In order to prevent teens from smoking, we need to consider the environment where they spend most of their time each day, according to a Scottish study published in the journal BMC Public Health. The study’s researchers examined how smoking rates varied from school to school, and their results indicate that a school’s environment along with the quality of its teacher-student relationships can affect the chances that a student will smoke.

The researchers focused on the perceptions of over 5,000 Scottish students from 24 high schools, interviewing them when they were 13 or 14 years old and then again when they were 15 or 16. In addition to smoking-related questions, they asked the students to rate their school and describe their relationships with teachers and other students. Teachers from each school also provided input on the school’s culture and students’ attitudes toward the school. By the time they were 16, 25 percent of the boys in the study and 39 percent of the girls reported being smokers, although a large amount of variation existed in the smoking behavior evident in each school, with smoking rates ranging from 8 percent to 33 percent for boys and from 28 percent to 49 percent for girls.

After adjusting for other factors that could have affected smoking rates, such as socioeconomic background, the school’s geographic location, and the number of students who already smoked when they entered high school, the researchers found that when teens or teachers rated their school poorly or criticized student-teacher relationships, the students were more likely to be smokers. Additionally, smoking rates were higher among schools with the worst overall ratings. This association was larger for boys and smaller, though still statistically-significant, for girls.

In a report released last month, the CDC announced that teen smoking rates in the US have leveled off after years of decline, and researchers must continue to work toward a better understanding of the risk factors for smoking and the most effective ways to help those most likely to become smokers. While some of this study’s findings will not generalize to American teens, the ideas it advocates may very well hold true. Many factors influence a teen’s decision to smoke, and while preventative programs often target teens with specific risk factors, such as the presence of friends and family who smoke, this study indicates that the school environment itself can contribute to smoking rates. Schools can make changes to promote healthy decisions while discouraging smoking, particularly by ensuring that teachers and students develop relationships based on respect. School health lessons might be beneficial in keeping some students from smoking and convincing teens who already smoke to quit, especially if a trusted teacher delivers the message.