Understanding school staff members’ enforcement of school tobacco policies to achieve tobacco-free school: a realist review

Abstract

Background School tobacco policies (STPs) that aim to achieve a tobacco-free environment require consistent enforcement by school staff. However, little is known about why staff choose whether or not to enforce STPs. Therefore, we investigated staff members’ responses to STPs that determine enforcement. Furthermore, we examined how these responses depend on contextual factors at the individual, interpersonal, school, implementation, and national levels. Methods We performed a realist review (RR), which synthesizes existing primary evidence into a programme theory demonstrating key causal pathways through Context-Mechanism-Outcome configurations (CMOs). These CMOs link contextual factors to outcomes (i.e. staff enforcement) by explaining the underlying generative mechanisms (i.e. staff members’ cognitive, psychosocial, and behavioural responses). A systematic literature search for the period 2000–2016 was performed using Academic Search Premier, PsycInfo, and MEDLINE. Forty English-language articles were identified for the synthesis. Results Our programme theory demonstrated three CMOs: when contextual factors make staff members experience STP enforcement as part of their professional role and duties, it may lead to staff members showing responsibility for STP enforcement (CMO1); when contextual factors make staff members feel their contribution is leading to positive outcomes, it may lead to staff members showing motivation to enforce STPs (CMO2), and when contextual factors make staff members feel that they are able to deal with students’ responses, it may lead to staff members showing confidence in STP enforcement (CMO3). Moreover, the programme theory provided more precise insights into what contextual factors contribute to triggering the individual mechanisms and the consequent outcomes. Conclusions By applying a realist approach, we have been able to detect three CMOs explaining staff members’ STP enforcement. The findings provide useful insights explaining how stakeholders can support staff members’ STP enforcement and consequently improve the impact of STPs on adolescent smoking. Electronic supplementary material The online version of this article (10.1186/s13643-019-1086-5) contains supplementary material, which is available to authorized users.

Are Danish vocational schools ready to implement ‘smoke-free school hours’? A qualitative study informed by the theory of organizational readiness for change

“…We identi ed two antagonistic discourses as prominent factors for change commitment: 1) believing that health promotion and smoking prevention is a school role and duty, which legitimizes SFSH versus 2) believing that SFSH violate personal freedom. The rst discourse corresponds with previous research showing that staff enforcement depends on whether staff members believe that STP enforcement is their role and duty 9 , whereas the second discourse has been identi ed as a general barrier to efforts to control environmental tobacco smoke 43 and as a speci c hindering belief for implementing SFSH in the Netherlands. 26 Moreover, the discourses can be said to echo a broader health-political debate concerning which means and models are most appropriate for health promotion and tobacco control.…”

“…This corresponds with the realist review, which contends that staff enforcement depends on whether staff members have con dence to deal with students' negative responses. 9 Additionally, we found that establishing smoking cessation assistance or other help for nicotine-dependent students when implementing SFSH is seen as a necessary action, and this has also been suggested in similar research. 26 Our study shows that, even though SFSH is practiced at two schools, some students smoke during school hours, and it is thus a daily struggle to manage the level of sanctioning and enforcement.…”

“…The effectiveness of SFSH depends on how well the policy is implemented. 9,10 As many implementation de nitions exist, our conceptualization is important. In this study, implementation is de ned as the social organization of the work of bringing an intervention into routine practice, which involves dynamic and contingent interactions within a context over time.…”

“…25 Additionally, a realist review contended that widespread inconsistent enforcement is the reason for implementation failure and showed that staff enforcement depends on whether they 1) believe that STP enforcement is their role and duty, 2) have con dence to deal with students' negative responses when enforcing the rules and 3) experience that enforcement has a positive impact on students. 9 A recent qualitative study 26 found that the insu cient readiness to implement SFSH in Dutch secondary schools can be explained by hindering beliefs (e.g., that smoking is not perceived as a pressing issue, that SFSH interfere with adolescents' autonomy and would be impossible to enforce consistently). Because most of the existing literature has focused on secondary schools (adolescents) or tertiary schools (young adults with higher education), it is currently unclear if comparable facilitators and barriers to implementation, enforcement and change readiness are present at vocational schools.…”

Why staff at European schools abstain from enforcing smoke-free policies on persistent violators

“…While the adoption of SFSPs by governments is important ( Rozema et al , 2016 ; Linnansaari et al , 2019 ), such top-down rules only become part of adolescents’ school life if these are consistently enforced by school staff. Consistent enforcement is a crucial requisite for realizing SFSP’s optimum effectiveness on the collective of adolescents ( Wakefield et al , 2000 ; Galanti et al , 2014 ; Schreuders et al , 2017 ), because adolescents may (i) interpret staff’s inconsistent enforcement as a sign that health risks of smoking are not so serious ( Clark et al , 2002 ; Baillie et al , 2007 ), (ii) believe consequences are applied in unfair and biased fashions ( Booth‐Butterfield et al , 2000 ; Gittelsohn et al , 2001 ; Clark et al , 2002 ) and (iii) abuse staff’s leniency in attempts to gradually weaken the rules ( Turner and Gordon, 2004 ).…”