INTRODUCTION

Smoking is a significant global public health concern, with profound implications for human well-being. In 2019, smoking was responsible for 7.69 million deaths worldwide, ranking as the primary risk factor for male mortality¹. Research consistently has highlighted that most smokers take up this habit during adolescence, a crucial phase of growth and development^2,3. This not only poses serious risks to both physical and mental health^4,5, but also increases the likelihood of becoming a regular smoker in adulthood and reduces the chances of successfully quitting⁶. Therefore, controlling adolescent smoking is pivotal to the overall tobacco control efforts. Regrettably, despite ongoing efforts, adolescent smoking remains a pressing global issue. According to a report by the World Health Organization (WHO) in 2021, there were 37 million current smokers among adolescents aged 13–15 years worldwide⁷. Additionally, there were urgent issues related to tobacco use among this age group, including the rising usage of novel tobacco products (e.g. electronic cigarettes) and alarmingly high rates of exposure to secondhand smoke (SHS) in public places^8-10.

The school environment is crucial in curbing adolescent smoking. Studies consistently show that schools that rigorously enforced tobacco control policies and strived to create smoke-free environments exhibited lower rates of adolescent smoking^11,12. Conversely, exposure to SHS in school settings would have increased their risk of smoking initiation^13,14. Consequently, many countries had proactively implemented a series of tobacco control measures to establish smoke-free schools. In Europe, for example, all secondary schools have adopted smoke-free school policies (SFSPs)¹⁵. Similarly, the United States, Canada and South Korea have also explicitly banned smoking in schools^16-19. However, it was concerning that the establishment of smoke-free schools has not been universally achieved. Studies indicate that a substantial number of adolescents had been exposed to SHS at schools in the past 7 days, with rates varying by country (e.g. US, 16.8%²⁰; and South Korea, 11.8% of boys and 11.6% of girls²¹⁾.

Since the promulgation and implementation of the Outline of the Health China 2030 Plan (2016), China has issued several significant tobacco control policies, such as the Notice on Further Strengthening Tobacco Control for Youth (2019) and the Notice on Further Strengthening the Construction of Smoke-Free Schools (2020). The revised Law on the Protection of Minors in 2021 explicitly banned all forms of smoking in schools, kindergartens and other public places frequented by minors. A smoke-free school environment encompassed the implementation of tobacco control system, the tobacco control education for school personnel, and the promotion of tobacco control behaviors among school personnel, etc. Nevertheless, there has been a paucity of research that evaluates the actual impact of these tobacco control laws and regulations on the tobacco control environment within schools.

School personnel, as leaders and mentors of students, play a pivotal role in student tobacco control efforts. The tobacco control behaviors of staff, such as discouraging students from smoking and advising them to quit smoking, could directly contribute to reducing the smoking rates among students²². Additionally, the tobacco control curriculum they deliver could indirectly prevent students from smoking by influencing students’ perceptions and attitudes toward tobacco^14,23. Some studies indicated that the tobacco control environment in schools could significantly influence both the smoking behaviors and tobacco control behaviors of school personnel. In schools with robust tobacco control systems, staff members were less likely to smoke²⁴, and they were more inclined to provide students with tobacco control information and promote smoking cessation behaviors^22,25,26.

While previous studies have primarily focused on the impact of school tobacco control environment on students’ smoking behavior, there has been limited exploration into the influence of the school tobacco control environment on school personnel’s tobacco control behaviors. Furthermore, existing research has predominantly centered on tobacco control policies or training programs^22,25, and there is a dearth of comprehensive analyses of multiple factors affecting school personnel’s tobacco control behaviors within the school tobacco control environment.

Therefore, this study aimed to conduct a comprehensive evaluation of the tobacco control environment within schools, including smoking rates and SHS exposure in schools, the situation of prohibiting students and school personnel from smoking, tobacco control education for school personnel, and the tobacco control behaviors exhibited by school personnel. By comparing the tobacco control environment in Shanghai’s secondary schools in 2017 and 2021, we sought to assess the effectiveness of Chinese tobacco control policies implemented after 2017. Furthermore, the study explored the impact of smoking policies and tobacco control education on school personnel’s tobacco control behaviors.

METHODS

RESULTS

DISCUSSION

This study revealed that the enforcement of smoking bans in Shanghai ‘s secondary schools, aimed at prohibiting both students and personnel from smoking, had significantly strengthened in 2021 compared to 2017. Nevertheless, despite this progress, certain challenges persisted within these schools, notably exposure to secondhand smoke (SHS), inadequate anti-smoking measures, and a scarcity of tobacco control education for school personnel. School personnel could play an active role in tobacco control work on campus, with teachers and staff who had been responsible for work related to health education or received education on tobacco control being more likely to engage in tobacco control behaviors with students.

Compared with 2017, there was an increased approval among staff in Shanghai’s secondary schools for strict smoking prohibition policies that apply to both students and personnel in 2021. Meanwhile, smoking rates and SHS exposure rates in schools decreased, which aligned with a survey conducted by China CDC that reported reduced percentages of secondary school students observing teachers smoking almost every day on campus compared to 2019²⁸. In addition, some schools had intensified their tobacco control education for staff, with a higher percentage of staff participating in tobacco control trainings in 2021 compared to 2017. These changes underscore the effectiveness of the series of school tobacco control policies implemented in China from 2017 to 2021.

However, the study also identified that some staff members contributed to exposure to SHS in schools, suggesting that Shanghai’s tobacco control policies on campus were not fully implemented across all institutions. Consequently, it is imperative to strengthen tobacco control policies and rigorously address SHS exposure on campus in the future. In schools where tobacco control policies were not strictly enforced, smoking rates among staff and students tended to be higher¹², indicating that these schools’ personnel did not have opportunities to intervene and discourage smoking among students. These staff members were less likely to inform students of the harmful effects of tobacco, as evidenced by previous research^22,25,26. Furthermore, there were several issues pertaining to tobacco control policies in Shanghai’s secondary schools, including a lack of specific systems, vacancies of functional departments and inadequate implementation of tobacco control measures. To ensure the effective enforcement of tobacco control policies on campus, more diverse measures, such as establishing more functional departments for tobacco control or hiring external professional supervisors, should be considered and tailored to the specific circumstances¹⁷.

In this study, staff perceived that the tobacco control policies for themselves were less stringent than those for students, a finding that concurred with the Global School Personnel Survey (GSPS)²⁹. Both student and personnel tobacco control policies were found to be associated with lower rates of teenagers smoking attempts and smoking within school^12,30. Staff members’ smoking behavior on-campus not only had a direct influence on adolescent smoking¹⁴, but also gave rise to disparities in policy implementation, making it challenging for students to internalize anti-smoking personal beliefs and, consequently, indirectly leading to adolescents smoking¹⁸. Therefore, tobacco control efforts should encompass all individuals in schools, including school personnel, with stricter measures to prohibit smoking by staff members on campus; for instance, making non-smoking during school hours a condition of employment for staff ¹⁵, or including staff smoking behavior on campus a factor for deduction in performance assessment.

The tobacco control behaviors of staff were closely related to the level of tobacco control education provided by schools. Staff members who had received tobacco control materials and participated in tobacco control trainings exhibited stronger awareness of anti-smoking and were more likely to adopt tobacco control behaviors with students^25,26,31. However, in 2021, only 51.90% of Shanghai secondary school staff received tobacco control materials, a value lower than those reported in the EU (57.4%) and certain regions of Pakistan (60.9–86.4%)²⁹. Furthermore, only 24.42% of staff participated in tobacco control trainings in 2021, far below their tobacco control training requirements (78.02%)³². This finding aligned with previous research, which indicated that the proportions of school personnel trained in tobacco control (7–27%) across all regions were consistently lower than their training requirements (38–85%)²⁹.

In addition, engaging in various forms of tobacco control education activities, such as class meetings and knowledge competitions, may not only improve teenagers’ awareness of tobacco control knowledge^33,34, but also promote the development of tobacco control behaviors among school personnel. However, only 37.08% of school personnel participated in tobacco control education activities in 2021, and the percentage of those who knew that the school had organized such activities showed a downward trend. A study had pointed out that the main reasons for staff to implement the school tobacco control policies included perceiving it as part of their responsibilities, believing in the positive effects of tobacco control, and having enough confidences in handling students’ reactions³⁵. Therefore, to enhance staff’s responsibility for tobacco control, schools should organize diverse tobacco control education activities and encourage active participation among staff members¹².

Moreover, the smoking rate of vocational school students was found to be higher than that of traditional school students^12,36. Vocational schools’ staff were more inclined to participate in tobacco control trainings or educational activities and adopt tobacco control behaviors with students. School personnel who had been responsible for work related to health education were likely to engage in tobacco control behaviors, consistent with previous findings that such personnel were more prone to advising students to quit smoking²². In 2021, 45.60% of staff participated in health teaching related work. Encouraging more staff to be involved in health teaching related work could enhance the health literacy of school personnel and foster a favorable environment for tobacco control on campus^22,25. Besides, compared with non-teaching staff, teachers were more inclined to inform about the harm of tobacco to students, possibly due to greater contact between teachers and students, which facilitated the easier detection of students’ smoking behavior. Given the potential role of non-teaching staff in tobacco control, it is essential to strengthen their tobacco control training and mobilize them²⁵.

CONCLUSIONS

The study revealed that the tobacco control environment in Shanghai’s secondary schools had significantly improved in 2021 compared with 2017. The reduction in smoking and SHS exposure among staff underscores the effectiveness of the tobacco control policies implemented in China from 2017 to 2021. However, challenges remain such as inadequate smoking control education for school personnel. Comprehensive tobacco control efforts should encompass everyone in the school, not just students. Regular distribution of tobacco control materials and active organization of tobacco control trainings or education activities can strengthen school personnel’s awareness of tobacco control and encourage them to adopt proactive tobacco control behaviors, thereby contributing to the construction and development of smoke-free schools.