Associations of school tobacco policies and legislation with youth smoking: a cross-sectional study of Danish vocational high schools

Abstract

BackgroundIn vocational high schools, the prevalence of smoking is high (nearly 40% daily smoking in Danish vocational high schools). Schools are increasingly adopting school tobacco policies (STPs) and a national law on smoke-free school grounds has been implemented. Our objective was to explore the extent of STPs in vocational schools and examine the association of STPs and smoke-free school grounds legislation with student smoking.MethodsWe used data from the cross-sectional Danish National Youth Study 2014, including 5013 vocational high school students (76% male) at 40 campuses. Implementation of STPs was measured by questionnaires to principals and field observations of smoking practices were conducted. Logistic regression models assessed whether STP characteristics were associated with students’ current smoking (ie, daily and occasional) compared with non-current smoking. Negative binominal regression models assessed cigarettes per day among daily smokers.ResultsSchools covered by the national law on smoke-free school ground had more comprehensive STPs than schools not covered by the law. Student smoking was observed on 78% of campuses, with less visibility of smoking in schools covered by the national law (69% vs 83%). Current smoking was lower for students attending a school covered by the national law (OR=0.86, 95% CI 0.75 to 0.97). Students who attended schools that allowed teacher–student smoking were more likely to smoke (OR=1.13, 95% CI 1.01 to 1.27).ConclusionsA law on smoke-free school grounds was associated with less current smoking in vocational high schools, while school norms that are supportive of teacher-student smoking were associated with greater odds of current smoking. Visibility of student smoking was less prevalent at schools covered by the law on smoke-free school grounds; nevertheless, the visibility of smoking was high. Better enforcement or an extension of the current law on smoke-free school grounds is recommended.

Effectiveness of the multi-component intervention ‘Focus’ on reducing smoking among students in the vocational education setting: a cluster randomized controlled trial

“…Thus, findings from this study add to the current evidence of the potential effects of multi-component and multi-level interventions. This study indicates that smoking preventive initiatives may impact smoking decisions among adolescents and young adults at higher risk of smoking in the VET setting, which is in line with the sparse previous research in this area [ 23 , 24 ]. Meanwhile, a range of factors may have influenced the opportunities to implement intervention components as intended.…”

“…The evaluation concluded that future preventive initiatives that also included individualized efforts were necessary when addressing this group of youth. Furthermore, another study found that current smoking was lower for students attending VET schools with smoke-free school grounds, while students attending schools allowing teacher-student smoking were more likely to smoke [ 24 ]. Thus, these findings indicate that multi-level and multi-component interventions may impact VET students’ smoking behaviors.…”

Why do apprentices smoke much more than high school students? Understanding educational disparities in smoking with a Oaxaca-blinder decomposition analysis

“…Although more research is needed to identify potential unmeasured characteristics impacting daily smoking at 17, we are confident our results support targeted interventions among apprentices. Different smoking prevention interventions in vocational schools have been designed notably in Denmark, such as a settings-based health promotion approach through everyday school practices and school tobacco policies [47,48] and Australia via electronic feedback and referral to online and telephone services [49]. In France, the TABADO program [50] aims at encouraging apprentices to engage in a smoking cessation program.…”

When smoking is the smallest problem: A qualitative study of smoking prevention in Danish vocational schools

“…Preventive actions in youth education settings have the potential to influence students' smoking behaviour (Andersen et al, 2019). Several studies highlight the importance of comprehensive and clear smoking bans, applicable to both students and school staff (Andersen et al, 2019;Rozema et al, 2016Rozema et al, , 2017. A smokefree environment is also associated with a reduced risk of young people taking up smoking (Egan et al, 2017).…”