School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
Am J Prev Med. 2010 Dec;39(6):507-14. doi: 10.1016/j.amepre.2010.08.019.
A substantial challenge in addressing adolescent tobacco use is that smoking behaviors occur in complex environments that involve the school setting and larger community context.
This study provides an integrated description of factors from the school and community environment that affect youth smoking and explains variation in individual smoking behaviors both within and across schools/communities.
Data were collected from 82 randomly sampled secondary schools in five Canadian provinces (British Columbia, Manitoba, Ontario, Quebec, Newfoundland, and Labrador) during the 2003-2004 school year. Cross-sectional data were obtained from students; school administrators (school-based tobacco control policies and programs); and from observations in the community. In 2009, hierarchic logistic regression was used to model the role of individual, school, and community variables in predicting student smoking outcomes.
Students who attended a school with a focus on tobacco prevention (OR=0.87, 95% CI=0.81, 0.94) and stronger policies prohibiting tobacco use (OR=0.92, 95% CI=0.88, 0.97) were less likely to smoke than students who attended a school without these characteristics. A student was more likely to smoke if a greater number of students smoked on the school periphery (OR=1.25, 95% CI=1.07, 1.47). Within the community, price per cigarette (OR=0.91, 95% CI=0.84, 0.99) and immigrants (OR=0.99, 95% CI=0.98, 0.99) were inversely related to students' smoking status.
The results suggest that school and community characteristics account for variation in smoking levels across schools. Based on the current findings, the ideal school setting that supports low student smoking levels is located in a neighborhood where the cost of cigarettes is high, provides tobacco prevention education, and has a policy prohibiting smoking.
解决青少年吸烟问题的一个重大挑战是，吸烟行为发生在复杂的环境中，涉及学校环境和更大的社区背景。
本研究综合描述了影响青少年吸烟的学校和社区环境因素，并解释了个体吸烟行为在学校和社区之间的差异。
2003-2004 学年，在加拿大五个省份（不列颠哥伦比亚省、马尼托巴省、安大略省、魁北克省、纽芬兰省和拉布拉多省）的 82 所随机抽样的中学收集数据。从学生、学校管理人员（基于学校的烟草控制政策和计划）以及社区观察中获得横断面数据。2009 年，采用层次逻辑回归模型，对个体、学校和社区变量在预测学生吸烟结果中的作用进行建模。
与就读于没有这些特征的学校的学生相比，就读于专注于烟草预防的学校（OR=0.87，95%CI=0.81，0.94）和拥有更强有力的禁止吸烟政策的学校（OR=0.92，95%CI=0.88，0.97）的学生吸烟的可能性较低。如果学校周边有更多的学生吸烟（OR=1.25，95%CI=1.07，1.47），学生吸烟的可能性就越大。在社区内，每支香烟的价格（OR=0.91，95%CI=0.84，0.99）和移民（OR=0.99，95%CI=0.98，0.99）与学生的吸烟状况呈反比。
研究结果表明，学校和社区特征解释了学校之间吸烟水平的差异。基于目前的发现，支持低学生吸烟水平的理想学校环境是位于香烟成本高、提供烟草预防教育和有禁烟政策的社区。
