Factors associated with schools personnel’s support for tobacco free policies in Uganda. Wanyonyi EFN, Ayo- Yusuf OA School of Health systems and Public Health, University of Pretoria, South Africa

Literature 1 Tobacco use begins in adolescence, with 4 out of every 5 smokers beginning before they reach adulthood and subsequently becoming lifetime users.(Mpabulungi L, Muula AS, 2004; CDC, 2013) Adolescents who begin to smoke at or before the age of 13 are twice as likely to remain smokers in adulthood as those who begin at age 17 or later (Peltzer K, 2011) 8.2% of all adolescents aged 13 to15 years in Uganda started smoking before the age of 14 years; (12.1% of boys and 5.0% of girls).; and of the 17.5% of students who reported to have ever smoked tobacco, 37.9% tried or started smoking before the age of ten. (Mpabulungi L, Muula AS, 2004) 2

Literature 2 Schools are an important setting for establishing life- long health habits because children spend a significant amount of their time there and are exposed to the influence of existing policies, peer and school personnel behaviour. (Franks AL. et al, 2007) Children in schools with no tobacco use restrictions perceive smoking as being acceptable, resulting in intentions to take up the habit. (Poulsen LH. Et al, 2002) In Wales- prevalence of daily smoking in schools increased from 9.5% in schools with a written policy, to 21.0% in schools with intermediate level of policies and further to 30.1% in schools with no similar policy. (Moore L, Roberts C, Tudor- Smith C, 2001) 3

Literature 3 Teachers are motivators and role models in the school & community and implementers of school curriculum/ policies ….thus are key to learner behaviour change Teacher smoking during school hours is associated with adolescent smoking and attitude of tolerance and acceptability (Poulsen LH. Et al, 2002) Their attitude towards tobacco control policy is critical in ensuring successful implementation of tobacco control in schools. Little data on personnel attitude in Ugandan schools 4

Research questions What factors are associated with support for TC policies among school personnel in schools in Uganda? Has there been any change in the level of support for tobacco policies among school personnel in Uganda between 2007 and 2011? Are the factors associated with these policies consistent between 2007 and 2011? 5

Study objectives To determine factors associated with school personnel’s support for tobacco control policies in Uganda in 2007 and 2011 To determine the proportion of schools with enforced TC policy for school personnel and students in Uganda. To assess school personnel’s knowledge of health effects of tobacco use and their attitude towards tobacco control in general in Uganda. 6

Method 1 Secondary data analysis — Global School Personnel Survey (GSPS) 2007 (n=515), 2011(n=682). Personnel= Head teachers and teaching staff GSPS: ~45 core questions measuring: -Tobacco use (cigarette and non- cig products) -Existence and enforcement of school policies prohibiting tobacco use by students and personnel -Capacity (curriculum & non class programs, access to material, training, knowledge on impact f tobacco use) -Attitude towards general tobacco control -Tobacco product availability 7

Method 2 Data analysis done using STATA v12 Datasets were merged (N= 1197) and weighting factor applied to adjust for sample selection of schools and non- response of school personnel. Multi-variable logistic regression done on variables found to be significant at bivariate level using backward deletion approach. All statistical tests were two-tailed with the level of significance set at p<

Main outcome variable ‘Personnel's support for school tobacco- free policy’- measured by a positive response to two questions: -Do you think schools should have a policy or rule specifically prohibiting tobacco use among school personnel on school premises/property? -Do you think schools should have a policy or rule specifically prohibiting tobacco use among students on school premises/property?” 9

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Results and discussion 1 No significant difference in the support for tobacco control policy between the male and the female personnel. Older personnel more likely to support tobacco- free policy - p> 0.05 Non smokers were significantly more likely to support the policy than current smokers; (94.78% vs % - p<0.05) 11

Results and discussion 2 Most schools had some policy prohibiting tobacco use (81.74% for students and 71.58% for personnel) Only % and 42.29% (95% CI: ) completely enforced policies prohibiting tobacco use by students and personnel respectively. Personnel from schools with existing policies were slightly more likely to support tobacco free policy- p>

Capacity for teaching tobacco use prevention 56.73% had tobacco use prevention in school curriculum; while 66.19% had non- class programs to teach tobacco use prevention. Majority had knowledge about the harmful effects of tobacco use with 80.04%; 96.73%; and knowing that tobacco use is addictive, causes cancer, causes heart disease, and does not cause malaria respectively. Only 19.81% had ever received training on prevention of tobacco use 13

Attitudes and perceptions towards tobacco control Majority (83.83%) felt that they needed training had ever advised a student to smoke concerned about youth tobacco use 92.75% support a ban on smoking in public places acknowledge harmful effects of second hand smoke said that teacher tobacco use can influence the students supported TAPS ban support regular increase of tobacco product prices said that the tobacco industry deliberately encourages youth to use tobacco said that TI should not be allowed to sponsor school events. 14

Bivariate Analysis 15

Bivariate Analysis 16

Significant independent variables associated with personnel support for tobacco- free policies 17 CharacteristicProportionOdds ratio95% Conf. Interval p- value Current smoker Tobacco control in school curriculum Teacher tobacco use influences students tobacco use Tobacco industry should be allowed to sponsor school events Tobacco product prices should be increased regularly In 2007 current smoker was found to be not significant and odds ratio was for personnel who think that teacher tobacco use influences students tobacco use and 3.98 for personnel who think tobacco industry should be allowed to sponsor school events

Conclusion Teachers have positive attitudes towards tobacco control policies Most of the schools already have some policies or rules prohibiting tobacco use, but enforcement is poor Personnel who supported TI sponsorship for schools also likely to support tobacco- free policy - Ignorance of tobacco industry TAPs tactics and objectives? - Resource poor? Support for tobacco- free policies is high and is influenced by smoking status, tobacco control in school curriculum and strongly by personnel’s attitude towards general tobacco control Catch them when they are young, and teachers are a good place to start! 18

Limitations The GSPS is not an Independent sample of schools and is dependent on the success of the GYTS because it uses the schools selected for the GYTS. Relies on self –reports- may lead to social desirability bias. Cross-sectional- Good for prevalence, but precludes any evidence on causality, given the limited information on the temporal order of events. 19

20 Acknowledgements: Prof. OA Ayo-Yusuf- Supervision Dr. B. Olutola- Technical & statistical support American Cancer Society- UPACS fellowship program

. THANK YOU 21