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Denormalising smoking in the classroom: does it cause bullying?
  1. Reiner Hanewinkel1,
  2. Barbara Isensee1,
  3. Karin Maruska1,
  4. James D Sargent2,
  5. Matthis Morgenstern1
  1. 1Institute for Therapy and Health Research, IFT-Nord, Kiel, Germany
  2. 2Norris Cotton Cancer Center, Dartmouth Medical School, Hanover, New Hampshire, USA
  1. Correspondence to Dr Reiner Hanewinkel, Institute for Therapy and Health Research, IFT-Nord, Harmsstrasse 2, Kiel 24114, Germany; hanewinkel{at}


Background The Smokefree Class Competition, the largest school-based smoking prevention programme in Europe, aims to create a class climate that denormalises smoking. An analysis was carried out to assess whether it increases bullying or perception of isolation.

Methods A cluster randomised controlled trial was conducted, with two waves of assessment directly before the start and immediately after the end of the prevention programme. Some 3490 students were recruited from 84 secondary schools in Germany, of whom 3123 students (90%) provided data from both waves. Classes from the intervention group (IG) participated in the Smokefree Class Competition, committing themselves to stay smokefree for a period of 6 months, and self-monitoring their smoking status on a weekly basis. Classes that refrained from smoking were eligible for a prize draw. To test the hypotheses that participation in the competition might foster bullying, we measured students' self report of (1) being victimised, (2) engaging in bullying and (3) being isolated.

Results There was a strong association between daily smoking and higher odds of bullying others at baseline (adjusted proportional OR 4.66; 95% CI 3.38 to 6.43). No significant pre–post differences across treatment assignment groups were found on any bullying measure using generalised linear latent and mixed models. For being isolated, the trends suggested that the programme, if anything, fostered lower levels of isolation at follow-up, especially for those who perceived high levels of isolation at baseline.

Conclusion Participation in the intervention had no effect on bullying or perceptions of isolation.

Trial Reg No ISRCTN27091233 in Current Control Trial Register.

  • Social unacceptability
  • randomised controlled trial
  • smoking prevention
  • side effects
  • Germany
  • addictive behaviour
  • adolescents CG
  • health education SA
  • randomised trials
  • social support

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  • Funding This study was funded by Deutsche Krebshilfe eV (German Cancer Aid). The implementation of the prevention programme was supported by Deutsche Krebshilfe eV, European Commission, Bundeszentrale für gesundheitliche Aufklärung (Federal Centre for Health Education), Deutsche Herzstiftung eV (German Heart Foundation), Deutsche Lungenstiftung eV (German Lung Foundation), and other charities and Governmental bodies in Germany.

  • Competing interests RH, BI, MM and KM received funding for implementation and evaluation of the prevention programme at the same time.

  • Ethics approval This study was conducted with the approval of the Landesverwaltungsamt Sachsen-Anhalt, Reg. -Nr. 504-50/06.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.