Intervention Activities Associated with the Implementation of a Comprehensive School Tobacco Policy at Danish Vocational Schools: A Repeated Cross-Sectional Study

Anneke Vang Hjort; Mirte A G Kuipers; Maria Stage; Charlotta Pisinger; Charlotte Demant Klinker

doi:10.3390/ijerph191912489

Intervention Activities Associated with the Implementation of a Comprehensive School Tobacco Policy at Danish Vocational Schools: A Repeated Cross-Sectional Study

Int J Environ Res Public Health. 2022 Sep 30;19(19):12489. doi: 10.3390/ijerph191912489.

Authors

Anneke Vang Hjort^{1

2}, Mirte A G Kuipers^{3

4}, Maria Stage⁵, Charlotta Pisinger^{6

7}, Charlotte Demant Klinker¹

Affiliations

¹ Health Promotion Research, Steno Diabetes Center Copenhagen-Copenhagen University Hospital, 2730 Herlev, Denmark.
² National Institute of Public Health, University of Southern Denmark, 5230 Odense, Denmark.
³ Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
⁴ Health Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, 1081 BT Amsterdam, The Netherlands.
⁵ The Danish Cancer Society, 2100 Copenhagen, Denmark.
⁶ Center for Clinical Research and Prevention, Capital Region, 2000 Frederiksberg, Denmark.
⁷ The Danish Heart Foundation, 1120 Copenhagen, Denmark.

Abstract

School tobacco policies are often poorly implemented, which may explain their limited effectiveness. Further, constructs to measure implementation outcomes of school tobacco policies are missing. The Smoke-Free Vocational Schools intervention was designed to stimulate the implementation of a comprehensive school tobacco policy into routine practice. This study (1) developed implementation fidelity outcomes measures for the school tobacco policy and (2) examined associations between intervention activities and implementation fidelity at two time points. We applied a repeated cross-sectional survey study design across seven schools: the first time point was >5 months after the policy was established and the second time point > 14 months after policy establishment. The dependent/outcome variables were four binary fidelity domains as well as a total score across domains. A total of six intervention activities were measured among either students (e.g., new school-break facilities) or staff/managers (e.g., a joint workshop before policy implementation). Associations were analyzed separately for students and staff/managers using generalized linear mixed models, adjusted for confounders. A total of n = 2674 students and n = 871 staff/managers participated. The total implementation fidelity scores increased over time among both students and staff/managers. Three intervention activities were consistently associated with the total implementation fidelity score, including: new school-break facilities (B_T1 = 0.08, 95% CI = 0.03; 0.12; B_T2 = 0.07, 95% CI = 0.04-0.50), the joint workshop before policy implementation (B_T1 = 0.13, 95% CI = 0.02; 0.25; B_T2 = 0.13, 95% CI = 0.004; 0.24), and internalization of fixed procedures for enforcement (B_T1 = 0.19, 95% CI = 0.13-0.26; B_T2 = 0.16, 95% CI = 0.13-0.26). These findings can be applied by schools and other actors in practice. The developed implementation fidelity outcomes measures can be applied in future research on school tobacco policies.

Keywords: implementation; implementation fidelity; implementation outcomes; school tobacco policy; smoke-free school hours; vocational schools.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Denmark
Humans
Nicotiana*
Public Policy
Schools*

Grants and funding

This research was supported by the Danish Health Authority.