Academic well-being and smoking among 14- to 17-year-old schoolchildren in six European cities

Academic well-being and smoking among 14- o 17-yea -old schoolchild en in six Eu opean ci ies Jaana M. Kinnunen a , * , Pi jo Lind o s a , b , A ja Rimpel€ a a , b , c , Ka a iina Salmela-A o d , e , Ka ha ina Ra hmann , Julian Pe elman g , B uno Fede ico h , Ma hias Rich e , An on E. Kuns i , Vincen Lo an j a School o Heal h Sciences, FI-33014 Uni e si y o Tampe e, Finland b PERLA eTampe e Cen e o Childhood, You h and Family Resea ch, FI-33014 Uni e si y o Tampe e, Finland c Depa men o Adolescen Psychia y, Tampe e Uni e si y Hospi al, Pi k€ aniemi Hospi al, FI-33380 Nokia, Finland d Depa men o Psychology, PO Box 35, FI-40014 Uni e si y o Jy € askyl€ a, Finland e Cice o Lea ning, PO Box 9, FI-00014 Uni e si y o Helsinki, Finland Ins i u e o Medical Sociology, Medical Facul y, Ma in Lu he Uni e si y Halle-Wi enbe g, Magdebu ge S . 8, 06112 Halle (Saale), Ge many g Escola Nacional de Saúde Pública and Cen o de In es igaç~ ao em Saúde Pública, Uni e sidade No a de Lisboa, A enida Pad e C uz, 1600-560 Lisboa, Po ugal h Depa men o Human Sciences, Socie y and Heal h, Uni e si y o Cassino and Sou he n Lazio, Via S. Angelo snc, Campus Folca a, 03043 Cassino (FR), I aly i Depa men o Public Heal h, Academic Medical Cen e, Uni e si y o Ams e dam, PO Box 22660, 1100 DD Ams e dam, The Ne he lands j Ins i u e o Heal h and Socie y, Uni e si  e Ca holique de Lou ain, Clos chapelle aux champs 30 /B1.30.15.05, 1200 B uxelles, Belgium a icle in o A icle his o y: Keywo ds: Adolescence Smoking School School bu nou Schoolwo k engagemen Academic pe o mance abs ac I is well es ablished ha poo academic pe o mance is ela ed o smoking, bu he as- socia ion be ween academic well-being and smoking is less known. We measu ed aca- demic well-being by school bu nou and schoolwo k engagemen and s udied hei associa ions wi h smoking among 14- o 17-yea -old schoolchild en in Belgium, Ge many, Finland, I aly, he Ne he lands, and Po ugal. A class oom su ey (2013 SILNE su ey, N¼11,015) was conduc ed using he Sho School Bu nou In en o y and he Schoolwo k Engagemen In en o y. Logis ic eg ession, gene alized linea mixed models, and ANOVA we e used. Low schoolwo k engagemen and high school bu nou inc eased he odds o daily smoking in all coun ies. Academic pe o mance was co ela ed wi h school bu nou and schoolwo k engagemen , and adjus ing o i sligh ly dec eased he odds o smoking. Adjus ing o socioeconomic ac o s and school le el had li le e ec . Al hough high school bu nou and low schoolwo k engagemen co ela e wi h low academic pe o mance, hey a e mu ually independen isk ac o s o smoking. ©2016 The Au ho s. Published by Else ie L d on behal o The Founda ion o P o- essionals in Se ices o Adolescen s. This is an open access a icle unde he CC BY-NC-ND license (h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/). *Co esponding au ho . Tel.: þ358 40 190 1667. E-mail add esses: [email p o ec ed].fi(J.M. Kinnunen), pi jo.lind o s@u a.fi(P. Lind o s), a ja. impela@u a.fi(A. Rimpel€ a), ka a iina.salmela- a o@helsinki.fi(K. Salmela-A o), ka ha ina. a hman[email p o ec ed] (K. Ra hmann), [email p o ec ed] (J. Pe elman), [email p o ec ed] (B. Fede ico), [email p o ec ed] (M. Rich e ), [email p o ec ed] (A.E. Kuns ), [email p o ec ed] (V. Lo an ). Con en s lis s a ailable a ScienceDi ec Jou nal o Adolescence jou nal homepage: www.else ie .com/loca e/jado h p://dx.doi.o g/10.1016/j.adolescence.2016.04.007 0140-1971/©2016 The Au ho s. Published by Else ie L d on behal o The Founda ion o P o essionals in Se ices o Adolescen s. This is an open access a icle unde he CC BY-NC-ND license (h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/). Jou nal o Adolescence 50 (2016) 56e64 In oduc ion Academic pe o mance and i s ela ionship o adolescen smoking ha e been widely s udied. S uden s who pe o m be e academically a e less likely o smoke, while hose whose pe o mance is weak smoke much mo e o en (B yan , Schulenbe g, Bachman, O'Malley, &Johns on, 2000; Pennanen, Haukkala, De V ies, &Va iainen, 2011; Schnoh , K eine , Rasmussen, Due, &Dide ichen, 2009). Poo subjec i e heal h and ac o s ela ed o well-being a e also known o be ela ed o adolescen smoking (Bo ello-Ha baum, Haynie, Mu ay, &Ianno i, 2010; Holmen, Ba e -Conno , Holmen, &Bje me , 2000; Rius, Fe nandez, Schia fino, Bo  as, &Rod íguez-A alejo, 2004; Vingilis, Wade, &Seeley, 2002). Howe e , i is no well known how school- ela ed aspec s o well-being, specifically academic well-being, ela e o smoking. In ou s udy, academic well-being is measu ed by he concep s o school bu nou and schoolwo k engagemen , which ha e been sugges ed o be cen al indica o s o well-being a school (Tuominen-Soini, Salmela-A o, &Niemi i a, 2012). Bu nou was o iginally ecognized as a wo k- ela ed diso de (Maslach, Jackson, &Lei e ,1996), and in he con ex o school, i has only been s udied o e he las decade (Walbu g, 2014). School- ela ed bu nou has been defined as a combina ion o exhaus ion om schoolwo k, cynicism abou he meaning o school, and a sense o inadequacy as a s uden (Salmela-A o, Kiu u, Leskinen, &Nu mi, 2009), and i can be caused by disc epancies among s uden s' in e nal esou ces, school wo k- load and expec a ions o school esul s (Kiu u, Aunola, Nu mi, Leskinen, &Salmela-A o, 2008). The e m “school engagemen ”has been in use since he la e 1980s, and i ypically desc ibes a mul idimensional cons uc ha includes psychological, academic, a ec i e, cogni i e and beha io al componen s (Upadaya &Salmela-A o, 2013). I s o igin is in wo k-li e s udies (Schau eli, Ma inez, Pin o, Salano a, &Bakke , 2002). The concep o school engagemen has mainly been applied in No h Ame ica. Recen ly, a somewha di e en app oach, schoolwo k engagemen , was de eloped in Eu ope ha ocuses mo e on emo ional (ene gy o schoolwo k), cogni i e (dedica ion owa d schoolwo k and a pe cep ion ha schoolwo k is meaning ul), and beha io al (abso p ion in schoolwo k so ha ime passes quickly when s udying) di- mensions (Upadaya &Salmela-A o, 2013). Academic well-being and academic pe o mance a e in e wined: Good academic pe o mance is posi i ely ela ed o schoolwo k engagemen (Salmela-A o &Upadaya, 2012) and nega i ely ela ed o school bu nou (Salmela-A o, Kiu u, e al., 2009). The associa ion o school bu nou and schoolwo k engagemen wi h smoking has no been s udied be o e. Rega ding he No h Ame ican concep o school engagemen , a ew s udies ha e shown ha high school engagemen can p omo e heal hy beha io and p o ec agains heal h-comp omising beha io s, such as smoking (Ca e , McGee, Taylo , &Williams, 2007; Wang &F ed icks, 2014). Wang and F ed icks (2014) ha e obse ed ha adolescen s wi h declines in beha io al and emo ional engagemen wi h school had inc eased subs ance use ( obacco, alcohol, and ma ijuana). Resea ch aims We s udied he associa ion be ween academic well-being, measu ed by school bu nou and schoolwo k engagemen , and daily smoking among 14- o 17-yea -old schoolchild en in six medium-sized Eu opean ci ies. Because academic pe - o mance is an impo an isk ac o o smoking and is ela ed o academic well-being, we a e also p esen ing esul s on academic pe o mance and a e explo ing whe he i explains o modifies he associa ion be ween academic well-being and smoking. Me hod Pa icipan s and s udy p ocedu e We used da a ha we e collec ed wi h he Smoking Inequali ies - Lea ning om Na u al Expe imen s (SILNE) school su ey be ween Feb ua y and No embe 2013. The pa icipan s we e 14- o 17-yea -old s uden s (n ¼11,015) om six Eu- opean ci ies (coun y): Namu (Belgium), Hanno e (Ge many), Tampe e (Finland), La ina (I aly), Ame s oo ( he Ne he lands) and Coimb a (Po ugal). Ques ionnai es we e adminis e ed du ing egula school hou s using a pape -and- pencil me hod and we e sealed in en elopes immedia ely a e comple ion. The answe s we e en e ed in o a web pla - o m by he esponsible ins i u ion o each coun y. The o e all esponse a e was 79.4%, bu i a ied om 66.0% in Hanno e (GE) o 89.8% in Namu (BE). Ac i e pa en al consen was equi ed in La ina (IT) and Hanno e (GE). Mo e in o ma ion on he SILNE su ey can be ound elsewhe e (Lo an e al., 2015). In each ci y, wo school g ades co e ing 14- o 17-yea -old s uden s we e selec ed because smoking and he ansi ion om expe imen a ion o egula smoking inc ease apidly a hese ages (Die ke , Swendsen, Rose, He, &Me ikangas, 2012). All s uden s in hese g ades we e in i ed o pa icipa e, leading o an age ange o 12e19 yea s among pa icipan s. Fo hese analyses, s uden s who we e 12,13,18 and 19 yea s old (n ¼424) and s uden s wi h missing in o ma ion on age (n ¼81) we e excluded o keep he age a ia ion as compac as possible because smoking inc eases apidly ac oss his age span. S uden s wi h missing in o ma ion on smoking (n ¼185) we e also excluded, leading o a s udy popula ion o 10,325 indi iduals. O he s udy popula ion, 52.4% we e gi ls and 47.6% we e boys. In all ci ies, he p opo ions o boys and gi ls we e ela i ely equal excep in La ina (IT), whe e gi ls comp ised 59.8% o he s udy popula ion. The cha ac e is ics o he s udy popula ion a e p esen ed in Table 1. J.M. Kinnunen e al. / Jou nal o Adolescence 50 (2016) 56e64 57 Measu es Smoking Smoking expe ience was assessed on he basis o adolescen s' sel - epo ed answe s o he ques ion “Ha e you e e ied ciga e e smoking, e en jus a ew pu s?”(No/Yes). Those who answe ed “Yes”we e hen asked “How many ciga e es ha e you smoked du ing he las 30 days?”Repo ing ha ing smoked a leas one ciga e e pe day was eco ded as daily smoking. Ques ions on smoking we e adop ed om he 2010e2011 You h Smoking Su ey (YSS, 2011), and hey ha e also been used in he Global You h Tobacco Su ey (GYTS, 2016). School bu nou School bu nou was assessed wi h he Sho School Bu nou In en o y (SSBI), which was de eloped om a alida ed ins umen , he School Bu nou In en o y (SBI; Salmela-A o, Kiu u, e al., 2009). The SSBI has been used p e iously, and i s psychome ic p ope ies ha e been es ed (Salmela-A o, Kiu u, Pie ik€ ainen, &Jokela, 2008). The SSBI con ains h ee i ems ha measu e he h ee dimensions o school bu nou : (1) a sense o inadequacy a school (I o en ha e eelings o inadequacy abou my schoolwo k), (2) cynicism owa d he meaning o school (I eel ha I am losing in e es in my schoolwo k), and (3) exhaus ion a school (I b ood o e ma e s ela ed o my schoolwo k a lo du ing my ee ime). Each i em is measu ed on a 6- poin scale (1 ¼Comple ely disag ee o 6 ¼Comple ely ag ee). A highe sco e indica es a highe le el o bu nou . C onbach's alpha ( eliabili y o he h ee-i em scale) was .379. The eliabili y be ween i em 3 and he fi s wo i ems was pa icula ly low, bu o i ems 1 and 2, C onbach's alpha and he Spea maneB own coe ficien we e .624, which is accep able. These wo i ems o med he final school bu nou scale in he analyses, and hey measu e well he clinical componen s o bu nou , and he e o e hey sepa a e s uden s acco ding o school bu nou le el (Salmela-A o, Kiu u, e al., 2009). Mean, skewness and ku osis o he scale as well as C onbach's alpha we e calcula ed o he whole sample and o each ci y (Table 1). Fo Ame s oo (NL), C onbach's alpha was lowe han i was o he o he ci ies (.460). Fo he analyses, he mean o hese wo i ems was calcula ed o measu e school bu nou . Fo he logis ic eg ession an- alyses, school bu nou was ca ego ized in o h ee g oups acco ding o he mean: 1.50 ¼low, 2.00e4.00 ¼a e age, and 4.50 ¼high. The a e age g oup comp ised 67.0% o he esponden s, wi h 14.9% in he low g oup, and 18.1% in he high g oup. Pa icipan s who did no answe bo h i ems we e excluded om he analysis (2.6%). Schoolwo k engagemen Schoolwo k engagemen was es ima ed wi h a sho e sion o a alida ed scale, he Schoolwo k Engagemen In en o y (EDA; Salmela-A o &Upadaya, 2012), which cap u ed h ee dimensions: (1) abso p ion (Time flies when I am s udying), (2) ene gy (I eel s ong and igo ous when I am s udying), and (3) dedica ion (I am en husias ic abou my s udies). I was sco ed on a 6-poin scale (0 ¼Ne e o 5 ¼Daily). Fo he analyses, he mean o he h ee i ems was calcula ed, wi h a highe sco e indica ing a highe le el o engagemen . Fo he logis ic eg ession analyses, schoolwo k engagemen was ca ego ized in o h ee g oups acco ding o he mean: 4.00 ¼high, 1.00e3.67 ¼a e age, and .67 ¼low. The a e age g oup comp ised 60.6% o he esponden s, wi h 24.3% in he low g oup, and 15.1% in he high g oup. Pa icipan s who did no answe all h ee i ems we e excluded om he analysis (3.1%). C onbach's alpha ( eliabili y o he h ee-i em scale) was .759. The mean, skewness and ku osis o he scale as well as C onbach's alpha we e calcula ed o he whole sample and o each ci y (Table 1). Fo Namu (BE), C onbach's alpha was lowe han o he o he ci ies (.673). Table 1 Mean age (yea s); pe cen age (%) o daily smoking and high academic pe o mance; and mean, s anda d de ia ion (SD), skewness, ku osis and alpha o school bu nou a and schoolwo k engagemen b by ci y (n ¼numbe o pa icipan s). Va iable All (n ¼10,325) Namu (BE) (n ¼1962) Tampe e (FI) (n ¼1480) Hanno e (GE) (n ¼1312) La ina (IT) (n ¼1996) Ame s oo (NL) (n ¼1844) Coimb a (PT) (n ¼1731) Mean age, yea s 15.19 15.46 14.82 14.81 15.11 15.02 15.77 Daily smoking, % 14.5 18.4 11.9 9.8 20.7 8.9 14.3 School bu nou a Mean (SD) 3.08 (1.24) 3.13 (1.27) 3.06 (1.21) 3.22 (1.24) 3.21 (1.30) 3.17 (1.14) 2.68 (1.17) Skewness .23 .25 .28 .10 .15 .13 .45 Ku osis .60 .62 .44 .65 .73 .54 .41 Alpha .624 .623 .576 .635 .667 .460 .725 Schoolwo k engagemen b Mean (SD) 2.11 (1.43) 2.00 (1.37) 3.00 (1.28) 1.58 (1.33) 1.95 (1.44) 1.89 (1.34) 2.25 (1.44) Skewness .09 .20 .79 .58 .28 .21 .07 Ku osis 1.16 .98 .13 .68 1.05 1.07 1.20 Alpha .759 .673 .848 .782 .719 .781 .827 High academic pe o mance, % 40.7 39.0 33.2 31.1 54.2 40.5 40.5 a School bu nou was measu ed by he mean o wo i ems on a scale o 1e6. In F pos hoc es s be ween each ci y, he di e ences we e s a is ically significan (p <.01) be ween Tampe e (FI) and Hanno e (GE), Tampe e (FI) and La ina (IT), and Coimb a (PT) and all o he ci ies. b Schoolwo k engagemen was measu ed by he mean o h ee i ems on a scale o 0e5. The di e ences in F pos hoc es s be ween each ci y we e all s a is ically significan (p <.001) excep be ween Namu (BE) and La ina (IT), Namu (BE) and Ame s oo (NL), and La ina (IT) and Ame s oo (NL). J.M. Kinnunen e al. / Jou nal o Adolescence 50 (2016) 56e6458 Academic pe o mance and o he a iables Academic pe o mance was assessed by asking “Which o he ollowing bes desc ibes you school ma ks du ing he pas yea ?”The op ions we e adap ed o each coun y; e.g., in Belgium, he op ions we e G en e alemen des TB, G en e alemen des B, G en e alemen des S, G en e alemen des F, and G en e alemen des I, while in I aly, hey we e 9e10, 7e8, Pe lo più 6, 4e5, and Mino e di 4. A s uden 's g ades on a school epo eflec a eache 's assessmen o he pe o mance o ha s uden . The e o e, school pe o mance epo ed by he s uden eflec s ac ual in o ma ion om he s uden 's school epo s. Al hough he measu emen ins umen a ied among coun ies, in each coun y, i sepa a ed s uden s in o ca ego ies based on whe he hei school pe o mance was ela i ely high o low. The eam in e e y coun y de e mined he ca ego ies o ‘high, a e age and low’based on hei measu emen ins umen o he dis ibu ion o s uden s. In he whole sample, he high ca ego y comp ised 40.7% o he esponden s, he a e age ca ego y comp ised 41.7%, and he low ca ego y comp ised 17.6%. Socioeconomic a iables we e included in he analyses as con olling a iables because hey a e associa ed wi h bo h smoking (G een, Leyland, Swee ing, &Benze al, 2014) and academic pe o mance (Sun &Li, 2001). The Family A fluence Scale (FAS) was cons uc ed o measu e adolescen s' socioeconomic s a us using ou ques ions (Cu ie e al., 2008). Ado- lescen s' subjec i e social s a us has been ound o be associa ed wi h se e al heal h measu es (Ka onen &Rahkonen, 2011) and was es ima ed wi h he you h e sion o he McA hu scale, which is a ladde ha asks s uden s o ank hei amily's social s a us a a scale om 10 (bes o ) o 0 (wo s o ) (Goodman e al., 2001). A bina y a iable o he McA hu scale was calcula ed as he indi idual sco e minus he mean sco e o he coun y. Sco es below ze o we e defined as low socioeconomic s a us, and sco es g ea e han o equal o ze o we e defined as high socioeconomic s a us. Pa en s' highes le el o educa ion was asked o bo h he a he and he mo he . The ques ion was adap ed o each coun y, bu o he analyses, a common ou -ca ego y a iable was used: high, middle, low and do no know/o he . S a is ical analyses Desc ip i e s a is ics and dis ibu ional p ope ies o he scales we e calcula ed in he pooled da a and sepa a ely o each ci y. To es he di e ences be ween ci ies in e ms o school bu nou and schoolwo k engagemen , he F- es was pe o med along wi h pai wise pos hoc es s be ween ci ies. School bu nou , schoolwo k engagemen and academic pe o mance we e hen c oss- abula ed wi h daily smoking. Nex , he associa ions in he pooled da a we e s udied using logis ic eg ession analyses. Age and gende we e adjus ed o in all models. In Model 1, school bu nou , schoolwo k engagemen and academic pe o mance we e aken in o he model sepa a ely. In Model 2, hese a iables we e aken in he model simul aneously. The in e ac ion e ms o school bu nou and academic pe o mance, schoolwo k engagemen and academic pe o mance, and school bu nou and schoolwo k engagemen we e hen added in o he model, bu because hey we e no significan , hey we e no included in Model 3. In Model 3, he FAS, he MacA hu scale and pa en s' educa ion we e fi s added in o he model, ollowed by he in e ac ion e ms o ci y and school bu nou , ci y and schoolwo k engagemen , and ci y and academic pe o mance. To assess he a iance be ween schools in e ms o school bu nou and schoolwo k engagemen , we used ANOVA. School explained 10% o he a iance o schoolwo k engagemen and 4% o school bu nou , and he e o e, school le el was adjus ed o in Model 4 along wi h he indi idual-le el a iables om Model 3. The analysis was conduc ed wi h gene alized linea mixed models. All analyses we e conduc ed wi h IBM SPSS S a is ics V.21.0. Resul s Table 1 p esen s he desc ip i e s a is ics o he whole sample and o each ci y. The di e ences be ween he ci ies we e s a is ically significan in e ms o school bu nou , wi h F(5, 10,049) ¼46.71, p<.001, and schoolwo k engagemen , wi h F(5, 10,003) ¼177.80, p<.001. Pai wise di e ences be ween ci ies a e shown in he oo no e oTable 1. School bu nou was highe among gi ls (3.11 ±1.23) han boys (3.04 ±1.25), wi h F(1, 10,025) ¼6.18, p¼.013, and in all ci ies excep Coimb a (PT). Co espondingly, gi ls we e mo e engaged wi h schoolwo k (2.27 ±1.40) han we e boys (1.93 ±1.44), wi h F(5, 9977) ¼140.32, p<.001, and gi ls we e also mo e engaged han boys in each ci y. In he co ela ion analyses, high school bu nou was posi i ely co ela ed o low schoolwo k engagemen ( ¼.316) and low academic pe o mance ( ¼.265), and low schoolwo k engagemen was posi i ely co ela ed o low academic pe o - mance ( ¼.192). Daily smoking was mos common among hose who had a high le el o school bu nou , a low le el o schoolwo k engagemen and low academic pe o mance (Table 2). Co espondingly, daily smoking was leas common among hose whose le el o school bu nou was low, who we e s ongly engaged wi h hei schoolwo k and who pe o med well a school. The same pa e n was ound in each ci y. In age- and gende -adjus ed logis ic eg ession analyses, bo h school well-being a iables and academic pe o mance we e significan ly associa ed wi h smoking (Table 3, Model 1). The associa ions weakened somewha when all h ee a iables we e aken in o he model simul aneously (Model 2), bu he associa ions s ill emained s a is ically significan . The in e - ac ion e ms o academic pe o mance and school bu nou (p¼.284), academic pe o mance and schoolwo k engagemen (p¼.302), and school bu nou and schoolwo k engagemen (p¼.209), which we e added in Model 2, we e no s a is ically J.M. Kinnunen e al. / Jou nal o Adolescence 50 (2016) 56e64 59 significan . Adjus ing o socioeconomic backg ound (Model 3) as well as school le el (Model 4) changed he odds a ios only sligh ly. In sepa a e analyses o boys and gi ls (Table 4), he ela ionships emained o bo h gende s. The in e ac ions be ween ci y and school bu nou , ci y and schoolwo k engagemen , and ci y and academic pe o mance we e added o Models 1 o 3. These all we e s a is ically significan (p.05), and he e o e, Table 5 p esen s he ci y-specific odds a ios in wo models. The basic pa e n was simila o all ci ies (Model 1). When school bu nou , schoolwo k engagemen and academic pe o mance we e aken in o he model simul aneously, and he socioeconomic backg ound o he amily and school le el we e adjus ed o , he s eng h o he associa ions dec eased in mos cases, and some o he s a is ical significances disappea ed (Table 5, Model 4). In addi ion o daily smoking, we es ed he numbe o ciga e es ha we e smoked as a dependen a iable in Models 1 and 2. The findings we e simila o hose o daily smoking. Discussion Ou esul s showed ha a high le el o school bu nou and a low le el o schoolwo k engagemen , in addi ion o low academic pe o mance, we e s ong isk ac o s o daily smoking. Compa ison wi h p e ious s udies The associa ion be ween schoolwo k engagemen and smoking has no been s udied p e iously. Howe e , a ela ed concep , school engagemen , has been associa ed wi h smoking, and low school engagemen has been associa ed wi h a highe isk o smoking (Ca e e al., 2007; Wang &F ed icks, 2014). The associa ion be ween school bu nou and smoking has also no been s udied p e iously. Because o his lack o p e ious s udies, we compa ed ou esul s wi h hose o s udies on dep essi e symp oms and smoking. School bu nou Table 2 P e alence, % (n), o daily smoking by school bu nou , schoolwo k engagemen and academic pe o mance among all pa icipan s and by ci y, and p- alue. Va iable All Namu (BE) Tampe e (FI) Hanno e (GE) La ina (IT) Ame s oo (NL) Coimb a (PT) School bu nou Low 9.1 (136) 16.0 (40) 3.4 (7) 5.3 (9) 12.4 (35) 7.0 (14) 8.1 (31) A e age 13.1 (883) 16.9 (211) 10.0 (100) 9.3 (78) 18.2 (223) 6.9 (88) 16.0 (183) High 22.6 (411) 23.3 (85) 24.3 (60) 14.8 (39) 31.9 (139) 17.6 (60) 16.5 (28) p-Value <.001 .013 <.001 .003 <.001 <.001 <.001 Schoolwo k engagemen High 7.3 (111) 10.6 (24) 5.9 (27) 7.1 (7) 11.6 (32) 3.9 (6) 4.9 (15) A e age 12.7 (772) 16.6 (196) 12.8 (109) 8.4 (59) 17.5 (201) 5.7 (66) 13.8 (141) Low 22.7 (551) 26.6 (121) 23.4 (30) 12.5 (56) 31.7 (167) 18.1 (91) 23.4 (86) p-Value <.001 <.001 <.001 .049 <.001 <.001 <.001 Academic pe o mance High 8.0 (329) 13.2 (99) 1.7 (8) 2.7 (11) 10.6 (114) 6.2 (46) 7.8 (51) A e age 15.6 (653) 18.3 (132) 8.0 (42) 11.3 (72) 30.1 (229) 9.0 (81) 14.9 (97) Low 25.0 (443) 26.6 (119) 26.0 (112) 18.4 (46) 47.2 (68) 17.3 (34) 20.9 (64) p-Value <.001 <.001 <.001 <.001 <.001 <.001 <.001 Table 3 Age- and gende -adjus ed odds a io (OR) and 95% confidence in e al (CI) o daily smoking by school bu nou , schoolwo k engagemen and academic pe o mance in ou di e en models in all ci ies. Va iable Model 1 Model 2 Model 3 Model 4 School bu nou Low 1.00 1.00 1.00 1.00 A e age 1.51 (1.25, 1.83) 1.23 (1.01, 1.52) 1.27 (1.03, 1.58) 1.31 (1.06, 1.63) High 2.98 (2.41, 3.68) 1.88 (1.49, 2.37) 1.88 (1.48, 2.38) 1.98 (1.55, 2.52) Schoolwo k engagemen High 1.00 1.00 1.00 1.00 A e age 1.79 (1.45, 2.21) 1.53 (1.23, 1.91) 1.60 (1.27, 2.01) 1.59 (1.27, 2.00) Low 3.60 (2.89, 4.48) 2.65 (2.10, 3.35) 2.76 (2.17, 3.52) 2.74 (2.15, 3.49) Academic pe o mance High 1.00 1.00 1.00 1.00 A e age 1.91 (1.65, 2.20) 1.64 (1.41, 1.90) 1.63 (1.40, 1.91) 1.63 (1.40, 1.90) Low 3.11 (2.65, 3.66) 2.47 (2.09, 2.93) 2.35 (1.96, 2.80) 2.31 (1.93, 2.76) Model 1: School bu nou , schoolwo k engagemen and academic pe o mance sepa a ely, age- and gende -adjus ed. Model 2: School bu nou , schoolwo k engagemen and academic pe o mance a he same ime, age- and gende -adjus ed. Model 3: Model 2 adjus ed o FAS, MacA hu scale and pa en s' educa ion. Model 4: Model 3 adjus ed o school le el as a andom e ec . No e: he odds a io (OR) is in bold when i indica es a s a is ically significan (p.05) di e ence om he OR o he e e ence ca ego y. J.M. Kinnunen e al. / Jou nal o Adolescence 50 (2016) 56e6460 has been closely ela ed o dep essi e symp oms in longi udinal s udies (Salmela-A o, Sa olainen, &Holopainen, 2009), and dep essi e symp oms ha e been used as a concu en alidi y measu e o school bu nou (Salmela-A o, Kiu u, e al., 2009). In ea lie s udies, dep essi e symp oms we e associa ed wi h smoking (S eube &Danne , 2006; To ikka, Kal iala- Heino, Rimpel€ a, Rimpel€ a, &Ran anen, 2001), which eflec s ou esul s on he ela ionship be ween school bu nou and smoking. Ou s udy confi med p e ious findings ha associa ed low academic pe o mance wi h a highe likelihood o smoking among adolescen s (B yan e al., 2000; Pennanen e al., 2011; Schnoh e al., 2009). Ou s udy also confi med p e ious findings o posi i e co ela ions among school bu nou , schoolwo k engagemen and academic pe o mance (Salmela-A o & Upadaya, 2012; Salmela-A o, Kiu u, &Nu mi, 2008). Table 4 Age-adjus ed odds a io (OR) and 95% confidence in e al (CI) o daily smoking among boys and gi ls by school bu nou , schoolwo k engagemen and academic pe o mance in all ci ies. Va iable Model 1 Model 4 Boys Gi ls Boys Gi ls School bu nou Low 1.00 1.00 1.00 1.00 A e age 1.34 (1.04, 1.73) 1.76 (1.31, 2.36) 1.27 (.92, 1.74) 1.62 (1.11, 2.36) High 2.33 (1.74, 3.10) 3.87 (2.82, 5.31) 1.84 (1.28, 2.65) 2.56 (1.70, 3.88) Schoolwo k engagemen High 1.00 1.00 1.00 1.00 A e age 1.81 (1.32, 2.49) 1.76 (1.33, 2.32) 1.55 (1.06, 2.27) 1.56 (1.11, 2.20) Low 3.00 (2.17, 4.16) 4.37 (3.25, 5.88) 2.47 (1.66, 3.67) 3.09 (2.12, 4.49) Academic pe o mance High 1.00 1.00 1.00 1.00 A e age 1.68 (1.36, 2.07) 2.13 (1.75, 2.58) 1.56 (1.22, 2.00) 1.88 (1.48, 2.38) Low 2.66 (2.12, 3.33) 3.63 (2.89, 4.55) 2.13 (1.61, 2.82) 2.49 (1.86, 3.35) Model 1: School bu nou , schoolwo k engagemen and academic pe o mance sepa a ely, age- and gende -adjus ed. Model 4: School bu nou , schoolwo k engagemen and academic pe o mance a he same ime, adjus ed o age, gende , FAS, MacA hu scale and pa en s' educa ion and school le el as a andom e ec . No e: he odds a io (OR) is in bold when i indica es a s a is ically significan (p .05) di e ence om he OR o he e e ence ca ego y. Table 5 Age- and gende -adjus ed odds a io (OR) and 95% confidence in e al (CI) o daily smoking in each ci y by school bu nou , schoolwo k engagemen and academic pe o mance in wo models. Va iable Namu (BE) Tampe e (FI) Hanno e (GE) La ina (IT) Ame s oo (NL) Coimb a (PT) Model 1 School bu nou Low 1.00 1.00 1.00 1.00 1.00 1.00 A e age 1.07 (.74, 1.57) 3.13 (1.43, 6.84) 1.78 (.86, 3.70) 1.59 (1.08, 2.35) 1.06 (.59, 1.91) 1.86 (1.24, 2.79) High 1.60 (1.04, 2.46) 9.09 (4.05, 20.40) 2.96 (1.36, 6.41) 3.26 (2.15, 4.94) 2.96 (1.59, 5.51) 1.88 (1.08, 3.28) Schoolwo k engagemen High 1.00 1.00 1.00 1.00 1.00 1.00 A e age 1.70 (1.07, 2.69) 2.31 (1.49, 3.58) 1.19 (.52, 2.76) 1.69 (1.12, 2.53) 1.41 (.60, 3.32) 2.92 (1.68, 5.07) Low 3.21 (1.98, 5.22) 4.69 (2.65, 8.29) 2.00 (.86, 4.66) 3.69 (2.42, 5.63) 4.94 (2.11, 11.58) 5.12 (2.85, 9.18) Academic pe o mance High 1.00 1.00 1.00 1.00 1.00 1.00 A e age 1.33 (.99, 1.78) 5.38 (2.49, 11.62) 3.57 (1.85, 6.89) 3.33 (2.59, 4.30) 1.35 (.92, 1.97) 1.66 (1.15, 2.41) Low 1.87 (1.38, 2.55) 22.66 (10.8, 47.55) 5.49 (2.73, 11.03) 6.21 (4.19, 9.23) 2.70 (1.66, 4.38) 2.19 (1.43, 3.36) Model 4 School bu nou Low 1.00 1.00 1.00 1.00 1.00 1.00 A e age 1.04 (.69, 1.58) 4.06 (1.21, 13.63) 1.74 (.72, 4.18) 1.34 (.86, 2.10) 1.27 (.66, 2.42) 1.52 (.94, 2.44) High 1.47 (.91, 2.37) 6.57 (1.87, 23.12) 2.15 (.84, 5.50) 2.00 (1.23, 3.26) 2.90 (1.44, 5.83) 1.25 (.65, 2.40) Schoolwo k engagemen High 1.00 1.00 1.00 1.00 1.00 1.00 A e age 1.86 (1.12, 3.09) 1.27 (.77, 2.10) .77 (.31, 1.95) 1.61 (1.02, 2.56) 1.15 (.44, 3.02) 2.79 (1.49, 5.25) Low 3.38 (1.97, 5.81) 1.54 (.77, 3.08) 1.18 (.46, 2.99) 2.49 (1.51, 4.10) 3.20 (1.21, 8.46) 4.47 (2.25, 8.85) Academic pe o mance High 1.00 1.00 1.00 1.00 1.00 1.00 A e age 1.23 (.89, 1.69) 4.35 (1.89, 10.01) 5.28 (2.29, 12.17) 2.45 (1.83, 3.27) .91 (.60, 1.41) 1.59 (1.06, 2.38) Low 1.44 (1.01, 2.05) 14.61 (6.33, 33.75) 7.62 (3.12, 18.66) 3.42 (2.16, 5.41) 1.44 (.82, 2.52) 2.00 (1.25, 3.21) Model 1: School bu nou , schoolwo k engagemen and academic pe o mance sepa a ely, age- and gende -adjus ed. Model 4: School bu nou , schoolwo k engagemen and academic pe o mance a he same ime, adjus ed o age, gende , FAS, MacA hu scale, pa en s' educa ion and school le el as a andom e ec . No e: he odds a io (OR) is in bold when i indica es a s a is ically significan (p .05) di e ence om he OR o he e e ence ca ego y. J.M. Kinnunen e al. / Jou nal o Adolescence 50 (2016) 56e64 61 In e p e a ion o he esul s The associa ion be ween academic well-being and smoking emained when adolescen s' socioeconomic backg ound and academic pe o mance we e con olled o . Ou esul s sugges ha school bu nou , schoolwo k engagemen , and academic pe o mance a e mu ually independen isk ac o s o adolescen smoking. A ecen s udy e ealed ha emo ional engagemen in school and school bu nou a e sepa a e and dis inc psychological p ocesses ha con ibu e independen ly o adolescen s' academic and psychological ou comes (Wang, Chow, Ho kens, &Salmela-A o, 2015). The e a e se e al explana ions o why academic well-being and smoking a e associa ed. Fi s , he sel -sys em model (a mo i a ional amewo k based on he sel -de e mina ion heo y) (Deci &Ryan, 2000) s a es ha he ex en o which ado- lescen s a e engaged in school builds a mo i a ional con ex ha enables hem o deal wi h di ficul ies and ailu es in school (Skinne &Pi ze , 2012). Consequen ly, s uden s who ail o engage o school may seek solace in p oblem beha io s, such as smoking, which in u n may exace ba e hei disengagemen wi h school (Bachman e al., 2008). Wang and F ed icks (2014) showed ha he associa ion be ween school engagemen and p oblem beha io is bidi ec ional: changes in adolescen s' subs ance use a e p edic ed by hei ea ly le el o school engagemen , and changes in school engagemen a e p edic ed by ea ly subs ance use. Second, adolescen s' in es men s in heal h and educa ion include a ade-o be ween cu en cos s and u u e benefi s (Fuchs, 1982). I can be assumed ha indi iduals who a e mo e p esen -o ien ed a e less likely o in es in hei u u e heal h and educa ion: hey smoke mo e, a e less engaged in schoolwo k, and ha e a highe le el o school bu nou and lowe ac- ademic pe o mance. In addi ion, i can be specula ed ha he associa ion be ween academic well-being and smoking eflec s he a i udes and alues o adolescen s' amilies, which a ec s adolescen s' engagemen wi h schoolwo k and hei educa ion and school bu nou (see, e.g., Ca e e al., 2007; S einbe g, Lambo n, Do nbusch, &Da ling, 1992). Thi d, ou s udy analyzed he associa ions on an indi idual le el, bu he obse ed associa ions could be ein o ced by p ocesses a a g oup le el and in ne wo ks wi hin schools. G oup-le el and ne wo k heo ies explaining adolescen smoking (Ho man, Sussman, Unge , &Valen e, 2006) sugges he selec ion o pee s and he o ma ion o iendship g oups by such cha ac e is ics as smoking (DeLay, Lau sen, Kiu u, Salmela-A o, &Nu mi, 2013; Ho man, Monge, Chou, &Valen e, 2007), academic pe o mance (Kiu u, Nu mi, Aunola, &Salmela-A o, 2009), school bu nou (Kiu u e al., 2008) and school engagemen (Kinde mann, 2007). Subcul u es in schools, e.g., g oups o adolescen s wi h poo school success, cynicism, eelings o inadequacy abou schoolwo k (bu nou ), and less in e es in schoolwo k (engagemen ), may induce exposed s uden s o pa icipa e in isk- aking and non-no ma i e beha io s. S eng hs and limi a ions Ou s udy has many s eng hs. Academic well-being was measu ed wi h he same school su ey design and ins umen s in he same age g oups. The sample selec ion was as simila as possible, and he s udy was conduc ed in he same yea in each ci y. In addi ion, he numbe o pa icipan s was la ge, and he pa icipa ion a e was high. The e a e also some limi a ions in ou s udy. We canno exclude he possibili y ha he di e ences be ween he ci ies in he le el o school bu nou and schoolwo k engagemen a e ela ed o di e ences in he alidi y o he su ey ins umen s ha we used in di e en cul u al se ings. These ins umen s ha e no been used in c oss-cul u al s udies be o e. Howe e , an ins umen wi h small p oblems in alidi y may s ill gi e alid esul s ega ding he ela ionship wi h smoking. Di e en educa ional sys ems and classifica ions o academic pe o mance esul ed in di e en p opo ions o high academic pe - o mance among he coun ies, which may ha e a ec ed he esul s. The highe p opo ion o high academic pe o mance in La ina (IT) may be ela ed o a highe p opo ion o gi ls among hei pa icipan s because in many cases, gi ls ge highe g ades. We we e no able o con ol o ex e nalizing beha io s (agg ession, delinquency o hype ac i i y; Liu, 2004), which a e known o be associa ed wi h bo h smoking (King, Iacono, &McGue, 2004; Modes o-Lowe, Dan o h, Nee ing, &Eas on, 2010) and low academic pe o mance (Hinshaw, 1992). Because school adjus men has been ound o media e he associa ion be ween a en ion defici /hype ac i i y diso de (ADHD) symp oms and smoking (Flo y, Malone, &Lamis, 2011), hese ex e nalizing beha io s can be conside ed possible con ounde s o he associa ion be ween academic well-being and smoking. Howe e , he p e alence is no e y high, e.g. o ADHD wi h medica ion, he es ima ed p e alence is 4.8% o child en be ween 4 and 17 yea s o age (Polanczyk, Willcu , Salum, Kieling, &Rohde, 2014). Al hough he selec ed ci ies in each coun y we e a e age ones, we canno exclude he possibili y ha some o he ci ies may no ep esen he en i e coun y. The a ying esponse a es among coun ies is also a limi a ion. The somewha lowe esponse a es in Ge many and I aly we e due o he equi emen o ac i e pa en al consen in hese coun ies. Finally, we used sel - epo ed da a, and smoking beha io may be unde epo ed due o he desi e o p o ide socially accep able answe s in he class oom (K umpal, 2013), leading o an unde es ima ion o smoking and i s associa ion wi h school bu nou , schoolwo k engagemen and academic pe o mance. In his s udy, smoking was no c oss-checked by biochemical me hods, bu p e ious s udies on adolescen s' sel - epo ing abou smoking ha e been shown o be accu a e and in ag eemen wi h biochemical measu es (Dolcini, Adle , Lee, &Bauman, 2003; Ken ala, U iainen, Pahkala, &Ma ila, 2004; Pos e al., 2005). Despi e hese limi a ions, ou s udy showed a simila pa e n in associa ions be ween academic well-being and smoking ac oss six Eu opean ci ies, which likely eflec s a gene al pa e n in Eu ope. Howe e , mo e s udies a e needed o e i y he J.M. Kinnunen e al. / Jou nal o Adolescence 50 (2016) 56e6462 gene alizabili y o hese findings and o ad ance he compa isons in e na ionally. Longi udinal designs would p o ide be e answe s ha could e eal he causali y and pa hways behind hese associa ions. Conclusions Ou esul s show a s ong associa ion be ween s uden s' poo academic well-being and daily smoking. In addi ion o academic pe o mance, academic well-being is an impo an ac o in shaping s uden s' heal h beha io s. To he ex en ha hese associa ions eflec a causal e ec , hey may imply ha p omo ing child en's academic well-being in he ea ly school yea sd ha is, inc easing hei engagemen wi h schoolwo k and lowe ing hei eelings o inadequacy and cynicism owa d schooldcould p o ide a bu e agains smoking. In a way, such a s a egy could help o “kill wo bi ds wi h one s one”by p e en ing smoking and imp o ing academic pe o mance. Funding This s udy was pa o he p ojec ‘Tackling socio-economic inequali ies in smoking (SILNE)’, which was financed by he Eu opean Commission unde he Se en h F amewo k P og amme, g an iden ifica ion numbe 278273. The unding sou ce had no in ol emen in he s udy design; he collec ion, analysis o in e p e a ion o he da a; he w i ing o he epo ; o he decision o submi he a icle o publica ion. Acknowledgemen s We hank he adolescen s and schools in Namu , Tampe e, Hanno e , La ina, Ame s oo and Coimb a o pa icipa ing in he SILNE su ey. We also hank Ame ican Jou nal Expe s o edi ing he manusc ip . Re e ences Bachman, J. G., O'Malley, P. M., Schulenbe g, J. E., Johns on, L. D., F eedman-Doan, P., & Messe smi h, E. E. (2008). The educa ioned ug use connec ion: How successes and ailu es in school ela e o adolescen smoking, d inking, d ug use, and delinquency. Mahwah, NJ: E lbaum. Bo ello-Ha baum, M., Haynie, D. L., Mu ay, K. W., & Ianno i, R. J. (2010). 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