, Vogel R, Tedders S, Epstein A. An assessment of America's tobacco-free colleges and universities. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2012; 60:162-167. [PMID: 22316413 DOI: 10.1080/07448481.2011.580030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE This study examined the extent to which US campuses identified as "100% tobacco-free" by the American Lung Association of Oregon adhered to the American College Health Association's the most recent guidelines and recommendations promoting tobacco-free environments in colleges and universities. PARTICIPANTS A key informant from 162 of 175 institutions (92.6% response rate) completed an online survey between January 2010 and February 2010. METHODS The variables under study were assessed via a cross-sectional research design. Participants completed a 35-item survey regarding their school's tobacco policies, procedures, and enforcement practices. RESULTS Although the vast majority of schools had written policies and procedures in place, schools with current policies were the most compliant. Numerous opportunities for improved adherence were identified in the results. CONCLUSIONS Findings from this study may help institutions in the development and implementation of a new tobacco policy, as well as strengthen policies among existing tobacco-free schools.
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Affiliation(s)
- Sara S Plaspohl
- Department of Health Sciences, Armstrong Atlantic State University, Savannah, Georgia 31419, USA.
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Hatzenbuehler ML, Wieringa NF, Keyes KM. Community-level determinants of tobacco use disparities in lesbian, gay, and bisexual youth: results from a population-based study. ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2011; 165:527-32. [PMID: 21646585 PMCID: PMC8329770 DOI: 10.1001/archpediatrics.2011.64] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
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.
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Affiliation(s)
- Mark L Hatzenbuehler
- Center for the Study of Social Inequalities and Health, Columbia University, New York, NY 10032, USA.
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WIIUM NORA, WOLD BENTE. Actions taken by schools when tobacco policies are violated: Associations with adolescent smoking prevalence. Scand J Psychol 2011; 52:494-501. [DOI: 10.1111/j.1467-9450.2011.00897.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mrug S, Gaines J, Su W, Windle M. School-level substance use: effects on early adolescents' alcohol, tobacco, and marijuana use. J Stud Alcohol Drugs 2011; 71:488-95. [PMID: 20557827 DOI: 10.15288/jsad.2010.71.488] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE School-level use of tobacco and alcohol are related to individual students' use in high school, but few studies have examined the effects of school-level substance use in early adolescence. In addition, little is known about factors modifying individuals' vulnerability to school-level influences. This study examined school-wide levels of alcohol, cigarette, and marijuana use in relation to early adolescents' substance use and the role of peer deviance and parenting practices as modifiers of school-level effects. METHOD This cross-sectional study included 542 students attending 49 public middle schools in a single metropolitan area. Students reported on their use of alcohol, cigarettes, and marijuana, and friends' deviant behavior in the last 12 months. Parents provided information about parental nurturance and harsh and inconsistent discipline. School-wide levels of substance use were obtained from the Pride Surveys completed by all students in Grades 6-8 at each school. Multilevel logistic regressions modeled individual use as a function of school-level use for each substance. Interactions of friends' deviance and poor parenting with school-level substance use evaluated differential susceptibility. RESULTS Among the three substances, only school-level rates of cigarette smoking were associated with individual smoking. The relationships of school-level smoking and alcohol use with individual use were stronger for students whose parents reported poorer parenting practices. CONCLUSIONS Antismoking programs may need to preferentially target middle schools with high rates of cigarette smoking. Students who receive suboptimal parenting may benefit from increased support to deter them from early initiation of smoking and alcohol use, especially in high-risk schools.
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Affiliation(s)
- Sylvie Mrug
- Department of Psychology, University of Alabama at Birmingham, CH 415, 1530 3rd Avenue South, Birmingham, Alabama 35294-1170, USA.
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Chen PL, Huang WG, Chao KY. Factors associated with Taiwanese junior high school personnel advising students to quit smoking. THE JOURNAL OF SCHOOL HEALTH 2011; 81:91-99. [PMID: 21223276 DOI: 10.1111/j.1746-1561.2010.00565.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Most smokers in developing countries begin smoking before age 18, and smoking prevalence is rising among adolescents. School personnel represent a target group for tobacco-control efforts because they interact daily with students, are role models for students, teach about tobacco-use prevention in school curricula, and implement school tobacco-control policies. The prevalence of teenage smoking has been examined in numerous studies, but few have focused on the influence of school personnel and the characteristics of school personnel who enforce school nonsmoking policy. The purpose of this study was to determine the factors associated with junior high school personnel advising students to quit smoking. METHODS School personnel (N = 7129) were recruited by cluster sampling from 60 junior high schools in Taiwan; of these, 5280 voluntarily returned self-administered, anonymous questionnaires (response rate = 74.06%) in 2004. RESULTS Most personnel (70%) had advised students to quit smoking. School personnel who were older, male, responsible for teaching health, smokers, with positive attitude against tobacco, or with more knowledge of tobacco hazards were more likely to advise students to quit smoking. Personnel with more interest in and access to tobacco-related materials were more likely to advise students to quit smoking. Personnel who had received tobacco-prevention training were 2.41 times more likely to persuade students to quit smoking after adjusting for other factors. However, only half of the participants had ever had access to educational materials about tobacco use, and 8% had ever received training to prevent tobacco use. CONCLUSIONS To reduce youth smoking prevalence, school tobacco-control programs should support tobacco-prevention training for school personnel.
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Affiliation(s)
- Ping-Ling Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan.
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