Department of Public Health, Amsterdam Public Health Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Faculty of Social and Behavioural Sciences, Department of Communication, University of Amsterdam, Amsterdam, The Netherlands.
Nicotine Tob Res. 2020 Oct 29;22(11):1964-1972. doi: 10.1093/ntr/ntz212.
Many European schools implement smoke-free school policies (SFSPs). SFSPs may decrease adolescent smoking by causing adolescents to perceive stronger antismoking norms, yet there exists no quantitative evidence that indicates for which norms and for whom such effects may occur. This study therefore assessed to what extent adolescents' perceived antismoking norms among best friends, teachers, and society at large were associated with SFSPs, and whether these associations were moderated by adolescents' level of school connectedness.
Survey data were collected in 2016/2017 on 10,653 adolescents aged 14-16 years old and 315 staff members in 55 schools from seven European cities. Associations of adolescent-perceived SFSPs and staff-reported SFSPs with best friend, teacher, and societal antismoking norms were estimated in multilevel logistic regression models, adjusted for demographics and school-level smoking prevalence. We tested for interaction between school connectedness and SFSPs.
Adolescent-perceived SFSPs were positively associated with antismoking norms by teachers (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 1.15-1.85), were negatively associated with antismoking norms by best friends (OR: 0.81, 95% CI: 0.67-0.99), but were not significantly associated with antismoking norms by society at large (OR: 0.87, 95% CI: 0.74-1.02). All interaction tests between adolescent-perceived SFSPs and school connectedness were nonsignificant. Staff-reported SFSPs were not associated with any norm and showed no significant interaction with school connectedness.
We found that SFSPs are associated with adolescents' perception of more antismoking norms by teachers, but less antismoking norms by best friends, irrespective of adolescents' level of school connectedness.
Smoke-free school policies, just as many other tobacco control policies, are assumed to foster adolescents' perception of antismoking norms. Still, current evidence does not demonstrate which antismoking norms may be influenced by SFSPs and whether this influence is equal for adolescents with different levels of school connectedness. This study suggests that SFSPs foster adolescents' perception of antismoking norms by teachers, but may concurrently lead to the perception of less antismoking norms by best friends, irrespective of adolescents' school connectedness. SFSPs may therefore need to be complemented with interventions that target antismoking norms in adolescent peer groups.
许多欧洲学校实施了无烟学校政策（SFSPs）。SFSPs 可能会通过使青少年对反吸烟规范的认知更强来减少青少年吸烟，但没有定量证据表明哪些规范和针对哪些人群可能会产生这种影响。因此，本研究评估了青少年对最好的朋友、教师和整个社会的反吸烟规范的看法与 SFSPs 的关联程度，以及这些关联是否因青少年的学校联系程度而有所不同。
2016/2017 年，在七个欧洲城市的 55 所学校中，对 10653 名 14-16 岁的青少年和 315 名工作人员进行了调查。使用多水平逻辑回归模型，调整了人口统计学和学校吸烟率，估计了青少年感知的 SFSPs 和工作人员报告的 SFSPs 与最好朋友、教师和社会反吸烟规范之间的关联。我们测试了学校联系与 SFSPs 之间的交互作用。
青少年感知的 SFSPs 与教师的反吸烟规范呈正相关（比值比[OR]：1.46，95%置信区间[CI]：1.15-1.85），与最好朋友的反吸烟规范呈负相关（OR：0.81，95% CI：0.67-0.99），但与整个社会的反吸烟规范无显著关联（OR：0.87，95% CI：0.74-1.02）。青少年感知的 SFSPs 与学校联系之间的所有交互检验均无统计学意义。工作人员报告的 SFSPs 与任何规范均无关，与学校联系也无显著交互作用。
我们发现，SFSPs 与青少年对教师的反吸烟规范的认知呈正相关，与最好朋友的反吸烟规范的认知呈负相关，而与青少年的学校联系程度无关。
无烟学校政策与许多其他烟草控制政策一样，被认为可以促进青少年对反吸烟规范的认知。然而，目前的证据并没有表明哪些反吸烟规范可能会受到 SFSPs 的影响，以及这种影响是否对不同学校联系程度的青少年都一样。本研究表明，SFSPs 促进了青少年对教师的反吸烟规范的认知，但同时也可能导致他们对最好朋友的反吸烟规范的认知减少，而与青少年的学校联系程度无关。因此，SFSPs 可能需要与针对青少年同伴群体反吸烟规范的干预措施相配合。
