Stockholm Prevents Alcohol and Drug Problems, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
Front Public Health. 2021 Apr 1;9:628748. doi: 10.3389/fpubh.2021.628748. eCollection 2021.
Tobacco use, often initiated in younger ages, is a serious health challenge worldwide. In Sweden, smoking has been prohibited on school grounds since 1994. Municipal environmental and health inspectors control the compliance of the ban. Nevertheless, the enforcement and maintenance of the ban are inadequate. The aim of the current study was to identify facilitators, barriers, and the potential for improved implementation of a 25-year outdoor school ground smoking ban in upper secondary schools. A process evaluation was conducted using semi-structured interviews with principals in upper secondary schools, local environmental and health inspectors, and local politicians ( = 30) in Stockholm County, with purposive sampling for informant recruitment. A qualitative content analysis of the transcribed interviews was performed. Three main categories and 10 subcategories were generated from the interviews, revealing facilitators, barriers, and the potential for improvement of the implementation of the ban. A prominent facilitator of the ban was informed and engaged principals and inspectors. Prominent barriers were conflicting goals governing the schools, which reduce staffs' motivation to maintain the ban, unclear school ground boundaries, and lack of resources. Potential for improvement was found in a new tobacco act with an extended ban on smoking at school entrances, extended support for schools and staff to strictly enforce the ban, and a continued denormalisation of smoking in society. To achieve effective implementation of outdoor school ground smoking bans in upper secondary schools, authorities need to address conflicts between different goals governing the schools and give necessary support to the staff to strictly enforce the ban. Policies on smoke-free working hours in the municipalities along with tobacco restrictive policies in the surrounding society may increase the possibility to maintain the smoking ban in upper secondary school grounds.
吸烟行为通常始于年轻时，是全球范围内严重的健康挑战。在瑞典，自 1994 年以来，学校内已禁止吸烟。市政环境和卫生检查员负责监督禁令的遵守情况。然而，禁令的执行和维护力度不足。本研究的目的是确定在实施实施 25 年室外学校禁烟令方面的促进因素、障碍因素和改进潜力，该禁令适用于瑞典斯德哥尔摩市的高中。我们采用半结构式访谈，对高中校长、当地环境和卫生检查员以及当地政治家（=30 人）进行了过程评估，采用目的性抽样招募信息提供者。对转录访谈进行了定性内容分析。访谈产生了三个主要类别和十个子类别，揭示了禁令实施的促进因素、障碍因素和改进潜力。禁令的一个显著促进因素是知情且参与的校长和检查员。主要障碍因素是管理学校的目标相互冲突，这降低了工作人员维持禁令的积极性、学校场地边界不明确以及资源匮乏。新的《烟草法案》有望改善这种情况，该法案扩大了在学校入口处禁止吸烟的范围，为学校和工作人员提供了更严格执行禁令的支持，以及持续减少社会对吸烟的正常化。为了有效实施高中室外学校禁烟令，当局需要解决管理学校的目标之间的冲突，并为工作人员提供必要的支持，以严格执行禁令。随着市政当局制定无烟工作时间政策以及周围社会采取烟草限制政策，维持高中学校禁烟令的可能性将会增加。
