title: Multilevel analysis of the impact of school-level tobacco policies on adolescent smoking: the case of Michigan.
abstract: BACKGROUND
  In efforts to curb and prevent youth smoking, school tobacco policies have become an important and effective strategy. This study explores the degrees and types of tobacco-free school policy (TFSP) enforcement that are associated with adolescent smoking.
  
  
  METHODS
  A multilevel analysis was performed using 983 students who are nested in 14 schools. The individual-level data are drawn from the 2009 Michigan Youth Risk Behavior Survey. The school-level data are drawn from the 2008 School Health Profiles survey.
  
  
  RESULTS
  Two factors are associated with lower adolescent smoking: greater punishment for TFSP violation and more tobacco control communication efforts. By contrast, the factors associated with higher adolescent smoking are designation of a tobacco-free school zone and school-level smoking.
  
  
  CONCLUSIONS
  This study theoretically and methodologically guides researchers to test TFSP effectiveness in other states. Three strategic implications emerge: (1) schools should provide a consistent antismoking message in smoke-free environments; (2) schools should integrate TFSP into a comprehensive tobacco control initiative, including community-wide tobacco control programs and messages; and (3) the way a specific TFSP is promoted and communicated could determine how effective it is.
authors.affiliation: Associate Professor, (hjpaek@gmail.com), Department of Advertising & Public Relations, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan, Kyeonggi-do 426-791, South Korea.
authors.forename: Hye-Jin
authors.initials: HJ
authors.lastname: Paek
authors.forename: Thomas
authors.initials: T
authors.lastname: Hove
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Oh
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D005260:Female; D006291:Health Policy; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008824:Michigan; D016134:Organizational Policy; D012572:School Health Services / Q000458:organization & administration*; D000074606:Smoking Prevention; D013334:Students / Q000706:statistics & numerical data*; D014028:Tobacco Smoke Pollution / Q000517:prevention & control*
chemical_list: D014028:Tobacco Smoke Pollution
keywords: adolescent smoking; social ecological model; tobacco control; tobacco-free school policy