School status may affect later smoking susceptibility

A low peer status in adolescence could significantly increase the risk for heavy and regular smoking in adulthood, researchers suggest.

Antismoking programs in schools are more likely to succeed if they encourage the integration and acceptance of all students, as well as promote a negative attitude toward smoking, recommend Ylva Almquist (Stockholm University, Sweden) and Viveca Østberg.

Their study involved 2329 Swedish individuals who were interviewed at the age of 13 years about their social status and again at 32 years about their smoking habits.

Each student was asked to nominate the three classmates they "worked best with at school." Almquist and Østberg checked the responses of all classmates from each school and thereby identified individuals who were not nominated at all by their classmates (defined as marginalized students), those who were nominated once (peripheral), two-to-three times (accepted), four-to-six times (popular), and more than seven times (class "favorites").

Students with few nominations were considered as less accepted and respected within the class, and had fewer friends, the authors explain in Addiction.

The results showed that marginalized children had a 3.67-fold increased risk for becoming heavy smokers (defined as >20 cigarettes per day) at the age of 32 years compared with the class favorites. The researchers say this may be because marginalized people are more likely to adopt controversial behaviors such as smoking, while favorites conform to the social expectations of "good" behavior.

Peripheral individuals, those who were accepted, and those who were popular at school also had increased, albeit to a lesser extent, risks for heavy smoking, at relative risks of 2.81, 1.99, and 1.45, respectively, compared with their favorite counterparts.

Low peer status was also associated with an increased risk for regular smoking (<20 cigarettes/day), at somewhat lower risk estimates than heavy smoking, the authors note.

The researchers say that implementing their findings into existing school antismoking campaigns "would have positive influences on broader social and health trajectories into health and health behaviors in adulthood," as well as a positive impact on smoking rates.

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