BACKGROUND: Structural anti-smoking measures, such as age limits for tobacco sale, restricted smoking in public areas, increased tobacco prices, and advertising regulations, have significantly contributed to the decline in smoking rates. In 2021, Denmark mandated smoke-free school hours for all youth education institutions, prohibiting use of tobacco and nicotine products during school hours. This study examines the association of this policy with tobacco and nicotine product use among students in a youth educational setting with high prevalence of tobacco use.
METHODS: The study utilized data from two nationwide surveys conducted in Danish preparatory basic education schools in 2023. A student survey (n=3.588) assessed use of cigarettes, e-cigarettes and smokeless tobacco (e.g., snus and nicotine pouches) during school hours. A school manager survey (n= 34) assessed the implementation degree of smoke-free school hours. We used multilevel logistic regression models, adjusting for sex, age and school as random effect. Additionally, we performed stratified analyses by students' sex.
RESULTS: Compared to schools with low implementation of smoke-free school hours, schools with high implementation had lower odds of students using e-cigarettes (adjusted OR = 0.38, 95% CI: 0.17, 0.85). Moreover, schools with high implementation had lower odds of cigarette use among female students (adjusted OR = 0.33, 95% CI: 0.1, 0.90) but not among male students (adjusted OR = 0.57, 95% CI: 0.27, 1.23). No statistically significant association was found with the use of smokeless tobacco (adjusted OR = 0.67, 95% CI: 0.36, 1.24).
CONCLUSIONS: The findings suggest that comprehensive implementation of smoke-free school hours can reduce tobacco and nicotine product use among youth. While high implementation degree of smoke-free school hours was associated with reduced use of cigarettes and e-cigarettes during school hours, it was not associated with use of smokeless tobacco. These results underscore the importance of targeted interventions and robust enforcement of tobacco control policies.