Environmental factors influence smoking behaviors (1,2), and the school environment is an important setting for substance use prevention efforts (3). Schools are places where social behaviors are modeled and reinforced, and they are identified in ecologic models as an influence proximal to behavior (4-6). School-based strategies are a key element of tobacco control among young people because school environments are established systems where smoking behaviors can be targeted (4). Policies are necessary for comprehensive school-based tobacco control, but little is known about the characteristics of school policies and their relationship to tobacco use.  Additionally, smoking rates vary among schools, even after controlling for individual characteristics, suggesting that school context contributes to student smoking (7,8).

Tobacco control policies targeted at the population level have been a successful public health strategy, but school smoking policies have had mixed effects on individual behavior (4,7-17). Several studies indicate that schools with tobacco control policies, such as smoking bans, have lower smoking prevalence (14-16). Smoking behavior is related to policy strength (13), and school tobacco policies are effective when strongly enforced (7,10,16-18).

A school smoking policy is considered to be strong if it was developed with input from students and is comprehensive, consistently enforced, and addresses prevention education and cessation strategies (7,19). A review examining the elements of tobacco control policies found that only bans and policy enforcement elements deterred smoking (20), and another study found that school smoking policies are ineffective at reducing smoking uptake among adolescents (12). By the time children reach secondary school, policy enforcement appears to lose its protective effect, and students' perceptions of strong rules can indicate higher smoking prevalence (4).

Both policy content and implementation need to be considered when predicting smoking behavior (7). Measuring school policy intent and enforcement will further our understanding of how policies may affect smoking behavior.

Both individual and community factors influence smoking behaviors, and the prevalence of smoking varies from school to school. This variation suggests that an ecologic analysis is necessary to understand student smoking behaviors. Yet most research on school smoking policies has focused on examining the relationship of policies to individual smoking status. Although we acknowledge that the purpose of school smoking policies is to influence individual smoking behavior, school policies are primarily intended to focus on the environment by encouraging and reinforcing nonsmoking norms within the school setting.

The purpose of this study was to examine how policy characteristics are associated with school smoking prevalence. We conducted a secondary analysis to examine how these characteristics influence the smoking status of individual students.

Of the 281 schools recruited, complete data were available for 272 schools and 27,892 students in grades 5 through 9. Students were approximately evenly distributed by sex (girls, 53%) and grade level.

The overall smoking prevalence was 1.5%; there was no significant difference in smoking status by sex. The grade configuration of each school (by highest grade at school) is reported in Table 4.

Eight percent of schools had no written tobacco policy. The mean smoking prevalence was highest for schools with only a school-developed policy (2.6%), followed by schools with their own policy and a district policy in place (1.6%), schools with only a district policy in place, (1.2%), and schools with no policy (0.7%).

We found that school smoking policies can influence individual smoking status at both the school and individual levels, which is consistent with previous studies (7,14,18). Policies that address purpose and goals and that prohibit smoking by all people and at all times are associated with lower school smoking prevalence. School bans have previously been reported as effective (8,14-16); thus, we conclude that prohibiting smoking by all people and at all times is a key policy message.

Policies that included a clearly stated purpose and goals predicted less smoking at both the individual and school levels. A clearly stated rationale may suggest a more established tobacco control strategy or a stronger commitment by school administrators to address smoking issues. Policy guidelines indicate that purpose and goals are key components of a good policy (19,23,26,27).

Schools with written policies that mandated cessation programs had higher smoking rates at both school and individual levels. Schools with many students and staff who smoke likely would have had more reason to develop and mandate tobacco cessation programs. The cross-sectional nature of this research does not allow us to address this question.

Most (92%) schools in this study had a written school or board tobacco policy in place. This finding is encouraging and suggests that schools are taking action to reduce and prevent student tobacco use. However, the policies were generally weak. In particular, scores for developing, overseeing, and communicating policy and strength of enforcement were very low, which may explain their lack of statistical significance. Also, many of the written policies, particularly in elementary schools, were simple excerpts from a student handbook and not fully developed. Anecdotally, many school personnel commented that they did not feel that a policy was necessary for an elementary school.

Older students were more likely to smoke than were younger students, and smoking rates among students in grades 5 through 9 were higher in schools with older students (up to grade 12) than in schools with younger students. Having older students at a school appears to influence the smoking behavior of younger students, which confirms similar findings (28,29).

In recent years, schools have been encouraged to provide tobacco use prevention education as part of an effective strategy. The effectiveness of these programs is mixed (12,30-32). In our study, policies that mandated tobacco use prevention education were not associated with school or student smoking rates. In other research we have conducted, schools with a strong focus on prevention education had lower smoking rates (33).

We found that many elements of school tobacco policies were not associated with smoking behaviors. Most policy characteristics alone likely account for only small variations in smoking. Many factors work together to influence smoking, including individual, school, and community factors that were not measured in this study. A study by Murnaghan et al (11) revealed that a combination of tobacco control programs and school tobacco policies were protective of occasional smoking only among students who perceived clear smoking rules. It is possible that school policies are more effective for certain students and when combined with other tobacco control efforts. No single factor accounts for all variance in student behavior, and some factors (eg, programs and policies) may have synergistic effects. Canada's Joint Consortium on School Health supports a school self-assessment tool that focuses on a tobacco policy as well as prevention and cessation programming (34).

Many studies have used multilevel analysis to address factors related to smoking, but this approach makes it difficult to "disentangle effects with observational data sets" (5,35). We found that results from the individual-level analysis were similar but not identical to school-level findings, suggesting that separate analyses should be considered. Further work is needed to guide researchers in this area.

This study has limitations that should be considered. First, students were in grades 5 through 9, where smoking rates tend to be lower than among older students. We coordinated this study with a national survey of youth focused on this age group. The survey has been recently expanded to include older students. Second, the coding rubrics in this study need to be further tested for reliability and validity. Policy scores derived from our coding scheme were restricted in range, particularly for certain items, which may have limited our ability to detect any relationship with smoking. Finally, data in this study are cross-sectional. Longitudinal analyses examining smoking and the school environment are needed to better understand the effects of school context on smoking behavior.

Despite these limitations, this study contributes to research on school tobacco policies by focusing on the school outcomes, the level to which policies are directed. On the basis of our results and the existing research, we conclude that school smoking policies can contribute to reducing youth smoking as part of a comprehensive school approach to tobacco control. To maximize impact, policies should describe their purpose and goals and should emphasize smoking prohibition.