To dare or not to dare. Is Smoke Free School an acceptable intervention in the eyes of Romanian stakeholders? – A FRESHAIR4Life Project

Introduction: The rising use of emerging tobacco products in Romanian schools, driven by weak enforcement of tobacco bans and aggressive marketing, is a growing public concern. WHO recommends Smoke-Free School policies banning all tobacco product use on school premises for students, staff, and teachers as effective measures to reduce adolescent smoking and health related risks. As part of the FRESHAIR4Life project, we explore stakeholder perspectives in Brașov County to assess the acceptability, feasibility, barriers, and facilitators for successfully implementing Smoke-Free Schools in Romania. Method: A two-day stakeholder workshop was conducted in Brasov with adolescents (A) (14-16 yrs), high-school teachers (T), healthcare providers (HCP) and policy makers (PM) (N=50). Using mixed-methods, stakeholders’ views were gathered on the intervention’s importance, target population, potential benefits, reach, feasible implementation strategies, adaptation requirements, likely costs and potential barriers or facilitators. Results: Stakeholders agree that implementing a Smoke-Free School policy may face resistance without a co-created internal regulation developed through collaboration, prioritizing cohesion over coercion. Key facilitators include gradual implementation (A, T), engaging in alternative activities to replace interest in smoking spots (A, T), teachers role modeling (A), and fostering health prevention skills (HCP, T). Barriers highlighted by teachers include administrative burdens and weak parent collaboration, prompting calls for additional resources and training. Adolescents and healthcare professionals saw the intervention as more beneficial and cost-effective than teachers, while all stakeholders acknowledged its moderate challenges. Policy makers stressed the importance of testing such a comprehensive intervention. Discussions: All stakeholders agree that, while challenging and requiring an incremental approach, the Smoke-Free School intervention has significant potential for long-term effectiveness and cost-efficiency. Its success relies on collaboration among school stakeholders, supported by co-created regulations and stronger parental engagement. An educational package with innovative methods embedding smoking prevention into the broader concept of "Health Promoting Schools" is viewed as appealing.