title: Smoking in Ontario schools: does policy make a difference?
abstract: OBJECTIVE
  Studies in other countries have shown that school tobacco control policy has potential to prevent smoking uptake in adolescents. Since no Canadian research has studied this association, we assessed the statistical link between school tobacco policy and smoking status in Ontario elementary and secondary schools.
  
  
  METHODS
  We conducted secondary analysis of data collected using the School Smoking Profile, a cross-sectional, self-report questionnaire. School policy variables were formed from five survey items concerning students' perceptions of school tobacco control policy. Smoking status was determined through self-report measures which had been validated by carbon monoxide testing. Logistic regression models used school policy variables to explain smoking status in elementary and secondary schools, controlling for school location, school size, and student's grade level.
  
  
  RESULTS
  The smoking policy variables, rules and enforcement, explained smoking status after controlling for other variables. In elementary schools, perceptions of stronger enforcement reduced the odds of being a smoker (OR = 0.39, CI99 = 0.34-0.44). In secondary schools, enforcement lost its protective effect (OR = 1.05, CI99 = 1.00-1.10). In addition, student perceptions that rules were strong were indicative of increased smoking in secondary schools (OR = 1.32, CI99 = 1.27-1.37).
  
  
  CONCLUSIONS
  Strong enforcement of school tobacco control policy appears to be effective in elementary schools but is not as helpful in secondary schools. Secondary school policymakers should consider modifying their sanctions to avoid alienating smokers.
authors.affiliation: Health Studies & Gerontology, University of Waterloo, Waterloo, Ontario. reitsmah@mcmaster.ca
authors.forename: Angela H
authors.initials: AH
authors.lastname: Reitsma
authors.forename: Steve
authors.initials: S
authors.lastname: Manske
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006291:Health Policy; D006801:Humans; D016015:Logistic Models; D008297:Male; D009864:Ontario / Q000453:epidemiology; D012424:Rural Population; D012574:Schools; D012907:Smoking / Q000453:epidemiology* / Q000331:legislation & jurisprudence; D011795:Surveys and Questionnaires; D014505:Urban Population