Impact of an Outdoor Smoking Ban at Secondary Schools on Cigarettes, E-Cigarettes and Water Pipe Use among Adolescents: An 18-Month Follow-Up
by
Andrea D. Rozema 1,*
, Marieke Hiemstra 1, Jolanda J. P. Mathijssen 1, Maria W. J. Jansen 2,3 and Hans J. A. M. Van Oers 1,4
Andrea D. Rozema 1,*, Marieke Hiemstra 1, Jolanda J. P. Mathijssen 1, Maria W. J. Jansen 2,3 and Hans J. A. M. Van Oers 1,4
1
Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Warandelaan 2, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
2
Academic Collaborative Centre for Public Health Limburg, Public Health Service South Limburg (GGD ZL), 6400 AA Geleen, The Netherlands
3
Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, 6211 LK Maastricht, The Netherlands
4
National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2018, 15(2), 205; https://doi.org/10.3390/ijerph15020205
Received: 10 November 2017 / Revised: 19 January 2018 / Accepted: 23 January 2018 / Published: 25 January 2018
(This article belongs to the Special Issue Development and Evaluation of New Tobacco Control Interventions)
The effectiveness of outdoor smoking bans on smoking behavior among adolescents remains inconclusive. This study evaluates the long-term impact of outdoor school ground smoking bans among adolescents at secondary schools on the use of conventional cigarettes, e-cigarettes (with/without nicotine) and water pipes. Outdoor smoking bans at 19 Dutch secondary schools were evaluated using a quasi-experimental design. Data on 7733 adolescents were obtained at baseline, and at 6 and 18-month follow-up. The impact of outdoor smoking bans on ‘ever use of conventional cigarettes’, ‘smoking onset’, ‘ever use of e-cigarette with nicotine’, ‘e-cigarette without nicotine’, and ‘water pipe’ was measured. Multilevel logistic regression analysis was used. At schools with a ban, implementation fidelity was checked. At schools where a ban was implemented, at 18-month follow-up more adolescents had started smoking compared to the control condition. No effect of implementation of the ban was found for smoking prevalence, e-cigarettes with/without nicotine, and water pipe use. Implementation fidelity was sufficient. No long-term effects were found of an outdoor smoking ban, except for smoking onset. The ban might cause a reversal effect when schools encounter difficulties with its enforcement or when adolescents still see others smoking. Additional research is required with a longer follow-up than 18 months.
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Keywords:
school-based intervention; prevention; tobacco control; adolescents; school smoking policies; smoking prevalence; smoke-free; quasi-experimental design; outdoor school ground; secondary schools
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MDPI and ACS Style
Rozema, A.D.; Hiemstra, M.; Mathijssen, J.J.P.; Jansen, M.W.J.; Van Oers, H.J.A.M. Impact of an Outdoor Smoking Ban at Secondary Schools on Cigarettes, E-Cigarettes and Water Pipe Use among Adolescents: An 18-Month Follow-Up. Int. J. Environ. Res. Public Health 2018, 15, 205.
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