Association between teachers’ outdoor smoking attitude and smoking initiation among in-school adolescents in Albania: A cross-sectional study

Abstract Background The initiation of smoking during adolescence is a critical public health issue with long-term implications for non-communicable diseases. Smoking rates among youth remain high despite efforts to implement tobacco control policies. This study examines the potential influence of teachers' outdoor smoking attitudes on the smoking behaviors of in-school adolescents. Methods We analyzed cross-sectional data from the 2020 Albania Global Youth Tobacco Survey. The study sample comprised 4,042 school-going adolescents aged 13–15, selected through a two-stage sampling methodology. The key outcome and explanatory variables were “smoking initiation among in-school adolescents” and "teachers' outdoor smoking attitude in school" respectively whilst 16 covariates were controlled. At 95% confidence interval and 5% alpha level, logistic regression models were performed to explore associations between the main explanatory variable and adolescent smoking initiation, and outputs reported in odds ratio. Results Out of 4,042 participants, 20% of the adolescents had initiated smoking. The study found an association between teachers’ outdoor smoking and smoking initiation among in-school adolescents. In-school adolescents exposed to teachers' outdoor smoking behavouir had a higher likelihood of smoking than their colleagues who were not exposed AOR = 1.28, CI = 1.05–1.56. Receiving pocket money per week AOR = 1.40, CI = 1.01–1.96, finding it easy to buy cigarettes AOR = 3.46, CI = 2.73–4.39, having a close friend who smokes AOR = 2.58, CI = 2.11–3.17, and unaware that smoking at public places is prohibited AOR = 1.61, CI = 1.32–1.95 predicted smoking initiation among in-school adolescents in Albania. Conclusions The study underscores the significant impact of teachers' smoking attitudes in school settings on the smoking behaviors of in-school adolescents in Albania. Promoting smoke-free school campuses and increasing awareness of smoking's harmful effects are crucial steps in mitigating smoking initiation among adolescents. The government through the Ministry of Education, Sports and Youth of Albania should enforce stringent policies against smoking in schools, emphasizing the role of teachers and school staff as role models in fostering a healthy, smoke-free environment for students.