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Ruokolainen O, Ollila H, Laatikainen T, Pätsi SM, Carreras G, Gorini G, Carnicer-Pont D, Cselkó Z, Guignard R, Karekla M, Kilibarda B, Koprivnikar H, Lambrou A, Nguyen-Thanh V, Papachristou E, Schoretsaniti S, Vasic M. Tobacco endgame measures and their adaptation in selected European countries: A narrative review synthesis. Tob Prev Cessat 2024; 10:TPC-10-18. [PMID: 38638446 PMCID: PMC11025294 DOI: 10.18332/tpc/186402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/20/2024]
Abstract
Due to the continued detrimental effects of tobacco use, a growing number of countries are embracing the idea of tobacco endgame, meaning ending the tobacco epidemic instead of controlling it. This narrative review aims to synthesize and update the evidence from earlier scientific reviews on effective tobacco endgame measures, as well as to assess their integration to current national strategies among European countries with official tobacco endgame goals. The synthesis of the prior scientific literature found most evidence on product-focused and some evidence for supply-focused policies. Little evidence was detected for user- and institutional-focused measures. An update for the tobacco-free generation measure showed uncertainty in reducing smoking prevalence, especially for adolescents' reactions to age-restrictive laws. All the countries that established a tobacco endgame strategy have included product standards in their measures, predominantly based on European Union regulations on conventional tobacco products, yet standards above this level and considering other products were also common. Cessation measures were given strong emphasis in strategies, yet none of the countries linked these to specific endgame measures. Despite commonly mentioning vulnerable groups, such as youth and pregnant women, adoption of measures to reduce tobacco use among these groups was scarce. Lastly, the decline in tobacco use seems to be modest, implying challenges in meeting the endgame goals. To meet these goals, European countries should reinforce the implementation of known effective tobacco control measures such as tax increases. Furthermore, new innovative strategies and measures to meet the objective of an endgame should be explored.
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Affiliation(s)
- Otto Ruokolainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Ollila
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tiina Laatikainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Salla-Maaria Pätsi
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Giulia Carreras
- Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | - Giuseppe Gorini
- Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | - Dolors Carnicer-Pont
- Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
- Programa de Prevenció i Control del Càncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Zsuzsa Cselkó
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Romain Guignard
- Prevention and Health Promotion Department, Santé publique France, Saint-Maurice, France
| | | | - Biljana Kilibarda
- Institute of Public Health of Serbia ‘Dr Milan Jovanovic Batut’, Belgrade, Serbia
| | | | - Angeliki Lambrou
- Directorate of Epidemiology and Prevention of Non-Communicable Diseases and Injuries, National Public Health Organization, Athens, Greece
| | - Viêt Nguyen-Thanh
- Prevention and Health Promotion Department, Santé publique France, Saint-Maurice, France
| | - Efstathios Papachristou
- Directorate of Epidemiology and Prevention of Non-Communicable Diseases and Injuries, National Public Health Organization, Athens, Greece
| | - Sotiria Schoretsaniti
- Directorate of Epidemiology and Prevention of Non-Communicable Diseases and Injuries, National Public Health Organization, Athens, Greece
| | - Milena Vasic
- Institute of Public Health of Serbia ‘Dr Milan Jovanovic Batut’, Belgrade, Serbia
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Ruokolainen O, Ollila H, Raitasalo K. Have there been changes in daily smoking and cigarette consumption among adolescents? Investigation between 1999 and 2019 among Finnish adolescents. Addiction 2024; 119:478-487. [PMID: 37984823 DOI: 10.1111/add.16385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/11/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND AND AIMS It is postulated that due to decreased smoking rates and increased denormalisation of smoking, those who start and maintain smoking have more socially disadvantaged characteristics and are more dependent on nicotine than those who do not (the so-called 'hardening' hypothesis). The aim of this study was to measure changes in daily smoking and cigarette consumption among Finnish adolescents according to background factors. DESIGN AND SETTING A repeated cross-sectional study using data from European School Survey Project on Alcohol and other Drugs (ESPAD) on six representative cross-sections of 15- to 16-year-old students between 1999 and 2019 in Finland. PARTICIPANTS A total of 11 377 males and 12 247 females. MEASUREMENTS The outcome measures included the proportion of daily smokers among current smokers, daily smoking and the estimated mean number of smoked cigarettes per day (CPD). Substance use, parental monitoring and school performance were used as independent variables. All measures were self-reported. FINDINGS Daily smoking decreased over time and daily smokers constituted a smaller part of current smokers in 2019 compared with 1999 (the ratio among boys 0.68 and 0.43, respectively; among girls 0.59 and 0.43). Boys using cannabis (interaction between cannabis*survey year: P = 0.020; in 2019 odds ratio [OR]: 3.68, 95% confidence interval [CI] 2.23-6.08) and girls with heavy episodic drinking (interaction between heavy episodic drinking*survey year: P = 0.006, in 2019 OR: 9.00, 95% CI 5.61-14.42) had elevated adjusted odds for daily smoking over time. The estimated mean number of CPD decreased among daily smokers from 9.0 in 1999 to 7.2 in 2019 (P = 0.0002) and the differences diminished between groups based on gender, snus/alcohol use and parental monitoring. The between-group differences remained with regard to cannabis use (P = 0.0233 in 2019) and school performance (P = 0.0111 in 2019). CONCLUSIONS Among currently smoking Finnish adolescents, the proportion of daily smokers decreased between 1999 and 2019, as did the number of cigarettes smoked per day (CPD) among daily smokers, suggesting an absence of 'hardening' in this group. However, differences were observed related to the odds of daily smoking and the mean number of CPD, indicating the change has been less favorable among some adolescent groups than others.
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Affiliation(s)
- Otto Ruokolainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Ollila
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kirsimarja Raitasalo
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Ylitörmänen T, Tarasenko Y, Hiilamo H, Ruokolainen O, Puska P, Ollila H. Cross-sectional study of the associations between the implementation of the WHO FCTC tobacco advertising, promotion and sponsorship bans and current e-cigarette use among youth from countries with different income levels. Tob Control 2024:tc-2023-058160. [PMID: 38286590 DOI: 10.1136/tc-2023-058160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/02/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND The WHO Framework Convention on Tobacco Control (WHO FCTC) Article 13 requires countries to ban tobacco advertising, promotion and sponsorship (TAPS), and bans are recommended to cover electronic cigarettes (e-cigarettes). We examined youth e-cigarette prevalence by TAPS regulations in countries with different income levels. METHODS We analysed data on 165 299 respondents from 48 countries with 2016/2018 WHO FCTC implementation reports and 2016-2019 Global Youth Tobacco Survey. We used multilevel logistic regressions to examine associations between TAPS regulations and current e-cigarette use, stratified by country income. RESULTS About 1 in 10 respondents was currently using e-cigarettes. Respondents in countries with TAPS bans on the internet were less likely to use e-cigarettes (adjOR=0.58; 95% CI 0.39 to 0.86) than youth in countries without such bans. In lower middle-income and low-income countries, bans on displaying tobacco products at the point of sale (adjOR=0.55; 95% CI 0.34 to 0.90), bans on product placement (adjOR=0.44; 95% CI 0.28 to 0.69) and strength of additional TAPS measures were associated with lower prevalence of e-cigarette use among students. Being taught about the dangers of the use of tobacco in school was associated with lower odds of e-cigarette use. No differences in the use of e-cigarettes were observed by types of TAPS among respondents in high-income countries. CONCLUSIONS Strengthening implementation of TAPS policies and assuring they cover new and emerging products, online channels and points of sales are essential, especially in lower income countries. Maintaining tobacco health education is also important to protect youth from e-cigarette use.
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Affiliation(s)
- Tuija Ylitörmänen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Yelena Tarasenko
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Heikki Hiilamo
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Otto Ruokolainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pekka Puska
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Ollila
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Ylitörmänen T, Tarasenko YN, Ruokolainen O, Hiilamo H, Pekka P, Ollila H. Implementation of the Article 13 WHO FCTC measures and changes in cigarette smoking among youth in 42 countries. BMJ Glob Health 2023; 8:e013255. [PMID: 38084494 PMCID: PMC10711898 DOI: 10.1136/bmjgh-2023-013255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/12/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Despite a decline in global smoking prevalence among adolescents, around 21 million youth report current cigarette smoking. Exposure to tobacco advertising, promotion and sponsorship (TAPS) is a risk factor for smoking initiation, and therefore the Article 13 of the WHO Framework Convention on Tobacco Control (WHO FCTC) requires comprehensive TAPS bans. We examined the associations between changes in youth cigarette smoking and implementation of Article 13. METHODS We used two rounds of cross-sectional data from the Global Youth Tobacco Survey (GYTS) for 42 countries: first between 2006 and 2015, and second between 2017 and 2020. The GYTS data were linked with the WHO FCTC implementation reports from 2016 and 2018. The outcome was current smoking. Multilevel binary logistic regression models, stratified by country income level, were used to test the prevalence differences between the latest and previous GYTS rounds and their associations with TAPS bans with postestimations using marginal analyses. RESULTS The percentage of students currently smoking decreased from 10.0% (95% CI 8.0 to 12.1) to 7.7% (95% CI 6.1 to 9.3) from first to second GYTS rounds (p<0.001), adjusting for country clustering. In low-income and lower-middle-income countries, the degree of decrease significantly differed between countries with versus without bans on display, partial internet TAPS ban, ban on depiction of tobacco products and by number of TAPS measures, adjusting for age and sex of the respondents. In high-income and upper-middle-income countries, the degree of decrease significantly differed by presence (or absence) of partial or full internet TAPS ban, ban on product placement and by number of TAPS measures. CONCLUSION Implementation of TAPS bans is associated with decreased smoking among adolescents both in high-income and low-income countries. Enhanced and continuous efforts are necessary to protect youth from the promotion of tobacco and nicotine products.
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Affiliation(s)
- Tuija Ylitörmänen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Yelena N Tarasenko
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Otto Ruokolainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Heikki Hiilamo
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Puska Pekka
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Ollila
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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González-Marrón A, Koprivnikar H, Tisza J, Cselkó Z, Lambrou A, Peruga A, Kilibarda B, Lidón-Moyano C, Carnicer-Pont D, Papachristou E, Nunes E, Carreras G, Gorini G, Pérez-Martín H, Martínez-Sánchez JM, Spizzichino L, Karekla M, Mulcahy M, Vasic M, Ruokolainen O, Guignard R, Schoretsaniti S, Laatikainen T, Nguyen-Thanh V, Ollila H. Tobacco endgame in the WHO European Region: Feasibility in light of current tobacco control status. Tob Induc Dis 2023; 21:151. [PMID: 38026503 PMCID: PMC10647070 DOI: 10.18332/tid/174360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION To assess the feasibility of developing World Health Organization (WHO) European Region countries' goals and measures in line with tobacco endgame objectives, information on the current tobacco control context and capacity is needed. The aim of this study was to assess the implementation of the Framework Convention on Tobacco Control (WHO FCTC) and MPOWER measures in the region. METHODS In this cross-sectional study we used data from the WHO FCTC implementation reports and MPOWER from 2020 in 53 WHO European Region countries. Six domains (i.e. capacity, taxation and price policies, other national key regulations, public awareness raising and communication, tobacco use cessation, and monitoring) were formed. Subsequently, available indicators under these domains were scored and the level of implementation was computed for each country. Mann-Whitney tests were carried out to compare the scores between the group of countries with and without official endgame goals. RESULTS Overall, implementation of the WHO FCTC with the selected indicators at the country level ranged from 28% to 86%, and of MPOWER from 31% to 96%. Full implementation was achieved by 28% of WHO FCTC Parties in the region in taxation and price policies, 12% in public awareness raising and communication, and 42% in monitoring. In capacity, tobacco use cessation and other national key regulations, none of the Parties in the region reached full implementation. Overall median WHO FCTC scores were significantly higher in countries with official endgame goals than in those without (p<0.001). CONCLUSIONS There is unequal implementation of both WHO FCTC and MPOWER measures among WHO European Region countries. MPOWER and WHO FCTC provide all the measures for the necessary first steps, followed by innovative measures, to accomplish tobacco endgame goals.
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Affiliation(s)
- Adrián González-Marrón
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Judit Tisza
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Zsuzsa Cselkó
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Angeliki Lambrou
- Directorate of Epidemiology and Prevention of Non-Communicable Diseases and Injuries, National Public Health Organization (NPHO), Athens, Greece
| | - Armando Peruga
- Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, (CIBERES), Madrid, España
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Biljana Kilibarda
- Institute of Public Health of Serbia “Dr Milan Jovanovic Batut”, Belgrade, Serbia
| | - Cristina Lidón-Moyano
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Dolors Carnicer-Pont
- Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, (CIBERES), Madrid, España
- Programa de Prevenció i Control del Càncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, España
| | - Efstathios Papachristou
- Directorate of Epidemiology and Prevention of Non-Communicable Diseases and Injuries, National Public Health Organization (NPHO), Athens, Greece
| | - Emilia Nunes
- General Directorate of Health, Ministry of Health, Lisbon, Portugal
| | - Giulia Carreras
- Clinical Epidemiology Unit, Oncologic network, prevention and research institute (ISPRO), Florence, Italy
| | - Giuseppe Gorini
- Clinical Epidemiology Unit, Oncologic network, prevention and research institute (ISPRO), Florence, Italy
| | - Hipólito Pérez-Martín
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Jose M. Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | | | | | - Maurice Mulcahy
- National Environmental Health Service, Health Service Executive (HSE), Galway Business Park, Dangan, Ireland
| | - Milena Vasic
- Institute of Public Health of Serbia “Dr Milan Jovanovic Batut”, Belgrade, Serbia
- Faculty of Dentistry, Pancevo, Serbia
| | | | - Romain Guignard
- Santé Publique France, the French National Public Health Agency, Saint-Maurice, France
| | - Sotiria Schoretsaniti
- Directorate of Epidemiology and Prevention of Non-Communicable Diseases and Injuries, National Public Health Organization (NPHO), Athens, Greece
| | - Tiina Laatikainen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Viêt Nguyen-Thanh
- Santé Publique France, the French National Public Health Agency, Saint-Maurice, France
| | - Hanna Ollila
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Peña S, Ilmarinen K, Kestilä L, Ruokolainen O, Ollila H, Parikka S, Karvonen S. Changes in prevalence and sociodemographic correlates of tobacco and nicotine use in Finland during the COVID-19 pandemic. Eur J Public Health 2023; 33:844-850. [PMID: 37400989 PMCID: PMC10567130 DOI: 10.1093/eurpub/ckad104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND The impact of the coronavirus disease 2019 (COVID-19) pandemic on tobacco and nicotine use remains debated. We examined whether the prevalence of tobacco and nicotine use and nicotine-replacement therapy (NRT) changed during the COVID-19 pandemic and whether changes differed by sociodemographic groups. METHODS Repeated cross-sectional study of three national surveys in Finland (2018, 2019 and 2020; n = 58 526 adults aged 20 and over). Outcomes were daily and occasional smoking, smokeless tobacco (snus) use, e-cigarettes use, total tobacco or nicotine use and NRT use. We examined changes for each outcome by sex, age, educational tertiles, marital status, mother tongue and social participation. RESULTS Daily smoking decreased among males by 1.15 percentage points (pp) [95% confidence interval (CI) -2.10 to -0.20] between 2018 and 2020 and 0.86 pp among females (95% CI -1.58 to -0.15). Daily snus use remained stable in both sexes. Daily e-cigarette use was below 1% and remained stable. We found weak evidence of a reduction in total tobacco or nicotine use between 2018 and 2020 (males -1.18 pp, 95% CI -2.68 to 0.32 and females -0.8 pp, 95% CI -1.81 to 0.22). NRT use remained stable. Snus and NRT use decreased among 60- to 74-year-olds but remained stable in other age groups. We did not find evidence of interactions by subgroup for other outcomes. CONCLUSIONS Daily smoking decreased in Finland between 2018 and 2020, but other forms of tobacco use did not experience a reduction. The COVID-19 pandemic does not seem to have altered the sustained reduction of smoking in Finland, although substantial sociodemographic differences persist.
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Affiliation(s)
- Sebastián Peña
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Katja Ilmarinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Laura Kestilä
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Otto Ruokolainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Ollila
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Suvi Parikka
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sakari Karvonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Ruokolainen O, Lilja E, Ollila H, Castaneda AE, Koponen P, Skogberg N. Changes in smoking due to COVID-19 pandemic among persons of migrant origin compared with the general population: a population-based study. Scand J Public Health 2023:14034948231199792. [PMID: 37726894 DOI: 10.1177/14034948231199792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
AIMS Prior studies have implied that smokers may have changed their smoking behaviour during the COVID-19 pandemic. However, little is known about changes in smoking behaviour and correlates of change due to the pandemic among persons of migrant origin compared with the general population. METHODS Population-based cross-sectional studies with comparable study protocols and measures, one focusing on persons of migrant origin living in Finland (n = 3587, response rate 60%) and the other on the general Finnish population (n = 3444, response rate 56%), were utilised. The outcome measure was self-reported change in smoking behaviour due to COVID-19 among current smokers. Explanatory factors included sociodemographic-, health-, and COVID-19-related factors. Multinomial logistic regression was used in the analyses. RESULTS Most of the current smokers reported no change in their smoking behaviour. In the adjusted model, younger age was positively associated with increased smoking, while region of origin (Russia, Africa, Asia, and Latin America) and worrying about getting infected with COVID-19 were associated with decreased smoking among persons of migrant origin. In the general population, younger age, female sex, being other than employed/student, increased loneliness, and decreased contact with close ones were associated with increased smoking, while reduced working capacity and worries that someone close to the respondent will be infected with COVID-19 were associated with decreased smoking. CONCLUSIONS The findings of this study contribute to better identification of at-risk populations in future crises situations. This will allow for more efficient targeting and tailoring of health promotion services, including smoking cessation.
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Affiliation(s)
- Otto Ruokolainen
- Finnish Institute for Health and Welfare, Department of Public Health and Welfare, Helsinki, Finland
| | - Eero Lilja
- Finnish Institute for Health and Welfare, Department of Public Health and Welfare, Helsinki, Finland
| | - Hanna Ollila
- Finnish Institute for Health and Welfare, Department of Public Health and Welfare, Helsinki, Finland
| | - Anu E Castaneda
- Finnish Institute for Health and Welfare, Department of Public Health and Welfare, Helsinki, Finland
| | - Päivikki Koponen
- Finnish Institute for Health and Welfare, Department of Public Health and Welfare, Helsinki, Finland
| | - Natalia Skogberg
- Finnish Institute for Health and Welfare, Department of Public Health and Welfare, Helsinki, Finland
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Ruokolainen O, Piirtola M, Korhonen T, Rahkonen O, Härkänen T. A Nationally Representative Study of the Hardening Hypothesis Among Educational Groups Over Four Decades. Nicotine Tob Res 2023; 25:1538-1546. [PMID: 37075474 DOI: 10.1093/ntr/ntad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 03/17/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION As smoking prevalence has decreased, there has been debate about "hardening" (smokers are more resistant to established tobacco control measures) or "softening" (smokers are more responsive to interventions) of the remaining smoking population. Despite growing evidence to reject the "hardening" hypothesis, there is lack of long-term population-based studies to test this hypothesis by educational level. AIMS AND METHODS Repeated cross-sectional population-based surveys during 1978-2014 and in 2018 were utilized. The target population consisted of ~5000 25-64-year-old Finns annually. The data included 109 257 respondents of which 53 351 ever-smoking individuals were included in the analyses. Response rates varied between 84% and 43%. Five hardening indicators considering smoking frequency, intensity and smoking cessation were used as the dependent variables. The main independent variable was study year (time). Statistical analyses were based on regression models using restricted cubic splines by educational level. RESULTS Contrary to the hardening hypothesis, hardening indicators showed softening over time among all educational groups. However, educational groups differed from each other. Compared with the highly educated, the quit ratio was lower, number of cigarettes per day (CPD) was higher, the proportions of daily smokers among current smokers and heavy smokers among daily smokers were higher among the less educated. CONCLUSIONS In accordance with growing evidence, also the Finnish smoking population has "softened" over time. Although the change has been predominantly in the same direction for all educational groups, the rate of change has been stronger among the highly educated, highlighting the continued burden of smoking among the less educated. IMPLICATIONS Even though "softening" of smoking has occurred, lighter smoking also poses health risks. Therefore, tobacco control policies and cessation services should be developed and targeted to a greater extent also for people who smoke less than daily and for those who smoke fewer CPD. Furthermore, interventions should focus on special requirements of the lower educational groups to promote health equity.
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Affiliation(s)
- Otto Ruokolainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Maarit Piirtola
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Tellervo Korhonen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tommi Härkänen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Solimini R, Ruokolainen O, Cselko Z, Koprivnikar H, Spizzichino L, Papachristou S, González-Marrón A, Nunes E, Carnicer-Pont D, Fernandez E, López AM, Demosthenous E, Kilibarda B, Gallus S, Gómez-Chacón C, Keć I, Valentic M, Ollila H. Good Practice Statements for the treatment of nicotine dependence. Tob Prev Cessat 2023; 9:24. [PMID: 37448706 PMCID: PMC10336859 DOI: 10.18332/tpc/167964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 06/05/2023] [Accepted: 06/10/2023] [Indexed: 07/15/2023]
Affiliation(s)
- Renata Solimini
- Istituto Superiore di Sanita, National Centre on Addiction and Doping, Rome, Italy
| | | | - Zsuzsa Cselko
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | | | | | | | - Adrián González-Marrón
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain
| | - Emilia Nunes
- National Programme for Smoking Prevention and Tobacco Control, General-Directorate of Health, Portugal
| | - Dolors Carnicer-Pont
- Tobacco Control Unit and WHO Collaborating Center for Tobacco Control, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Esteve Fernandez
- Tobacco Control Unit and WHO Collaborating Center for Tobacco Control, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Anna Mar López
- Tobacco Control Unit and WHO Collaborating Center for Tobacco Control, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Elena Demosthenous
- Policy Department of the Cyprus National Addictions Authority, Nicosia, Cyprus
| | - Biljana Kilibarda
- Institute of Public Health of Serbia "Dr Milan Jovanović Batut", Belgrade, Serbia
| | - Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Ivona Keć
- Croatian Institute of Public Health, Zagreb, Croatia
| | - Maja Valentic
- Croatian Institute of Public Health, Zagreb, Croatia
| | - Hanna Ollila
- Finnish Institute for Health and Welfare, Helsinki, Finland
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10
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Pätsi SM, Toikka A, Ollila H, Ruokolainen O. Area-level sociodemographic differences in tobacco availability examined with nationwide tobacco product retail licence data in Finland. Tob Control 2023:tc-2022-057798. [PMID: 37015745 DOI: 10.1136/tc-2022-057798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/17/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Differences in tobacco retailer density between areas by sociodemographic composition have been observed. However, little research comes from European jurisdictions and from countries with a tobacco retail licensing system. In Finland, the system consists of criteria for retailers and supervision fees. METHODS The tobacco product retail licence data and sociodemographic data were retrieved from corresponding Finnish authorities. Area-level tobacco availability was measured as the presence of a retailer and as the number of retailers per 1000 inhabitants by postcode area. Sociodemographic indicators included median income, percentage of inhabitants in the lowest income tertile, percentage of adults with higher education and unemployment rate. Analyses were based on logistic regression and Ordinary Least Squares regression with log-transformed density. RESULTS Lower area-level sociodemographic composition was mainly associated with higher tobacco availability. Income was the strongest correlate of the tobacco retailer availability: areas with higher median income had lower odds of having a tobacco retailer (OR 0.54, 95% CI 0.48 to 0.61 per €1000) and lower retailer density (-4.4% per €1000, Cohen's f=0.51). Areas with a greater proportion of people in the lowest income category had higher densities of tobacco retailers (+2.8% per percentage point, Cohen's f=0.07). Other sociodemographic indicators showed inconsistent associations with retailer presence and density. CONCLUSION Tobacco availability can be higher in areas with lower sociodemographic composition also in a country with a comprehensive tobacco retail licensing system and small income inequalities. Retailing policies should be further developed to reduce tobacco availability and narrow inequalities in tobacco use.
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Affiliation(s)
- Salla-Maaria Pätsi
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Arho Toikka
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Hanna Ollila
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Otto Ruokolainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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11
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Ruokolainen O, Ollila H, Karjalainen K. Correlates of e-cigarette use before and after comprehensive regulatory changes and e-liquid flavour ban among general population. Drug Alcohol Rev 2022; 41:1174-1183. [PMID: 35106874 DOI: 10.1111/dar.13435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In 2016, the Finnish Tobacco Act was revised to harmonise e-cigarette regulations with the EU Tobacco Products Directive. Unlike before, the sale of nicotine-containing e-liquids was allowed while additional national regulations included, for example, a ban for other than unflavoured and tobacco-flavoured e-liquids. This study examines the correlates of e-cigarette use before and after the comprehensive regulatory change, and characteristics and correlates of flavoured e-cigarette use after the flavour ban in the general Finnish population. METHODS Repeated cross-sectional population-based drug surveys for 15-69-year-olds in 2014 (n = 3485; 50% response rate) and in 2018 (n = 3229; 46%). Correlates of e-cigarette use were studied with logistic regression models. RESULTS Current e-cigarette use remained infrequent (approximately 2%) and the correlates of e-cigarette use varied only slightly between the study years. In 2018, of past-year e-cigarette users (n = 316), 43% used unflavoured e-liquids, 24% used tobacco and 43% used other flavours, fruits being the most common. In univariate models, demographic variables, smoking and e-cigarette use-related factors were associated with flavoured e-cigarette use. In multivariable models, those who used e-cigarettes to experiment used unflavoured e-cigarettes more likely than other than tobacco flavours (odds ratio 3.00, 95% confidence interval 1.15-7.82). DISCUSSION AND CONCLUSIONS In Finland, the regulated entry of nicotine-containing e-liquids to retail sales has not led to increased e-cigarette use in the general population. After the flavour ban, other than tobacco-flavoured e-cigarette use still occurs. The use of flavoured e-cigarettes is associated with reasons for e-cigarette use. Flavoured e-cigarette use and its correlates warrant further monitoring.
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Affiliation(s)
- Otto Ruokolainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Ollila
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Karoliina Karjalainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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12
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Ruokolainen O, Härkänen T, Lahti J, Haukkala A, Heliövaara M, Rahkonen O. Association between educational level and smoking cessation in an 11-year follow-up study of a national health survey. Scand J Public Health 2021; 49:951-960. [PMID: 33648397 PMCID: PMC8573358 DOI: 10.1177/1403494821993721] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aims: There is a lack of longitudinal, population-based studies on the association between education and smoking cessation. A more thorough examination of this association is needed to address inequalities in smoking. Methods: The longitudinal Health 2000 Survey and Health 2011 Survey, representing the Finnish population aged ⩾30 years, were analysed. Of the 1352 baseline daily smokers, 945 (70%) provided a smoking status at the follow-up. The analytic sample size was 884 (excluding the follow-up occasional smokers). Self-reported questionnaire data and measurements (e.g. plasma cotinine) from the baseline were utilised. The outcome variable was smoking cessation at the follow-up, and the main explanatory variable was education. Logistic regression was the main method for statistical analyses. All of the analyses accounted for the sampling design. Results: At the follow-up, 28% of the baseline daily smokers had quit smoking. An adjusted regression model showed that highly educated respondents had a higher likelihood of quitting smoking compared with those with basic education. Controlling for demographic and health-related variables had a modest effect on this association. Higher scores for plasma cotinine, symptoms of depression and heavy alcohol use were associated with a lower likelihood of quitting smoking. The association between education and smoking cessation was weaker for women than it was for men. Conclusions: High education is associated with smoking cessation among the general adult population, especially among men. A higher plasma cotinine level is strongly associated with continued smoking among both sexes. Background variables only modestly affected the association between education and smoking cessation.
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Affiliation(s)
| | | | - Jouni Lahti
- Faculty of Social Sciences, University of Helsinki, Finland
| | - Ari Haukkala
- Faculty of Social Sciences, University of Helsinki, Finland.,Helsinki Collegium for Advanced Studies, University of Helsinki, Finland
| | | | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Finland
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13
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Raitasalo K, Karjalainen K, Ollila H, Ruokolainen O, Hakkarainen P. Smoke in the air - Associations between experimentation with cannabis and the use of tobacco and nicotine products among 15-16-year-old school students. Addict Behav 2021; 114:106714. [PMID: 33139144 DOI: 10.1016/j.addbeh.2020.106714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cannabis is the most popular illicit drug among adolescents in developed countries, including Finland. The aim of this study was to estimate 1) how cannabis experimentation among Finnish adolescents changed between 2003 and 2019, and 2) whether the associations between cannabis experiments and factors related to it, especially the use of tobacco and nicotine products, changed during the same time period. METHODS The analyses are based on the European School Survey Project on Alcohol and Other Drugs data, collected from Finnish adolescents aged 15 to 16 in 2003, 2007, 2011, 2015, and 2019 (N = 20,630). RESULTS Experimentation with cannabis among Finnish adolescents has increased since the beginning of our follow-up. At the same time, alcohol use and smoking have decreased markedly, and attitudes toward cannabis use have become more relaxed. The association between smoking and cannabis experimentation has become weaker over time. However, the use of tobacco and nicotine products, especially polytobacco, is still a strong risk factor for experimentation with cannabis. The higher the number of tobacco or nicotine products used, the higher the probability for cannabis experimentation. CONCLUSIONS Experimentation with cannabis has previously been concentrated predominantly on adolescents who smoke, but recently non-smokers are increasingly trying cannabis. It is possible that alternative ways of using cannabis may have increased its use. Despite the strict cannabis policy in Finland, its use has increased, which may be an indication that youth cultures and images of different substances play a significant role in adolescents experimenting with cannabis.
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Affiliation(s)
| | | | - Hanna Ollila
- Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland.
| | - Otto Ruokolainen
- Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland.
| | - Pekka Hakkarainen
- Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland.
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14
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Ruokolainen O, Ollila H, Lahti J, Rahkonen O. Intergenerational social mobility, smoking and smokeless tobacco (snus) use among adolescents during 2008-2017. Addict Behav 2019; 98:106022. [PMID: 31233948 DOI: 10.1016/j.addbeh.2019.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 06/05/2019] [Accepted: 06/10/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Socioeconomic differences in smoking and other tobacco use are prevalent in adolescents. Less is known about the association between intergenerational social mobility and tobacco use. METHODS Five waves of national cross-sectional School Health Promotion Study during 2008-2017 in Finland were used, including non-academically and academically oriented adolescents (15-21 years, N = 384,379). The adolescents' educational orientation was compared with the educational track of the parents as a proxy for intergenerational social mobility, which was used as the independent variable in regression models to examine the differences in daily smoking and daily snus use. RESULTS Smoking declined in all mobility groups over time, but remained more prevalent among non-academically oriented adolescents among boys and girls. Daily snus use among boys increased over time in all mobility groups. Multiple adjusted models showed that upward mobility and downward mobility are differently associated with tobacco use, the latter increasing the probability of tobacco use compared with the stable high group (boys: smoking: OR = 5.24, 95% CI 5.02-5.46; snus use: OR = 1.57, 95% CI 1.50-1.66). In smoking, absolute socioeconomic differences between the mobility groups decreased over time while relative differences increased. In snus use, both absolute and relative differences increased. CONCLUSIONS Adolescent smoking and snus use associate strongly with the adolescent's educational track, irrespective of the social mobility class. Non-academically oriented adolescents have an increased risk of tobacco use. The academic and non-academic orientation should already be taken into account in tobacco use prevention in basic education.
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Affiliation(s)
- Otto Ruokolainen
- National Institute for Health and Welfare, Department of Public Health Solutions, Helsinki, Finland, Mannerheimintie 166, 00271, Po Box 30, Helsinki, Finland.
| | - Hanna Ollila
- National Institute for Health and Welfare, Department of Public Health Solutions, Helsinki, Finland, Mannerheimintie 166, 00271, Po Box 30, Helsinki, Finland.
| | - Jouni Lahti
- Department of Public Health, University of Helsinki, Tukholmankatu 8 B, 00014 University of Helsinki, Po Box 20, Helsinki, Finland.
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Tukholmankatu 8 B, 00014 University of Helsinki, Po Box 20, Helsinki, Finland.
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15
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Tuovinen EL, Saarni SE, Kinnunen TH, Ollila H, Ruokolainen O, Patja K, Männistö S, Jousilahti P, Kaprio J, Korhonen T. Weight concerns as a predictor of smoking cessation according to nicotine dependence: A population-based study. Nordisk Alkohol Nark 2018; 35:344-356. [PMID: 32934537 PMCID: PMC7434149 DOI: 10.1177/1455072518800217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/22/2018] [Indexed: 11/17/2022] Open
Abstract
Background: Nicotine-dependent smokers find it difficult to quit smoking. Additionally,
smoking-specific weight concerns may affect smoking cessation although the
evidence is controversial. We investigated whether smoking-specific weight
concerns predict the probability of cessation and, if so, whether the effect
varies according to the level of nicotine dependence. Methods: The study was conducted with a population-based sample of 355 adult daily
smokers who participated in the baseline examination in 2007 and in the 2014
follow-up. Baseline nicotine dependence was classified as low or high
(Fagerström Test for Nicotine Dependence; 0–3 vs. 4–10 points). Within these
groups, we examined whether baseline weight concerns predict smoking status
(daily, occasional, ex-smoker) at follow-up by using multinomial logistic
regression with adjustment for multiple covariates. Results: Among low-dependent participants at baseline, 28.5% had quit smoking, while
among highly dependent participants 26.1% had quit smoking. The interaction
between weight concerns and nicotine dependence on follow-up smoking status
was significant. Among participants with low nicotine dependence per the
fully adjusted model, greater weight concerns predicted a lower likelihood
of both smoking cessation (relative risk ratio 0.93 [95% CI 0.87–1.00]) and
smoking reduction to occasional occurrence (0.89 [95% CI 0.81–0.98]). Weight
concerns were not associated with follow-up smoking status among
participants with high nicotine dependence. Conclusions: Weight concerns are associated with a smaller likelihood of quitting among
smokers with low nicotine dependence. Weight concerns should be addressed in
smoking cessation interventions, especially with smokers who have low
nicotine dependence.
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Affiliation(s)
| | | | - Taru H Kinnunen
- University of Helsinki, Finland; and Behavioral Science Consulting, North Andover, MA, USA
| | - Hanna Ollila
- National Institute for Health and Welfare, Helsinki, Finland
| | | | | | - Satu Männistö
- National Institute for Health and Welfare, Helsinki, Finland
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16
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Ruokolainen O, Ollila H, Patja K, Borodulin K, Laatikainen T, Korhonen T. Social climate on tobacco control in an advanced tobacco control country: A population-based study in Finland. Nordisk Alkohol Nark 2018; 35:152-164. [PMID: 32934524 PMCID: PMC7434151 DOI: 10.1177/1455072518767750] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 02/26/2018] [Indexed: 11/17/2022] Open
Abstract
Aims Finland has implemented a gradually tightening tobacco control policy for decades. Recently the objective of a tobacco-free Finland was introduced. Still, the population's acceptance of tobacco control policy has not been measured. More knowledge is needed on differences in attitudes and factors associated with tobacco control opinions for future policy-making. Methods A population-based study with quantitative analysis. Attitudes on smoking and tobacco control policy were assessed within the National FINRISK 2012 Study in Finland involving 25-74-year-old adults (N = 4905). In analyses, smoking status groups were compared. Results In general, attitudes differed systematically by smoking status. Differences increased or decreased when moving from never smokers to other smoking groups. Similarities in attitudes were found particularly on youth smoking, while differences between smoking groups were notable on statements regarding smoking on balconies and availability of tobacco products. The adjusted analysis showed that smoking status was most strongly associated with attitudes on different tobacco control policy measures. Daily smokers viewed stricter tobacco control policy and workplace smoking bans more negatively than others, though they viewed societal support for quitters and sufficiency of tobacco control policy more positively compared with others. Differences were vast compared with non-smokers, but also occasional smokers differed from daily smokers. Conclusions Tightening tobacco control and workplace smoking bans were supported by the Finnish adult population, but societal support for quitters to a lesser extent. Attitude change, where smokers are seen as deserving help to quit smoking, is important.
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Affiliation(s)
| | - Hanna Ollila
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Katja Borodulin
- National Institute for Health and Welfare, Helsinki, Finland
| | - Tiina Laatikainen
- University of Eastern Finland, Kuopio, Helsinki, Finland National Institute for Health and Welfare, Helsinki, Finland Joint Municipal Authority for North Karelia Social and Health Services, Siun Sote, Joensuu, Finland
| | - Tellervo Korhonen
- University of Helsinki, Helsinki, Finland National Institute for Health and Welfare, Helsinki, Finland
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17
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Ruokolainen O, Heloma A, Jousilahti P, Lahti J, Pentala-Nikulainen O, Rahkonen O, Puska P. Socioeconomic differences in smoking declining? Result from population-based surveys in 1978 - 2016 in Finland. Tob Induc Dis 2018. [DOI: 10.18332/tid/83783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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18
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Ruokolainen O, Ollila H, Karjalainen K. Determinants of electronic cigarette use among Finnish adults: Results from a population-based survey. Nordisk Alkohol Nark 2017; 34:471-480. [PMID: 32934506 PMCID: PMC7450849 DOI: 10.1177/1455072517736618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/06/2017] [Indexed: 11/15/2022] Open
Abstract
Background Electronic cigarette (e-cigarette) use is rising in the Western world, but studies from the Nordic countries are lacking. Many countries are implementing policy changes, brought about for example by the 2014 European Tobacco Products Directive, and monitoring e-cigarette use is considered important. The aim of this article is to account for the prevalence of e-cigarette use among the Finnish adult population and to examine correlates of ever use and current use of e-cigarettes prior to some changes in the Finnish regulatory scheme. Methods A population-based survey was conducted in 2014. A representative random sample (N = 7000) of Finnish people aged 15-69 years was drawn from the Finnish Population Information System. Data were collected by self-administered anonymous online/postal questionnaire. The response rate was 50% (n = 3485). A multinomial logistic regression model was used to estimate the association between e-cigarette use and different explanatory variables. Results Of all participants, 2% were current and 12% were ever users of e-cigarettes. Younger age and current or previous tobacco use increased the odds for both current and ever use of e-cigarettes when compared with never users. Unemployment and lower education were associated with current e-cigarette use and being a student was associated with ever use of e-cigarettes. Conclusions The current use of e-cigarettes in the adult population is low in Finland, having at least tried is more common. Both types of e-cigarette use are concentrated to groups considered to be more vulnerable, such as younger people and those with a lower socioeconomic position. Further monitoring of e-cigarette use is needed in view of Finland's aim to become nicotine and tobacco free by 2030.
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Affiliation(s)
| | - Hanna Ollila
- National Institute for Health and Welfare, Finland
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