Health Education Research Advance Access originally published online on November 30, 2004
Health Education Research 2005 20(4):466-475; doi:10.1093/her/cyg143
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Health Education Research Vol.20 no.4, © Oxford University Press 2004; All rights reserved
Compliance and support for smoke-free school policies
1 Cancer Prevention and Control Program, Cancer Center, University of California, San Diego, La Jolla, CA 92093-0645, USA
2 Correspondence to: J. P. Pierce; E-mail: jppierce{at}ucsd.edu
 |
Abstract |
|---|
 Top Abstract IntroductionMethodResultsDiscussionAppendixReferences |
|---|
Our objective was to examine factors associated with compliance and support for a smoke-free campus before and after a 1995 campus-wide smoking ban for everyone, including teachers and visitors, in California. Adolescent (12–17 years) data from the 1993, 1996, 1999 and 2002 (N
6000 each year) California Tobacco Surveys (population-based telephone surveys) were analyzed. Trends in compliance with smoke-free school policies and support for smoke-free campuses were examined among students in public and private schools. Perceived compliance with the no-smoking rule by most or all student smokers increased from 43.7 ± 1.6% in 1993 to 71.5 ± 1.4% in 2002. While non-smokers have overwhelmingly favored smoke-free school grounds since 1993 (more than 85% each survey year), support among current smokers increased from 55.8 ± 4.7% in 1996 to 69.1 ± 6.8% in 2002. Student smokers who saw teachers smoking in school were less likely to favor school smoking bans (odds ratio = 0.25, 95% confidence interval 0.12–0.49). The percentage of private school students seeing teachers smoke on school grounds has been at least twice that of public school students since 1996. Compliance with and support for smoke-free schools increased since smoking was banned on campus for everyone. Perceived compliance by teachers, much lower in private schools, appears to undermine student smokers' support of this policy. Increased efforts are necessary to communicate to teachers the importance of their modeling of policy compliance to students. |
Introduction |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionAppendixReferences |
|---|
School smoking prevention topics have been a part of health education curricula in public schools for decades and have the potential to influence youth smoking, particularly in communities with comprehensive tobacco control programs (Pentz et al., 1989b
; US Department of Health and Human Services, 1989, 1994, 2000; Hansen, 1992). Since 1995, the state of California mandated Tobacco Use Prevention Education (TUPE) for Grades 4–8, with optional competitive grants for tobacco education in Grades 9–12. To qualify for TUPE funding, high schools were required to have completely smoke-free campuses by July 1995. Elementary and middle schools have been smoke-free in California since 1952 (Pentz et al., 1989a). Many California schools have had a rule against students smoking on school property for years, but this policy did not necessarily extend to adults.
It has been shown that smoking rates are higher in schools with no policies banning smoking (Porter, 1982; Pentz et al., 1989b) and if smoking bans are not consistently enforced in schools, they can convey a mixed message to students (Bowen et al., 1995; Balch et al., 2004). When consistently enforced, school no-smoking policies are associated with decreased smoking prevalence among adolescents (Pentz et al., 1989a). Further, the existence and enforcement of these policies both promote and are a reflection of norms against smoking as an acceptable behavior for everyone (Wakefield et al., 2000; Gilpin et al., 2001). This includes teachers, who are important role models for adolescents. Earlier research has established a link between teachers' smoking at school and adolescent smoking uptake (Allen et al., 1991, 1992), and it is plausible that teachers' smoking at school influences whether students favor a smoke-free school campus. Gaining student compliance and support for smoke-free school policies, along with increased teacher compliance, are important objectives for tobacco control because they can lead to decreases in student smoking and initiation in a setting where many begin to smoke (Hill and Borland, 1991; Moore et al., 2001).
In this article, we examined trends in the extent to which students believed that their peers and teachers complied with the school-smoking ban and support for the ban. This was done for both non-smokers and current smokers, and among students in public schools and in private schools. The data were from large, population-based telephone surveys conducted in California every 3 years from 1993, before the ban, to 2002. Further, using data from the 2002 California Tobacco Survey (CTS), we used multivariate analyses to identify variables potentially associated with student support for a smoke-free campus.
|
Method |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionAppendixReferences |
|---|
Data source
The CTSs are large, population-based, random-digit-dialed surveys designed to monitor changes in tobacco use and attitudes in California. They are conducted every 3 years as part of the evaluation of the California Tobacco Control Program (Bal et al., 1990
). The methods for the 2002 and earlier CTSs are described in detail elsewhere (Social Sciences Data Collection, 1990–2002). The 2002 CTS enumerated a total of 35 133 households, representing a 45.7% screening response rate, with at least 15 calls made to working-unanswered or machine-answered telephone numbers. A total of 8796 adolescents between the ages of 12 and 17 years were identified, and completed interviews were obtained for 5857 (66.6% completion response rate). In 2002, the rate at which parents refused to allow their adolescents to be interviewed was 11.6%. After obtaining consent from a household adult, the interviewer made an appointment to call the selected adolescent back several days later for the interview. Similar methodology was employed during the other years of the CTS reported here (1993, 1996, 1999; sample size range 5531–6252; screening response rate range 51.1–71.1%; completion response rate range 71.2–80.3%; parental refusal rate range 8.5–13.8%).
Demographics
Perceptions regarding smoke-free school policies were examined by age, gender and race/ethnicity. The mean age of the adolescents surveyed was 14.4 years old (12–14 years 52.1%; 15–17 years 47.9%). Approximately 51.6% were males. In terms of race/ethnicity, 7.5% were African-American, 13.7% Asian/Pacific Islander, 36.4% Hispanic/Latino, 37.2% White and 5.2% other. In 2002, 87.7% of adolescents interviewed attended public schools. An additional 3.2% attended private, non-religious schools and an additional 8.4% attended private, religious schools, for a total of 11.6% attending private schools. Because of the small numbers attending non-religious private schools, all private school students were analyzed together.
Cigarette use
The CTS asked all adolescents about experimentation with cigarettes: ‘Have you ever smoked a cigarette?’. Adolescents who answered ‘no’ were considered non-smokers. Those who answered ‘yes’ were asked the following question: ‘Think about the last 30 days. On how many of these days did you smoke?’. Those who answered ‘yes’ to the ever-smoking question, but did not smoke in the last 30 days, were also considered non-smokers. Those who answered ‘yes’ to the ever-smoking question and smoked in the last 30 days were considered current smokers. Further, current smokers were asked: ‘Have you smoked at least 100 cigarettes in your life?’. Those who answered ‘yes’ were considered established smokers, while those who answered ‘no’ were considered experimenters.
Perceptions regarding smoke-free school policies
Obeying the rule not to smoke
To assess compliance with smoke-free policies at schools, the 1993, 1996, 1999 and 2002 CTS asked adolescents the following question: ‘How many students who smoke obey the rule prohibiting smoking on school property? Would you say...all, most, some, a few or none?’. Response choices indicating that most or all students obeyed the rule were combined and contrasted with other explicit response choices, as well as those who ‘refused’ or said they ‘don't know’ (approximately 1%).
Student preferences for smoke-free school grounds
To determine student support for the smoke-free policies, the 1993, 1996, 1999 and 2002 CTS asked adolescents the following question: ‘Do you think that all smoking by anyone should be banned on school grounds at all times, including meetings and sporting events?’. Those who responded ‘yes’ were contrasted with those who answered ‘no, and those who said they ‘don't know’ or ‘refused’ to answer (less than 2%). The word ‘ban’ was deliberately used in this question to maximize the number of adolescents who would disagree and thereby provide a conservative estimate of student support for school smoking policies.
Students' perceptions of teachers smoking in school
To assess students' perception of teachers smoking in school, all students in the 1996, 1999 and 2002 CTS were asked: ‘As far as you know, do any teachers smoke on your school's grounds?’. Again, those who responded ‘yes’ were contrasted with all others (don't know and refusals approximately 6%).
Correlates of support for smoke-free school grounds
Utilizing CTS data from 2002, for all students and for current smokers separately, we examined whether perceptions of students obeying school no-smoking rules and perceptions of teachers' smoking were associated with students preferring smoke-free school grounds. The aim of such multivariate analyses was to identify, for the most recent survey year, the correlates of students favoring smoke-free school grounds. Identifying the most recent, important factors associated with student support for smoke-free school grounds allows us to make further policy recommendations.
Prior level of experience with cigarettes would likely alter whether a student would favor smoke-free school grounds. For multivariate analyses of all students, smoking status was dichotomized into current smokers and non-smokers. For multivariate analyses of current smokers, cigarette use was dichotomized into established smokers and experimenters. Additionally, we examined a number of variables associated with adolescent smoking that could influence support for smoke-free school grounds. A complete description of the survey items that established these potential correlates and how they were coded for analysis is presented in the Appendix. Briefly, a number of family, peer and tobacco-related influences were considered, including parental smoking and attitudes about smoking; home smoking restrictions; best friends' attitude about smoking, smoking among close friends, perceptions of peer smoking, peer smoking norms and attitudes about secondhand smoke; observing student smoking in school; possession or willingness to use tobacco promotional items, having a favorite cigarette advertisement; risk-taking behavior; desire to quit smoking; perceiving benefits of smoking; and exposure to anti-smoking messages on TV.
Statistical analyses
Weights were developed for the respondents so that survey estimates would be representative of the California adolescent population by gender, age, race/ethnicity and education level of the head of the household (Social Sciences Data Collection, 1990–2002). Variance estimation was conducted using the modified jackknife procedure (Efron, 1982) in WesVar PC, a special statistical analysis software package for use with complex survey designs (Westat, Rockville, MD, 1996). Weighted percentages and 95% confidence intervals (CIs) are shown in the text, figures and table.
Multivariate logistic regression analyses in the same software package were used to identify independent predictors of supporting a school smoking ban in 2002 for all students (n = 5767) and for current smokers (n = 296). The dependent variable in these logistic regression models was student preference for a completely smoke-free school, while the independent variables were as described above. Preliminary analyses selected independent variables by performing a forward stepwise selection procedure using the SAS statistical software package (SAS Institute, Cary, NC). These analyses forced age, gender and race/ethnicity into the models. Demographics and significant independent variables (from the stepwise models) were then included in the final logistic regression analyses, using WesVar PC. Those variables that were not significant in the stepwise analyses were not entered in the final logistic regression models. Thus, the odds ratios (ORs) and 95% CIs presented in Table I were only for the variables included in the final models.
|
|
|
Results |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionAppendixReferences |
|---|
Trends in students obeying the rule not to smoke, 1993–2002
Figure 1 shows that after a slight decline from 43.7 ± 1.6% in 1993 to 40.7 ± 1.4% in 1996, the percentage of adolescents who perceived that most or all students obey the rule not to smoke on school property increased significantly to 66.7 ± 1.5% by 1999 and to 71.5 ± 1.4% by 2002. The 2002 percentage represents an increase by 75.7% since 1996.
Figure 2 illustrates that, when broken down by smoking status, trends in the percentage of adolescents who perceived that most or all students obey the rule not to smoke on school property followed the overall trends, although the percentages were lower for current smokers. Among non-smokers, after a slight decline from 45.0 ± 1.8% in 1993 to 41.0 ± 1.6% in 1996, the percentage increased significantly to 67.5 ± 1.5% by 1999 and to 72.2 ± 1.3% by 2002. Among adolescent current smokers, 34.1 ± 5.1% in 1993 perceived that most or all students obeyed the rule not to smoke on school property. After a non-significant increase to 37.4 ± 4.5% in 1996, the percentage increased dramatically to 56.9 ± 5.8% by 1999 and remained relatively level at 57.7 ± 6.6% in 2002.
|
Trends in student preferences for smoke-free school grounds, 1993–2002
In 2002, an overwhelming majority of students (90.5 ± 0.9%) surveyed supported the imposition of a policy prohibiting smoking at any time on school grounds, up from about 84% in both 1993 and 1996, and not significantly increased compared to 1999 (89.2 ± 0.8%). As shown in Figure 3, current smokers (any smoking in the past 30 days) showed impressive changes in support for the smoke-free policy between 1996 and 2002. While non-smokers have overwhelmingly favored smoke-free school grounds since 1993 (more than 85% for each survey year), support for smoke-free school grounds among current smokers increased steadily from 1996 to 2002. In 1996, a slight majority of smokers (55.8 ± 4.7%) favored a ban on smoking on school grounds and this increased significantly, so that by 2002 over two-thirds did so (69.1 ± 6.8%).
|
Perceptions of teachers smoking on school grounds
There have been significant declines in the perception among all students surveyed that teachers smoked on school grounds between 1996 and 2002. Overall, this perception significantly decreased from 19.4 ± 1.4% in 1996 to 15.7 ± 1.8% in 1999, a decline of about 19%, and further significantly decreased to 13.0 ± 1.3% in 2002, an additional 17% decline.
Comparing private and public school students (Figure 4), in 1996, nearly three times as many students in private schools reported teachers smoking on school grounds, compared with public school students (44.2 ± 6.2 versus 16.7 ± 1.4%). This ratio decreased so that by 1999 about twice as many students in private schools reported teachers smoking in school relative to public school students (29.2 ± 5.8 versus 14.4 ± 1.8%). This difference between private and public schools was similar in 2002 (26.4 ± 6.3 versus 11.7 ± 1.4%).
|
Factors associated with student preference for a smoke-free school environment
Table I presents the results of multivariate analyses examining factors associated with favoring smoke-free school grounds for all students and for current smokers.
All students
For all students, logistic regression analyses indicated that of the factors considered in relation to student preference for smoke-free school grounds, four were independently associated with preference for a smoke-free school. Current smokers were only 0.30 times as likely to favor smoke-free school grounds (OR = 0.30, 95% CI 0.20–0.46) compared to non-smokers. Those who were receptive to tobacco industry marketing, by indicating that they either had or would use a tobacco promotional item, were only 0.65 times as likely to support a school smoke-free policy (OR = 0.65, 95% CI 0.50–0.84). On the other hand, those who perceived that most or all students who smoked obeyed the school no-smoking rule were 1.53 times more likely to favor a school smoking ban than those who did not (OR = 1.53, 95% CI 1.21–1.93). Finally, those who believed that their best friends would disapprove if they smoked daily were 2.63 times more likely to favor a school smoking ban, compared to those who did not hold this belief (OR = 2.63, 95% CI 2.14–3.23).
Smokers only
Similar logistic regression analysis were conducted for current smokers only (n = 296). If students who smoked had seen teachers smoking in school, they were only 0.25 times as likely to be in favor of a school smoking ban, compared to those smokers who not had seen teachers smoking in school (OR = 0.25, 95% CI 0.12–0.49). Being an established smoker (100 or more cigarettes) was also significantly associated with not favoring a smoke-free school environment (OR = 0.40, 95% CI 0.20–0.82).
|
Discussion |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionAppendixReferences |
|---|
Following the implementation of the smoke-free school policy in 1995, perceived student compliance with the long-standing student no-smoking rule dipped slightly, likely because students were more aware of the policy and violators, but subsequently perceived compliance has increased greatly. Further, fewer students perceived that their teachers smoked on campus. However, private school students were more likely to report that their teachers smoked on campus than public school students. Teachers' smoking behavior appeared to affect whether students who were current smokers supported a complete smoking ban for everyone on campus.
A teacher's influence on students extends far beyond the classroom knowledge they convey. If students who smoke perceive that it is acceptable for teachers to smoke in school, then they are less likely to support school smoking bans. Likely, their rationale is that if it is acceptable for teachers to smoke on campus, then it should be acceptable for students to smoke as well. Furthermore, given that this association was only observed among student smokers (not non-smokers), it is possible that student smokers' perception that teachers are smoking is a rationalization of their own behavior, rather than an accurate perception of teachers' smoking behavior. Youth smokers may also be more likely than non-smokers to see teachers smoking, because they may frequent the areas where the teachers go to smoke. It should be noted that our measure of teacher smoking is not meant as an indicator of smoking prevalence among teachers. Rather, it provides information regarding teachers' smoking behavior in a context that is very influential to students. Whether or not fewer teachers are actually smokers, our results indicate that fewer are now perceived by their students to smoke on campus. Nonetheless, additional information such as independent, objective measures of teachers smoking at school would be valuable in strengthening our findings.
When considering all students (current smokers and non-smokers), perceptions of teachers smoking on campus were not significantly associated with favoring smoke-free school grounds. Instead, perceptions of student smokers obeying school smoking bans or best friends disapproving of smoking were associated with supporting a smoke-free campus. It should be noted that recent focus group research has confirmed that poorly enforced smoke-free school rules made ‘smoking easy and tempting’ for adolescents (Balch et al., 2004). Further, being receptive to tobacco industry marketing was negatively associated with favoring smoke-free school grounds. Not surprisingly, those who were current smokers were not as likely to favor smoke-free school grounds.
While elementary and middle schools are required to be completely smoke-free, private schools and public schools that did not elect to apply for TUPE funding did not have to implement a policy completely banning smoking on campus for everyone. It is likely that most of these schools have a rule against students smoking on campus, but many of them may still provide an area for teachers, staff and visitors to smoke, or adults can smoke in the parking lot. In which case, they would be potentially visible to students, as California schools are generally clusters of small buildings with considerable traffic outside throughout the campus. Another California law (AB-13) implemented in January 1995 bans smoking in all indoor workplaces. Some non-TUPE schools may have decided on a complete smoking ban for everyone because of AB-13. By the end of 1995, 95% of all public school districts had adopted a completely smoke-free policy (Independent Evaluation Consortium, 1998).
This article should not be considered an evaluation of the TUPE program, but only a report on changes in perceived compliance and support for one component of the program, a completely smoke-free learning environment. The TUPE program included anti-smoking curricula, as well as resources for teacher training and enforcement of the smoke-free campus policy. However, it should be noted that private schools were not eligible for TUPE funding (Independent Evaluation Consortium, 1998). Thus, administrators and teachers in these schools did not have the benefit of the training and resources this program provided.
Limitations
The measures we used regarding compliance with smoke-free policies were students' perceptions, which could differ from actual rates of compliance, perhaps ascertained by a vice principal via periodic systematic sweeps of the campus. It should be noted that smoking status was by self-report and not validated biochemically. Also, the CTS did not collect information identifying the school that adolescent respondents attended.
As reported in Methods, from 1993 to 2002, the household level response rates for the CTS have declined and this has occurred for other state surveillance systems as well (Biener, 2004). However, a careful analysis indicated that the samples obtained were at least as representative of the population in later years when the household response rates had declined as they were in earlier years when they were higher (Biener, 2004). Further, estimates of adult smoking prevalence from the CTS were very similar to state-specific estimates from the Current Population Survey (Bureau of Labor Statistics and US Census Bureau, 2002), which showed much less of a decline in household response rates (Biener, 2004).
Conclusions and implications
The increase in support for smoke-free schools in recent years, especially among current smokers, suggests that the California Tobacco Control Program, of which TUPE is only one component, has had positive effects in terms of changing smoking social norms in schools. General acceptance of school smoking bans for everyone at school may be a factor in the reduced level of adolescent smoking documented in recent years (Social Sciences Data Collection, 1990–2002), along with other tobacco control efforts, such as the anti-tobacco media campaign, increased enforcement of laws banning the sale of tobacco to minors, cigarette price increases, and bans on smoking in other public and workplaces.
This research contributes to tobacco control objectives by identifying factors associated with student support of smoke-free school grounds and it highlights how the smoking behaviors of teachers conveys a strong message to students who smoke that affects their support for smoke-free school policies. This finding suggests that increased efforts are necessary to communicate to teachers the importance of their modeling of appropriate behavior, particularly in private schools, which have not been eligible for TUPE funds in California. This can be accomplished through school-wide teacher orientation at the beginning of the school year, and through teacher and administrator training for tobacco prevention curricula. Encouraging teachers not to smoke, especially on school grounds, in addition to the maintenance of smoke-free school grounds, should also be considered as a key component of school-based tobacco prevention programs. Furthermore, the implementation of a statewide workplace smoking ban, such as those in California and in several other states, would facilitate increased compliance with campus no-smoking policies and curb exposure to smoking in many settings (including establishments directly outside of school grounds). The lessons from this report are likely to be applicable in other child and adolescent care institutions (e.g. after school programs, day care centers, boys-and-girls clubs, scouts, YMCAs, etc.), as well as for any other locality or state that is contemplating implementation of a school campus smoke-free policy.
|
Appendix |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionAppendixReferences |
|---|
For each of the predictors of preference for smoke-free school grounds we considered, the exact survey item(s) is given below, along with an explanation of how the item was coded for analysis.
Family influences
Parental smoking
This was assessed with the following question: ‘Do any of your parents, step-parents or guardians now smoke cigarettes?’. A ‘yes’ response indicated a negative parental influence regarding smoking.
Parental attitude about smoking
‘Have your parents expressed a desire for you not to smoke?’. A ‘yes’ response indicated a positive parental influence against smoking.
Home smoking restrictions
Adolescents were asked about the smoking rules or restrictions in their home, if any. Those who responded that smoking was completely banned for everyone were contrasted with other responses (e.g. partial bans, no bans).
Peer influences
Best friends' attitudes about smoking
‘How do you think your best friends would feel about you smoking on a daily basis?’. Respondents who answered ‘disapprove’ were considered to have strong peer norms against smoking.
Smoking among close friends
‘Of your best friends who are male, how many of them smoke?’ and ‘Of your best friends who are female, how many of them smoke?’. If the respondents gave a number other than zero to either question, they were considered exposed to smoking among their peers.
Perceptions of peer smoking
Perceptions of peer smoking was assessed with the question, ‘How many people your age that you know smoke cigarettes’. Those who replied ‘most’ were contrasted with others (none, a few, some or most, don't know or refused).
Peer objections to secondhand smoke
Adolescents were asked, ‘How many people your age that you know object to secondhand smoke?’. Those who answered ‘none’ were considered to have permissive peer attitudes regarding secondhand smoke.
Observing student smoking in school
Adolescents were asked if, during the past 2 weeks, they had seen anyone smoking on school property. Those who reported seeing anyone smoking on school property in the past 2 weeks were contrasted with others.
Tobacco marketing receptivity
Possession or willingness to use a tobacco promotional item
To assess tobacco marketing receptivity, adolescents were asked: ‘In the past 12 months, have you ever: Exchanged coupons for an item with a tobacco brand name or logo on it?, Received as a gift, or for free, any item with a tobacco brand name or logo on it? or Purchased any item with a tobacco brand name or logo on it?’. Those answering ‘yes’ to any of these questions indicated that the adolescent had a tobacco promotional item. Adolescents were then asked, ‘Do you think you would ever use a tobacco industry promotional item, such as a tee shirt?’. Those answering ‘yes’ to this question indicated a willingness to use a promotional item. Those who had a promotional item or were willing to use such an item were contrasted to all others.
Having a favorite cigarette advertisement
‘What is the name of the cigarette brand of your favorite cigarette advertisement?’. Respondents who did not have a favorite advertisement were contrasted with those who did.
Other variables considered
Risk taking behavior
‘I get a kick out of doing things every now and then that are a little risky or dangerous’. Adolescents answered yes or no and those who agreed with this statement were classified as more likely to engage in risk-taking behavior.
Desire to quit smoking
Adolescents who had smoked in the past month were asked if they had ever seriously thought about quitting smoking. Those who had thought about quitting were contrasted with others.
Benefits of smoking
Students were asked five additional questions assessing their opinions regarding the benefits of smoking: ‘Smoking can help people relax’, ‘Smoking can help people when they are bored’, ‘Smoking helps people feel more comfortable at parties and in other social situations’ and ‘Smoking helps people keep their weight down’. Each question was considered individually. If a student responded ‘yes’ to a question, she/he was considered to perceive that benefit of smoking.
Exposure to anti-smoking messages on TV
Adolescents were asked if, in the last month, they had seen anything on TV against smoking. Those who responded that they had not seen anything on TV against smoking were contrasted against other responses.
|
Acknowledgments |
|---|
This research was supported by grant 12RT-0082 from the Tobacco Related Diseases Research Program of the University of California, Office of the President.
|
References |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionAppendixReferences |
|---|
Allen, K.F., Moss, A. and Botman, S. (1991) Teenage Attitudes and Practices Survey (TAPS): methodology and response rates. Paper presented at the 119th Annual Meeting of the American Public Health Association. Atlanta, GA.
Allen, K.F., Moss, A.J., Giovino, G.A., Shopland, D.R. and Pierce, J.P. (1992) Teenage Tobacco-Use: Data Estimates from the Teenage Attitudes and Practices Survey: United States, 1989. Advance Data 224. National Center for Health Statistics, Hyattsville, MD.
Bal, D.G., Kizer, K.W., Felten, P.G., Mozar, H.N. and Niemeyer, D. (1990) Reducing tobacco consumption in California. Journal of the American Medical Association, 264, 1570–1574.
Balch, G.I., Tworek, C., Barker, D.C., Sasso, B., Mermelstein, R. and Giovino, G.A. (2004) Opportunities for youth smoking cessation: findings from a national focus group study. Nicotine and Tobacco Research, 6, 9–17.[CrossRef]
Biener, L. (2004) Declining survey response rates do not bias smoking prevalence estimates. American Journal of Preventive Medicine, in press.
Bowen, D.J., Kinne, S. and Orlandi, M. (1995) School policy in COMMIT: a promising strategy to reduce smoking by youth. Journal of School Health, 65, 140–144.[Medline]
Bureau of Labor Statistics and US Census Bureau (2002) Current Population Survey: Design and Methodology. Technical Paper 63RV. US Department of Commerce, Washington, DC.
Efron, B. (1982) The Jackknife, The Bootstrap and other Resampling Plans. Society for Industrial and Applied Mathematics, Philadelphia, PA.
Gilpin, E.A., Emery, S.L., Farkas, A.J., Distefan, J.M., White, M.M. and Pierce, J.P. (2001) The California Tobacco Control Program: A Decade of Progress. Results from the California Tobacco Surveys, 1990–1998. University of California, San Diego, La Jolla, CA.
Hansen, W.B. (1992) School-based substance abuse prevention: a review of the state of the art in curriculum, 1980–1990. Health Education Research, 7, 403–430.
Hill, D. and Borland, R. (1991) Adults' accounts of onset of regular smoking: influences of school, work and other settings. Public Health Reports, 106, 181–185.[Web of Science][Medline]
Independent Evaluation Consortium (1998) Final Report of the Independent Evaluation of the California Tobacco Control Prevention and Education Program: Wave I Data, 1996–1997. Gallup, Rockville, MD.
Moore, L., Roberts, C. and Tudor-Smith, C. (2001) School smoking policies and smoking prevalence among adolescents: multilevel analysis of cross-sectional data from Wales. Tobacco Control, 10, 117–123.
Pentz, M.A., Brannon, B.R., Charlin, V.L., Barrett, E.J., MacKinnon, D.P. and Flay, B.R. (1989a) The power of policy: the relationship of smoking policy to adolescent smoking. American Journal of Public Health, 79, 857–862.
Pentz, M.A., Dwyer, J.H., MacKinnon, D.P., Flay, B.R., Hansen, W.B., Wang, E.Y. and Johnson, C.A. (1989b) A multicommunity trial for primary prevention of adolescent drug abuse. Effects on drug use prevalence. Journal of the American Medical Association, 261, 3259–3266.
Porter, A.M.W. (1982) Disciplinary attitudes and cigarette smoking: a comparison of two schools. British Medical Journal, 285, 1725–1726.
Social Sciences Data Collection (1990–2002) Final Reports, Technical Documentation, Questionnaires and Data Sets for the California Tobacco Surveys. University of California, San Diego, CA. Available: http://ssdc.ucsd.edu/tobacco; retrieved 10 July 2003.
US Department of Health and Human Services (1989) Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General. Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA.
US Department of Health and Human Services (1994) Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA.
US Department of Health and Human Services (2000) Reducing Tobacco Use. A Report of the Surgeon General. Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA.
Wakefield, M.A., Chaloupka, F.J., Kaufman, N.J., Orleans, C.T., Barker, D.C. and Ruel, E.E. (2000) Effect of restrictions on smoking at home, at school and in public places on teenage smoking: cross sectional study. British Medical Journal, 321, 333–337.
Received on February 10, 2004; accepted on October 26, 2004
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  D. Piontek, A. Buehler, U. Rudolph, K. Metz, C. Kroeger, S. Gradl, S. Floeter, and C. Donath Social contexts in adolescent smoking: does school policy matter? Health Educ. Res., December 1, 2008; 23(6): 1029 - 1038. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. Murnaghan, S. T. Leatherdale, M. Sihvonen, and P. Kekki A multilevel analysis examining the association between school-based smoking policies, prevention programs and youth smoking behavior: evaluating a provincial tobacco control strategy Health Educ. Res., December 1, 2008; 23(6): 1016 - 1028. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Thomas, D Fayter, K Misso, D Ogilvie, M Petticrew, A Sowden, M Whitehead, and G Worthy Population tobacco control interventions and their effects on social inequalities in smoking: systematic review Tob. Control, August 1, 2008; 17(4): 230 - 237. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Lee, E. J. Hahn, C. A. Riker, A. Hoehne, A. White, D. Greenwell, and D. Thompson Secondhand Smoke Exposure in a Rural High School The Journal of School Nursing, August 1, 2007; 23(4): 222 - 228. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The GTSS Collaborative Group The Global School Personnel Survey: a cross-country overview. Tob. Control, June 1, 2006; 15(suppl_2): ii20 - ii30. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||