Evaluation of the Implementation of a 25-Year Outdoor School Ground Smoking Ban: A Qualitative Interview Study With Implications for Prevention Practise

Abstract

Introduction: 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.Materials and Methods: A process evaluation was conducted using semi-structured interviews with principals in upper secondary schools, local environmental and health inspectors, and local politicians (n = 30) in Stockholm County, with purposive sampling for informant recruitment. A qualitative content analysis of the transcribed interviews was performed.Results: 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.Conclusion: 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.

Facilitating conditions for staff’s confidence to enforce school tobacco policies: qualitative analysis from seven European cities

“…Finally, aligning with earlier research [ 3 , 14 , 43 – 45 ], we suggest strengthening national tobacco control especially on tobacco-free environments (WHO FCTC Article 8). Our findings demonstrate that staff’s legitimacy for STP enforcement and students’ ability to question the rules strongly intertwine with the broader tobacco control environment and STPs being integrated into the governmental legislation.…”

State of the literature discussing smoke-free policies globally: A narrative review

“…Several studies also found that some institutions, businesses, or stakeholders do not enforce smoke-free policies because it is a low priority amid competing needs and interests 39,44,52,53,73,110,111 . For example, police at public universities in California stated that enforcing tobacco-free policies on campus was not a priority because they 'have real crimes [such as armed robbery] to investigate' 44 .…”

“…For example, police at public universities in California stated that enforcing tobacco-free policies on campus was not a priority because they 'have real crimes [such as armed robbery] to investigate' 44 . Resource constraints, including limited money, time, and personnel, may further exacerbate this issue and contribute to low prioritization of enforcing smokefree policies 29,33,37,39,44,50,72,89,104,[110][111][112][113] . For example, a study conducted in schools across multiple European cities found that teachers and principals, who already face time constraints and have competing priorities, may be unable or unwilling to accept additional responsibilities related to enforcing smoke-free school policies 39 .…”

“…Additionally, some enforcement stakeholders believed that enforcing smoke-free policies would interfere with more important goals and values 70,111 . For example, school principals in Sweden expressed concern that punishing students (e.g.…”

Compliance Checks Decrease Cigarette Sales Rates to Pseudo-Underaged Mystery Shoppers: A Quasi-Experimental Control Group Study

“…Adolescents are a particularly vulnerable group as smoking during adolescence increases the risk of remaining a smoker as an adult [ 4 , 5 ]. To reduce the prevalence of smoking among adolescents, a variety of interventions have been investigated, including raising taxes on tobacco products, plain packaging, health warnings, smoking cessation support using mass media campaigns and technology, as well as preventive efforts in the school setting [ 6 , 7 , 8 ]. Studies have also shown that prevention efforts and policy changes that reduce the availability and sales rates of cigarettes to adolescents were effective strategies to reduce smoking prevalence among adolescents [ 9 , 10 , 11 , 12 ].…”