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School smoking policies and educational inequalities in smoking behaviour of adolescents aged 14–17 years in Europe
  1. Mirte A G Kuipers1,
  2. Rosaline de Korte1,
  3. Victoria Eugenia Soto2,
  4. Matthias Richter3,
  5. Irene Moor3,
  6. Arja H Rimpelä4,5,
  7. Julian Perelman6,
  8. Bruno Federico7,
  9. Anton E Kunst1,
  10. Vincent Lorant2
  1. 1Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
  3. 3Medical Faculty, Institute of Medical Sociology (IMS), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
  4. 4School of Health Sciences, University of Tampere, Tampere, Finland
  5. 5Department of Adolescent Psychiatry, Pitkäniemi Hospital, Nokia, Tampere University Hospital, Tampere, Finland
  6. 6National School of Public Health, University of Lisbon, Lisbon, Portugal
  7. 7Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy
  1. Correspondence to Mirte Kuipers, Department of Public Health, Academic Medical Center/University of Amsterdam, Room K2-206, P.O. Box 22660, Amsterdam 1100 DD, The Netherlands; m.a.kuipers{at}


Background Studies on the effects of school smoking policies are inconclusive and there is no research on whether the effects of school policies vary by educational level. We examined the association between school smoking policies and smoking behaviour among adolescents aged 14–17 years in Europe and assessed educational inequalities in these associations.

Methods Data on 10 325 adolescents from 50 schools in six European cities were obtained from the 2013 SILNE survey. We measured student perceived policy, staff reported policy and its three subscales: regulations, communication and sanctions. The association between school policies and smoking outcomes (daily smoking and smoking on school premises) was adjusted for individual characteristics and for parental smoking. We tested interaction between school policies and educational level.

Results Daily smoking was not associated with school smoking policies (eg, OR total policy=1.04, 95% CI 0.93 to 1.16 and OR student perceived policy=1.04, 95% CI 0.98 to 1.10). Smoking on school premises was less prevalent in schools with stronger staff reported total policy (OR=0.71, 95% CI 0.53 to 0.96). Other policy variables were also negatively associated with smoking on school premises, but not significantly (eg, OR student perceived policy=0.89, 95% CI 0.78 to 1.02). Associations between policy and smoking on school premises tended to be stronger in those with a low educational level, but none of the interactions tested were statistically significant.

Conclusions Our results suggest that school smoking policies may not have a direct effect on daily smoking but may reduce smoking on the school premises. We found no clear evidence for the effects of school policies to differ by educational level.


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