A multilevel analysis examining the association between school-based smoking policies, prevention programs and youth smoking behavior: evaluating a provincial tobacco control strategy

This paper examined how smoking policies and programs are associated with smoking behavior among Grade 10 students (n = 4709) between 1999 and 2001. Data from the Tobacco Module from the School Health Action Planning and Evaluation System were examined using multilevel logistic regression analyses. We identified that (i) attending a school with smoking prevention programs only was associated with a substantial risk of occasional smoking among students with two or more close smoking friends and (ii) attending a school with both smoking prevention programs and policies was associated with substantial risk of occasional smoking among students who did not believe there were clear smoking rules present. Students attending schools where year of enrollment in high school starts in Grade 9 were more likely to be regular and occasional smokers. Each 1% increase in Grade 12 smoking rates increased the odds that a Grade 10 student was an occasional smoker. It appears that grade of enrollment, senior student smoking behavior, close friend's smoking behavior and clear rules about smoking at school can impact school-based tobacco control programming. These preliminary study findings suggest the need for further research targeting occasional smoking behavior and the transition stage into high school.     

山东省小学生吸烟行为与健康素养的相关性分析

目的 探讨4~6年级小学生吸烟行为与健康素养的相关性。方法 采用多阶段分层整群抽样方法,以问卷形式调查2017年山东省4~6年级小学生健康素养水平及烟草使用情况,收集调查对象一般人口学资料、健康素养水平、吸烟情况,采用二分类logistic回归分析烟草使用与健康素养的相关性。结果 共发放9 240份调查问卷,合格问卷9 210份,调查对象应答率为99.7%。4~6年级小学生现在吸烟率为2.6%,男生现在吸烟率（3.1%）高于女生（2.0%）;总体健康素养水平为60.8%,其中男生为56.7%,女生为64.9%。吸烟者健康素养水平为14.4%,非吸烟者为62.0%。logistic回归分析显示,影响吸烟的自变量有年级、父亲文化程度、经济发展水平、自我评价学习成绩和健康素养水平（P<0.01）。控制了混杂因素影响后,不具有健康素养水平小学生吸烟率是具有健康素养水平的8.62倍（1/0.116）。结论 山东省4~6年级小学生吸烟行为与健康素养水平存在相关性。     

医学生吸烟行为的调查分析

目的　了解医学生的吸烟情况及心理、行为状态。方法　选取广州中医药大学 95～ 99级男生共 5 0 0人 ,以年级为单位统一发放和回收不记名自填问卷 ,将所调查的每个项目分别列出频数表 ,计算吸烟率 ,各种吸烟原因的比例及各种症状在吸烟学生中的比例。结果　医学生吸烟率为 3 9.8% ,部分吸烟学生已出现各种不同症状 ,且 86.4%的吸烟学生有烟瘾。结论　吸烟原因主要有心理因素和社会因素     

Human papillomavirus vaccine uptake in boys and girls in a school-based vaccine delivery program in Prince Edward Island,Canada

BackgroundIn 2013, Prince Edward Island was the first province to introduce HPV vaccine universally to grade six boys in a school-based program. Because uptake rates in boys are unknown in this type of vaccination program, uptake of HPV vaccination in boys was measured and compared with uptake rates in girls and then analyzed with factors such as county, urban–rural location of the school, and school board to identify where the vaccine program could be improved.MethodsHPV vaccination records from the provincial childhood immunization registry in PEI were merged with Department of Education data containing all grade six girls and boys in PEI. Vaccine uptakes between years and between sexes were compared using two sample tests of proportions. Logistic regression modeling which accounted for the hierarchical nature of the data was used to analyze associations between factors and uptake rates.ResultsAlthough uptake was high in boys and girls, a significantly greater proportion of girls (85%) received all three doses of the HPV vaccine compared to boys (79%; p = 0.004). The odds of grade six girls being fully vaccinated for HPV were 1.5 times greater than of grade six boys, and the odds of students in the English Language School Board receiving all three doses were more than twice as great as the odds of French Language School Board students.ConclusionsHPV vaccination for boys in PEI has had a successful launch, almost reaching the Canadian Immunization Committee recommendations of >80% for the early years of a program. PEI has a highly organized Public Health Nursing program that is involved in all childhood and school-based vaccinations in PEI and in this context very high coverage rates were obtained. Areas to target for improving uptake include the boys and the students in the French Language School Board.     

Senior student smoking at school, student characteristics, and smoking onset among junior students: a multilevel analysis

BACKGROUND: Current research on the etiology of tobacco use has largely focused on identifying the influential psychosocial characteristics of individual students; the influences of characteristics in the school environment are generally ignored. The purpose of this study was to simultaneously examine how school and individual student characteristics were related to smoking onset. METHOD: Multilevel logistic regression analysis was used to examine how the senior student smoking rate at a school and the psychosocial characteristics of students were able to differentiate tried-once smokers from experimental smokers in a sample of 4850 grade 9, 10, and 11 students from the School Smoking Profile (SSP) project. RESULTS: Each 1% increase in smoking rate among high school seniors increased the odds that a junior student was an experimental smoker vs. a tried-once smoker (OR 1.07, 95% CI 1.03-1.12). A significant contextual interaction was identified where the senior student smoking rate at a school moderates the negative influence of having close friends who smoke. Influential student characteristics were also identified. CONCLUSIONS: The smoking prevalence of older students at a school is directly related to smoking onset among younger students at that school. Prevention programs should target schools that put students at-risk.     

The evaluation of school-based violence prevention programs: a meta-analysis

Background: Youth violence and related aggressive behaviors have become serious public health issues with physical, economic, social, and psychological impacts and consequences. This study identified and evaluated the characteristics of successful school‐based violence prevention programs. Methods: Twenty‐six randomized controlled trial (RCT), school‐based studies that were designed to reduce externalizing, aggressive, and violent behavior between the 1st and 11th grades were analyzed for assessing the effects of 5 program characteristics by comparing results of intervention groups to control groups (no intervention) after intervention using a meta‐analysis. Electronic databases and bibliographies were systematically searched, and a standardized mean difference was used for analysis. Results: There was no significant difference between interventions, although programs that used non–theory‐based interventions, focused on at‐risk and older children, and employed intervention specialists had slightly stronger effects in reducing aggression and violence. Interventions using a single approach had a mild positive effect on decreasing aggressive and violent behavior (effect size =?0.15, 95% CI =?0.29 to ?0.02, p = .03). Conclusions: Unlike previous individual study findings, this meta‐analysis did not find any differential effects for 4 of the 5 program characteristics. In addition, the significant effect noted was contrary to expectation, exemplifying the complexity of identifying effective program strategies. This study adds to the current literature by assessing the program characteristics of RCT studies in an effort to determine what factors may affect school‐based violence prevention program success.     

高中生吸烟行为特征及与其他危险行为关系分析

目的了解蚌埠市高中生的吸烟特征,为制定有效的干预措施提供科学依据。方法采取分层随机整群抽样,在蚌埠市区12所中学高中班中随机抽取11所中学22个班的全体学生进行问卷调查。结果3 131名高中生中,有800名高中生曾经吸过一整支烟,曾经吸烟率为25.6%,男生高于女生,其中,35.8%的学生吸一整支烟时的年龄<13岁,15~16岁是青少年尝试吸烟的高发年龄。8.9%的高中生曾有过经常性吸烟行为。在调查前30 d,4.6%的学生在学校吸烟,男生高于女生;4.9%的学生平均每天吸烟≥2支,男生高于女生;获得香烟的方式以在商店买烟为主,占50.5%。多因素logistic回归分析表明:最近12个月打架,厌学情绪、最近30 d饮酒、谈恋爱、性行为、最近7 d上网吧、参加校内运动队、性别对高中生吸烟影响最大。结论应及早对青少年进行控制吸烟的健康教育,使他们认识到吸烟的危害,自觉抵制烟草。同时对其他相关危险行为进行干预,以发挥干预措施的综合效应,提高控烟效果。     

A multilevel analysis examining the relationship between social influences for smoking and smoking onset

OBJECTIVES: To examine how older smoking peers at school and the smoking behavior of friends and family members are related to youth smoking. METHODS: The School Smoking Profile was used to collect data on tobacco use and determinants of tobacco use from 22,091 students from 29 secondary schools in Ontario, Canada. Correlates of occasional and regular smoking were examined using multilevel logistic regression analyses. RESULTS: Students are at increased risk for smoking if they (a) have smoking friends, (b) have smoking family members, and (c) attend a school with a relatively high senior-student smoking rate. CONCLUSION: These findings suggest that prevention programs should target both at-risk schools and at-risk students.     

Cost-effectiveness analyses of health promotion programs: a case study of smoking prevention and cessation among Dutch students

Little research has been done to connect health promotion programs to outcomes in terms of life expectancy, health care costs and cost-effectiveness. For a policy maker, economic evaluation may be an important tool to support decisions on how to allocate the health care budget. The aim of this paper was to determine the cost-effectiveness of a Dutch school-based smoking education program. The incremental cost-effectiveness ratio of the school program was estimated at euro19 900 per quality adjusted life year gained. For a complete analysis, not only intervention costs but also savings for smoking-related diseases and differences in total health care costs should be taken into account. As several assumptions had to be made in order to estimate cost-effectiveness, the study outcomes should be interpreted with caution. Main problem in estimating the cost-effectiveness was the lack of proper effectiveness data on daily smokers among adolescents. Absence of specific effectiveness data often is an obstacle in the economic evaluation of public health interventions. While some problems may be the result of insufficient sample size or follow-up, another possible explanation might be the different basic principles of analysis of health promoters and economists.     

The effectiveness of school-based smoking prevention interventions among low- and high-SES European teenagers

Preventing smoking initiation among adolescents of lower socio-economic groups is crucial for the reduction of socio-economic inequalities in health. The aim of the present study was to examine whether effective smoking prevention interventions in Europe are equally effective among adolescents of low- and high-socio-economic status (SES). As part of the European Union-funded TEENAGE project, three school-based smoking prevention intervention studies in Europe were selected for secondary analyses: (i) a Dutch class competition intervention, (ii) the European Smoking Prevention Framework (ESFA) study and (iii) the A Stop Smoking in Schools Trial (ASSIST) intervention. All three studies differed in effectiveness by SES. The Dutch class competition study only had a significant effect among higher SES adolescents. The results for the ESFA study and ASSIST study were mixed and depended on which SES indicator was used. The conclusion of the study is that stratified analyses provide important insights in differential intervention effects for higher and lower socio-economic groups. Although findings from the different studies were mixed, interventions that use a social network approach in which youngsters are allowed to deliver the intervention themselves may be a successful strategy in targeting adolescents from lower socio-economic groups.     

The association between overweight and school policies on physical activity: a multilevel analysis among elementary school youth in the PLAY-On study

The objective is to examine school-level program and policy characteristics and student-level behavioural characteristics associated with being overweight. Multilevel logistic regression analysis were used to examine the school- and student-level characteristics associated with the odds of a student being overweight among 1264 Grade 5-8 students attending 30 elementary schools in Ontario, Canada. Data were derived from the Physical Activity of Youth in Ontario Schools host study. Significant between-school random variation in overweight was identified [σ2(μ0)=0:187 (0:084), P < 0.001]; school-level differences accounted for 5.4% of the variability in the odds of a student being overweight versus a normal weight. A student attending a school that was in the action phase for the school-level construct 'Availability and use of interschool programs' was significantly less likely to be overweight than a similar student attending a school that was in the initiation phase for this construct. Important student-level characteristics included physical activity (PA) and gender. Developing a better understanding of the school- and student-level characteristics associated with overweight among youth is critical for informing school-based prevention policies. Future research should evaluate if implementing and promoting interschool PA programming, and which types of interschool activities, are effective in preventing or reducing overweight.     

Exposure to, and perceived usefulness of, school-based tobacco prevention programs: associations with susceptibility to smoking among adolescents.

PURPOSE: To examine the relationships of exposure to school-based tobacco prevention programs and perceived usefulness of such programs to smoking susceptibility. METHODS: An ethnically representative sample of 6929 Grade 10 students participated in a cross-sectional survey of tobacco-related activities and behaviors. Perceived usefulness of prevention programs was investigated according to two dimensions: perceived helpfulness of information received at school with regard to making decisions about tobacco use and perceived availability of social resources that might help students cope with tobacco-related issues. RESULTS: The extent of exposure to school prevention programs and both dimensions of perceived usefulness of these programs were inversely associated with susceptibility to smoking. In addition, perceived information helpfulness mediated the effect of program exposure on susceptibility status, whereas perceived availability of social resources moderated that effect. The study also presented evidence suggesting ethnic/cultural variability in the status of susceptibility to smoking at this age. CONCLUSIONS: The study indicates a need to examine the perceptions of students receiving school prevention programs. Perceived usefulness of school prevention programs may be used to identify youth at high risk for smoking susceptibility. Future studies, however, should investigate other dimensions of perceived usefulness as well as intrapersonal, interpersonal, and environmental correlates of this construct.     

四城市初中生吸烟与不健康行为的关系研究

目的了解北京、杭州、武汉和乌鲁木齐四城市初中生的吸烟情况,并分析其吸烟行为与多种危害健康的行为和心理问题的关系。方法中国疾病预防控制中心(CDC)健康教育所提供四城市所有中学资料,由美国CDC用特殊的抽样软件从中抽取100所学校,采用WHO的全球学校学生健康调查问卷对9015名初中生进行调查。结果参加调查的初中生尝试吸烟率为29.4%,过去30d中6.6%的学生使用过烟草。27.0%的吸烟学生在9岁及以前开始吸第1支烟,31.8%的学生从学校教育中学到过拒烟技巧。吸烟组的饮酒、使用毒品、伤害、旷课行为和心理问题发生率均显著高于不吸烟组。结论初中生的尝试吸烟率和吸烟率有上升趋势。吸烟行为的发生与多种不健康行为和心理问题密切相关。     

童年期虐待经历与中学生吸烟行为的关联性

了解童年期虐待经历对中学生吸烟行为的影响,为中学生吸烟行为的防控提供参考.方法 采用分层整群抽样的方法,选取深圳、郑州、南昌和贵阳4个地区14 500名在校中学生为研究对象,采用儿童期虐待问卷、青少年亚健康多维评定问卷进行问卷调查,并自我报告吸烟行为.结果 中学生吸烟行为报告率为3.6%,男生(5.8%)高于女生(1.4%),高中生(5.0%)高于初中生(2.3%),农村学生(6.0%)高于城市学生(2.8%),差异均有统计学意义(P值均<0.01).高水平各种类型童年期虐待经历中学生吸烟行为报告率均高于虐待低水平者.多因素Logistic回归模型显示,情感虐待(OR=1.69,95%CI=1.38~2.07)、躯体虐待(OR=2.17,95%CI=1.78~2.64)、性虐待(OR=2.56,95%CI=2.10~ 3.12)、情感忽视(OR=2.27,95%CI=1.89~2.74)、躯体忽视(OR=2.21,95%CI=1.83~2.67)、童年期虐待经历(OR=2.66,95%CI=2.21~3.21)与中学生吸烟行为均呈正性相关(P值均<0.01).结论 童年期虐待与中学生吸烟行为呈正相关,加强对童年期虐待的重视和干预有益于中学生吸烟行为的防控.     

宝鸡市某高校大学生吸烟行为分析

目的了解宝鸡市宝鸡文理学院大学生吸烟行为状况,为制定控烟措施提供依据。方法运用分层抽样法,随机抽取4个年级2 129名学生进行问卷调查。结果大学生的总吸烟率为22.8%,尝试吸烟男生所占比例为36.4%,女生为14.1%;第1次吸烟年龄存在性别与年级差异;过去30 d内男生吸烟的天数明显多于女生;男生轻度吸烟率为19.2%,女生为17.9%;经常吸烟率男生为1.4%,女生为1.2%;男生重度吸烟率为1.3%,女生为0。结论宝鸡文理学院大学生吸烟率与全国相比处于中等水平,应通过健康教育,对吸烟成瘾行为定期进行调查,并进行干预。     

National and school policies on restrictions of teacher smoking: a multilevel analysis of student exposure to teacher smoking in seven European countries

The paper examines the association between restrictions on teacher tobacco smoking at school and student exposure to teachers who smoke during school hours. The data are taken from a European Commission-funded study 'Control of Adolescent Smoking' (the CAS study) in seven European countries. Multilevel modelling analyses were applied to investigate associations between national legislation concerning tobacco smoking in school, local school smoking restrictions and students' exposure to teachers who smoke at school. The analyses integrate data from three levels: national (types of policy and how restrictive they are), school (survey among teachers, n = 455) and student (survey among 15-year-old students, n = 10890). The results suggest that both national- and school-level policies on restriction of smoking among teachers are associated with a decreased probability of students reporting that they are exposed to teachers who smoke indoors, but an increased probability of being exposed to teachers smoking outdoors.     

Cigarette smoking among university students in Greece: a comparison between medical and other students

Objectives  

The purpose of the study was to investigate the smoking habits of medical and other students and to explore the most important factors associated with students’ smoking.     

The relationship between social capital and self-rated health in a Japanese population: a multilevel analysis

Objective  

The aim of this study was to use a multilevel analysis to examine whether cognitive and structural dimensions of regional social capital were associated with individual health outcomes after adjusting for compositional factors.     

The relationship between employment and substance use among students aged 12 to 17.

PURPOSE: To examine the association between employment status and substance use among students aged 12 to 17 years. METHODS: Secondary analysis of data from the 1995 and 1996 National Household Surveys on Drug Abuse was conducted. The survey is a primary source of data on licit and illicit drug use among noninstitutionalized Americans aged 12 years or older. Participants are interviewed at their places of residence. Multiple logistic regression procedures yielded estimated associations. RESULTS: About one in six adolescents reported both going to school and holding a job. Approximately one-fourth of students smoked cigarettes, and one-third consumed alcohol in the past year. An estimated 1.6% of students were current heavy cigarette smokers, and 2.6% were current heavy alcohol users. One-year prevalence estimates of any illicit drug use and heavy illicit drug use were 16.7% and 1.8%, respectively. Among students employed full time, prevalence estimates increased to 9.7% for heavy cigarette smoking, 13.1% for heavy alcohol use, 38.1% for any illicit drug use, and 5.0% for heavy illicit drug use. Logistic regression analyses supported relatively high rates of cigarette use, alcohol use, illicit drug use, and heavy substance use among working students. Mental health problems, especially externalizing behavioral syndromes, were found to coexist with the use and heavy use of substances. The observed associations varied somewhat by gender. CONCLUSIONS: The workplace may be an appropriate venue for establishing substance use prevention and early intervention programs focused on younger workers, including adolescents who work part time.