Effects of a school tobacco policy on student smoking and snus use

Objective: A school tobacco policy (STP) commonly is used to reduce smoking among adoles-cents, but the effectiveness of such programs is unclear. We evaluated the impact of an STP on tobacco use in 4 schools. Methods: The study included 4 intervention and 4 control schools, located in the inner city of Stockholm, Sweden. Schools self-selected for assignment to either an intervention program or a comparison group. In total, the study was comprised of 2671 students in grades 9 and 11, ages 15 to 18, and 1998 students (75%) responded to the questionnaire. We used a repeated cross-sectional design with assessment of tobacco use prevalence before im-plementation of the STP in 2016 and after 2 years under the program, in 2018. Results: Two years after the STP, the intervention school in grade 9 showed a lower prevalence (13.5% vs 1.6%) in the proportion of students who reported smoking (χ² = 4.54; p < .05) whereas the proportion reporting snus use was practically unchanged. We found no statistically significant impact of the STP for grade 11. Conclusions: The results are promising with regard to smoking, when the STP is implemented in early adolescence.