Smoking in Ontario Schools: Does Policy Make a Difference?

Article excerpt

ABSTRACT

Objective: Studies in other countries have shown that school tobacco control policy has potential to prevent smoking uptake in adolescents. Since no Canadian research has studied this association, we assessed the statistical link between school tobacco policy and smoking status in Ontario elementary and secondary schools.

Methods: We conducted secondary analysis of data collected using the School Smoking Profile, a cross-sectional, self-report questionnaire. School policy variables were formed from five survey items concerning students' perceptions of school tobacco control policy. Smoking status was determined through self-report measures which had been validated by carbon monoxide testing. Logistic regression models used school policy variables to explain smoking status in elementary and secondary schools, controlling for school location, school size, and student's grade level.

Results: The smoking policy variables, rules and enforcement, explained smoking status after controlling for other variables. In elementary schools, perceptions of stronger enforcement reduced the odds of being a smoker (OR=0.39, Cl^sub 99^11=0.34-0.44). In secondary schools, enforcement lost its protective effect (OR=1.05, Cl^sub 99^ =1.00-1.10). In addition, student perceptions that rules were strong were indicative of increased smoking in secondary schools (OR= 1.32, Cl^sub 99^=I .27-1.37).

Discussion: Strong enforcement of school tobacco control policy appears to be effective in elementary schools but is not as helpful in secondary schools. Secondary school policymakers should consider modifying their sanctions to avoid alienating smokers.

Currently 45,000 Canadians die of smoking-related causes each year, and despite all efforts at reduction, more than one fifth of all Canadians smoke.1 Many people start smoking in their adolescent years. In fact, recent statistics show that of all adult smokers, 85% began before the age of 18.1 Although Canadian federal laws make it illegal for people under the age of 18 to buy cigarettes, 22 % of Canadians aged 15 to 19 smoke.2 Therefore, it is important that all avenues of smoking prevention directed at youth be considered.

Comprehensive prevention programs that aim to change smoking behaviour at a population level usually include a mix of public education and policy with the goal of changing the social environment in which smoking occurs.3 Schools are an important target for youth smoking prevention because schools can be environments that socially reinforce behaviours.''

We systematically searched for literature published from 1966-2002 that statistically assessed the association of school tobacco control policies with smoking status. Four of five studies identified reported moderate associations of school tobacco policy with smoking status.5'8 The association in one study was not significant.9 Wakefield et al.8 reported the strongest relation for lower prevalence when school smoking bans were strongly enforced (r = 0.86 [CI95 0.77-0.9]) p<0.001). These studies spanned geography (three continents), time (1989-2002) and definitions for smoking status and tobacco policy. All studies were cross-sectional, and ranged in size from 55 to 347 schools. All but one studied secondary schools. The search did not identify any Canadian studies.

The current study assessed the statistical link between school tobacco policy and the smoking rates in Ontario elementary and secondary schools. Ontario's 1994 Tobacco Control Act (TCA) banned smoking in school buildings and on school property in all publicly funded schools.10 However, since schools monitor compliance, wide variation exists.11 The current study associates student perceptions of smoking rules and enforcement with smoking status.

METHODS

Design and sample

Researchers approached 14 school boards in proximity to the research centre and accepted the first 8 boards who agreed to participate. …