Home > School policies for preventing smoking among young people.

Coppo, Alessandro and Rosaria Galanti, Maria and Buscemi, Daria and Giordano, Livia and Faggiano, Fabrizio (2014) School policies for preventing smoking among young people. Cochrane Database of Systematic Reviews, (10), Art. No.: CD009990. DOI: 10.1002/14651858.CD009990.pub2.

External website: https://www.cochranelibrary.com/cdsr/doi/10.1002/1...

Do school tobacco policies prevent uptake of smoking?


Background: We reviewed the evidence that School tobacco policies (STPs) might prevent smoking initiation among adolescents, as there may be some evidence that the school environment can influence young people to smoke. STP is intended to regulate whether and where pupils can smoke, adult smoking in school, and penalties for pupils caught smoking. We were also interested to know whether specific components of STPs might increase their impact. Components such as a smoking ban for students and/or teachers and their extent, levels of enforcement, monitoring strategies, sanctions for students or teachers found smoking, and the offer of tobacco cessation programmes.


Study characteristics: Our study search was conducted in May 2014. We identified one c-RCT from China that we judged to be at high risk of bias. We also focussed on 24 observational studies to generate a hypothesis for future research.


Key findings: In the only included c-RCT with 1807 participants, the intervention did not significantly affect students' smoking behavior. The majority of observational studies reported that schools with highly enforced policies, smoking ban extended to outdoor spaces, involving teachers and including sanctions for transgressions, with assistance to quit for smokers plus support by prevention programmes, did not show a significant difference in smoking prevalence, when compared to schools adopting weaker or no policies.


Quality of the evidence: We found no relevant high-quality experimental studies. A great limitation within observational studies is the heterogeneity of exposure definitions. There is large variability in policy formats, which can include several different characteristics, which in turn makes comparison difficult. Only a few studies are based on policy definition in written documents, while in the majority the information was obtained by interviewing school heads, teachers or administrators. With regard to analysis methods, some studies did not mention any adjustment for potential confounders and in the others there was a large variability in the factors considered for adjustment. Studies differed in statistical methods employed to examine the relationship between policy and smoking behaviour.


Conclusions: We cannot draw conclusions about the effectiveness of STP from currently available data. Large, possibly multi-centric studies, employing experimental or a quasi-experimental design to assess the effectiveness of STPs are needed. Characteristics that could be studied are: degree of formality, participants to which the policy applies, extension of the ban (indoor areas or external school premises), level of enforcement, sanctions for transgression; assistance with smoking cessation and combination with prevention and education activities.

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