Smoke-Free Car Legislation and Student Exposure to Smoking.

BACKGROUND: Policies protecting children from exposure to secondhand smoke (SHS) may help prevent SHS-related negative health outcomes in children and discourage them from intending to smoke in the future. In this study, we assess the impact of California's 2007 smoke-free vehicle law on changes in middle and high school students' reported exposure to smoking in cars. Secondary aims included assessing the association of student-reported exposure to smoking in vehicles and lifetime asthma diagnosis and future intentions to smoke. METHODS: Population-weighted data from the California Student Tobacco Survey and the National Youth Tobacco Survey were used to evaluate California and national trends, respectively. Weighted logistic regression models using California Student Tobacco Survey 2011 data assessed the association between the number of days of exposure to smoking in cars and student-reported lifetime asthma diagnosis as well as intention to smoke in the future. RESULTS: The proportion of California students reporting exposure to smoking in cars in the last 7 days declined <1% annually from 2001 through 2005, but declined 12% annually from 2007 to 2011. National trends did not show comparable declines after 2006. Students reporting exposure to smoking in vehicles were more likely to report having ever been diagnosed with asthma and intending to smoke in the future than students who were not exposed to SHS. CONCLUSIONS: These findings support the legislative intent that public policies that are designed to protect children from exposure to smoking in vehicles will yield better adolescent health outcomes and a lower risk of future adolescent cigarette smoking.

Evaluation of California's in-school tobacco use prevention education (TUPE) activities using a nested school-longitudinal design, 2003-2004 and 2005-2006.

BACKGROUND: Current legislative language requires the California Department of Public Health, California Tobacco Control Program, to evaluate the effectiveness of the school-based Tobacco Use Prevention Education (TUPE) programme in California every 2 years. The objective of the study was to measure change and to identify the impact of school-based tobacco use prevention education activities on youth smoking prevalence and attitudes over time, spanning two school year surveys (2003-2004 and 2005-2006). METHODS: Evaluation focused on school-based tobacco use prevention activities in 57 schools (student sample size, n=16 833) that participated in the in-school administration of the 2003-2004 and 2005-2006 California Student Tobacco Surveys. Hierarchical linear models were used to predict student tobacco use and precursors to tobacco use. RESULTS: Overall, student tobacco use, intention to smoke, number of friends smoking and perceived smoking prevalence by peers increased as students moved through grades 9 and 10 to grades 11 and 12. TUPE-related activities showed a suggestive association (p=0.06) with reduced rate in student tobacco use between the two surveys after adjusting for other contextual factors such as each school's socioeconomic characteristics. CONCLUSIONS: TUPE activities appears to be beneficial in reducing tobacco use in California high school students over time. Other contextual factors were important moderating influences on student tobacco use.

Density of tobacco retailers near schools: effects on tobacco use among students.

OBJECTIVES: We examined the relationship between students' tobacco use and the density and proximity of tobacco retailers near their schools. METHODS: We used data from the 2003-2004 California Student Tobacco Survey and California retail licensing data. Measures included students' self-reported tobacco use and geocoded state-reported locations of tobacco retailers. We used random-intercept generalized linear mixed modeling to jointly evaluate individual-level and school-level predictors. RESULTS: Density of retailers was associated with experimental smoking (odds ratio [OR] = 1.11; 95% confidence interval [CI] = 1.02, 1.21) but not established smoking (OR = 1.06; 95% CI = 0.94, 1.20). The effects on experimental smoking were confined to high school students (OR = 1.17; 95% CI = 1.06, 1.29) in urban areas (OR = 1.11; 95% CI = 1.01, 1.21); no effects were observed among middle school students or in rural schools. High school students were more likely to obtain cigarettes from a retailer; middle school students relied more heavily on social sources. CONCLUSIONS: Our results support the plausibility of reducing rates of students' experimental smoking, but not established smoking, by restricting their access to commercial sources of tobacco in urban areas.