Health Education Research Advance Access originally published online on June 16, 2008
Health Education Research 2008 23(6):1016-1028; doi:10.1093/her/cyn034
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A multilevel analysis examining the association between school-based smoking policies, prevention programs and youth smoking behavior: evaluating a provincial tobacco control strategy
1 School of Nursing
2 Prince Edward Island Health Research Institute, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island C1A 4P3, Canada
3 Division of Preventive Oncology, Cancer Care Ontario, 620 University Avenue, Toronto, Ontario M5G 2L7, Canada
4 Department of Public Health Sciences, University of Toronto, 6th Floor, Health Sciences Building, 155 College Street, Toronto, Ontario M5T 3M7, Canada
5 Department of Health Studies and Gerontology, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
6 Department of General Practice and Primary Health Care, University of Helsinki, Mannerheimintie 172, FIN - 00300, Helsinki, Finland
7 Department of General Practice and Primary Health Care & Institute of Clinical Medicine, University of Helsinki, Mannerheimintie 172, FIN - 00300, Helsinki, Finland
* Correspondence to: D. A. Murnaghan. E-mail: dmurnaghan{at}upei.ca
This paper examined how smoking policies and programs are associated with smoking behavior among Grade 10 students (n = 4709) between 1999 and 2001. Data from the Tobacco Module from the School Health Action Planning and Evaluation System were examined using multilevel logistic regression analyses. We identified that (i) attending a school with smoking prevention programs only was associated with a substantial risk of occasional smoking among students with two or more close smoking friends and (ii) attending a school with both smoking prevention programs and policies was associated with substantial risk of occasional smoking among students who did not believe there were clear smoking rules present. Students attending schools where year of enrolment in high school starts in Grade 9 were more likely to be regular and occasional smokers. Each 1% increase in Grade 12 smoking rates increased the odds that a Grade 10 student was an occasional smoker. It appears that grade of enrolment, senior student smoking behavior, close friend’s smoking behavior and clear rules about smoking at school can impact school-based tobacco control programming. These preliminary study findings suggest the need for further research targeting occasional smoking behavior and the transition stage into high school.
Received on September 28, 2007; accepted on May 11, 2008