Smoke-Free School Zone Policy and Its Association with Attitudes Toward Smoking and Secondhand Smoke Exposure Among School-Aged Children and Key Stakeholders.

Background: Smoke-free zone policies in school settings have been widely implemented; however, evidence regarding their impact on smoking-related attitudes and secondhand smoke (SHS) exposure remains limited. This study aimed to examine the association between a smoke-free zone policy implemented along school commuting routes and attitudes toward smoking and SHS exposure among elementary school students, their parents, and school staff in Seoul, South Korea.

Methods: A cross-sectional study was conducted. Participants were 210 students, 272 parents, and 137 school staff from the five schools randomly selected according to the criteria of regional deprivation index and prevalence of designated smoke-free zones from all the 25 districts of Seoul, South Korea. "Attitudes toward smoking" and "exposure to SHS" were the outcome variables, and the "presence of a smoke-free zone along the school commuting route" was the predictor variable. All variables were assessed using self-reported questionnaires. Data were collected between November 2020 and December 2020. The multiple logistic regression analysis was performed to test main hypotheses.

Results: Students and school staff in schools with designated smoke-free zones along school commuting routes were significantly less likely to be exposed to SHS along those routes, compared to their counterparts without such zones (odds ratio [OR] = 0.29; 95% confidence interval [CI], 0.098-0.853; p =0.025 for students; OR = 0.09; 95% CI, 0.008-0.939; p =0.044 for school staff). However, the presence of smoke-free zones along school commuting routes was not significantly associated with attitudes toward smoking among students, parents, or school staff.

Conclusion: Designation of smoke-free zones along school commuting routes may be effective in reducing exposure to SHS among students and school staff. The active and consistent enforcement of smoke-free policies within school settings may play a critical role in further reducing SHS exposure among children and related stakeholders.