Tobacco use is the leading cause of preventable disease and premature death in the United States. In 2014, an estimated 16.8% of adults were current cigarette smokers, and 9.2% of high school students smoked cigarettes. Nearly 90% of smokers developed their habit as teenagers, and students' tobacco use in high school influences their behaviors later in adulthood. Smoking behaviors appear to be inseparable from the social environment, physical environment, small social groups, and cognitive and affective processes. Preventive strategies, such as advertising bans, clean indoor air laws, education programs, increased taxes, labeling limitations, mass-media campaigns, and youth access regulations, have been commonly used to prevent and reduce youth tobacco use nationwide. In Florida, local public school districts were authorized to develop new tobacco-free school policies through an amendment to the Florida Clean Indoor Air Act in June 2011. The purpose of this study was to determine the impact of the recently implemented smoking cessation policies, as well as individual-level factors and interpersonal-level factors, on youth tobacco use in Florida public schools. This study employed a pooled cross-sectional design with data for high school students from the Florida Youth Tobacco Survey (FYTS) in 2010 (n=37,797) and 2014 (n=32,930). It was guided by a theoretical framework based on the reasoned action approach and the social ecological model. Hierarchical logistic regression was used to analyze the data. The four models were binary logistic regression for cigarette use, multinomial logistic regression for cigarette use, binary logistic regression for cigar use, and multinomial logistic regression for cigar use. The results of this study support the importance of the individual-level constructs of background factors, behavioral beliefs, and control beliefs, the interpersonal-level construct of normative beliefs, and the policy-level construct of actual behavioral control when applied to youth tobacco use. These findings led to a better understanding of which policies, environments, and cognitions contribute to preventing and reducing teenage tobacco use, which is imperative in controlling the risks related to smoking and improving youth health. Now that the individual-level factors, interpersonal-level factors, and policy-level factors that contribute to youth tobacco use were recognized, preventative and therapeutic programs and interventions can be suggested and improved. This study provided evidence-based knowledge for improving public policies and interventional strategies towards smoking prevention and cessation for youth.


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Graduation Date





Zhang, Ning


Doctor of Philosophy (Ph.D.)


College of Health and Public Affairs

Degree Program

Public Affairs; Governance and Policy Reseach









Release Date

May 2016

Length of Campus-only Access


Access Status

Doctoral Dissertation (Open Access)