Health promotion psychology: Legislation (study by Wakefield)

Approach: cognitive

Aim: to determine the relation between the extent of restrictions on smoking at home, in school and in public places an smoking uptake and prevalence among school students

Method: self report

Sample: sample of 17 000 Hugh school students, from 202 schools In the United States. One school (grades 9-12; age  14-17) in each county of the mainland of United States were randomly selected-73% of all schools selected agreed to participate.

One class from each grade was selected. All the students in these class's were invited to participate -
80% of students in samples class's completed the questionnaire.

Procedure: questionnaire measures

Questionnaires contained demographic data and information on whether adults in the home and sibling in the home were smokers.

They added some additional questions on family planning, sexual activity and behaviour, and exposure to various media campaigns.

Smokers were then classified by stage of smoking uptake. This was done on the basis of responses of questions on smoking history and intentions.

Participants were classified into the follow categories:

1. Non susceptible non-smokers
2. susceptible non-smokers
3. early experimenters
4. advanced experimenters
5. established smokers
6. current smoker

Home smoking restrictions were defined by responses go questions such as '£9/ is cigarette smoking handled in your home?' Included closed questions such as;
(a) no one is allowed (b) Special guests allowed only (c) Smoking allowed in certain areas in my home (d) smoking as allowed anywhere in my home.

Two measures of school smoking were ascertained:

1. Whether there was a ban or not.
2. If there was a ban how strictly was it enforced.

Researchers then added information on: state,county and city laws relating to restrictions on smoking in public places for the 202 school sites.

• Strong public place restrictions were defined as: (a) Restrictions in private worksites and public restaurants.
• Moderate public place restrictions were defined as: (b) Restrictions in either private worksites or public restaurants.
• Weak public place restrictions were defined as : (c) restrictions in neither of these enviroments

Results:The study found that legal restrictions and enforced bans were significantly associated with not developing an early smoking habit, that home bans were more effective that legal restrictions on taking up smoking, and extensive restrictions on smoking in public places were associated with lower probability of transition between later stages of transition. However, school bans appeared to actually increase the probability of transitions to the last stage. It was concluded that school bans needed to be enforced to actually be effective and that although causality cannot be deduced, their findings are consistent in showing that parental opposition and banning smoking in the home reduces the uptake of smoking amongst teenagers.

Statistical analysis: Logical regression analysis was used to examine yh association between smoking status and smoking restrictions. Each analysis was adjusted for school,grade,sex, whtter adults/ siblings at home smoked.

Evaluation:

Sample:
Advantage(A): large sample size, range of schools across USSA, high response rate of both schools and students in classes, no bias in sampling method
Disadvantage(D): Only generalizable to America and to P's aged 14-17 (young people maybe more influenced by restrictions) what about the opinions od those who said no? A typical-bad kids not even taking the survey

Validity:
A: Appears to have face validity and internal validity as the questions were straight forward and classification of students should have been self explanatory
D: Cause and effect was difficult to establish. There might be other factors which influence teenage smoking apart from restrictions on smoking and these might lead to an artificial relation between restrictions and smoking as the study didn't control for other factors. Also the self-report method is always open to lies and social desirability, which may be enhanced by the p's age.

Reliability:
A: the same questionnaire was used for all students. Quantitative measures were used which allows for comparisons. Statistical tests were used to analyse data.

Ethics:
A:  P's agreed to take part so consent was given
D: Is it possible that consent and withdrawal may have been compromised because of the link to authority within the school setting?

Effectiveness:
A: Parental opposition to smoking and banning smoking in the home effectively reduce the uptake of smoking in teenagers
D: Legal restrictions in the public places and school bans, have a less effective impact upon smoking uptake, with school bans only being effective when strictly enforced.

Usefulness:
A: The study could be used to advise parents on the strategies they could use to help prevent children from starting to smoke.
D: The study is reductionist which lowers the usefulness, as does the weaknesses of self-reports.