title: School smoking policies and educational inequalities in smoking behaviour of adolescents aged 14-17 years in Europe.
abstract: 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.
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Mirte A G
authors.initials: MA
authors.lastname: Kuipers
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Rosaline
authors.initials: R
authors.lastname: de Korte
authors.affiliation: Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Victoria Eugenia
authors.initials: VE
authors.lastname: Soto
authors.affiliation: Medical Faculty, Institute of Medical Sociology (IMS), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Richter
authors.affiliation: Medical Faculty, Institute of Medical Sociology (IMS), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
authors.forename: Irene
authors.initials: I
authors.lastname: Moor
authors.affiliation: School of Health Sciences, University of Tampere, Tampere, Finland Department of Adolescent Psychiatry, Pitkäniemi Hospital, Nokia, Tampere University Hospital, Tampere, Finland.
authors.forename: Arja H
authors.initials: AH
authors.lastname: Rimpelä
authors.affiliation: National School of Public Health, University of Lisbon, Lisbon, Portugal.
authors.forename: Julian
authors.initials: J
authors.lastname: Perelman
authors.affiliation: Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Federico
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
authors.affiliation: Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lorant
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D015995:Prevalence; D061845:Smoke-Free Policy; D012907:Smoking / Q000453:epidemiology*; D012959:Socioeconomic Factors
keywords: ADOLESCENTS CG; PUBLIC HEALTH; SMOKING; SOCIAL CLASS; SOCIAL INEQUALITIES