The association between smoke-free school policies and adolescents’ anti-smoking beliefs: moderation by family smoking norms

Michael Schreuders, Mirte AG Kuipers, Martin Mlinarić, Adeline Grard, Anu Linnansaari, Arja Rimpela, Matthias Richter, Julian Perelman, Vincent Lorant, Bas van den Putte, Anton E. Kunst

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12 Citations (Scopus)


Background: Smoke-free school policies (SFSPs) may influence adolescents’ smoking through the development of anti-smoking beliefs. We assessed which types of anti-smoking beliefs (health, social and societal) are associated with SFSPs and whether these associations were different for adolescents in smoking permissive versus prohibitive families. Methods: Survey data was collected in 2016–2017 from 10,980 adolescents between 14–16 years old and 315 staff in 55 schools from seven European cities. We separately measured adolescent-perceived SFSP and staff-reported SFSP at the school-level. Associations between SFSP and anti-smoking health, social and societal beliefs were studied using multi-level logistic regression, adjusting for demographics and school-level smoking prevalence. We tested for interactions between family norms and SFSP, and estimated associations for adolescents in permissive and prohibitive families, respectively. Results: Adolescent-perceived SFSP was not significantly associated with anti-smoking health (OR:1.08, 95%CI:0.94–1.25), social (OR:0.89, 95%CI:0.75–1.04) and societal beliefs (OR:1.15, 95%CI:0.99–1.33). Staff-reported SFSP were associated with anti-smoking health beliefs (OR:1.12, 95%CI:1.01–1.24), but not with social (OR:0.94, 95%CI:0.83–1.07) or societal beliefs (OR:1.02, 95%CI:0.90–1.14). Most results were comparable between adolescents in smoking prohibitive and permissive families. However, in smoking prohibitive families, adolescent-perceived SFSP were associated with societal beliefs (OR:1.24, 95%CI:1.06–1.46), but not in permissive families (OR:1.06, 95%CI:0.90–1.25). Also, in smoking permissive families, staff-reported SFSP were associated with more pro-smoking social beliefs (OR:0.83, 95%CI:0.72-0.96), but not in prohibitive families (OR:1.05, 95%CI:0.92-1.16). Conclusions: We found evidence that SFSP are associated with some anti-smoking beliefs, but more so among adolescents from smoking prohibitive families than from permissive families.

Original languageEnglish
Article number107521
JournalDrug and Alcohol Dependence
Publication statusPublished - 1 Nov 2019


  • Adolescents
  • Equity
  • Mechanism
  • School
  • Smoke-free
  • Tobacco control


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