Examining the impact of changes in school tobacco control policies and programs on current smoking and susceptibility to future smoking among youth in the first two years of the COMPASS study: looking back to move forward
More details
Hide details
School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
Scott T. Leatherdale   

School of Public Health and Health Systems, University of Waterloo, 200 University Avenue, Waterloo, ON N2L 3G1, Canada
Publish date: 2015-03-30
Tobacco Induced Diseases 2015;13(March):8
School-based prevention activities continue to be an important tobacco control resource, however there is little guidance for school-based tobacco control programming within Ontario. The objective of this study is to identify real-world changes in school-based tobacco control programs or policies in the COMPASS study and examine of those interventions (natural experiments) had any impact on the school-level prevalence of smoking susceptibility and current smoking over time.

This paper uses longitudinal school-level smoking behaviour data from Year 1 (Y1: 2012–13) and Year 2 (Y2: 2013–14) of the COMPASS study. Changes to school-level tobacco control programs and policies were measured using the COMPASS School Programs and Policies Questionnaire and knowledge broker follow-up interviews. Quasi-experimental tests of proportion and difference-in-difference models were used to evaluate the impact of the interventions identified between Y1 and Y2 on school-level prevalence of smoking susceptibility among never smokers and current smoking.

Between Y1 and Y2, 17 schools reported a change in their tobacco control programming or policies. In four of the intervention schools, the increase in the within-school prevalence of susceptible never smokers between Y1 and Y2 was significantly greater than the natural change observed in the control schools. In five of the intervention schools, the decrease in the within-school prevalence of current smokers between Y1 and Y2 was significantly greater than the natural change observed in the control schools. Only two of the new interventions evaluated (both focused on policies of progressive punishment for students caught smoking on school property), were associated with significant desirable changes in both smoking susceptibility and current smoking between Y1 and Y2.

Interventions specific to effective and enforced tobacco control were the most common and consistently had the desired impact on the school-level prevalence of smoking susceptibility and current smoking. Due to the variation in the types of interventions implemented and their effectiveness, additional evaluation evidence is necessary to determine the most successful activities and contexts among individual students. The results presented here highlight which of these real-world promising interventions should be further evaluated using the longitudinal individual-level data in COMPASS over time.

Mayhew KP, Flay BR, Mott JA. Stages in the development of adolescent smoking. Drug Alcohol Depend. 2000;59(Suppl1):S61–81.
Kaai S, Brown KS, Leatherdale ST, Manske KS, Murnaghan D. We do not smoke but some of us are more susceptible than others: a multilevel analysis of a sample of Canadian youth in grades 9 to 12. Add Behav. 2014;39:1329–36.
Leatherdale ST, Rynard V. A cross-sectional examination of modifiable risk factors for chronic disease among a nationally representative sample of youth: are Canadian students graduating high school with a failing grade for health? BMC Public Health. 2013;13:569. doi:10.1186/10.1186/1471-2458-13-569.
Flay BR. Understanding environmental, situational and interpersonal risk and protective factors for youth tobacco use: the Theory of Triadic Influence. Nicotine Tob Res. 1999;1:S111–4.
U.S. Department of Health and Human Services. Preventing tobacco Use among youth and young adults: a report of the surgeon general. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2012.
Leatherdale ST, Brown KS, Cameron R, McDonald PW. Social modelling in the school environment, student characteristics, and smoking susceptibility: a multi-level analysis. J Adolesc Health. 2005;37:330–6.
Kaai S, Leatherdale ST, Manske KS, Brown KS. Using student and school factors to differentiate adolescent current smokers from experimental smokers in Canada: a multilevel analysis. Prev Med. 2013;57:113–9.
Leatherdale ST, McDonald PW, Cameron R, Brown KS. A multi-level analysis examining the relationship between social influences for smoking and smoking onset. Am J Health Behav. 2005;29:520–30.
Galanti MR, Coppo A, Jonsson E, Bremberg S, Faggiano F. Anti-tobacco policy in schools: upcoming preventive strategy or prevention myth? A review of 31 studies. Tob Control. 2014;23:295–301.
Wiehe SE, Garrison MM, Christakis DA, Ebel BE, Rivara FP. A systematic review of school-based smoking prevention trials with long-term follow-up. J Adolesc Health. 2005;36:162–9.
Ministry of Health Promotion: Comprehensive Tobacco Control: Guidance Document. Queen’s Printer for Ontario, 2010. (ISBN: 978-1-4435-2910-5). Available at: Accessed on August 9, 2014.
Smoke-Free Ontario - Scientific Advisory Committee. Evidence to guide action: comprehensive tobacco control in Ontario. Toronto, ON: Ontario Agency for Health Protection and Promotion; 2010. Available at: http://www.publichealthontario.... Accessed on August 5, 2014.
Ontario Tobacco Research Unit: Smoke-Free Ontario Strategy Monitoring Report. Toronto: Ontario Tobacco Research Unit, Special Report, January 2014. Available at: Accessed on August 9, 2014.
Leatherdale ST. Evaluating school-based tobacco control programs and policies: an opportunity gained and many opportunities lost. Can J Prog Eval. 2012;24:91–108.
Green LW. Public health asks of systems science: to advance our evidence-based practice, can you help us get more practice-based evidence? Am J Public Health. 2006;96:406–9.
Petticrew M, Cummins S, Ferrell C, Findlay A, Higgins C, Hoy C, et al. Natural experiments: an underused tool for public health? Public Health. 2005;119:751–7.
Cameron R, Manske S, Brown KS, Jolin MA, Murnaghan D, Lovato C. integrating public health policy, practice, evaluation, surveillance, and research: the school health action planning and evaluation system. Am J Public Health. 2007;97:648–54.
Leatherdale ST, Brown KS, Carson V, Childs RA, Dubin JA, Elliott SJ, et al. The COMPASS study: a longitudinal hierarchical research platform for evaluating natural experiments related to changes in school-level programs, policies and built environment resources. BMC Public Health. 2014;14:331. doi:10.1186/1471-2458-14-331.
Marcus SE, Leischow SJ, Mabry PL, Clark PI. Systems science: a revolution in public health policy research. Am J Public Health. 2010;100:1161–5.
Wong S, Shields M, Leatherdale ST, Malaison E, Hammond D. Assessment of the validity of self-reported smoking status among Canadians. Health Rep. 2012;23:47–53.
Pierce JP, Choi WS, Gilpin EA, Farkas AJ, Merritt RK. Validation of susceptibility as a predictor of which adolescents take up smoking in the United States. Health Psych. 1996;15:355–61.
Pan Canadian Joint Consortium for School Health. Healthy School Planner. 2014.
Shadish WR, Cook TD, Campbell DT. Experimental and quasi-experimental designs for generalized causal inference. Boston, MA: Houghton Mifflin; 2002.
Picard A. Is tobacco control no longer a federal priority? The Globe and Mail. May 25, 2011. Available at: Accessed on August 06, 2014.
Cameron R, Brown KS, Best JA, Pelkman CL, Madill CL, Manske SR. Effectiveness of a social influences smoking prevention program as a function of provider type, training method, and school risk. Am J Public Health. 1999;89:1827–31.
Lovato CY, Pullman AW, Halpin P, Zeisser C, Nykiforuk CI, Best F, et al. The influence of school policies on smoking prevalence among students in grades 5–9, Canada, 2004–2005. Prev Chronic Dis. 2010;7:A129.
Pinilla J, Gonzalez B, Barber P, Santana Y. Smoking in young adolescents: an approach with multilevel discrete choice models. J Epi Comm Health. 2002;56:227–32.
Moore L, Roberts C, Tudor-Smith C. School smoking policies and smoking prevalence among adolescents: multilevel analysis of cross-sectional data from Wales. Tob Control. 2001;10:117–23.
Wakefield MA, Chaloupka FJ, Kaufman NJ, Orleans CT, Barker DC, Ruel EE. Effect of restrictions on smoking at home, at school and in public places on teenage smoking: cross sectional study. BMJ. 2000;321:333–7.
Leatherdale ST, Viehbeck S, Murphy C, Norman C, Schultz A. The tobacco control community of tomorrow: a vision for training. Can J Public Health. 2007;98:30–2.
Diggle PJ, Liang K-L, Zeger SL. Analysis of longitudinal data. 2nd ed. Oxford: Oxford Science; 2002.
Elton-Marshall T, Leatherdale ST, Burkhalter R, Brown KS. Changes in tobacco use, susceptibility to future smoking, and quit attempts among Canadian youth over time: a comparison of off-reserve Aboriginal and non-Aboriginal youth. Int J Env Res Public Health. 2013;10:729–41. doi:10.3390/ijerph10020729.
Changing the Smoking Trajectory: Evaluating the Impact of School-Based Tobacco Interventions on Changes to Susceptibility to Future Smoking
Adam Cole, Wei Qian, Scott T. Leatherdale
International Journal of Environmental Research and Public Health
A quasi-experimental examination of how school-based physical activity changes impact secondary school student moderate- to vigorous- intensity physical activity over time in the COMPASS study
Stephen Hunter, Scott T. Leatherdale, Kate Storey, Valerie Carson
International Journal of Behavioral Nutrition and Physical Activity
School Breakfast-Club Program Changes and Youth Eating Breakfast During the School Week in the COMPASS Study
Scott T. Leatherdale, Jennifer M. Stefanczyk, Sharon I. Kirkpatrick
Journal of School Health
Understanding the impact of school tobacco policies on adolescent smoking behaviour: A realist review
Michael Schreuders, Paulien A.W. Nuyts, Bas van den Putte, Anton E. Kunst
Social Science & Medicine
School-level disadvantage and failed cessation treatment among adolescent smokers
Kimberly Horn, Maliha Ali, Tiffany Gray, Andrew Anesetti-Rothermel, Steve Branstetter
Tobacco Prevention & Cessation
Susceptibility to cigarette smoking among secondary and high school students from a socially disadvantaged rural area in Poland
Kinga Polańska, Piotr Wojtysiak, Leokadia Bąk-Romaniszyn, Dorota Kaleta
Tobacco Induced Diseases
Strategies for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease
Luke Wolfenden, Nicole K Nathan, Rachel Sutherland, Sze Lin Yoong, Rebecca K Hodder, Rebecca J Wyse, Tessa Delaney, Alice Grady, Alison Fielding, Flora Tzelepis, Tara Clinton-McHarg, Benjamin Parmenter, Peter Butler, John Wiggers, Adrian Bauman, Andrew Milat, Debbie Booth, Christopher M Williams
Cochrane Database of Systematic Reviews
Stratified Multilevel Logistic Regression Modeling for Risk Factors of Adolescent Obesity in Tennessee
Shimin Zheng, Sheryl Strasser, Nicole Holt, Megan Quinn, Ying Liu, Casey Morrell
International Journal of High Risk Behaviors and Addiction
An evaluation of school-based e-cigarette control policies’ impact on the use of vaping products
Sandra Milicic, Philip DeCicca, Emmanuelle Pierard, Scott Leatherdale
Tobacco Induced Diseases
Food safety knowledge, attitudes and self-reported practices among Ontario high school students
Shannon Majowicz, Kenneth Diplock, Scott Leatherdale, Chad Bredin, Steven Rebellato, David Hammond, Andria Jones-Bitton, Joel Dubin
Canadian Journal of Public Health