Analyzing Multilevel Factors Underlying Adolescent Smoking Behaviors: The Roles of Friendship Network, Family Relations, and School Environment

Since 2015, universal comprehensive school-based tobacco control programs have been provided in all primary and secondary schools in Korea. This study explored the association of school-level tobacco control with adolescent smoking, and the interactions to investigate whether gender moderates the impact of school tobacco control programs and school-level norms. Both school- and individual-level data were drawn from the 2015 School-Based Tobacco Prevention Program Survey. Multilevel logistic regression analyses were performed using data from 4631 students (ages 10–18 years) who were nested in 62 secondary schools in Seoul, Korea. Students who participated in more prevention programs were less likely to smoke (OR = 0.47, 95% CI 0.30–0.74). The effect of the programs was significantly moderated by gender. For boys, exposure to a greater number of programs decreased the risk of smoking (OR = 0.32, 95% CI 0.18–0.57) but not for girls. At the school level, the school norm regarding tobacco control regulations was negatively associated with smoking (OR = 0.28, 95% CI 0.11–0.76), and its effect was significant for girls only (OR = 0.35, 95% CI 0.17–0.76). This study highlights how the school environment is associated with adolescent smoking behavior, and the effects of programs and norms are different by gender. The findings suggest the need to develop strategies to enhance school-based tobacco control programs and the school norm considering gender differences.

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Association of violence in schools’ vicinity and smoking in schools’ premises with tobacco use among Brazilian adolescents

Cadernos de Saúde Pública ◽

10.1590/0102-311x00057919 ◽

2019 ◽

Vol 35 (12) ◽

Author(s):

Alexandra Crispim Boing ◽

Antonio Fernando Boing ◽

S. V. Subramanian

Keyword(s):

Tobacco Use ◽

School Environment ◽

School Health ◽

School Level ◽

Tobacco Products ◽

Current Smoking ◽

Logistic Regression Models ◽

Smoking Behaviors ◽

Individual Covariates ◽

The Individual

Abstract: This study aims to quantify the overall importance of schools in explaining the individual variance of tobacco use and to test the association between characteristics of the school environment and its vicinity with the experimentation and current use of cigarettes. We analyzed data from 102,072 Brazilian adolescents interviewed in the 2015 National School Health Survey (PeNSE). Multilevel logistic regression models were performed to estimate the between-schools variance and to test the association between school-level variables and the use of tobacco. Violence in the vicinity of the school and presence of teachers or students smoking on school premises were the school-level characteristics. The analyses were adjusted by individual covariates and stratified by gender. Around 12.5% of the individual variance in ever smoking was explained by between-school variation among girls (9.2% among boys). The figures were even higher for current smoking (14.9% girls; 12.2% boys) and current use of other tobacco products (27.7% girls; 17.8% boys). In general, the use of tobacco was associated with the existence of violence in the vicinity of the schools and was higher among students whose schools reported that students and teachers (teachers only for use of other tobacco products among girls) smoke on school premises. Tobacco use on school premises and the safety of the neighborhood where the school is located are associated with some smoking behaviors among adolescents. Such findings reinforce the necessity to effectively consider interventions in the school environment and neighborhood to fight smoking among adolescents.

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