Objectives: The aim of this study was to use a multilevel analysis to assess the schoollevel tobacco control policy and individual-level characteristics of students in relation to cigarette smoking among elementary schoolchildren. Methods: We conducted a multilevel study to assess two-level effects on smoking among 2,350 grade 3-6 students in 26 randomly selected elementary schools in southern Taiwan. The individual- and school-level characteristics regarding smoking were estimated using multi-level logistic regression. Results: School- and individual-level effects, accounting for 85% and 48% respectively of variance in the odds of being a smoker, indicated that the school cluster was very important. The risk of smoking was significantly associated with those schools located in a mountainous region [adjusted odds ratio (AOR=2.40, 95%CI: 1.00-5.79)], schools where staff smoked (OR=2.57, 95%CI: 1.59-4.17) and schools without anti-tobacco activities or curricula implementation (AOR=2.88, 95%CI: 1.39-5.94). Individual-level characteristics having a significant relationship with student smoking behavior were student's perceptions of smoking, having best friends or family always smoking in front of them, ever-drinking and -chewing betelnut behavior. Conclusions: The findings suggest that tobacco control policies and preventive programs should be strongly considered for implementation in those elementary schools where students are at the greatest risk for cigarette smoking.
Date:
2010-04
Relation:
Taiwan Journal of Public Health. 2010 Apr;29(2):145-157.
