Multilevel analysis of the impact of school-level tobacco policies on adolescent smoking: the case of Michigan

J Sch Health. 2013 Oct;83(10):679-89. doi: 10.1111/josh.12081.


Background: In efforts to curb and prevent youth smoking, school tobacco policies have become an important and effective strategy. This study explores the degrees and types of tobacco-free school policy (TFSP) enforcement that are associated with adolescent smoking.

Methods: A multilevel analysis was performed using 983 students who are nested in 14 schools. The individual-level data are drawn from the 2009 Michigan Youth Risk Behavior Survey. The school-level data are drawn from the 2008 School Health Profiles survey.

Results: Two factors are associated with lower adolescent smoking: greater punishment for TFSP violation and more tobacco control communication efforts. By contrast, the factors associated with higher adolescent smoking are designation of a tobacco-free school zone and school-level smoking.

Conclusions: This study theoretically and methodologically guides researchers to test TFSP effectiveness in other states. Three strategic implications emerge: (1) schools should provide a consistent antismoking message in smoke-free environments; (2) schools should integrate TFSP into a comprehensive tobacco control initiative, including community-wide tobacco control programs and messages; and (3) the way a specific TFSP is promoted and communicated could determine how effective it is.

Keywords: adolescent smoking; social ecological model; tobacco control; tobacco-free school policy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adolescent Behavior / psychology
  • Female
  • Health Policy*
  • Health Promotion / methods*
  • Humans
  • Male
  • Michigan
  • Organizational Policy
  • School Health Services / organization & administration*
  • Smoking Prevention*
  • Students / statistics & numerical data*
  • Tobacco Smoke Pollution / prevention & control*


  • Tobacco Smoke Pollution