Moving forward: research questions and a framework for analysis

3.5.1 Research objectives

This work set out to fulfil the following objectives:

1. To collect rigorous data on the development, content and enforcement of school smoking policy in Wales

• Undertake a teacher survey to identify patterns o f

smoking policy and its enforcement within Welsh HBSC 2001/2 schools.

• Undertake teacher interviews with school experts

within Welsh HBSC 2001/2 schools. These will use

survey findings (including inconsistencies in

reporting) as a basis to probe more deeply into smoking policies and their enforcement).

2. To identify characteristics of school smoking policies and their

enforcement that may potentially moderate the extent to which policies reduce adolescent smoking behaviour

• Transcribe teacher interviews and undertake a

thematic analysis o f these data in order to develop this conceptual framework

3. To define new indicators to enhance analysis o f the relationship between school smoking policies and adolescent smoking behaviour

• Create new policy indicators (quantitative variables) that describe variation in characteristics o f school smoking policies and their enforcement identified through analysis o f teacher interview data • Use teacher interview data to allocate schools into

these variables

4. To assess the extent to which characteristics of school smoking

policies and their enforcement are associated with lower prevalence of adolescent smoking in Welsh schools

• Conduct multi-level analyses o f the new policy indicators in

association with self-reported data on pupil smoking prevalence from HBSC 2001/2 in order to:

• Examine the extent to which various policy-level characteristics are associated with lower levels o f adolescent smoking in Welsh schools

• Examine the extent to which smoking policies that produce

more consistent no-smoking messages are associated with lower levels o f adolescent smoking in Welsh schools

• Examine the extent to which Wider School Environments (as

defined by enforcement-level characteristics) that are more supportive o f school smoking policies are associated with lower levels o f adolescent smoking in Welsh schools

• Examine the extent to which schools where the whole policy context (i.e. policy and its enforcement) is more supportive o f producing consistent no-smoking messages are associated with lower levels o f adolescent smoking in Welsh schools

5. To draw conclusions about the potential relationship between

characteristics of school smoking policies and their enforcement, and the potential success of those policies

• Use the results o f the qualitative and quantitative analyses to

draw conclusions about the potential relationship between the characteristics o f school smoking policies and their enforcement, and the potential success o f those policies

During the study, the terms policy content and policy enforcement became replaced by the terms policy-level characteristics and enforcement-level characteristics. This was in order to reflect the fact that telephone interviews demonstrated policy-level characteristics to be about more than just policy content.

Please consult Sections 5.5 and 8.1 for explanations of the collaboration surrounding the statistical analysis presented in this thesis.

3,5.2 Consistency: a framework fo r analysis

This study aimed to contribute to knowledge on school smoking policies in several ways. Among Whitelaw et a l ’s (2001) criticisms o f the settings approach is the fact that it can too often be used as a vehicle to continue traditional health education approaches, so that in fact Mittlemark’s 1997 statement that '‘'the properties o f settings themselves are too rarely objects o f

regard with reference to their health promoting and health damaging properties” (cited in Whitelaw et al, 2001:342) still holds true. This project

answers such criticisms, by examining how school policy contexts, as well as school policies, may influence health behaviours.

As the study progressed, a reading of the literature alongside the emerging data suggested that there was a potentially interesting lens through which to look at the data which would further add to the originality o f this work. The importance of consistent messages across the WSE is repeated throughout the HPS literature, and the importance of consistent no-smoking messages to promote normative no-smoking behaviour is present in the smoking policy literature (especially that related to the importance of smoking bans). These ideas are not themselves new. However, to the best o f the author’s knowledge, they do not appear to have been brought together and applied specifically to studies o f smoking policy in Wales before. Typically, the WSE is used to understand the value context in which the formal curriculum is taught. Some smoking policy studies also discriminate between policy and its enforcement (e.g. Moore et al, 2001). This study brings these ideas together and applies them to Welsh school smoking policy, asking to what extent the WSE produces a value context in which smoking policy operates. Thus, smoking policy-level characteristics (themselves just one element o f the WSE) may be approximated to the way that formal curriculum is understood in the HPS model, and elements o f the WSE (including enforcement-level characteristics) can be examined as to the extent that they support or undermine the policy. These enforcement-level characteristics have been less often discussed in the smoking policy literature. Together, policy and its enforcement create the policy context and consequently, this study focuses on both these levels.

Further, f the importance of consistent no-smoking messages (from both the HPS and smoking prevention literatures) is particularised to smoking policy, it can be seen that in order to be effective and reduce adolescent smoking behaviour, it is important both for policy-level characteristics to produce consistent messages regarding the importance of no-smoking, and for the WSE (including enforcement-level characteristics) to support this. As far as the author is aware, published studies o f Welsh school smoking policies have rarely, if ever, used such an approach, with such a data set in order to

investigate policy before. They also do not appear to have been commonly used in investigations focussed elsewhere.

Having established these points, the analysis aims to contribute to knowledge on school smoking policies in the following ways:

a) Adding to existing literature on policy- level characteristics

As has been asserted, most studies into school smoking policies focus on policy- level characteristics. However these often merely reduce data to policy indicators commonly using close-questioned surveys to do this. Having collected data from interviews with local experts on smoking policy (Research Objective 1), this study adopts a mixed-method approach in order to collect more rigorous data on school smoking policies than in many other studies to date. This mixed-methods approach is illustrated in Table 1.1. and discussed further in Section 5.2. This study included more rigorous analysis o f characteristics commonly identified as important within the literature. These analyses include both qualitative and quantitative stages.

The work further contributes to the literature by using the often discussed but rarely analysed notion of consistency in order to create some of the indicators which describe schools on the extent to which their policy-level characteristics support or undermine consistent no-smoking messages. This indicator was added to other indicators describing policy-level characteristics for multi­ level analysis of their association with prevalence o f pupil smoking (Research Objective s 3 and 4).

b) Adding to existing knowledge by examining policy context through analysis o f the supportiveness o f the WSE towards school smoking policy

Having examined policy-level characteristics, the interview data are then used to investigate policy context (Research Objective 2). Through application o f the above framework, data are analysed to investigate how discretionary choices at this level either undermine or support the school smoking policy in place. As less of the existing literature on smoking policy examines these issues, and because the qualitative analysis of data allows exploration o f emerging themes, this raises some issues not, or seldom, encountered in the literature, such as the physical space of the school. An indicator variable is then developed for each school to describe the policy context by assessing the extent to which the WSE in each school appears to support or undermine the school smoking policy (Research Objective 3). This is added to the multi-level model (Research Objective 4). It is also used to create an indicator describing the extent to which the WSE supports or undermines consistent messages. This is combined with the policy-level scores, in order to produce a score for each school based on the extent to which their policy promotes consistent no­ smoking messages and the extent to which the WSE supports this, to give an overall indicator for each school describing the consistency of the no-smoking message (Research Objective 3). This will also be analysed against pupil smoking prevalence (Research Objective 4) to add more data on policy context.

c) Undertaking this investigation using a large-scale Welsh data set

Not only has this approach rarely been undertaken using mixed- methods to produce a rigorous investigation into school smoking policy before, but such a large-scale empirical investigation into Welsh school smoking policies using mixed-methods have also, as far as the author is aware, rarely or never been undertaken