Background:Smoking and poor mental health in youth represent important public health priorities. This study aimed to (i) compare tobacco-related behaviors and mental health in two educational settings with high smoking rates: vocational education and training (VET) schools and preparatory basic education (PBE) schools, and (ii) examine associations between smoking at school start and mental health 5 months later.Methods:Data were obtained from baseline ( N = 1843) and follow-up ( N = 1039) assessments conducted as part of a school-based trial in two rounds (baseline in August 2018 and August 2019). Students’ characteristics were presented by adjusted prevalences. Logistic regression analyses assessed associations between smoking and measures of mental health: school-related well-being, overall loneliness, and stress.Results:More PBE students than VET students reported daily smoking (40% vs. 27%), nicotine dependence, perceived benefits of smoking (e.g., stress reduction: 41% vs. 33%), low smoking-related self-efficacy (e.g., ability to resist smoking if offered by a friend: 20% vs. 32%), school-related loneliness, and low school connectedness (25% vs. 11%). Daily smokers at VET and PBE schools had lower odds of school-related loneliness (AOR = 0.51, 95% CI: 0.35–0.74) and higher odds of stress (AOR = 2.75, 95% CI: 2.00–3.80). Smoking was associated with better classmate relations in VET schools but not in PBE schools.Conclusions:Our study suggested that students in PBE schools constitute a more vulnerable group in terms of smoking and mental health compared with students in VET schools. Smoking seemed to prevent loneliness in school but was associated with heightened stress levels.

中文翻译：

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高吸烟率教育环境中吸烟与心理健康的关系：丹麦青少年的队列研究

背景：青少年吸烟和心理健康状况不佳是重要的公共卫生优先事项。本研究旨在 (i) 比较两种吸烟率较高的教育环境中与烟草相关的行为和心理健康：职业教育和培训 (VET) 学校和预科基础教育 (PBE) 学校，以及 (ii) 研究吸烟率与吸烟率之间的关联。开学和 5 个月后的心理健康状况。 方法：数据来自基线 (N = 1843) 和后续 (N = 1039) 评估，作为两轮校本试验的一部分（基线于 2018 年 8 月和 8 月） 2019）。学生的特征通过调整后的患病率来呈现。逻辑回归分析评估了吸烟与心理健康指标之间的关联：学校相关的幸福感、整体孤独感和压力。 结果：与 VET 学生相比，PBE 学生中报告每天吸烟（40% 比 27%）、尼古丁依赖、感知的人数更多吸烟的好处（例如，减轻压力：41% vs. 33%）、与吸烟相关的低自我效能感（例如，如果有朋友吸烟，则有能力抵制吸烟：20% vs. 32%）、与学校相关的孤独感、学校连通性较低（25% vs. 11%）。VET 和 PBE 学校的每日吸烟者出现与学校相关的孤独感的几率较低（AOR = 0.51，95% CI：0.35–0.74），而承受压力的几率较高（AOR = 2.75，95% CI：2.00–3.80）。在 VET 学校中，吸烟与更好的同学关系有关，但在 PBE 学校中则不然。结论：我们的研究表明，与 VET 学校的学生相比，PBE 学校的学生在吸烟和心理健康方面构成更脆弱的群体。吸烟似乎可以防止在学校感到孤独，但与压力水平升高有关。