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School personnel smoking, school-level policies, and adolescent smoking in low- and middle-income countries
  1. Silda Nikaj1,
  2. Frank Chaloupka2
  1. 1Department of Economics, Texas Christian University, Fort Worth, Texas, USA
  2. 2Department of Economics, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Silda Nikaj, Department of Economics, Texas Christian University, TCU Box 298510, 2800 S. University Drive, Fort Worth, TX 76129, USA; s.nikaj{at}


Objectives This paper examines the link between personnel and teacher smoking on school grounds, and student smoking in 62 low-income and middle-income countries.

Methods We use a two-part model to estimate the effect of smoking by school personnel on youth smoking. In the first part, we model the decision to smoke for all students, using a linear probability model. In the second part, we estimate cigarette consumption among smokers. We employ country fixed effects to address country-level time-invariant unobservable factors and control for an array of local-level variables to address local-level heterogeneity.

Results We find that smoking by personnel and teachers on school grounds is associated with higher smoking prevalence among all youths, and higher cigarette consumption among female smokers. Our findings suggest that consumption among female smokers is primarily affected by smoking among female personnel, and that younger personnel/teachers appear to be more influential in determining behaviours among young people. In addition, we find that smoking restrictions on staff are associated with reductions in average consumption among female students.

Conclusions Low-income and middle-income countries may reduce smoking among young people by banning smoking for teachers and school personnel on school grounds.

  • Secondhand smoke
  • Environment
  • Prevention
  • Priority/special populations
  • Public policy

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  • Contributors Both authors contributed in conceptualising and designing the study, and writing up the manuscript. SN completed the statistical analysis and tabulated results. FC provided feedback on the empirical framework.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.