Journal of Community Health

, Volume 31, Issue 3, pp 225–248 | Cite as

Parents’ perceptions of the role of schools in tobacco use prevention and cessation for youth

  • Jodi Wyman
  • James H. Price
  • Timothy R. Jordan
  • Joseph A. Dake
  • Susan K. Telljohann
Article

Abstract

The purpose of this study was to examine Ohio parents’ perceptions of the role of schools in smoking prevention, cessation, and anti-tobacco policy for their children. A 46-item questionnaire was based on the CDC Guidelines for School Health Programs to Prevent Tobacco Use and Addiction. Surveys (n = 800) were sent to a stratified random sample of parents of junior high and high school aged students and 57% responded. Parents were supportive of smoking prevention activities, but almost two-thirds believed their child’s school should get parents’ input. Furthermore, mothers/step-mothers were more likely than fathers/step-fathers to agree that the school had a role in smoking prevention activities. The majority of parents were also supportive of smoking cessation activities. However, only 8% of parent respondents supported schools providing nicotine gum or patches to students trying to quit smoking. Overall, the majority of parents were supportive of the seven recommendations developed by the CDC as guidelines for school health programs to prevent tobacco use and addiction. Schools have the opportunity to impact student smoking through prevention and cessation activities. Schools need to know that parents are supportive of these activities and want to be included in the process of implementing effective prevention or cessation programs.

Keywords

parent perceptions role of schools adolescent tobacco use tobacco prevention tobacco cessation 

Introduction

Smoking has its roots early in life with over 3000 children and adolescents beginning to smoke every day.1 It is estimated that about half of adolescents who continue to smoke will die from a smoking-related illness.2 This will result in premature loss of life for over 5 million youths.3 As many as 63% of smokers began the practice before the age of 13.4

Past research suggests that adolescents who began experimenting with smoking at a younger age were at increased risk of becoming a regular smoker.5, 6, 7, 8 For this reason, it is very important that smoking education begin at a young age.5 School health programs can be an effective means of preventing tobacco use among youth.9,10 In addition, schools should offer cessation programs to help those students who have started to smoke.

Unfortunately, there are too few required prevention and cessation programs in schools. The School Health Policies and Programs Study (SHPPS) (2000) indicated that less than 20% of states and less than 60% of school districts required schools to offer tobacco prevention services. Also, only 10% of states and 42% of school districts required schools to provide tobacco-use cessation to students when needed.11

When investigating the tobacco prevention activities available to students in Ohio, results found that Ohio does not require school districts or schools to provide tobacco use prevention services.11 Ohio does have a tobacco free environment policy which includes prohibiting cigarette smoking, cigar or pipe smoking, and smokeless tobacco use among students, faculty, staff, and visitors both on and off campus for school-sponsored events. In Ohio, it is estimated that over 127,000 children ranging from 12–18 years of age smoke cigarettes.12 Within Ohio, current cigarette smoking for students in grades six through eight was estimated at 14%, and in grades nine through 12 was estimated at 33%.13

If effective smoking prevention and cessation programs are going to be developed and implemented within schools, it is important to understand parents’ perceptions of the schools role in various school health issues (including children’s tobacco use). Only one study was found concerning parent’ perceptions of the role of schools in their children’s tobacco use. Clark and colleagues (1999) found many white parents believed that they did not have to worry about their children using tobacco because of school influence. White parents acknowledged that tobacco control among teens is an appropriate role for the schools, while Black parents believed schools should only reinforce the teachings of the parents concerning tobacco use.14

To assist in the reduction of adolescent smoking, the Centers for Disease Control and Prevention (CDC) developed guidelines and recommendations concerning tobacco use prevention and addiction.15 The seven guidelines were developed to assist school personnel in planning, implementing, and assessing educational programs and school policies to prevent tobacco use and addiction and tobacco-related morbidity and mortality. To ensure the greatest impact, schools need to implement all seven recommendations.

Parents’ perceptions of tobacco issues in schools are important because coordinated school health programs list parents and families as one of the eight components. Thus, it is useful for schools to know what parents think about an issue before they implement curricular changes. Therefore, the purpose of this study was to examine Ohio parents’ perceptions of the role of schools in smoking prevention, cessation, and anti-tobacco policy for their children. More specifically, are Ohio parents’ supportive of smoking cessation and/or prevention activities for their children within junior high and high school? Furthermore, are Ohio parents supportive of selected anti-tobacco policies for their children within junior high and high school?

Methods

Instrument Development

A 46-item closed format survey instrument was developed regarding parental beliefs about the schools’ role concerning tobacco policies along with smoking prevention and cessation programs for their children. The survey instrument was constructed based mainly on the CDC Guidelines for School Health Programs to Prevent Tobacco Use and Addiction.15 In addition, three questions were generated using the School Health Index in regards to having a committee that oversees school tobacco policies, training student leaders to help health teachers present tobacco prevention lessons, and providing nicotine gum or patches to students trying to quit smoking.

To establish content validity, the instrument was sent to a panel of tobacco and/or survey research experts for review (n = 6). Experts were considered to be individuals who were well published in the aforementioned areas. After expert review, minor changes were made to the survey to ensure that adequate measures of parent perceptions of the role of schools in smoking prevention/cessation were included. A Likert-type response format was used (Strongly Disagree to Strongly Agree). In addition, a SMOG readability test was conducted on the survey questions. The reading level of the survey was set at grade eight, with a standard error of plus or minus one and a half grades.

The questionnaire was pilot tested for stability reliability through testing and re-testing, one week apart, with a convenience sample of parents (n = 22). Percent agreement (87%) and Pearson product moment correlation coefficients (r = 0.66) were calculated for the dichotomous and scale items, respectively. Internal reliability using Cronbach alpha for the final sample responses, was 0.86.

Subjects

Hugo-Dunhill List Management was contacted regarding the generation of a data set for this study. Hugo-Dunhill is a list service company that provides current address lists for households located in specific geographical areas. A total of 2000 names were generated from the current address and telephone list of households located within the state of Ohio. The list was generated based upon those households that had children in junior high and high school (ages 12 to 17 years).

Based on an a priori power analysis (using a 50/50 split), it was determined that data from 384 households would be needed for generalizing the overall results to the population of junior high and high school student’s parents in Ohio, with a +/−5% sampling error at a 95% confidence level.16 To account for non-response, a stratified random sample of 800 households (400 junior high school families and 400 high school families) were included in the sample.

Procedures

The mailing to parents consisted of a brief cover letter assuring confidentiality and a copy of the four-page, booklet format questionnaire printed on colored paper. Postage-paid, self-addressed, return envelopes, along with a $1 incentive were included in the initial mailing.17, 18 Two-weeks after the initial mailing, a second cover letter, another copy of the survey and another postage-paid return envelope were sent to non-respondents. Two-weeks after the second mailing, a colored post-card reminder was sent to non-respondents. A response rate of 57% was obtained. This study protocol was approved by the University Human Subjects Research Review Committee.

Data Analysis

Data from the study were analyzed using SPSS 11.0. Data analysis included descriptive statistics such as frequencies, means, and standard deviations used to describe the responses to the questionnaire items as well as the demographic background characteristics of the respondents. T-tests were calculated to determine relationships between dichotomous independent and parametric dependent variables. Multivariate analysis of variance tests (MANOVAs) were calculated to determine the relationship between categorical independent and multiple parametric dependent variables. Analysis of variance tests (ANOVAs) were calculated to determine the relationships between categorical independent and parametric dependent variables. For all significant MANOVAs and ANOVAs, post-hoc Bonferroni t-tests were conducted to determine which levels of the independent variables were significantly different. Chi-square analyses were calculated to determine relationships between non-parametric independent and dependent variables.

Results

Demographic and Background Characteristics of Respondents

A majority of responding parents were male (51%); white (94%); between the ages of 40–49 (60%); had children in the seventh or eighth grade (58%); were nonsmokers that had never smoked (63%); a plurality had four or more years of college education (43%); and had a total household income between $50,000 and $74,999 (29%). Furthermore, 96% did not and would not allow their child to smoke; did not believe their child was a current smoker (89%); and had talked to their child about the rules regarding the use of tobacco (83%) (Table 1).
Table 1

Demographics and Background of Parent Respondents in Ohio

Item

Junior High N (%)

High School N (%)

Total N (%)

Parent relationship to child

 Mother/Step-mother

105 (47.3)

103 (47.9)

208 (47.6)

 Father/Step-father

104 (46.8)

110 (51.2)

214 (49.0)

 Aunt/Uncle

1 (0.5)

0 (0)

1 (0.2)

 Grandparent

10 (4.5)

2 (0.9)

12 (2.7)

 Guardian

1 (0.5)

0 (0)

1 (0.2)

Sex

 Male

110 (49.5)

113 (52.6)

223 (51.0)

 Female

111 (50.0)

102 (47.4)

213 (48.7)

Age

 20–29

1 (0.5)

0 (0)

1 (0.2)

 30–39

37 (16.7)

13 (6.0)

50 (11.4)

 40–49

134 (60.4)

128 (59.5)

262 (60.0)

 50–59

41 (18.5)

71 (33.0)

112 (25.6)

 60+

8 (3.6)

3 (1.4)

11 (2.5)

Region of Ohio

 Northwest

49 (22.1)

22 (10.2)

71 (16.2)

 Northeast

83 (37.4)

79 (36.7)

162 (37.1)

 Southwest

48 (21.6)

53 (24.7)

101 (23.1)

 South-Central

29 (13.1)

47 (21.9)

76 (17.4)

 Southeast

11 (5.0)

11 (5.1)

22 (5.0)

School Location

 Urban

50 (22.5)

57 (26.5)

107 (24.5)

 Suburban

105 (47.3)

102 (47.4)

207 (47.4)

 Rural

62 (27.9)

55 (25.6)

117 (26.8)

Number of school age children

 1

49 (22.1)

90 (41.9)

139 (31.8)

 2

97 (43.7)

83 (38.6)

180 (41.2)

 3

55 (24.8)

29 (13.5)

84 (19.2)

 4+

20 (9.2)

13 (6.1)

33 (7.6)

Grades of school age children

 K-3

70 (31.7)

21 (9.8)

91 (20.8)

 4–6

81 (36.5)

35 (16.2)

116 (26.5)

 7–8

206 (92.8)

49 (22.8)

255 (58.3)

 9–10

73 (32.9)

140 (65.1)

213 (48.7)

 11–12

57 (25.7)

125 (58.2)

182 (41.7)

Parent level of education

 Less than high school

6 (2.9)

5 (2.4)

11 (2.4)

 High School Graduate

56 (25.2)

56 (26.0)

112 (25.6)

 1–3 years college

65 (29.4)

60 (27.9)

125 (28.6)

 4 + years of college

93 (41.9)

94 (43.8)

187 (42.7)

Smoking behavior of parent

 1+ pack of cigarettes/day

12 (5.4)

9 (4.2)

21 (4.8)

 1/2-1 pack of cigarettes/day

11 (5.0)

14 (6.5)

25 (5.7)

 Less than 1/2 pack of cigarettes/day

6 (2.7)

5 (2.3)

11 (2.5)

 Used to smoke cigarettes but quit within last 6 months

2 (0.9)

3 (1.4)

5 (1.1)

 Used to smoke cigarettes but quit over 6 months ago

48 (21.6)

53 (24.7)

101 (23.1)

 Do not smoke and never have smoked cigarettes

142 (64.0)

131 (60.9)

273 (62.5)

Income

 Less than $10,000 per year

10 (4.5)

5 (2.3)

15 (3.4)

 $10,000 to $14,999 per year

6 (2.7)

9 (4.2)

15 (3.4)

 $15,000 to $24,999 per year

19 (8.6)

11 (5.1)

30 (6.9)

 $25,000 to $34,999 per year

21 (9.5)

23 (10.7)

44 (10.1)

 $35,000 to $49,999 per year

37 (16.7)

39 (18.1)

76 (17.4)

 $50,000 to $74,999 per year

68 (30.6)

60 (27.9)

128 (29.3)

 $75,000 and over per year

49 (22.1)

55 (25.6)

104 (23.8)

Race

 African-American (Black)

10 (4.5)

5 (2.3)

15 (3.4)

 Asian/Pacific Islander

0 (0)

0 (0)

0 (0)

 Caucasian (White)

207 (93.2)

203 (94.4)

410 (93.8)

 Hispanic (Latino)

3 (1.4)

2 (0.9)

5 (1.1)

 Other

1 (0.5)

3 (1.4)

4 (0.9)

Perceptions of smoking

Do you believe that your child currently smokes or currently experimenting with tobacco?

 Yes

8 (4)

24 (11)

32 (7)

 No

208 (94)

181 (84)

389 (89)

 Not Sure

5 (2)

9 (4)

14 (3)

Do you (or would you) allow your child to smoke?

 Yes

0 (0)

8 (4)

8 (2)

 No

219 (99)

200 (93)

419 (96)

 Not Sure

3 (1)

6 (3)

9 (2)

Do you believe there is a problem with too many students using tobacco at your child’s school?

 Yes

56 (25)

102 (47)

158 (36)

 No

80 (36)

37 (17)

117 (27)

 Not Sure

86 (39)

74 (34)

160 (37)

Have you talked to your child about your rules regarding the use of tobacco?

 Yes

185 (83)

179 (83)

364 (83)

 No

33 (15)

34 (16)

67 (15)

N = 222; Junior High

N = 215; High School

N = 437; Total

Perceptions of the Role of Schools in Tobacco Prevention/Cessation/Use

There were 24 items that measured Ohio parent’s perceptions of the role of schools in tobacco prevention (n = 12), cessation (n = 1), and policy (n = 11) (Table 2). On 5 of the items, there were over 90% of parents who strongly agreed or agreed with the statement. There were only four items where less than 50% of parents either strongly agreed or agreed with the statement. When comparing the responses of parents with children in junior high schools to those parents with children in high schools, no significant differences were seen overall. Thus, the two categories were collapsed into one for data analysis.
Table 2

Ohio Parent Perceptions of the Role of Schools in Tobacco Prevention/Cessation/Use

Item

Junior High N (%)

High School N (%)

Total N (%)

SA/A

D/SD

SA/A

D/SD

SA/A

D/SD

My child’s school should tell students about the school’s tobacco policies.

218 (98)

1 (1)

209 (97)

2 (1)

427 (98)

3 (1)

My child’s school should tell parents if their child is caught using tobacco at school.

217 (98)

3 (1)

204 (95)

4 (2)

421 (96)

7 (2)

My child’s school should have rules that ban tobacco advertising on school property and at school sponsored functions.

213 (96)

4 (2)

205 (95)

6 (3)

418 (96)

10 (2)

My child’s school should teach about the harmful physical effects of tobacco use.

210 (95)

4 (2)

202 (94)

6 (3)

412 (94)

10 (2)

My child’s school should tell families about the school’s tobacco policies.

211 (95)

3 (1)

200 (93)

2 (1)

411 (94)

5 (1)

My child’s school should teach students how to help them avoid tobacco use.

206 (93)

11 (5)

182 (85)

10 (5)

388 (89)

21 (5)

My child’s school should teach about the harmful social effects (e.g. smelly cloths, bad breath) of tobacco use.

194 (87)

13 (6)

185 (86)

8 (4)

379 (87)

21 (5)

My child’s school should teach students why young people start to use tobacco.

193 (87)

17 (8)

176 (82)

10 (5)

369 (84)

27 (6)

The school should ban all tobacco use by anyone on school property and at school sponsored functions.

178 (80)

16 (7)

182 (85)

13 (6)

360 (82)

29 (7)

My child’s school should evaluate its smoking prevention/stop smoking programs to make sure they are working.

191 (86)

11 (5)

168 (78)

16 (7)

359 (82)

27 (6)

My child’s school should have a rule that requires students who are caught smoking to attend programs to help them stop smoking.

169 (76)

23 (10)

144 (67)

32 (15)

313 (72)

55 (13)

Lessons that are taught on preventing smoking in junior high should be repeated in more detail during high school.

163 (73)

22 (10)

149 (69)

26 (12)

312 (71)

48 (11)

My child’s school should teach students that most young people do not smoke.

161 (73)

22 (10)

148 (69)

20 (9)

309 (71)

42 (10)

My child’s school should train teachers to teach tobacco prevention lessons.

159 (72)

27 (12)

136 (63)

30 (14)

295 (68)

57 (13)

My child’s school should have a tobacco policy that requires students to receive classroom lessons on avoiding tobacco use.

160 (72)

27 (12)

133 (62)

39 (18)

293 (67)

66 (15)

My child’s school should train student leaders to help health teachers present tobacco prevention lessons.

155 (70)

29 (13)

138 (64)

28 (13)

293 (67)

57 (13)

My child’s school should get parents’ input about what should be taught in tobacco prevention programs.

154 (69)

26 (12)

123 (57)

31 (14)

277 (63)

57 (13)

My child’s school should suspend students who are caught smoking.

152 (69)

36 (16)

123 (57)

55 (26)

275 (63)

91 (21)

My child’s school should provide classroom lessons to help students refuse pro tobacco messages.

140 (63)

31 (14)

119 (55)

39 (18)

259 (59)

70 (16)

My child’s school should have a committee that oversees school policies dealing with reducing tobacco-use by students and staff.

126 (57)

33 (15)

114 (53)

45 (21)

240 (55)

78 (18)

My child’s school should give homework and projects about tobacco that involve families.

109 (49)

56 (25)

89 (41)

65 (30)

198 (45)

121 (28)

Tobacco prevention lessons do NOT need to be taught to students all through high school.

20 (9)

181 (82)

20 (9)

169 (79)

40 (9)

350 (80)

The school should remain neutral about tobacco use, as it is NOT an educational issue.

17 (8)

195 (88)

21 (10)

177 (82)

38 (9)

372 (85)

My child’s school should provide nicotine gum or patches for students who are trying to quit.

18 (8)

170 (77)

16 (7)

158 (74)

34 (8)

328 (75)

SA/A = Strongly Agree/Agree and D/SD = Disagree/Strongly Disagree

N = 222; Junior High

N = 215; High School

N = 437; Total

Interactions of Independent Variables

For data analysis, potential confounding between independent variables was investigated. All significant interactions were controlled for in subsequent analysis. Several demographic and background characteristics from the parent respondents were found to interact with Ohio parent’s perceptions of the role of schools in tobacco prevention, cessation, and policy for their children.

Smoking Prevention

The majority of parents were supportive of smoking prevention activities for their children (Table 3). In addition, as grade level increased (at least through grade seven), so too did parents support of tobacco education in the schools; peaking in the seventh and eighth grades (82% and 81%, respectively) (Figure 1). As students advanced through high school, parents were less supportive of tobacco education for their children; with 57% of parents agreeing that tobacco education is appropriate by the 12th grade.
Table 3

Percentage of Parents Who are Supportive of Smoking Prevention Activities for Their Children within Junior High/High Schools

Item

N (% Agree)

My child’s school should teach about the harmful physical effects of tobacco use.

412 (94)

My child’s school should teach students how to help them avoid tobacco use.

388 (89)

My child’s school should teach about the harmful social effects (e.g. smelly cloths, bad breath) of tobacco use.

379 (87)

My child’s school should teach students why young people start to use tobacco.

369 (84)

Lessons that are taught on preventing smoking in junior high should be repeated in more detail during high school.

312 (71)

My child’s school should teach students that most young people do not smoke.

309 (71)

My child’s school should train teachers to teach tobacco prevention lessons.

295 (68)

My child’s school should train student leaders to help health teachers present tobacco prevention lessons.

293 (67)

My child’s school should get parents’ input about what should be taught in tobacco prevention programs.

277 (63)

My child’s school should provide classroom lessons to help students refuse pro tobacco messages.

259 (59)

My child’s school should give homework and projects about tobacco that involve families.

198 (45)

Tobacco prevention lessons do NOT need to be taught to students all through high school.

40 (9)

Figure 1

Percent of parents who support tobacco education at various grade levels.

Furthermore, there was a statistically significant difference by gender of parents’ regarding their support of smoking prevention activities for their children (F = 4.922, df = 12, p = 0.001). On all prevention items except one, females had stronger agreement than males. Additionally, there was a statistically significant difference by respondents’ relationship to the child and their support of smoking prevention activities for their children (F = 2.465, df = 24, p = 0.001). Statistically significant differences were found between mothers/step-mothers and fathers/step-fathers on 8 of the 12 prevention items. Mothers/step mothers more than fathers/step- fathers were of the opinion that schools should: teach students why young people start to use tobacco (86% vs. 83%); teach about the harmful social effects of tobacco use (92.0% vs. 82%); train teachers to teach tobacco prevention lessons (72% vs. 62%); train student leaders to help health teachers present tobacco prevention lessons (74% vs. 60%); provide classroom lessons to help students refuse pro- tobacco messages (67% vs. 51.0%); repeat smoking prevention lessons that were taught in junior high in more detail in high school (80% vs. 64%); and teach about the harmful physical effects of tobacco use (97% vs. 92%). In addition, mothers/step-mothers were in stronger disagreement than fathers/step-fathers concerning prevention lessons not needing to be taught to students when they are in high school (87% vs. 74%).

Also, a statistically significant difference was found by parent’s current smoking status and their support of smoking prevention activities for their children when stratified by school location (χ 2 = 15.97, df = 4, p = 0.003). There was a statistically significant difference in parents support of smoking prevention activities for their children for urban (F = 1.661, df = 24, p = 0.03) and rural school locations (F = 1.674, df = 24, p = 0.03), but not for suburban school locations (F = 0.671, df = 24, p = 0.88). Statistically significant differences were found between parents on three of the 12 prevention items. In urban school locations, a significant difference was found between past and never smokers for the prevention item concerning teaching students that most young people do not smoke. Those who never smoked were more likely to agree than past smokers that schools should teach students that most young people do not smoke (81% vs. 56%). In rural school locations, a significant difference was found between current and never smokers for the prevention item concerning giving homework and projects about tobacco that involves families as well as providing classroom lessons to help students refuse pro tobacco messages. Those who never smoked were more likely than current smokers to agree that schools should give homework and projects about tobacco that involves families (36% vs. 25%, respectively). In addition, those who never smoked were more likely than current smokers to agree that schools should provide classroom lessons to help students refuse pro-tobacco messages (67% vs. 46%, respectively).

Smoking Cessation

The majority of parents were supportive of smoking cessation activities for their children. Seventy-two percent of parents agreed that students who were caught smoking should be required to attend a program to help them stop (Table 2).

The majority of parents (75%) were not supportive of schools providing nicotine replacement therapy for their children who are trying to quit. There was a statistically significant difference by school location when stratified by parental smoking status regarding parents’ support of nicotine replacement therapy for their children for never smokers (F = 3.472, df = 2, p = 0.03), but not for current smokers (F = 0.059, df = 2, p = 0.94) and past smokers (F = 0.107, df = 2, p = 0.90). When investigating never smokers, statistically significant differences were found between suburban and rural school locations with regard to providing nicotine gum or patches for students. Parents in rural school locations were more likely than parents in suburban school locations to agree that schools should provide nicotine gum or patches for adolescents trying to quit smoking (11% vs. 6%, respectively); which was minimal support regardless of school location.

Additionally, there was a statistically significant difference by total household income and parents’ support of providing nicotine patches or gum to adolescent smokers trying to quit (F = 7.640, df = 3, p = 0.001). Statistically significant differences were found between parents with regard to schools providing nicotine patches or gum to adolescents trying to quit smoking. The two lowest income groups (less than $25,000 and $25,000–$50,000) were statistically significantly more likely than the two highest income groups ($50,000–$75,000 and $75,000+) to support schools providing nicotine patches or gum for adolescent smokers trying to quit (15% and 12% vs. 3% and 4%, respectively). Also, 65% of those making less than $25,000 a year; 70% of those making $25,000–$50,000 a year; 80% of those making $50,000–75,000 a year; and 84% of those making greater than $75,000 a year did not believe nicotine gum or patches should be provided by schools.

Furthermore, parental smoking status by school location was statistically significant (χ 2 = 15.978, df = 4, p = 0.003). Thus, a series of ANOVA’s were calculated for parental smoking status by school location. There was a statistically significant difference by parental smoking status and their support of nicotine replacement therapy for their children when stratified by school location in suburban (suburban: F = 4.339, df = 2, p = 0.014), but not urban (F = 0.855, df = 2, p = 0.43) or rural (F = 0.004, df = 2, p = 0.996) areas. In suburban school locations, a significant difference was found between past and never smokers regarding providing nicotine gum or patches to students trying to quit smoking. Past smokers were more likely than those who never smoked to agree that schools should provide nicotine gum or patches for adolescents trying to quit smoking (13% vs. 6%, respectively); indicating minimal support regardless of parental smoking status.

Additionally, there was a statistically significant difference between parents’ belief as to whether their child was a current smoker or currently experimenting with smoking and their support of nicotine replacement therapy for their children (F = 6.009, df = 2, p = 0.003). Significant differences were found between parents who believed their child was a current smoker or experimenter and those who did not regarding support for schools providing nicotine patches or gum to adolescent smokers trying to quit, but not between those who were unsure. The majority of parents who believed their child was a current smoker or experimenter (8%) and those who did not (92%) were of the opinion that the school should not provide nicotine gum or patches to their children (56% vs. 77%, respectively).

Tobacco Policies

The majority of parents were supportive of having anti-tobacco policies for their children (Table 4). There was also a statistically significant difference by gender of parents’ regarding their support of anti-tobacco policies for their children (F = 2.148, df = 11, p = 0.016). On all but one of the anti-tobacco policy items, females had stronger agreement than the males.
Table 4

Percentage of Parents Who are Supportive of Anti-Tobacco Policies for Their Children within Junior High/High Schools

Item

N (% Agree)

My child’s school should tell students about the school’s tobacco policies.

427 (98)

My child’s school should tell parents if their child is caught using tobacco at school.

421 (96)

My child’s school should have rules that ban tobacco advertising on school property and at school sponsored functions.

418 (96)

My child’s school should tell families about the schools’ tobacco policies.

411 (94)

My child’s school should ban all tobacco use by anyone on school property and at school sponsored functions.

360 (82)

My child’s school should evaluate its smoking prevention/stop smoking programs to make sure they are working.

359 (82)

My child’s school should have a rule that requires students who are caught smoking to attend programs to help them stop smoking.

313 (72)

My child’s school should have a tobacco policy that requires students to receive classroom lessons on avoiding tobacco use.

293 (67)

My child’s school should suspend students who are caught smoking.

275 (63)

My child’s school should have a committee that oversees school policies dealing with reducing tobacco-use by students and staff.

240 (55)

My child’s school should remain neutral about tobacco use, as it is NOT an educational issue.

38 (9)

There was a statistically significant difference by total household income and parents’ support of anti-tobacco policies for their children (F = 1.509, df = 33, p = 0.03). Statistically significant differences were found between parents and/or guardians on one of the 12 anti-tobacco policy items. Significant differences existed between total household income and having a committee that oversees schools policies dealing with reducing tobacco use by students and staff. The lowest income group (less than $25,000) was statistically significantly more likely than the two highest income groups ($50,000–$75,000 and $75,000+) to support schools having a committee that oversees school policies dealing with reducing tobacco use (72% vs. 48% and 50%, respectively).

Also, parental smoking status by level of education of parents was found to be statistically significant (χ 2 = 26.790, df = 4, p = 0.001). For this reason, a series of MANOVA’s were calculated for parental smoking status stratified by level of education of parents. There was a statistically significant difference by parental smoking status regarding parents’ support of anti-tobacco policies for their children for parents who graduated from high school (F = 1.598, df = 22, p = 0.05) and for those parents who had some college experience (F = 1.864, df = 22, p = 0.01), but not for those who graduated from college (F = 0.983, df = 22, p = 0.49). Statistically significant differences were found between parents by smoking status (current, past, and never) on 3 of the 12 anti-tobacco policy items. Parents who were high school educated and who were current smokers were statistically significantly less likely than past smokers and never smokers to support banning all tobacco use on school property/functions (54, 79, and 89%, respectively). Parents who were past smokers, were not statistically different than those who have never smoked in support of banning all tobacco use on school property/functions. Also, parents with only a high school education and who were current smokers were statistically significantly more likely than past smokers to support schools remaining neutral about tobacco use because it was not perceived to be an educational issue (11% and 0%, respectively).

Parents with some college experience (1–3 years) and who were current smokers were statistically significantly less likely than never smokers to support banning all tobacco use on school property/functions (55% vs. 88%, respectively). No statistically significant difference was found when current smokers were compared with past smokers (71% agreed).

Also, parents with some college experience (1–3 years) and who were current smokers were statistically significantly less likely than never smokers to support having a rule that requires students who are caught smoking to attend programs to help them stop (45% and 75%, respectively). No statistically significant difference was found when current smokers were compared with past smokers (71% of both groups agreed).

In addition, parental smoking status by school location was found to be statistically significant (χ 2 = 15.978, df = 4, p = 0.003). For this reason, a series of MANOVA’s were calculated for parental smoking status stratified by school location. There was a statistically significant difference in parental smoking status and support of anti-tobacco policies for their children when stratified by school location for suburban (F = 1.920, df = 22, p = 0.008) and rural (F = 1.821, df = 22, p = 0.017), but not urban (F = 1.220, df = 22, p = 0.24) locations. Statistically significant differences were found between parents on three of the 11 anti-tobacco policy items. Significant differences were found in suburban school locations regarding the ban of all tobacco use on school property/functions.

Parents who lived in suburban school locations and who were current smokers were statistically significantly less likely than never smokers to support banning all tobacco use by anyone on school property/functions (56% vs. 88%, respectively). No statistically significant difference was found when suburban current smokers were compared with suburban past smokers (80% agreed). For suburban parents who were past smokers, no statistical significance was found when compared to those who had never smoked with regard to banning all tobacco use on school property/functions.

Significant differences were also found in rural school locations regarding the ban of all tobacco use and advertising on school property/functions; telling families about the schools tobacco policies; and whether the school should remain neutral about tobacco use because it is not an educational issue. Parents who lived in rural school locations and who were current smokers were statistically significantly less likely than never smokers and past smokers to support banning all tobacco use on school property/functions (50%, 88%, and 79%, respectively). For parents who were rural past smokers, no statistical significance was found when compared to those who had never smoked with regard to banning all tobacco use on school property/functions. As for the ban on advertising, parents who were current smokers were statistically significantly less likely than past smokers and never smokers to support schools having rules that ban tobacco advertising on school property/functions (83, 100, and 94%, respectively). For parents who were past smokers, no statistical significance was found when compared to those who had never smoked with regard to support of rules that ban all tobacco advertising on school property/functions.

Parents who lived in rural school locations and who were current smokers were statistically significantly less likely than past smokers to support telling families about schools tobacco policies (71% and 100%, respectively). No statistical difference was found when current smokers were compared to those who never smoked.

Parents who lived in rural school locations and who were current smokers were statistically significantly more likely than past smokers to believe schools should remain neutral about tobacco use because it was not perceived to be an educational issue (13% and 0%, respectively). No statistical difference was found when current smokers were compared to those who have never smoked.

Finally, there was a statistically significant difference between parents who talked with their children about their rules regarding tobacco use and those who did not with regard to support of anti-tobacco policies for their children (F = 2.144, df = 11, p = 0.02). Results showed that on all 11 of the anti-tobacco policy items, parents who had talked to their children about their rules regarding tobacco use were in stronger support of anti-tobacco policies for their children (82% vs. 73%, respectively).

Discussion

The findings of this study presents some important implications for tobacco education. First, the vast majority of parents were supportive of smoking prevention activities for their children. If the research shows that parents are in support of schools providing tobacco prevention programming, school districts need to find ways to make this happen. School districts need to reach out to the appropriate community organizations such as the American Heart Association and the American Cancer Society in an effort to help provide necessary tobacco prevention services to adolescents. If the school and outside community organizations work together, effective, affordable tobacco prevention and cessation programs for adolescents should be possible.

Second, 63% of parents believed their child’s school should get parents’ input about what should be taught in tobacco prevention programs, however only 45% believed the school should give homework and projects about tobacco that involve families. Further programming/education needs to be provided to parents’ to attempt to change their perceptions concerning their child’s tobacco prevention education. Being a supportive parent and getting involved in the lives of one’s children can provide a protective effect against smoking.19 Parents can serve as good role models by not using tobacco and showing their non-acceptance of tobacco use.20,21

Third, the majority of parents were supportive of smoking cessation activities for their children; however 75% of parents were not in favor of their child’s school providing nicotine gum or patches for adolescents trying to quit smoking. Why are parents’ against the school providing nicotine replacement therapy for their children? May be parents believe nicotine replacement therapy (NRT) is more of a medical approach and do not feel comfortable with their child’s school providing this type of service. Some parents may have thought that NRT is not safe for adolescents, even though the research indicates NRT is safe in this population. It is also possible that parents believed that adolescent smoking at school was not a big enough problem for the school to address. In the current study, one-third of parent respondents indicated they were unsure if there was a problem with adolescent smoking at their child’s school. With such a high percentage of parents indicating they were unsure if a problem existed at their child’s school with adolescent smoking, an attitude of indifference may have been in effect for some parents. Further education of parents concerning the problem of adolescent smoking both in general and at school is essential.

Fourth, the majority of parents agreed that schools should develop and enforce a school policy on tobacco use. Unfortunately, the SHPPS (2000) study indicated tobacco-free environment policies existed in only 25% of states, 46% of school districts, and 45% of schools. Also, virtually all parents believed that their child’s school should tell students and their families about the tobacco policies with almost all parents wanting to be notified if their child was caught using tobacco at school. In addition, almost three-fourths of parents believed a rule should be in place at their child’s school requiring students who are caught smoking to attend programs to help them stop smoking, while 63% of parent respondents believed suspensions for smoking were appropriate.

Total household income was an important factor to consider regarding parents support of anti-tobacco policies for their children. The lowest income group was more likely than the two highest income groups to support schools having a committee that oversees school policies dealing with reducing tobacco use by students and staff. Past research shows that as income decreases, smoking increases.22 It is possible that parents in the lowest income category recognized that a problem exists with adolescent smoking; possibly even with their own child. Thus, these parents may have been more in favor of having a committee that oversees school policies dealing with reducing tobacco use.

Furthermore, parents with some college experience and who were current smokers were less likely than never smokers to support having a rule that requires students who are caught smoking to attend programs to help them stop. Eight in ten parents who had never smoked indicated being in favor of requiring students who are caught smoking to attend programs to help them stop; while only four in ten current smokers with some college experience agreed with this position. It is possible that current smokers who had some college experience may have been under the impression that they had made the choice to smoke and they would not be supportive of someone forcing them to stop. It is also possible that most of these smokers have attempted to quit on numerous occasions and may have perceived smoking cessation programs as ineffective.

Lastly, even though seven out of 10 parents indicated that they believed tobacco prevention lessons that were taught in junior high should be repeated in more detail in high school, over 40% of parents’ surveyed indicated that once their child reached the last two years of high school tobacco prevention lessons were unnecessary. The CDC Guidelines for School Health Programs to Prevent Tobacco Use and Addiction recommends that tobacco use prevention education be provided in grades K-12. Additional programming/education needs to be done to change parents’ perceptions regarding the role of schools in smoking cessation activities (such as nicotine replacement therapy) for their children.

Evaluation of the smoking prevention/cessation programs is vital to program success and in turn was important to parent respondents. Well-designed anti-tobacco policies, as well as smoking prevention programs are key to preventing the onset of smoking in school-aged youths. School-based prevention programs are the most cost-effective and accessible programs that specifically target youth. The current study indicated that parents’ were supportive of the seven recommendations developed by the CDC as guidelines for school health programs to prevent tobacco use and addiction (Table 5). If tobacco prevention programs are properly developed (for example, by using the CDC Guidelines for School Health Programs to Prevent Tobacco Use and Addiction as a foundation), a good chance of success exists for prevention of adolescent smoking.
Table 5

Percent of Parents Who Agreed with the CDC Guidelines for School Health Programs to Prevent Tobacco Use and Addiction

Guideline (Category & Number of Questionnaire Items)

Percent Range

Develop and enforce a school policy on tobacco use (Policy-10 items)

55%–98%

Provide instruction about the short and long-term negative physiologic and social consequences of tobacco use, social influences on tobacco use, peer norms regarding tobacco use, and refusal skills (Prevention-7 items)

59%–94%

Provide tobacco-use prevention education in kindergarten through 12th grade; instruction should be especially intensive in junior high or middle school and should be reinforced in high school (Prevention-3 items)

71%–91%

Assess the tobacco-use prevention programs at regular intervals (Policy-1 item)

82%

Involve parents or families in support of school-based programs to prevent tobacco use (Prevention-4 items)

45%–96%

Support cessation efforts among students and all school staff who use tobacco (Cessation-2 items)

72%–75%

Provide program specific training for teachers (Prevention-1 item)

68%

N = 437

Source: Centers for Disease Control and Prevention (1994). CDC’s guidelines for school health programs: preventing tobacco use and addiction. Atlanta, GA, US Department of Health and Human Services.

Finally, a variety of limitations to this study should be noted. The monothematic nature of the survey may have sensitized some parents to the research issues, resulting in a response-set bias in some, which could potentially threaten the internal validity of the findings. Because the survey was a cross-sectional study of parental beliefs/perceptions, no cause and effect relationship can be drawn from the study results. The instrument did not discriminate between those who were supportive and not supportive of tobacco prevention, therefore other items not measured by the current questionnaire may have been more important to include on the survey. The survey response rate was only 57%, a potential threat to the external validity if non-respondents had different perceptions than the parents who responded. Furthermore, if those parents surveyed were not involved with their child’s education (e.g. PTA, school board, and curriculum review), using a stratified random sample may not have been the best way to obtain perceptions of parents who hold the most influential opinions. Some would suggest that a better sample would have consisted of parents who are the most active in their child’s school activities.

Notes

Acknowledgment

Acknowledgment for funding of this study goes to the Ohio Tobacco Use Prevention and Control Foundation.

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Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Jodi Wyman
    • 1
  • James H. Price
    • 2
  • Timothy R. Jordan
    • 2
  • Joseph A. Dake
    • 3
  • Susan K. Telljohann
    • 2
  1. 1.Department of Public HealthThe University of ToledoToledoUSA
  2. 2.The University of ToledoToledoUSA
  3. 3.Wayne State UniversityDetroitUSA

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