ArticleBMC public health2026
Context, mechanisms, and outcomes of smoke-free school hours in social and health care vocational schools: a realist informed qualitative analysis.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundComprehensive school tobacco policies can reduce young people’s smoking, but evidence from upper secondary school settings with high smoking prevalence is limited. A smoke-free school hours policy was tested across different Danish vocational school types with the intended outcome of reduced smoking only observed among students at social and health care vocational schools. This study examines the contextual factors and mechanisms shaping smoking-related outcomes in this setting.
methodsWe analyzed interview transcripts from six semi-structured focus group interviews with social and health care vocational students (N = 41) conducted in 2018–2019. Using a realist evaluation perspective, we did a thematic analysis followed by Context–Mechanism–Outcome configurations to examine how outcomes were generated through interactions between contextual conditions and underlying mechanisms. To analyze and identify mechanisms, we used the heuristic tool of distinguishing between the resources offered by the intervention, and the reasoning of the students in response.
resultsWe identified five overall Context-Mechanism-Outcome configurations illustrating pathways through which smoke-free school hours produced different outcomes. Contextual conditions such as students’ professional orientation and expectations of future smoke-free workplaces activated mechanisms of trust in schools’ intentions and perceived policy meaningfulness, leading to acceptability and reduced smoking during school hours. Conversely, contexts characterized by strong beliefs in smoking as an individual responsibility and weak enforcement activated mechanisms related to perceived loss of autonomy, low perceived need for intervention, and low perceived risk of sanctions, resulting in policy disapproval, resistance, continued smoking, and increased smoking during school hours.
conclusionsThe findings show that the implementation of smoke-free school hours is highly context-dependent and operates through mechanisms that can generate both intended and unintended outcomes. Successful implementation in vocational school settings requires alignment with students’ professional identities, consistent enforcement, and communicative strategies to consider students’ attitudes and beliefs. Realist evaluation adds critical insight into how and why smoke-free school policies succeed or fail to inform future context-sensitive implementation strategies.
trial registrationNot applicable.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.