Assessing the Relationship between Tobacco Control School Policies and Adolescent Smoking in Israel: A Multilevel Analysis - Abstract
Cigarette smoking is one of the most dangerous behaviors affecting health. The World Health Organization (WHO) has stated that tobacco smoking is the second most common cause of death and is the fourth most dangerous risk factor for disease worldwide.
Health promotion policies can help reduce health-related risk behaviors and policies targeting risk behaviors have been gradually implemented across schools in Israel. This study identified the most effective school health promotion policy components and their association with risk behaviors, specifically tobacco smoking among adolescents.
Data from the random-sample Israeli 2011/12 Health Behavior in School-Aged Children (HBSC) survey was analyzed. This included interviews with 5,279 students in 95 Jewish public schools. In addition, 100 principals from the participating schools were interviewed to measure the extent of implementation of health promotion policies in their schools. A logistic hierarchical linear model (HLM) analysis was performed to simultaneously estimate the relationship between individual and school level factors with tobacco smoking.
Most variance in adolescent smoking was explained by student level variables including negative perceptions of school, lack of parental support for school issues, and time spent with friends. Among the school level measures, parental participation in health promotion intervention programs proved to be associated with lower rates of Adolescents Tobacco Smoking, over and above student characteristics. School health promotion policies should focus on parents’ participation in intervention programs and should seek to improve students’ perceptions of school and their sense of well-being to promote resilience.