Elsevier

Public Health

Volume 151, October 2017, Pages 169-176
Public Health

Original Research
Link between perceived smoking behaviour at school and students smoking status: a large survey among Italian adolescents

https://doi.org/10.1016/j.puhe.2017.07.004Get rights and content

Highlights review

  • There is an association between perception of smoking and smoking status.

  • Perception of employees or pupils smoking at school was higher among smoker.

  • Smokers were less aware of preventive intervention organized at school.

  • Knowledge about health effects of smoking differed between smokers and non-smokers.

  • The article may serve as a basis for more tailored school-based interventions.

Abstract

Objectives

To investigate a possible link between sociodemographic factors, the perception of smoking habits at school and smoking status of Italian adolescents attending secondary school.

Study design

The study was a cross-sectional study.

Methods

An anonymous online survey was employed to gather information on age, gender, smoking status and to examine the perception of smoking behaviour on the school premises. Chi-squared and Kruskal–Wallis tests were performed for the univariate analysis and logistic and multinomial regressions for the multivariate analysis.

Results

The statistical analyses included 1889 students. Univariate analysis showed significant differences concerning knowledge between smoker and non-smoker concerning the harmfulness of smoking (P < 0.001). According to the multivariate analysis smokers had a higher perception of teacher, principal or janitor smoking at school (odds ratio: 1.54 [95% confidence interval 1.26–1.89]). Students older than 19 years most often begin smoking because their friends smoke compared with younger students (adjusted odds ratio: 1.18 [95% confidence interval 0.48–2.89]).

Conclusion

School environment and behaviour of role models play a crucial part in student smoking. To prevent and reduce youth tobacco smoking, not merely the presence of preventive measures is important but greater attention needs to be placed on the enforcement of smoking policies.

Introduction

Smoking poses an important threat to the current and future health of the European youth population and with about six million deaths annually, the tobacco epidemic is one of the greatest public health challenges.1 Unfortunately, it is during adolescence when nicotine addiction is most likely to develop2 and the earlier in life adolescents try a cigarette, the more likely they are to become daily or regular smokers.3 Besides, nicotine addiction, cigarette smoking by youth comes along with several serious health consequences such as respiratory effects and risk of cardiovascular disease in adulthood.4

Even with a long history of smoking control reforms and substantial efforts to reduce the smoking prevalence in Italy, including the introduction of an anti-smoking law (Sirchia Law) that prohibits smoking in all enclosed public premises, public transport, libraries, bars, and so forth,5 the smoking prevalence among young people in Italy remains at 20%, far above the European average (14%).6 These developments indicate the need for a more rigorous understanding about the dynamics that influence adolescents smoking. In particular, because a healthy population may result in substantial benefit in terms of public health, productivity and social development.

An adolescent's perception about smoking by peers and role models can play an important role in smoking initiation and continuation. In fact, positive associations to smoking, including the perception of smoking of role models (e.g. teachers and friends) smoking and social acceptability, has been suggested as predictors for adolescents' intention to smoke.7 Negative association to smoking, on the other hand, such as undesirable effects on one's physical appearance, the perception of lower social acceptability and believing that second-hand smoke can cause harm to others have been closely linked to smokers' intention to quit.8

Adolescent smoking should be of particular interest from both a research and a policy perspective since it has important implications for lifetime. Given that most adolescents attend school, the school environment represents a vital arena in which learning takes place. The school environment therefore plays a significant role in shaping the smoking behaviour of an adolescent. The correlations of adolescent smoking with exposure to peer smoking and to school personnel smoking has been documented in some countries.9 However, until now, little is known about how Italian students perceive smoking at school in relation to their smoking behaviour. Consequently, the present study was carried out to assess the relation between sociodemographic factors (age and gender), tobacco smoking status and the perception of tobacco use at school of peers, janitors, teachers or principals among Italian educated adolescents.

Section snippets

Study design and setting

This cross-sectional study took place in Italy in November 2016. It was performed in accordance with the STROBE statement10 and was a self-completed anonymous online survey developed by Skuola.net. Skuola.net is an Italian internet forum for middle, high school and university students to share notes, advices, doubts, news and perspectives.

Participants

The present study included students aged 14 years and older. All students participated voluntarily.

Data collection

Data collection was carried out using an online survey. The

Results

A total of 1889 students were included in the analysis. Table 1 provides details of the descriptive statistics and sample characteristics.

Discussion

The present study investigated the relationship between sociodemographic factors, smoking status of Italian educated adolescents and their perception of smoking behaviour at school. To date, a limited number of studies have focused on the relation between student's perception of schoolmates and teachers' smoking habit at school. Data were collected from a relatively large sample among Italian adolescents aged 14 years and older through an online survey.

The majority of students reported that

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Funding

None declared.

Competing interests

None declared.

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