Impact of an Outdoor Smoking Ban at Secondary Schools on Cigarettes, E-Cigarettes and Water Pipe Use among Adolescents: An 18-Month Follow-Up.
Abstract: 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.
['Rozema|Andrea D|AD|0000-0002-7556-2409', 'Hiemstra|Marieke|M|', 'Mathijssen|Jolanda J P|JJP|', 'Jansen|Maria W J|MWJ|', 'van Oers|Hans J A M|HJAM|0000-0003-4063-2240']
D000293:Adolescent D002648:Child D066300:Electronic Nicotine Delivery Systems D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D009426:Netherlands D009538:Nicotine D015995:Prevalence D012574:Schools D061845:Smoke-Free Policy D012907:Smoking D062789:Tobacco Products D000073867:Water Pipe Smoking
secondary schools adolescents outdoor school ground quasi-experimental design smoking prevalence prevention school smoking policies school-based intervention smoke-free tobacco control