Impact of an Outdoor Smoking Ban at Secondary Schools on Cigarettes, E-Cigarettes and Water Pipe Use among Adolescents: An 18-Month Follow-Up.

Abstract: The effectiveness of outdoor smoking bans on smoking behavior among adolescents remains inconclusive. This study evaluates the long-term impact of outdoor school ground smoking bans among adolescents at secondary schools on the use of conventional cigarettes, e-cigarettes (with/without nicotine) and water pipes. Outdoor smoking bans at 19 Dutch secondary schools were evaluated using a quasi-experimental design. Data on 7733 adolescents were obtained at baseline, and at 6 and 18-month follow-up. The impact of outdoor smoking bans on 'ever use of conventional cigarettes', 'smoking onset', 'ever use of e-cigarette with nicotine', 'e-cigarette without nicotine', and 'water pipe' was measured. Multilevel logistic regression analysis was used. At schools with a ban, implementation fidelity was checked. At schools where a ban was implemented, at 18-month follow-up more adolescents had started smoking compared to the control condition. No effect of implementation of the ban was found for smoking prevalence, e-cigarettes with/without nicotine, and water pipe use. Implementation fidelity was sufficient. No long-term effects were found of an outdoor smoking ban, except for smoking onset. The ban might cause a reversal effect when schools encounter difficulties with its enforcement or when adolescents still see others smoking. Additional research is required with a longer follow-up than 18 months.

Quality aspects of Dutch general practice-based data: a conceptual approach.

BACKGROUND: General practice-based data, collected within general practice registration networks (GPRNs), are widely used in research. The quality of the data is important but the recording criteria about what type of information is collected and how this information should be recorded differ between GPRNs. OBJECTIVE: We aim to identify aspects that describe the quality of general practice-based data in the Netherlands. METHODS: To investigate the quality aspects, we used the method of concept mapping, a structured conceptualization process for a complex multi-dimensional topic. We explored the ideas of representatives from 10 Dutch GPRNs on the quality of general practice-based data in five steps: preparation, generation of statements, structuring, representation and interpretation. In a brainstorm session, 10 experts generated statements about good data quality from general practice, which we completed with information from the literature. In total, 18 experts participated in the ranking and clustering of the statements. These results were analysed using ARIADNE software, using a combination of principal component analysis and cluster analysis techniques. Finally, the clusters were labelled based on their content. RESULTS: A total of 72 statements were analysed, which resulted in a two-dimensional picture with six clusters, 'complete health record', 'coding of information', 'episode oriented recording', 'diagnostic validity', 'recording agreements' and 'residual category'. CONCLUSIONS: The quality of general practice-based data can be considered on five content-based aspects. These aspects determine the quality of recording.