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Background A non-negligible proportion of Swedish students is recurrently absent from school due to various health problems. Recurring absence from school has potentially severe consequences for future prospects. Thus, identifying factors that may contribute to counteracting recurring sickness absence among students is important. The aim of this study was to investigate whether higher levels of teacher-reported school ethos were associated with lower levels of recurring sickness absence among their students, when adjusting for relevant confounders at the student- and the school-level. Methods Data from four cross-sectional surveys performed in 2014 and 2016 were combined. The Stockholm School Survey was carried out among 9,298 ninth grade students (ages 15-16 years) in 147 school units, and the Stockholm Teacher Survey was performed among 2,024 teachers in the same units. School ethos was captured by an index of 12 teacher-reported items that was aggregated to the school-level. Recurring student sickness absence was based on self-reports and defined as absence on &amp;gt; 10 occasions during the current school year. Student-level control variables were gender, family structure, parental education, parental unemployment and migration background. School-level control variables were sociodemographic composition and student-teacher ratio. Two-level logistic regressions were performed. Results About 9.5% of the students reported recurrent sickness absence. Students attending schools with higher levels of teacher-rated school ethos had a lower likelihood of reporting recurring sickness absence compared with those attending schools with lower levels of ethos, even when adjusting for potential confounders at the student- and the school-level (OR 0.78, p = 0.015). Conclusions Recurring sickness absence was less common among students attending schools with higher levels of teacher-rated ethos. The findings suggest that schools have the capacity to promote student health. Key messages A strong school ethos was linked with lower levels of recurring sickness absence among the students, even when adjusting for potential confounders at the student- and the school-level. A strong school ethos may contribute to counteracting recurring sickness absence among students.

School ethos and recurring sickness absence: a multilevel study of ninth grade students in Stockholm