NEW YORK (Reuters Health) - Children in classrooms where students and teachers relate to one another in a positive way are less likely to start smoking than those in classes where students and teachers don't get along as well, according to a Swedish study.

However, the classroom relationship may not be the cause of students' smoking behavior, according to study author Dr. M. Rosaria Galanti of the Center for Tobacco Prevention at the Karolinska Institute in Stockholm.

The students may be more likely to have disciplinary problems or other factors that could be responsible for both their smoking initiation and their teachers' perceptions of the classroom relationship, Galanti said in an interview with Reuters Health.

Overall, however, the study results suggest that "when considering school-based interventions to prevent smoking, attention should be paid to...factors (such as) how engaged/engaging are the teachers and how general social skills are promoted, etc., rather than to tobacco-specific policy or teaching," Galanti said.

Galanti and her colleagues investigated the relationship between class environments and future smoking in a one-year follow-up study of 2,883 fifth-grade students. They also asked teachers to rate their various classes as positive or problematic in terms of interpersonal relations.

Nearly one out of every five fifth-grade students reported ever smoking, but by the sixth grade, one third of the students said they had ever puffed on a cigarette, the investigators report in the June issue of Preventive Medicine.

Students in classes with negative ratings were 42% more likely to report ever smoking than were their peers in classes with positive ratings. These students were also more likely to say they had increased smoking between their fifth- and sixth-grade school years.

Fifth-grade students whose fellow classmates reported a high prevalence of ever smoking were also more likely to say that they had puffed on a cigarette at least once by follow-up, the report indicates.

Those who received 1 to 2 hours of anti-tobacco education during the fourth grade, however, were less likely to say they had ever smoked than those who received less than 1 hour of anti-tobacco education. But more intensive anti-smoking education did not further decrease the pre-adolescents' risk of ever smoking, the researchers note.

In light of the findings, "school leaders, school personnel, and parents should work to keep the general school standards as high as possible and to enhance the school socializing function," Galanti said. Also, "school healthcare personnel, (such as) school nurses, may be an important resource in tobacco prevention and their role should be better understood."

The findings may not be applicable to other countries or to other age groups, Galanti noted.

"The effect of enforcing tobacco policy in schools can be expected to be different in countries or regions with different background of tobacco-control activities," she said. Also, "the young age of the study subjects makes the results not easily generalizable to other ages."

SOURCE: Preventive Medicine 2002;34:649-654.

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