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Lareyre O, Cousson-Gélie F, Pereira B, Stoebner-Delbarre A, Lambert C, Gourlan M. Effect of a peer-led prevention program (P2P) on smoking in vocational high school students: Results from a two-school-year cluster-randomized trial. Addiction 2024. [PMID: 38780044 DOI: 10.1111/add.16528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/17/2024] [Indexed: 05/25/2024]
Abstract
AIMS The aim of this work was to measure the impact of P2P (i.e. peer-to-peer), a peer-led smoking prevention intervention, on daily smoking prevalence of adolescents over 2 school years. DESIGN A cluster-randomized controlled trial was performed over a 16-month follow-up (trial status: closed to follow-up). P2P was implemented 1-3 and 13-15 months after baseline. Assessments took place at baseline and 4, 10 and 16 months after baseline. The research team, assessors and adolescents were blinded to the study-arm assignment only at baseline. SETTING Fifteen vocational high schools in France were randomized into two clusters, using a 1:1 allocation ratio per French department (n intervention = 7, n control = 8). PARTICIPANTS Participants comprised a sample of 2010 students in year 11 (i.e. 15-16 years) in vocational high schools. A total of 437 students could not be assessed at baseline (absent or left school), yielding a total sample of 1573 students (n intervention = 749, n control = 824). INTERVENTION AND COMPARATOR The P2P programme trained voluntary students to become peer educators and design smoking prevention actions for their schoolmates in the intervention group (n = 945 students), compared with a passive control group (n = 1065 students). MEASUREMENTS The primary outcome was change from baseline in the prevalence of self-reported daily smoking (i.e. at least one cigarette per day) at 16 months. FINDINGS The 'time × group' interaction indicated that, compared with the control group, the intervention group had statistically significantly fewer daily smokers after 16 months [odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.20, 0.53]. Similarly, compared with the control group, the intervention group had statistically significantly fewer daily smokers after 4 months (OR = 0.50, 95% CI = 0.30, 0.82) and 10 months (OR = 0.60, 95% CI = 0.37, 0.98). No adverse events of P2P2 were reported. CONCLUSIONS A cluster-randomized trial found evidence that the peer-led P2P (peer-to-peer) smoking prevention intervention reduced the uptake of daily smoking among high school students in France over 16 months.
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Affiliation(s)
- Olivier Lareyre
- Epidaure-Prevention Department of the Montpellier Cancer Institute, Montpellier Cancer Institute, Montpellier, France
- Univ. Paul Valéry Montpellier 3, EPSYLON UR 4556, F34000, Montpellier, France
| | - Florence Cousson-Gélie
- Epidaure-Prevention Department of the Montpellier Cancer Institute, Montpellier Cancer Institute, Montpellier, France
- Univ. Paul Valéry Montpellier 3, EPSYLON UR 4556, F34000, Montpellier, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Biostatistics Unit, DRCI, Clermont-Ferrand, France
| | - Anne Stoebner-Delbarre
- Onco-Addiction and Patient Education Unit-Supportive Care Department, Montpellier Cancer Institute, Montpellier, France
| | - Céline Lambert
- CHU Clermont-Ferrand, Biostatistics Unit, DRCI, Clermont-Ferrand, France
| | - Mathieu Gourlan
- Epidaure-Prevention Department of the Montpellier Cancer Institute, Montpellier Cancer Institute, Montpellier, France
- Univ. Paul Valéry Montpellier 3, EPSYLON UR 4556, F34000, Montpellier, France
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Kjeld SG, Glenstrup S, Andersen S, Bast LS. From a teacher and school leader perspective: What happened with smoking rules and practices during a three-year smoking preventive intervention? - Findings from the X:IT II study. EVALUATION AND PROGRAM PLANNING 2023; 97:102236. [PMID: 36645953 DOI: 10.1016/j.evalprogplan.2023.102236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/16/2022] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND School-based smoking preventive interventions are most effective if they consist of multiple components; one of them being strict anti-smoking rules, i.e., no smoking by anyone at any location during school hours. However, there is a lack of in-depth knowledge about how smoking practices and rules about smoking actually change over time. Therefore, the purpose of this study was to examine how smoking practices changed during a three-year period in which a smoking preventive intervention with strict anti-smoking rules was implemented at schools. METHODS We used data from 46 Danish schools that were enrolled in the evaluation of the X:IT II study - a smoking preventive intervention with three main components: one of them being strict anti-smoking rules. We collected questionnaire data among school employees at four timepoints from the autumn of 2017 until April 2020. The questionnaire covered topics regarding students' and employees' tobacco patterns at the school, control with smoking, and aspects of the intervention delivery. RESULTS Over time, student smoking rules got stricter; from three out of four at baseline to almost all schools having rules about no student smoking during school hours three years later. Employee smoking rules also changed, although not as much as student rules. Overall, smoking at school grounds seemed to decline - however, student smoking at other locations increased, hence, violating the rule about no smoking during school hours. Enforcement of smoking rules also increased over time. CONCLUSION Although implementing and enforcing new rules in a school setting may be difficult, it seemed that most schools in the X:IT II study changed their rules and smoking practices for both students and employees over the three-year intervention period. It seemed, however, that students relocated their smoking to other places than the school or just outside school grounds. Implications of these findings are important to consider in future interventions, i.e., students leaving school during school hours to smoke and the physical separation between those who smoke and those who do not.
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Affiliation(s)
- S G Kjeld
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - S Glenstrup
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - S Andersen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - L S Bast
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark.
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Kjeld SG, Thygesen LC, Danielsen D, Jakobsen GS, Jensen MP, Holmberg T, Bast LS, Lund L, Pisinger C, Andersen S. Effectiveness of the multi-component intervention 'Focus' on reducing smoking among students in the vocational education setting: a cluster randomized controlled trial. BMC Public Health 2023; 23:419. [PMID: 36864450 PMCID: PMC9979485 DOI: 10.1186/s12889-023-15331-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 02/27/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Social inequality in smoking remains an important public health issue. Upper secondary schools offering vocational education and training (VET) comprise more students from lower socioeconomic backgrounds and have higher smoking prevalence than general high schools. This study examined the effects of a school-based multi-component intervention on students' smoking. METHODS A cluster randomized controlled trial. Eligible participants were schools offering VET basic courses or preparatory basic education in Denmark, and their students. Schools were stratified by subject area and eight schools were randomly allocated to intervention (1,160 invited students; 844 analyzed) and six schools to control (1,093 invited students; 815 analyzed). The intervention program comprised smoke-free school hours, class-based activities, and access to smoking cessation support. The control group was encouraged to continue with normal practice. Primary outcomes were daily cigarette consumption and daily smoking status at student level. Secondary outcomes were determinants expected to impact smoking behavior. Outcomes were assessed in students at five-month follow-up. Analyses were by intention-to-treat and per protocol (i.e., whether the intervention was delivered as intended), adjusted for covariates measured at baseline. Moreover, subgroup analyses defined by school type, gender, age, and smoking status at baseline were performed. Multilevel regression models were used to account for the cluster design. Missing data were imputed using multiple imputations. Participants and the research team were not blinded to allocation. RESULTS Intention-to-treat analyses showed no intervention effect on daily cigarette consumption and daily smoking. Pre-planned subgroup analyses showed statistically significant reduction in daily smoking among girls compared with their counterparts in the control group (OR = 0.39, 95% CI: 0.16, 0.98). Per-protocol analysis suggested that schools with full intervention had higher benefits compared with the control group (daily smoking: OR = 0.44, 95% CI: 0.19, 1.02), while no marked differences were seen among schools with partial intervention. CONCLUSION This study was among the first to test whether a complex, multicomponent intervention could reduce smoking in schools with high smoking risk. Results showed no overall effects. There is a great need to develop programs for this target group and it is important that they are fully implemented if an effect is to be achieved. TRIAL REGISTRATION https://www.isrctn.com/ISRCTN16455577 , date of registration 14/06/2018.
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Affiliation(s)
- Simone G Kjeld
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark.
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Dina Danielsen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Gitte S Jakobsen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Marie P Jensen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Teresa Holmberg
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Lotus S Bast
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Lisbeth Lund
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Denmark.,Faculty of Health Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Danish Heart Foundation, Copenhagen, Denmark
| | - Susan Andersen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
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Andersen MB, Kjeld SG, Bast LS. Changes in Cigarette Smoking and Smokeless Tobacco Use During the Coronavirus Disease 2019 Lockdown Period Among Youth and Young Adults in Denmark. Nicotine Tob Res 2022; 25:298-308. [PMID: 36000931 PMCID: PMC9452126 DOI: 10.1093/ntr/ntac203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 08/01/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Cigarettes and smokeless tobacco (snus and nicotine pouches) are prevalent among youth and young adults in Denmark. Here, we examined the extent of changes in the use of cigarettes and smokeless tobacco during the first Coronavirus Disease 2019 (COVID-19) lockdown in March and April 2020 in Denmark as well as reasons for changed behavior. AIMS AND METHODS This study used data from a nationwide survey conducted among 15- to 29-year-olds from January to March 2021 including 13 530 respondents (response rate = 36.0%). Logistic regression analyses assessed the associations between sociodemographic characteristics and the odds of initiating or increasing as well as trying to stop or decreasing cigarette smoking and smokeless tobacco use. RESULTS The prevalence of cigarette smoking was 17.8% and 10.5% reported using smokeless tobacco. Around 40% of those currently smoking cigarettes reported smoke on par during the COVID-19 lockdown as before, 24.5% started to smoke or increased their smoking, and 27.4% tried to stop or smoked less. Approximately 37% used smokeless tobacco on the same level as, before the COVID-19 lockdown, 38.8% initiated or used more, and 14.1% tried to stop or used less. Females were more prone to initiate smokeless tobacco use and increase their level of smoking during the lockdown, and younger participants smoked less. More females compared with males changed their smoking behaviors because of their mood, and more younger participants did so because of fewer social gatherings. CONCLUSION Although most youths and young adults' tobacco behaviors remained the same during the COVID-19 lockdown, many also increased or decreased their behaviors-especially females and younger participants. IMPLICATIONS This study enables the possibility of detecting new tendencies in smoking and the use of smokeless tobacco among subgroups of the population during the COVID-19 lockdown. This knowledge is crucial for identifying which groups of youths are vulnerable to increasing their tobacco use in other pandemic situations and which groups call for special attention after the lockdown period. Future efforts may focus on vulnerable groups affected by the COVID-19 pandemic, such as females, and there is a need to monitor closely whether youth tobacco use changes as society becomes more normalized.
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Affiliation(s)
- Marie Borring Andersen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen K, Denmark
| | - Simone G Kjeld
- Corresponding author: Simone G. Kjeld, MSc, National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen K, Denmark, E-mail:
| | - Lotus S Bast
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen K, Denmark
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Bast LS, Klitgaard MB, Kjeld SG, Jarlstrup NS, Christensen AI. Use of Tobacco and Nicotine Products among Young People in Denmark-Status in Single and Dual Use. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5623. [PMID: 35565011 PMCID: PMC9099614 DOI: 10.3390/ijerph19095623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 12/02/2022]
Abstract
Lots of new tobacco or nicotine products are being launched, e.g., e-cigarettes and smokeless tobacco, which appeal especially to the youngest part of the population. For example, the use of smokeless tobacco among Danish youth rose from approx. 2% in 2010 to 9% in 2020. Hence, there is an urgent need to follow and intervene against youth tobacco or nicotine product use. This study explored the current use of cigarettes, e-cigarettes, heated tobacco, and smokeless tobacco among Danish 15- to 29-year-olds. Further, we examined the concurrent use of two products or more. We used a nationwide survey conducted among 15- to 29-year-olds in February and March 2020. Overall, approx. 35,700 individuals received the questionnaire of which 35.5% responded (n = 13,315). One out of five (20.1%) smoked cigarettes, half of them daily, the other half occasionally. About one in twenty (3.9%) used e-cigarettes (daily or occasionally), and more than one in three (31.6%) had tried e-cigarettes. The use of heated tobacco among Danish youth is still relatively limited (0.3%). In comparison, about 9% used smokeless tobacco (daily or occasionally). Overall, 27.0% stated that they use at least one type of tobacco or nicotine product, while 5.6% used more than one product. Monitoring tobacco-related behavior in youth provides extremely important information for, e.g., policymakers and health professionals.
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Affiliation(s)
- Lotus Sofie Bast
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark; (M.B.K.); (S.G.K.); (N.S.J.); (A.I.C.)
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Kjeld SG, Lund L, Madsen KR, Damsgaard MT, Bast LS. Trends in Use of Alcohol and Cigarettes among Danish Adolescents, 2002-2018: Exclusive and Dual Use. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063490. [PMID: 35329173 PMCID: PMC8951320 DOI: 10.3390/ijerph19063490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 12/04/2022]
Abstract
Many young adolescents experiment with substance use which can have substantial health implications later in life. This study examined trends in substance use among Danish adolescents from 2002 to 2018, including exclusive and dual current use of alcohol and cigarettes. Data on 13- and 15-year-olds (N = 15,295) from five comparable cross-sectional Health Behavior in School-aged Children (HBSC) surveys were used. Cochran-Armitage test for trend assessed the development in substance use patterns over time. Overall, a decreasing trend in current use of alcohol and cigarettes was found among Danish adolescents during the 16-year study period: from 71.7% in 2002 to 51.6% in 2018. In 2018, most adolescents (41.8%) currently used alcohol exclusively, 8.6% had a dual current use of cigarettes and alcohol, and 1.3% smoked cigarettes exclusively. Trends in alcohol use differed according to age groups, while no gender-specific trends in substance use were found. Findings suggest that a significant prevention potential in adolescent substance use remains, and future initiatives may focus on dual use of substances as well as tailored efforts to specific subgroups in high risk of using substances.
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Kjeld SG, Lund L, Andersen S, Bast LS. Socioeconomic Differences in Cigarette Smoking and Alternative Tobacco Product Use Among Adolescents in a School-Based Smoking Preventive Intervention: Findings From the Second Year of the X:IT II Study. Front Public Health 2022; 10:825585. [PMID: 35265577 PMCID: PMC8900944 DOI: 10.3389/fpubh.2022.825585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background Health interventions may differently impact adolescents from diverse backgrounds. This study examined whether a smoking preventive intervention was equally effective in preventing cigarette smoking and use of alternative tobacco products (ATPs, i.e., snus, e-cigarettes, and waterpipe) among students from different socioeconomic backgrounds, i.e., occupational social classes (OSC). Methods Data was from the school-based intervention X:IT II targeting 13- to 15-year-olds Danes. The intervention focused on three main components: smoke-free school time, smoke-free curriculum, and parental involvement. In total, 46 schools were included at baseline (N = 2,307, response rate = 86.3%). Using a difference-in-differences approach, changes in current smoking and ever use of ATPs were estimated among students in high versus low OSC at second follow-up. Analyses were based on available cases (N = 826) and multiple imputations of missing data at the second follow-up (N = 1,965). Results At baseline (age 13), 1.0% of students from high OSC and 4.8% from low OSC currently smoked cigarettes, while this was the case among 24.5 and 25.6%, respectively, at the second follow-up (age 15). Estimates indicated that social inequalities in current smoking diminished over time (p < 0.001). Regarding ATPs, 10.0% of high OSC students and 13.9% of low OSC students had ever used ATPs at baseline, while at second follow-up, 46.8 and 60.8%, respectively, had ever used ATPs. Estimates indicated that social inequalities in ever use of ATPs widened over time (p < 0.001). Conclusions The X:IT II intervention seemed to diminish socioeconomic disparities in smoking over the study period. Meanwhile, social inequalities in ever use of ATPs increased. Therefore, besides focusing on narrowing the social disparities in cigarette smoking, future efforts may, to a larger extent, focus on adolescents' use of ATPs.
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Affiliation(s)
- Simone Gad Kjeld
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Chronic backpain among adolescents in Denmark: trends 1991-2018 and association with socioeconomic status. Eur J Pediatr 2022; 181:691-699. [PMID: 34529135 DOI: 10.1007/s00431-021-04255-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
Chronic backpain among adolescents is important because the prevalence is high, above 10%, and more than 10% of all adolescents experience impacts on important day-to-day activities. Chronic backpain tracks into adulthood and is associated with several health problems. The objective was to study trends in the prevalence of chronic backpain among adolescents 1991-2018, to examine the association with socioeconomic status (SES), and whether this association changed over time. The study used data from eight comparable cross-sectional school surveys of nationally representative samples of 11-15-year-olds in 1991, 1994, 1998, 2002, 2006, 2010, 2014, and 2018, which constitute the Danish arm of the international Health Behaviour in School-aged Children (HBSC) study. The participation rate was 74.6% of the eligible study population, n = 29,952. Chronic backpain was defined as self-reported backpain daily or several days a week during the last 6 months. The prevalence of chronic backpain was 11.1%, significantly increasing from 8.9% in 1991 to 11.7% in 2018. The OR for chronic backpain was 1.20 (95% CI: 1.10-1.31) in middle, and 1.56 (95% CI: 1.41-1.73) in low compared to high SES. Sensitivity analyses with two other cut-points for backpain frequency showed similar associations.Conclusion: Chronic backpain is common among adolescents and the prevalence increased from 1991 to 2018. The prevalence was highest in lower SES families. We recommend increased efforts to prevent chronic backpain. What is Known: • Chronic backpain among adolescents is common, has a high burden of disability, is associated with several health problems, and tracks into adulthood. What is New: • The prevalence of chronic backpain among adolescents in Denmark increased from 8.9% in 1991 to 11.7% in 2018. • The prevalence was highest among adolescents from lower SES families.
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Strizek J, Uhl A, Schaub M, Malischnig D. Alcohol and Cigarette Use among Adolescents and Young Adults in Austria from 2004-2020: Patterns of Change and Associations with Socioeconomic Variables. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413080. [PMID: 34948689 PMCID: PMC8701464 DOI: 10.3390/ijerph182413080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022]
Abstract
Background: Adolescents and young adults are a crucial target group for preventing harm related to substance use. Recently, declining alcohol and tobacco consumption in young people has been observed in many countries. Based on survey data from 2004 to 2020, we describe time trends for several subgroups of adolescents and young adults (based on consumption levels and socioeconomic variables) and analyze associations between the level of alcohol per capita consumption or daily smoking and socioeconomic variables. Methods: Time trends for males and females are analyzed by a two-way ANOVA and predictors of use by using multivariate regression and logistic regression. Results: Alcohol per capita consumption decreased significantly for both sexes in the 16-year period, with male and female consumption levels converging. Daily smoking was equally prevalent for young males and females and decreased to a similar degree for both sexes. Being male and living in rural areas are associated with a higher level of alcohol consumption. Daily smoking is associated with a low level of education and is more prevalent among young adults who have already started to work. Conclusions: The decline in alcohol use and daily smoking among adolescents and young adults is taking place simultaneously. However, higher levels of alcohol consumption and daily smoking occur in different groups of adolescents and young adults, which should be considered in prevention strategies.
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Affiliation(s)
- Julian Strizek
- Gesundheit Österreich GmbH (Austrian Public Health Institute), 1010 Vienna, Austria;
- Correspondence: (J.S.); (D.M.); Tel.: +43-1-51561-148 (J.S.); +43-1-4000-87321 (D.M.)
| | - Alfred Uhl
- Gesundheit Österreich GmbH (Austrian Public Health Institute), 1010 Vienna, Austria;
- Faculty of Psychotherapy Science, Sigmund Freud University Vienna, 1020 Vienna, Austria
| | - Michael Schaub
- Swiss Research Institute of Public Health and Addiction (ISGF), University of Zürich, 8006 Zurich, Switzerland;
| | - Doris Malischnig
- Institute for Addiction Prevention, Office of Addiction and Drug Policy of Vienna, 1030 Vienna, Austria
- Correspondence: (J.S.); (D.M.); Tel.: +43-1-51561-148 (J.S.); +43-1-4000-87321 (D.M.)
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Jørgensen SE, Thygesen LC, Michelsen SI, Due P, Bidstrup PE, Høeg BL, Andersen A. Why Do Some Adolescents Manage Despite Parental Illness? Identifying Promotive Factors. J Adolesc Health 2021; 69:335-341. [PMID: 34024713 DOI: 10.1016/j.jadohealth.2020.12.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to examine the association between social support, leisure time, school experience, and well-being among adolescents with an ill parent. Moreover, we explored the cumulative effect of promotive factors in relation to well-being. METHODS The population included a subsample of 676 students reporting serious or chronic parental illness, selected from a nationwide Danish survey, the Well-being Despite Study. Well-being was measured by the five-item World Health Organization Well-Being Index. Social support included support from parents, siblings, and friends. A positive school experience encompassed trust in teachers, classroom community, and overall judgment of the school. Leisure time included frequency of activities and having enough time for friends and oneself. We performed multilevel logistic regression analyses using SAS 9.4. RESULTS Social support, a positive school experience, and leisure time were positively associated with well-being. For instance, for boys and girls who felt they had enough time to themselves, the odds ratio of moderate to high well-being was 3.7 (95% confidence interval [CI]: 1.8-7.7) and 2.9 (95% CI: 1.9-4.3) respectively, compared with boys and girls who did not. Cumulative analyses showed increasing odds of moderate to high well-being with increasing number of promotive factors, the odds ratio being 39.7 (CI 95%: 11.6-136.2) among adolescents with 10 promotive factors compared with adolescents with 0-5 promotive factors. CONCLUSIONS Social support, a positive school experience, and satisfying leisure time may be important promotive factors, and the results point toward a more ecological approach to improve well-being among adolescents with ill parents.
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Affiliation(s)
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Susan I Michelsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Pernille Due
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Beverly Lim Høeg
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anette Andersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
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Bast LS, Lund L, LauemØller SG, Kjeld SG, Due P, Andersen A. Socio-economic differences in smoking among adolescents in a school-based smoking intervention: The X:IT II study. Scand J Public Health 2021; 49:961-969. [PMID: 33863260 DOI: 10.1177/14034948211007683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: Socio-economic inequalities in health behaviour may be influenced by health interventions. We examined whether the X:IT II intervention, aiming at preventing smoking in adolescence, was equally effective among students from different occupational social classes (OSC). Methods: We used data from the multi-component school-based smoking preventive intervention X:IT II, targeting 13- to 15-year-olds in Denmark. The intervention was tested in 46 schools with 2307 eligible students at baseline (response rate=86.6%) and had three main intervention components: smoke-free school time, smoke-free curriculum and parental involvement. We used a difference-in-difference design and estimated the change in current smoking after the first year of implementation in high versus low OSC. Analyses were based on available cases (N=1190) and imputation of missing data at follow-up (N=1967). Results: We found that 1% of the students from high OSC and 4.9% from low OSC were smokers at baseline (imputed data), and 8.2% of the students from high OSC and 12.2% from low OSC were smokers at follow-up. Difference-in-difference estimates were close to zero, indicating no differential trajectory. Conclusions: As intended, the X:IT II intervention, designed to apply equally to students from all socio-economic groups, did not seem to create different trajectories in current smoking among adolescents in high and low socio-economic groups. To diminish social inequality in health, future studies should carefully consider the ability to affect all socio-economic groups equally, or even to appeal mainly to participants from lower socio-economic groups, as they are often the ones most in need of intervention.
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Takakura M, Miyagi M, Kyan A. Time trends of socioeconomic inequalities in adolescent smoking in Okinawa, Japan, 2008-2016: a repeated cross-sectional study. Environ Health Prev Med 2021; 26:24. [PMID: 33596818 PMCID: PMC7891032 DOI: 10.1186/s12199-021-00948-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/09/2021] [Indexed: 12/28/2022] Open
Abstract
Background Smoking among Japanese adolescents has decreased noticeably. However, little is known whether the decreasing trend in adolescent smoking can be seen across all socioeconomic status (SES) groups. This study aimed to examine trends in socioeconomic inequalities in smoking among Japanese adolescents between 2008 and 2016. Methods We conducted a repeated cross-sectional study using data from three surveys of high school students in Okinawa, Japan, in 2008, 2012, and 2016. The study participants consisted of 7902 students in grades 10 through 12 (15–18 years). Smoking was assessed as current cigarette use. SES indicators included familial SES (parental education and family structure) and student’s own SES (school type). To evaluate absolute and relative inequalities, prevalence differences (PDs) and ratios (PRs) between low and high SES groups were estimated. The slope index of inequality (SII) and relative index of inequality (RII) were also calculated. Results Smoking prevalence among boys and girls significantly declined from 11.5% and 6.2% in 2008 to 4.7% and 1.9% in 2016, respectively. Similar decreasing trends in smoking were found among most of the SES groups. The PDs and SII for parental education in boys and family structure in girls decreased over time while those for school type persisted among boys and girls. The PRs and RII for school type in boys increased while those for other SES indicators among both sexes remained stable over time. Conclusions Smoking among Japanese adolescents has been declining and time trends of socioeconomic inequalities in smoking varied by absolute and relative measures. Further policies and/or interventions to reduce smoking inequalities should focus on the context of schools, especially in vocational high schools.
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Affiliation(s)
- Minoru Takakura
- School of Health sciences, Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
| | - Masaya Miyagi
- Faculty of Education, University of the Ryukyus, 1 Senbaru, Nishihara, Okinawa, 903-0213, Japan
| | - Akira Kyan
- School of Health sciences, Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.,Department of Childhood Education, Okinawa Women's Junior College, 1 Agarihama, Yonabarucho, Okinawa, 901-1304, Japan
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