Department Tranzo, Academic Collaborative Centre for Public Health Brabant, Tilburg University, Tilburg, The Netherlands.
Academic Collaborative Centre for Public Health Limburg, Public Health Service South Limburg (GGD ZL), Geleen, The Netherlands.
Eur J Public Health. 2018 Feb 1;28(1):43-49. doi: 10.1093/eurpub/ckx099.
Although increasing numbers of countries are implementing outdoor school ground smoking bans at secondary schools, less attention is paid to the post-implementation period even though sustainability of a policy is essential for long-term effectiveness. Therefore, this study assesses the level of sustainability and examines perceived barriers/facilitators related to the sustainability of an outdoor school ground smoking ban at secondary schools.
A mixed-method design was used with a sequential explanatory approach. In phase I, 438 online surveys were conducted and in phase II, 15 semi-structured interviews were obtained from directors of relevant schools. ANOVA (phase I) and a thematic approach (phase II) were used to analyze data.
Level of sustainability of an outdoor school ground smoking ban was high at the 48% Dutch schools with an outdoor smoking ban. Furthermore, school size was significantly associated with sustainability. The perceived barriers/facilitators fell into three categories: (i) smoking ban implementation factors (side-effects, enforcement, communication, guidelines and collaboration), (ii) school factors (physical environment, school culture, education type and school policy) and (iii) community environment factors (legislation and social environment).
Internationally, the spread of outdoor school ground smoking bans could be further promoted. Once implemented, the ban has become 'normal' practice and investments tend to endure. Moreover, involvement of all staff is important for sustainability as they function as role models, have an interrelationship with students, and share responsibility for enforcement. These findings are promising for the sustainability of future tobacco control initiatives to further protect against the morbidity/mortality associated with smoking.
尽管越来越多的国家在中学实施户外校园吸烟禁令，但对实施后的情况关注较少，尽管政策的可持续性对于长期有效性至关重要。因此，本研究评估了户外校园吸烟禁令的可持续性水平，并研究了与中学户外校园吸烟禁令可持续性相关的感知障碍/促进因素。
采用混合方法设计，采用顺序解释方法。在第一阶段，进行了 438 次在线调查，在第二阶段，从相关学校的校长那里获得了 15 次半结构化访谈。使用 ANOVA（第一阶段）和主题方法（第二阶段）分析数据。
在实施户外校园吸烟禁令的 48%的荷兰学校中，户外校园吸烟禁令的可持续性水平较高。此外，学校规模与可持续性显著相关。感知障碍/促进因素分为三类：（i）禁烟实施因素（副作用、执行、沟通、准则和合作）、（ii）学校因素（物理环境、学校文化、教育类型和学校政策）和（iii）社区环境因素（立法和社会环境）。
在国际上，可以进一步推广户外校园吸烟禁令的实施。一旦实施，禁令就成为了“常态”做法，投资往往会持续下去。此外，所有员工的参与对于可持续性很重要，因为他们是榜样，与学生有相互关系，并共同负责执行。这些发现为未来的烟草控制倡议的可持续性提供了希望，以进一步防止与吸烟相关的发病率/死亡率。
