Introduction:
Prevention of youth smoking is a cornerstone of tobacco control policies, where schools have a crucial role to play. However, the well-known long-term consequences of adolescent smoking may be insufficient to convince education stakeholders to implement tobacco control policies at school level. Although they may be individually aware of public health issues, they may hardly devote much time to efforts for which they will not be rewarded. In this paper, we investigate the link between smoking behaviors and school attendance.

Material and Methods:
We performed logistic regressions on the risk of more than three missed school days, by cause, as function of daily smoking, adjusting for age, sex, socioeconomic status, academic performance, parental involvement, and other risk behaviours. Then, generalized linear models were estimated on the number of missed days, by cause, as function of regular smoking, adjusting for the same covariates. The consistency of results was assessed by replicating the analyses for each sex and age group.

Results:
Daily smoking was significantly linked to school absenteeism, with a 43% excess risk of more than three missed school days per month due to illness (OR=1.43, IC95% 1.37-1.49), and a 86% excess risk due to skipping (OR=1.86; IC95% 1.78-1.95). Daily smoking was also linked to a 26% excess number of monthly missed days due to illness (beta=0.26; IC95% 0.24-0.29), and to a 66% excess number of monthly missed days due to skipping (beta=0.66; IC95% 0.64-0.69). These findings were consistent across age and sex groups.

Conclusions:
By showing the link between daily smoking and absenteeism, we argue that smoking may also be upholding school performance, and thus bringing short-term damaging effects to the adolescents.

Funding Statement:
This project was financed the European Union’s Horizon 2020 research and innovation programme (SILNE-R, Grant Agreement number 635056)