Introduction:
School anti-tobacco policies (SAPs) that limit smoking during school hours are increasingly common. Notwithstanding, adolescents may continue smoking by adapting the patterns in where, when and with whom they smoke, and the social meanings about why. We therefore aimed to identify and understand which patterns occur and how these collective smoking lifestyles may contribute to persisting smoking at schools implementing SAPs. Methods

Methods:
A qualitative design was used to compare two Dutch vocational schools with a contrasting smoking prevalence. Four focus group discussions were held with adolescents who smoke or were susceptible to smoking. Fourteen interviews were held with individual adolescent smokers. The analysis focussed on identifying the collective smoking lifestyles in each school.

Results:
The high prevalence, in contrast to the low prevalence, school implemented strict SAPs and adolescents perceived a strong anti-smoking norm. Two collective smoking lifestyles at the high prevalence school were identified. ‘Dependent smoker’: smoking in a large group at the official smoking area helps to deal with stress and nicotine addiction. ‘Rebellious smoker’: smoking in friendship groups outside the school premises expresses toughness. Three collective smoking lifestyles at the low prevalence school were identified. ‘Social bonding smoker’: boys’ daily smoking outside the premises is an indispensable part of group membership that creates a smoking-tolerant environment. ‘Good smoker’: girls’ occasional smoking outside the premises for so-called personal pleasure prevents others from thinking they are addicted or smoke to impress. ‘Smoking-friendly event smoker’: adolescents smoking only after school hours at smoking-friendly events makes them feel free to smoke without risking social consequences.

Conclusions:
Collective smoking lifestyles may decrease SAPs’ impact by allowing adolescents to collectively adapt their smoking patterns and the social meanings for justifying these patterns. These collective smoking lifestyles are less persistent when SAPs limit adolescents’ opportunities to adapt their smoking patterns and adolescents perceive a strong anti-smoking norm.