The influence of school smoking policies on student tobacco use

Objective: To investigate the association between smoking behavior among secondary school students and school smoking policies. Design: Cross-sectional provincially representative study. Setting: Quebec secondary schools. Participants: Complete data were available for 763 of 1058 students aged 13 years in 50 schools and for 768 of 1160 students aged 16 years in 57 schools. School principals provided data on school smoking policies. Main Exposure: School smoking policies. Outcome Measure: Student tobacco use. Results: Of students aged 13 years, 3.8% of boys and 7.1% of girls smoked daily; 21.0% of boys and 25.2% of girls aged 16 years smoked daily. Of schools, 28.0% permitted staff to smoke indoors, 84.1% permitted staff to smoke outdoors on school grounds, and 83.2% permitted students to smoke outdoors on school grounds. Daily smoking was not associated with policies targeting student smoking or those targeting indoor smoking by staff. In multilevel analyses, girls aged 13 years were almost 5 times more likely to be daily smokers if they attended schools at which staff were permitted to smoke outdoors. Conclusions: Younger girls may be more susceptible to social influences at school related to tobacco use. School policies banning smoking by teachers and other school personnel within and outside the school should be an important component of comprehensive adolescent smoking prevention programs.