The ecological factors influencing
middle school student tobacco use are
complex. The results from multinomial
logistical regression analysis showed
school health education and tobacco-free
school policies had no significant association
with smoking behavior of students.
Further research with in-depth and focus
group discussions is needed to explain
these findings. The research evaluating these measures and policies should be
carried out. The organizational factors
(tobacco-free schools, smoking intervention
programs), community factors (community
tobacco control activities, student
access to cigarettes) and tobacco-control
policies had influence on smoking behavior
among students. A follow-up study to
evaluate the change in smoking behavior
is needed to better understand these factors
and to evaluate causality.