Monica Adams

The Relationship Between School Policies and Youth Tobacco Use

BACKGROUND The school setting is frequently used both to educate youth about risks involved in tobacco use and to implement tobacco prevention and cessation programs. Given that school-based programs have resulted in limited success, it is necessary to identify other setting-level intervention strategies. School tobacco policies represent a type of universal intervention that might have some promise for preventing or reducing tobacco use. METHODS Hierarchical linear modeling was used to assess whether school tobacco policies were related to observations of tobacco use and current smoking among 16,561 seventh through twelfth graders attending 40 middle and high schools in Illinois. RESULTS Results indicated that the enforcement of school tobacco policies, but not the comprehensiveness of those policies, was associated with fewer observations of tobacco use by minors on school grounds as well as lower rates of current smoking among students. CONCLUSIONS The school setting is a key system to impact youth tobacco use. Findings underscore the need to train school personnel to enforce school tobacco policy.

Exploration of the link between tobacco retailers in school neighborhoods and student smoking.

BACKGROUND School smoking bans give officials the authority to provide a smoke-free environment, but enacting policies within the school walls is just one step in comprehensive tobacco prevention among students. It is necessary to investigate factors beyond the school campus and into the neighborhoods that surround schools. The purpose of this study was to explore the relationship between the density of tobacco retailers and the illegal tobacco sales rate within school neighborhoods and smoking behaviors among students. METHODS This study utilized secondary data from the baseline of the Youth Tobacco Access Project. Data were collected from 10,662 students attending 21 middle schools and 19 high schools, in addition to 512 tobacco retailers, all within 24 towns in Illinois during 2002. A random-effects regression analysis was performed to assess the relationship between the density of tobacco retailers and illegal tobacco sales rates on current smoking and lifetime smoking prevalence. RESULTS Schools had a range between 0 and 9 tobacco retailers within their neighborhood with a mean of 2.76 retailers (SD = 2.45). The illegal sales rate varied from 0% to 100%, with a mean of 13%. The density of tobacco retailers was significantly related to the prevalence of ever smoking among students (b = 0.09, t(29) = 2.03, p = .051, OR = 1.10), but not to current smoking (p > .05); the illegal tobacco sales rate was not related to current smoking or lifetime smoking prevalence (p > .05). CONCLUSION Results indicate that tobacco retailer density may impact smoking experimentation/initiation.

A randomized trial evaluating tobacco possession-use-purchase laws in the USA

Tobacco Purchase-Use-Possession laws (PUP) are being implemented throughout the US, but it is still unclear whether they are effective in reducing smoking prevalence among the youth targeted by these public health policies. In the present study, 24 towns in Northern Illinois were randomly assigned to one of two conditions. One condition involved reducing commercial sources of youth access to tobacco (Control), whereas the second involved both reducing commercial sources of youth access to tobacco as well as fining minors for possessing or using tobacco (Experimental). Students in 24 towns in Northern Illinois in the United States completed a 74 item self-report survey in 2002, 2003, 2004 and 2005. At the start of the study, students were in grades 7-10. During each time period, students were classified as current smokers or nonsmokers (i.e., completely abstinent for the 30 consecutive days prior to assessment). The analyses included 25,404 different students and 50,725 assessments over the four time periods. A hierarchical linear modeling analytical approach was selected due to the multilevel data (i.e., town-level variables and individual-level variables), and nested design of sampling of youth within towns. Findings indicated that the rates of current smoking were not significantly different between the two conditions at baseline, but over time, rates increased significantly less quickly for adolescents in Experimental than those in Control towns. The implications of these findings are discussed.

Maintenance of community change: enforcing youth access to tobacco laws.

Youth access to tobacco remains a significant problem for this nation. Methods have been developed to reduce youth access to commercial outlets and these involve enforcement efforts of monitoring and fining merchant offenders. In the present study, over a three year period of time, readiness to participate in these types of enforcement programs were assessed in 11 communities. Several years after the research study was completed, enforcement activities were re-assessed. Findings indicated that those communities that had made the largest changes in community readiness to enforce youth access laws during the three year intervention were the ones most likely to continue enforcement activities into the follow-up period. There is a need to better understand how youth access to tobacco community-based interventions can be maintained.

Youth Caught in Violation of Tobacco Purchase, Use, and Possession Laws: Education versus Fines.

Each day, thousands of children are caught for violation of tobacco purchase, use, and possession (PUP) laws. Little is known about their impact on violators; we do not know how the youth who are caught perceive these consequences or the effects they have on their tobacco use. Moreover, many communities are beginning to use brief tobacco education programs as a diversion from the normal processing of PUP law violators (i.e., fining the youth violator) without knowing the consequences of these classes. Consequently, it is important to review the literature and studies that have evaluated the effects of civic fines versus tobacco education as a consequence for PUP law violations. A consolidation of this information along with a presentation of pilot data on this issue might suggest areas of needed future research as well as help policy officials make decisions about best practices in their communities regarding these types of laws.

Effects of Youth Tobacco Access and Possession Policy Interventions on Heavy Adolescent Smokers

This study evaluated the effects of tobacco PUP (Purchase, Use and Possession) laws on tobacco use patterns among students in twenty-four towns, which were randomly assigned into an experimental and a control group. The experimental group involved both PUP law enforcement and reducing minors’ access to commercial sources of tobacco, and the condition for the control group involved only efforts to reduce minors’ access to commercial sources of tobacco. The present study found that adolescents in the control group had a significantly greater increase in the percentage of youth who smoked 20 or more cigarettes per day when compared to the experimental group.

Assessing police community readiness to work on youth access and possession of tobacco.

Researchers are only beginning to investigate how to measure a communitys readiness to engage in an intervention. In this study, we investigated the readiness of police departments to deal with tobacco policies about youth access to tobacco and youth possession of tobacco. Police officers in 24 towns completed structured interviews designed to assess each police departments community readiness to enforce tobacco sales and possession laws. Community readiness ratings were compared to outcome measures in the community, such as tobacco sales and possession enforcement activity, youth knowledge of such activities, and youth reports of smoking history. Higher readiness ratings on the youth tobacco possession enforcement scale was related to higher youth possession citation rates, higher number of youth reporting knowing someone who received a possession ticket, and a smaller number of youth reporting seeing minors smoking in their community. Youth in communities with higher possession readiness ratings in Efforts and Knowledge Regarding the Efforts had lower reports of youth reporting ever having smoked. Higher readiness ratings in the Leadership dimension of tobacco sales enforcement was related to lower tobacco commercial sales rates in the community. Higher tobacco sales readiness ratings in the Efforts, Knowledge Regarding the Efforts, and Knowledge Regarding the Problem dimensions were related to a lower number of youth reporting ever having smoked. The implications of these findings are discussed.

Monitoring and Decreasing Public Smoking Among Youth

This study examined the impact of tobacco possession laws on public smoking among youth. There were two intervention sites: a fast food restaurant and a shopping mall. Two control sites were also monitored for public smoking among youth. Preliminary findings suggest that when police issued tickets to minors for violating tobacco possession laws, the number of youth smoking in public declined in both towns, with a more dramatic decrease occurring at the fast food site. In contrast, public smoking among youth in the control sites was not affected. The significance of reducing number of youth smoking in public through tobacco possession laws is discussed.