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OP145 Social inequalities in adolescent smoking: Are school tobacco policies implemented where they are most needed?
  1. Nora Mélard1,
  2. Alexandre Jacquemain2,
  3. Vincent Lorant1
  1. 1Institute of Health and Society, UCLouvain, Brussels, Belgium
  2. 2Institute of Statistics, Biostatistics and Actuarial Sciences, UCLouvain, Louvain-la-Neuve, Belgium


Background The social gradient in smoking is not declining and it has been reported that adolescents of lower socio-economic status initiate smoking earlier and smoke more frequently than those of higher socio-economic status. There is a need to tackle inequalities in smoking as early as possible, including in schools, where most adolescents initiate smoking. The implementation of school tobacco policies varies greatly from one school to another but such differential implementation may increase health inequalities. More resources should be allocated to schools with larger needs. Inequity arises when the policy is not implemented according to the schools’ needs. This study measures inequity in the implementation of school tobacco policies and decomposes it in a sum of explanatory factors.

Methods We used data from the SILNE and SILNE-R projects that collected data in Tampere – Finland, Dublin – Ireland, Amersfoort – the Netherlands, Namur – Belgium, Hanover – Germany, Latina – Italy, and Coimbra – Portugal. A student (n= 18,805) and a staff survey (n= 438) were conducted in 2013 and 2016 in 38 schools. We assessed the school tobacco policy on a 10-point score and calculated need ratios to quantify whether schools received the policy they needed, less or more. Need was defined according to the prevalence of adolescent smoking: a school with a high smoking prevalence is a school with higher needs, while a school with a low smoking prevalence is a school with lower needs. Gini coefficients of these need ratios were used as measures of inequity.

Results Inequity increased from 8.8% in 2013 to 9.8% in 2016. We were able to explain 83% and 60% of these inequities, respectively. Explanatory factors were gathered into six groups: socio-demographic, socio-economic, home environment, school environment, smoking behaviour and network. Adolescents’ socio-economic characteristics and home environment contributed the most to explaining inequities in the distribution of school tobacco policies across schools.

Conclusion School tobacco policies are not equitably distributed according to the schools’ needs. Next to evaluating their impact on smoking outcomes, research should also focus on the contribution of these preventive policies to social inequalities in adolescent smoking.

  • health inequalities
  • adolescent health
  • school tobacco policies

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