The European Journal of Public Health Advance Access originally published online on June 7, 2005
The European Journal of Public Health 2005 15(3):329-330; doi:10.1093/eurpub/cki072
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Letters to the Editor |
Preliminary evaluation of the school-smoking-prevention policy in Greece
Georgios Labiris, M.D, Ph.DA. Voutsinas
D. Niakas
Sirs,
Cigarette smoking among adolescents is one of the leading health indicators that reflect major health concerns at the European Union. Greece's leading position on cigarette smoking among its European partners forced the Hellenic Ministry of Health and Welfare to assume tobacco-control programs, introducing smoke-free zones, smoking-cessation centres, and an intense promotional strategy against smoking.1 Among the primary target populations were the school students by the introduction, in 1997, of the school-smoking-prevention policy (implementation of smoke-free policies on school property, strict enforcement of these policies, incorporation of anti-tobacco education into the curriculum), in collaboration with the Ministry of National Education.2
The primary objective of this report was the preliminary evaluation of the school-smoking-prevention policy in Greece. The study was conducted by the Athens Technological & Educational Institute in collaboration with the School of Social Sciences of the Hellenic Open University during the spring of 2004. Three public Lyceums in Athens were randomly selected and 909 students (474 males/435 females) were recruited and successfully responded to the questionnaires (response rate: 87%). The questionnaires utilised similar forms to the School-Age-Smoking Questionnaire, adapted to the integrated needs of the student sample.3
The results of this study confirmed the high prevalence of smoking among Greek students since 255 males and 201 females were regular smokers (50.2%). Limited participation of the after-school health-education curriculum was detected since less than 10% of the smokers (20 males/31 females) could recall having attended a school class on smoking hazards. In fact, limited attendance has been indicated in numerous studies since the needs of the program could be met neither in the general classroom context nor in the expense of after-school hours.4 The poor efficacy of the program may partly explain the unfortunate perceptions regarding smoking since less than 20% (54 males/36 females) of the smokers considered its impact as extremely hazardous while 6% (24 males and 33 females) specifically declared that smoking had no significant negative impact on their health, and 49% (109 males/79 females) considered smoking as an enjoyment. Further to the poor efficacy of the health-education program, unsatisfactory enforcement of the school-smoke-free-zone directive was detected. More than 80% of the students (378 males/356 females) have witnessed at least one schoolmate smoke in school during the previous two weeks. In fact, the school was the prevalent place of smoking for 37% (108 males/64 females) of the smokers. Moreover, peer bonding proved to be stronger for the students who primarily smoked in school since 13% of the smokers (36 males/24 females) depended on their peers to get their cigarettes.
It is known that Greece is an unfortunate leader in tobacco consumption in Europe. Thus, Greek students are already socially ‘predisposed’ due to high exposure to tobacco, and familiar association with smoking. Unfortunately, the preliminary results of the study confirmed the high prevalence of smoking among Greek students, indicating the overall poor efficacy of the school-smoking-prevention policy. Significant flaws were detected both in the introduction of the health-education curricula and the enforcement of the smoke-free policies.
Upon confirmation of these preliminary results by a representative sample of the Greek schools, a total societal antismoking strategy introducing a ‘health-promoting school’ is considered as necessary for the adoption of a ‘trendy’, smoke-free lifestyle from Greek students. This strategy should be considered a first priority on the healthcare political agenda.
References
1 Corrao MA, Guindon GE, Sharma N, Shokoohi DF, Editors. Tobacco control country profiles. American Cancer Society, 2000.
2 The Council of European Union. Council's recommendation on the prevention of smoking and on initiatives to improve tobacco control. J Eur Union 2003;L22:31–4.
3 Post A, Galanti MR, Gilliam H. School and family participation in a longitudinal study of tobacco use: some methodological notes. Eur J Public Health 2003;1:75–6.
4 Bruvold WH. A meta-analysis of adolescent smoking prevention programs. Am J Public Health 1993;83:872–80.
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