Impact of an Outdoor Smoking Ban at Secondary Schools on Cigarettes, E-Cigarettes and Water Pipe Use among Adolescents: An 18-Month Follow-Up

Andrea D. Rozema*, Marieke Hiemstra, Jolanda J. P. Mathijssen, MariaW. J. Jansen, Hans J. A. M. van Oers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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The effectiveness of outdoor smoking bans on smoking behavior among adolescents remains inconclusive. This study evaluates the long-term impact of outdoor school ground smoking bans among adolescents at secondary schools on the use of conventional cigarettes, e-cigarettes (with/without nicotine) and water pipes. Outdoor smoking bans at 19 Dutch secondary schools were evaluated using a quasi-experimental design. Data on 7733 adolescents were obtained at baseline, and at 6 and 18-month follow-up. The impact of outdoor smoking bans on 'ever use of conventional cigarettes', 'smoking onset', 'ever use of e-cigarette with nicotine', 'e-cigarette without nicotine', and 'water pipe' was measured. Multilevel logistic regression analysis was used. At schools with a ban, implementation fidelity was checked. At schools where a ban was implemented, at 18-month follow-up more adolescents had started smoking compared to the control condition. No effect of implementation of the ban was found for smoking prevalence, e-cigarettes with/without nicotine, and water pipe use. Implementation fidelity was sufficient. No long-term effects were found of an outdoor smoking ban, except for smoking onset. The ban might cause a reversal effect when schools encounter difficulties with its enforcement or when adolescents still see others smoking. Additional research is required with a longer follow-up than 18 months.
Original languageEnglish
Article number205
Number of pages14
JournalInternational Journal of Environmental Research and Public Health
Issue number2
Publication statusPublished - 1 Feb 2018


  • school-based intervention
  • prevention
  • tobacco control
  • adolescents
  • school smoking policies
  • smoking prevalence
  • smoke-free
  • quasi-experimental design
  • outdoor school ground
  • secondary schools
  • HARM

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