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a Cardiff School of
Social Sciences, Cardiff University, Cardiff, UK, b Health Promotion Division, National Assembly for
Wales, Cardiff, UK
Correspondence to: Dr L Moore, Cardiff School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WT, UK MooreL1{at}cf.ac.uk
Received 22 October
2000; Revision received 3 January 2001;
Accepted 25 January 2001
OBJECTIVE
To examine
the association between school smoking policies and smoking prevalence
among pupils.
DESIGNMultilevel
analysis of cross-sectional data from surveys of schools and pupils.
SETTING55 secondary
schools in Wales.
SUBJECTS55 teachers
and 1375 pupils in year 11 (aged 15-16).
MAIN OUTCOME
MEASURESSelf-reported smoking behaviour.
RESULTSThe prevalence
of daily smoking in schools with a written policy on smoking for
pupils, teachers, and other adults, with no pupils or teachers allowed
to smoke anywhere on the school premises, was 9.5% (95% confidence
interval (CI) 6.1% to 12.9%). In schools with no policy on pupils'
or teachers' smoking, 30.1% (95% CI 23.6% to 36.6%) of pupils
reported daily smoking. In schools with an intermediate level of
smoking policy, 21.0% (95% CI 17.8% to 24.2%) smoked every day.
School smoking policy was associated with school level variation in
daily smoking (p = 0.002). In multilevel analysis, after adjusting
for pupils' sex, parents' and best friends' smoking status, parental
expectations, and alienation from school, there was less unexplained
school level variation, but school smoking policy remained significant
(p = 0.041). The association of smoking policy with weekly smoking
was weaker than for daily smoking, and not significant after adjustment
for pupil level variables. Both daily and weekly smoking prevalence
were lower in schools where pupils' smoking restrictions were always
enforced. Enforcement of teacher smoking restrictions was not
significantly associated with pupils' smoking.
CONCLUSIONSThis study
demonstrates an association between policy strength, policy
enforcement, and the prevalence of smoking among pupils, after having
adjusted for pupil level characteristics. These findings suggest that
the wider introduction of comprehensive school smoking policies may
help reduce teenage smoking.
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