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Tobacco Use Prevention
October 2019


What does the research say about prevention and reduction of tobacco use in middle and high school?

Ask A REL Response

Thank you for your request to our Regional Educational Laboratory (REL) Reference Desk. Ask A REL is a collaborative reference desk service provided by the 10 RELs that, by design, functions much in the same way as a technical reference library. Ask A REL provides references, referrals, and brief responses in the form of citations in response to questions about available education research.

Following an established REL Northwest research protocol, we conducted a search for evidence- based research. The sources included ERIC and other federally funded databases and organizations, research institutions, academic research databases, Google Scholar, and general Internet search engines. For more details, please see the methods section at the end of this document.

The research team has not evaluated the quality of the references and resources provided in this response; we offer them only for your reference. The search included the most commonly used research databases and search engines to produce the references presented here. References are listed in alphabetical order, not necessarily in order of relevance. The research references are not necessarily comprehensive and other relevant research references may exist. In addition to evidence-based, peer-reviewed research references, we have also included other resources that you may find useful. We provide only publicly available resources, unless there is a lack of such resources or an article is considered seminal in the topic area.


Carpenter, C. S., Bruckner, T. A., Domina, T., Gerlinger, J., & Wakefield, S. (2015). State education standards for tobacco prevention and classroom instruction. Health Behavior & Policy Review, 2(5), 352–361. Retrieved from

From the Abstract:
"Objectives: We examine whether state educational standards regarding tobacco correspond with teacher reports of classroom instruction. Methods: We test this relation with data on tobacco use prevention standards, reports of middle and high school teachers from the 2008 and 2010 School Health Profiles study, and logistic regression models. Results: State education standards are significantly related to increased likelihood of a lead health education teacher in that state reporting that the specific topic was taught in the school. These relationships are stronger for middle school teachers than for high school teachers. Conclusions: Associations between state standards and teacher reports of actual instruction are consistent with education standards influencing the teaching of these health education topics."

Evans-Whipp, T. J., Bond, L., Ukoumunne, O. C., Toumbourou, J. W., & Catalano, R. F. (2010). The impact of school tobacco policies on student smoking in Washington State, United States and Victoria, Australia. International Journal of Environmental Research and Public Health, 7(3), 698–710. Retrieved from

From the Abstract:
"This paper measures tobacco polices in statewide representative samples of secondary and mixed schools in Victoria, Australia and Washington, US (N = 3,466 students from 285 schools) and tests their association with student smoking. Results from confounder-adjusted random effects (multi-level) regression models revealed that the odds of student perception of peer smoking on school grounds are decreased in schools that have strict enforcement of policy (odds ratio (OR) = 0.45; 95% CI: 0.25 to 0.82; p = 0.009). There was no clear evidence in this study that a comprehensive smoking ban, harsh penalties, remedial penalties, harm minimization policy or abstinence policy impact on any of the smoking outcomes."

Galanti, M. R., Coppo, A., Jonsson, E., Bremberg, S., & Faggiano, F. (2014). Anti-tobacco policy in schools: Upcoming preventive strategy or prevention myth? A review of 31 studies. Tobacco Control, 23(4), 295–301. Retrieved from

From the Abstract:
"Objective: To summarise the evidence on effectiveness of school anti-tobacco policies (exposure) in preventing tobacco use (outcome) among high school students. Data sources: The search was conducted between 1 September and 30 November 2011 on six electronic databases with keywords: ‘policy', ‘ban', ‘restriction' and ‘environment' in combination with ‘adolescent' or ‘student', ‘school' and ‘smoking' in titles, abstracts or keywords. Restrictions were made to articles published in English. Data synthesis: Studies were very heterogeneous in the definitions of exposure to school anti-tobacco policy and of tobacco use, adjustment for potential confounders and reporting of results, therefore summary quantitative measures of effect were not calculated. Qualitative summary statements were derived by reviewing the results reported in text and tables for distinct policy constructs. Evidence could be classified as low or very low, resting on cross-sectional studies with high risk of bias. Studies were rather consistent in indicating that comprehensive smoking bans, clear rules, strict policy enforcement, availability of education and prevention were associated with decreased smoking prevalence. Formally adopted and written policies, surveillance of students' behaviour and presence/severity of sanctions were not consistently associated to students' tobacco use. Conclusions: The evidence concerning the effectiveness of a school policy alone in preventing youth tobacco use is weak and inconclusive. Experimental studies or observational studies with longitudinal design are warranted, employing clear definitions of policy components and careful control for confounding."

Hallingberg, B., Fletcher, A., Murphy, S., Morgan, K., Littlecott, H. J., Roberts, C. et al. (2016). Do stronger school smoking policies make a difference? Analysis of the health behaviour in school-aged children survey. European Journal of Public Health, 26(6), 964–968. Retrieved from

From the Abstract:
"Associations of the strength of school smoking policies with cigarette, e-cigarette and cannabis use in Wales were examined. Methods: Nationally representative cross-sectional survey of pupils aged 11–16 years (N=7376) in Wales. Senior management team members from 67 schools completed questionnaires about school smoking policies, substance use education and tobacco cessation initiatives. Multi-level, logistic regression analyses investigated self-reported cigarette, e-cigarette and cannabis use, for all students and those aged 15–16 years. Results: Prevalence of current smoking, e-cigarette use and cannabis use in the past month were 5.3%, 11.5% and 2.9%, respectively. Of schools that provided details about smoking policies (66/67), 39.4% were strong (written policy applied to everyone in all locations), 43.9% were moderate (written policy not applied to everyone in all locations) and 16.7% had no written policy. There was no evidence of an association of school smoking policies with pupils' tobacco or e-cigarette use. However, students from schools with a moderate policy [OR = 0.47; 95% (confidence interval) CI: 0.26–0.84] were less likely to have used cannabis in the past month compared to schools with no written policy. This trend was stronger for students aged 15–16 years (moderate policy: OR = 0.42; 95% CI: 0.22–0.80; strong policy: OR = 0.45; 95% CI: 0.23–0.87). Conclusions: School smoking policies may exert less influence on young people's smoking behaviours than they did during times of higher adolescent smoking prevalence. Longitudinal studies are needed to examine the potential influence of school smoking policies on cannabis use and mechanisms explaining this association."

Kong, G., Morean, M. E., Cavallo, D. A., Camenga, D. R., & Krishnan-Sarin, S. (2015). Reasons for electronic cigarette experimentation and discontinuation among adolescents and young adults. Nicotine & Tobacco Research, 17(7), 847–854. Retrieved from

From the Abstract:
"Introduction: Understanding why young people try and stop electronic cigarette (e-cigarette) use is critical to inform e-cigarette regulatory efforts. Methods: We conducted 18 focus groups (N = 127) in 1 middle school (MS), 2 high schools (HSs), and 2 colleges in Connecticut to assess themes related to e-cigarette experimentation and discontinuation. We then conducted surveys to evaluate these identified themes in 2 MSs, 4 HSs, and 1 college (N = 1,175) to explore whether reasons for e-cigarette experimentation and/or discontinuation differed by school level or cigarette smoking status. Results: From the focus groups, we identified experimentation themes (i.e., curiosity, flavors, family/peer influence, easy access, and perceptions of e-cigarettes as "cool" and as a healthier/better alternative to cigarettes) and discontinuation themes (i.e., health concerns, loss of interest, high cost, bad taste, and view of e-cigarettes as less satisfying than cigarettes). The survey data showed that the top reasons for experimentation were curiosity (54.4%), appealing flavors (43.8%), and peer influences (31.6%), and the top reasons for discontinuation were responses related to losing interest (23.6%), perceiving e-cigarettes as "uncool" (16.3%), and health concerns (12.1%). Cigarette smokers tried e-cigarettes because of the perceptions that they can be used anywhere and to quit smoking and discontinued because they were not as satisfying as cigarettes. School level differences were detected. Conclusions: E-cigarette prevention efforts toward youth should include limiting e-cigarette flavors, communicating messages emphasizing the health risks of use, and changing social norms surrounding the use of e-cigarettes. The results should be interpreted in light of the limitations of this study."

Leatherdale, S. T., & Cole, A. (2015). Examining the impact of changes in school tobacco control policies and programs on current smoking and susceptibility to future smoking among youth in the first two years of the COMPASS study: Looking back to move forward. Tobacco Induced Diseases, 13(1), 1–13. Retrieved from

From the Abstract:
"Background: School-based prevention activities continue to be an important tobacco control resource, however there is little guidance for school-based tobacco control programming within Ontario. The objective of this study is to identify real-world changes in school-based tobacco control programs or policies in the COMPASS study and examine if those interventions (natural experiments) had any impact on the school-level prevalence of smoking susceptibility and current smoking over time. Methods: This paper uses longitudinal school-level smoking behaviour data from Year 1 (Y1: 2012–13) and Year 2 (Y2: 2013–14) of the COMPASS study. Changes to school-level tobacco control programs and policies were measured using the COMPASS School Programs and Policies Questionnaire and knowledge broker follow-up interviews. Quasi-experimental tests of proportion and difference-in-difference models were used to evaluate the impact of the interventions identified between Y1 and Y2 on school-level prevalence of smoking susceptibility among never smokers and current smoking. Results: Between Y1 and Y2, 17 schools reported a change in their tobacco control programming or policies. In four of the intervention schools, the increase in the within-school prevalence of susceptible never smokers between Y1 and Y2 was significantly greater than the natural change observed in the control schools. In five of the intervention schools, the decrease in the within-school prevalence of current smokers between Y1 and Y2 was significantly greater than the natural change observed in the control schools. Only two of the new interventions evaluated (both focused on policies of progressive punishment for students caught smoking on school property), were associated with significant desirable changes in both smoking susceptibility and current smoking between Y1 and Y2. Discussion: Interventions specific to effective and enforced tobacco control were the most common and consistently had the desired impact on the school-level prevalence of smoking susceptibility and current smoking. Due to the variation in the types of interventions implemented and their effectiveness, additional evaluation evidence is necessary to determine the most successful activities and contexts among individual students. The results presented here highlight which of these real-world promising interventions should be further evaluated using the longitudinal individual-level data in COMPASS over time."


Keywords and Search Strings: The following keywords, subject headings, and search strings were used to search reference databases and other sources: Tobacco OR Smoking OR Nicotine OR Vaping OR Cigarette, Prevent, Discipline, Policy OR Policies, Practices, Intervention, School, Student

Databases and Resources: We searched ERIC for relevant resources. ERIC is a free online library of more than 1.6 million citations of education research sponsored by the Institute of Education Sciences (IES). Additionally, we searched Google Scholar and EBSCO databases (Academic Search Premier, Education Research Complete, and Professional Development Collection).

Reference Search and Selection Criteria

When we were searching and reviewing resources, we considered the following criteria:

Date of publications: This search and review included references and resources published in the last 10 years.

Search priorities of reference sources: Search priority was given to study reports, briefs, and other documents that are published and/or reviewed by IES and other federal or federally funded organizations, as well as academic databases, including ERIC, EBSCO databases, and Google Scholar.

Methodology: The following methodological priorities/considerations were given in the review and selection of the references:

  • Study types: randomized control trials, quasi experiments, surveys, descriptive data analyses, literature reviews, and policy briefs, generally in this order
  • Target population and samples: representativeness of the target population, sample size, and whether participants volunteered or were randomly selected
  • Study duration
  • Limitations and generalizability of the findings and conclusions

This memorandum is one in a series of quick-turnaround responses to specific questions posed by stakeholders in Alaska, Idaho, Montana, Oregon, and Washington, which is served by the Regional Educational Laboratory (REL) Northwest. It was prepared under Contract ED-IES-17-C-0009 by REL Northwest, administered by Education Northwest. The content does not necessarily reflect the views or policies of IES or the U.S. Department of Education, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.