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Denormalising Smoking in the Classroom: Does it Cause Bullying?
  1. Reiner Hanewinkel1,*,
  2. Barbara Isensee1,
  3. Karin Maruska1,
  4. James Sargent2,
  5. Matthis Morgenstern1
  1. 1 Institute for Therapy and Health Research, Germany;
  2. 2 Dartmouth Medical School, Germany
  1. To whom correspondence should be addressed. E-mail: 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. We assessed 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 3,490 students were recruited from 84 secondary schools in Germany, of whom 3,123 students (90%) provided data from both waves. Classes from the intervention group participated in the Smokefree Class Competition, committing themselves to stay smokefree for a period of six 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 (a) being victimised, (b) engaging in bullying, and (c) being isolated.

Results: There was a strong association between daily smoking and higher odds of bullying others at baseline (Adjusted proportional odds ratio=4.66; 95% confidence interval, 3.38-6.43). No significant pre-post differences across treatment assignment groups were found on any bullying measure using generalized 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 registration: ISRCTN27091233 in Current Control Trial Register

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