Research articleAdolescent Smoking: Effect of School and Community Characteristics
Introduction
A substantial challenge in addressing adolescent tobacco control is that smoking behaviors occur in complex environments that involve the school setting and larger community context. The ecologic approach emphasizes the importance of the broader environment on individual behavior. Current research1, 2, 3, 4, 5 on social determinants of health consistently shows an association between neighborhood factors and individual health. Elucidating the influence of school and community characteristics on adolescent smoking could inform the development and implementation of new approaches to adolescent tobacco control interventions.6
School-based tobacco control policies and programs play a key role in youth smoking prevention because school settings are established systems in which smoking behaviors can be addressed.7 Previous research8, 9 has shown that schools with smokefree environments have a lower prevalence of smoking and less overall cigarette consumption than schools with minimal guidelines. However, findings from studies7, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 examining the effects of school policies on student smoking are mixed. Similarly, research20, 21 on the effectiveness of school-based smoking prevention programs has been inconclusive. Other factors in the school's contextual environment likely influence youth smoking. A school effect was reported in three reviews10, 22, 23 of the literature on students' smoking behavior. An earlier cohort study11 found that interschool variation in smoking was not explained by differences in pupil composition but by unidentified school contextual factors. Schools as well as governments have implemented strategies aimed at lowering the prevalence of smoking in the community (e.g., educational programs, polices, and municipal regulations). What is also needed is an understanding of the relationships among these strategies, how they are implemented, and their effectiveness at reducing youth smoking.
Smoking outcomes need to be assessed at the individual level, as well as at the school and community levels, in order to discern the impact of various factors in students' social and school environment. The findings and recommendations that emerge from an integrated analysis would provide a wider and more robust basis on which to make evidence-based decisions in planning school smoking interventions.
As a first wave of data from Project Impact: Youth and Tobacco, the current research addresses predictors at multiple levels. Previously published findings from Project Impact confirm that there are substantial effects of tobacco retailer variables between schools with high and low smoking prevalence,24 that smoking prevalence varies across schools, and that policy characteristics can explain some of this variation.7, 25 There is a lack of research examining multiple factors in the school and community environment and how these factors work in combination to influence adolescent smoking.
The purpose of the present study was to investigate the influence of school-based tobacco control policies/programs, in combination with other factors in the school and community environment, on adolescent smoking. The hope is to identify factors that hold the most promise for reducing smoking. Findings will contribute to policy and program planning in tobacco control by identifying the approaches that are most likely to be effective.
Section snippets
Participants
During 2003–2004, recruitment of 82 secondary schools with students in Grades 10 and 11 was achieved in five Canadian provinces: British Columbia (BC); Manitoba (MB); Newfoundland and Labrador (NL); Ontario (ON); and Quebec (QC). These provinces were selected because they had an established infrastructure for data collection, central survey research centers, represented a reasonable geographic balance, and spanned the range of smoking prevalence for those aged 15–19 years (15% –24%) at the time
Descriptive Statistics
The average school smoking prevalence was 13.14% (SD=6.1%) with a total of 3041 smokers and 19,640 nonsmokers. Smokers were more likely to be girls/women (55.0%) and were proportionately older than nonsmokers (30.8% of smokers were aged >16 years vs 19.6% of nonsmokers). Descriptive statistics for the predictors used in the preliminary model are listed in Table 1.
Multilevel Analysis
Model assumptions, examined using Mahalanobis distance and comparing robust versus model-implied SEs, were found to be reasonable.43
Discussion
In the present study, smoking varied across schools—both school and community characteristics accounted for some of this variation. Findings suggest that the ideal school setting supporting low prevalence of student smoking is located in a neighborhood where the cost of cigarettes is high, the school provides tobacco prevention education, and the school has a policy prohibiting smoking. This information contributes to what is known about adolescent tobacco control by simultaneously addressing
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