Environmental factors as predictors of smoking among ninth-grade adolescents in Pitkäranta (Russian Karelia) and in eastern Finland

Parental transmission of smoking among middle-aged and older populations in Russia and Belarus

OBJECTIVES

The very high rates of smoking among men and the rapid changes among women in the Post-Soviet countries mean that this region offers an opportunity to understand better the intergenerational role of parental influences on smoking.

METHODS

In this study, we exploit a unique data set, the PrivMort cohort study conducted in 30 Russian and 20 Belarusian towns in 2014-2015, which collects information on behaviours of middle-aged and older individuals and their parents, including smoking. We explored the associations between smoking by parents and their offspring using multiply imputed data sets and multilevel mixed-effect Poisson regressions.

RESULTS

Adjusting for a wide array of social origin, socio-demographic, and socio-economic variables, our analysis suggests that sons of regularly smoking fathers have prevalence ratios of 1.35 [95% confidence intervals (CI) 1.21-1.50] and 1.39 (CI 1.23-1.58) of smoking, while the figures for daughters of regularly smoking mothers are 1.91 (CI 1.40-2.61) and 2.30 (CI 1.61-3.28), respectively, in Russia and Belarus.

CONCLUSIONS

Intergenerational paternal and maternal influences on smoking should be taken into account in studies seeking to monitor the rates of smoking and the impact of tobacco control programmes.

Family members’ and best friend’s smoking influence on adolescent smoking differs between Eastern Finland and Russian Karelia

Aims: The aim of this study was to find out whether family members’ (mother, father, siblings) and best friend’s smoking is related to 9th grade pupils’ daily smoking in Eastern Finland and in the Pitkäranta district, in the Republic of Karelia, Russia, and whether these relations have changed in these two culturally very different neighbourhood countries from 1995 to 2013. Methods: Data comprised four cross-sectional studies in all schools of the Pitkäranta region and selected schools in Eastern Finland. In data analyses, structural equation modelling techniques were used. Results: Our findings showed that best friend’s smoking had the strongest influence on adolescents’ smoking in both countries and study years (p < .01). The relations among family members were highly different between Pitkäranta and Eastern Finland, particularly in 2013. Conclusions: Results suggest that health promotion in schools should take into account cultural impacts and pay special attention to pupils who have family members and friends who smoke.

Adolescents' Attitudes on Smoking Are Related to Experimentation with Smoking, Daily Smoking and Best Friends' Smoking in Two Karelias in Finland and in Russia

PURPOSE

Becoming a smoker usually starts during adolescence and is a dynamic process involving experimentation before the establishment of daily smoking. It has been suggested that adolescents who smoke differ from those who do not in their attitudes to smoking. The purpose of this study was to find out whether attitudes related to smoking legislation and restrictions, social pressures in smoking and image of smokers are associated with smoking experimentation, daily smoking and best friends' smoking.

METHOD

The data were gathered with a self-administered questionnaire in North Karelia, Eastern Finland and in the Pitkyaranta district, Republic of Karelia, Russia. The respondents were 15-year-old 9th grade pupils in local schools. In Pitkyaranta, the data analyses covered pupils in all eight schools in the area (n = 179). In North Karelia, the data analyses comprised of selected eight schools (n = 601). Data were analysed with exploratory factor analysis.

RESULTS

The models revealed that attitudes related to restrictions and social pressure were significantly associated with experimenting with smoking [OR (95 % CI) 7.923 (5.787-10.847)], daily smoking [OR (95 % CI) 9.575 (6.727-13.628)] and the likelihood of best friends' smoking [OR (95 % CI) 3.154 (2.579-3.858)]. The stronger the young peoples' attitudes and opinions, for example, towards restrictions and with more difficulties in refusing smoking, the higher the likelihood for smoking experimentations, daily smoking as well as the likelihood for their best friends' smoking. The country and factor interactions were not associated with smoking experimentations, daily smoking or best friends' smoking.

CONCLUSION

Regardless of cultural background, adolescents who smoke have more positive attitudes to smoking, and perceive more social support for smoking, than do adolescents who do not smoke. The study stresses the similarity of the results in both Karelia's despite the enormous differences in culture, economy and public policy.

The relation of socio-ecological factors to adolescents’ health-related behaviour

Purpose

– The purpose of this paper is to identify and describe adolescents’ health-related behaviours from a socio-ecological perspective. Socio-ecological factors have been widely shown to be related to health behaviours (smoking, alcohol consumption, physical activity and diet) in adolescence and to affect health. The review integrates evidence with socio-ecological factors (social relationships, family, peers, schooling and environment).

Design/methodology/approach

– The data were collected from electronic databases and by manual search consisting of articles (n=90) published during 2002-2014. The selected articles were analysed using inductive content analysis and narrative synthesis.

Findings

– The findings suggest that there was a complex set of relations connected to adolescent health behaviours, also encompassing socio-ecological factors. The authors tentatively conclude that socio-ecological circumstances influence adolescents’ health-related behaviour, but that this review does not provide the full picture. There seemed to be certain key factors with a relation to behavioural outcomes that might increase health inequality among adolescents.

Practical implications

– School health education is an important pathway for interventions to reduce unhealthy behaviours among adolescents including those related to socio-ecological factors.

Originality/value

– Some socio-ecological factors were strongly related to health behaviours in adolescence, which may indicate an important pathway to current and future health. This paper may help schoolteachers, nurses and other school staff to understand the relationships between socio-ecological factors and health-related behaviours, which may be useful in developing health education to reduce health disparities during adolescence.

Changes in smoking among adolescents in the Republic of Karelia, Russia and Eastern Finland from 1995 to 2013

AIMS

The aim of this study was to compare the prevalence of smoking, smoking experimentation and future intention to smoke in the Pitkäranta district, the Republic of Karelia, Russia and Eastern Finland in the years 1995 and 2013.

METHODS

Cross-sectional studies were carried out among 15-year-old ninth grade adolescents in all schools in the Pitkäranta region (1995: n=385, response rate 95%; 2013: 182, response rate 98%) and a sample of schools in Eastern Finland (1995: n=2098, response rate 91%; 2013: 635 response rate 95%).

RESULTS

The daily smoking prevalence among adolescents did not change either in Eastern Finland or in the Pitkäranta district from 1995 to 2013. However, smoking among Finnish adolescents was more common than among Russians (p<0.001) and boys, in general, smoke more commonly than girls (p<0.001). In Finland, early smoking experimentations declined by half among both genders but in Pitkäranta the girls' smoking experimentations tripled (relative risk 3.03, 95% confidence interval 1.76-5.20) from 1995 to 2013. The combined effect of country and gender was significant (p<0.001) for future intention to smoke. In Finland future intentions to smoke were very similar in boys and girls compared with obvious gender differences in Russia.

CONCLUSIONS

These results suggest that more attention should be paid for programmes that consider better gender and culture-specific issues in preventing initiation of smoking and promoting an anti-smoking climate in societies.

Family characteristics and health behaviour as antecedents of school nurses' concerns about adolescents' health and development: a path model approach

BACKGROUND

Family socio-economic factors and parents' health behaviours have been shown to have an impact on the health and well-being of children and adolescents. Family characteristics have also been associated with school nurses' concerns, which arose during health examinations, about children's and adolescents' physical health and psychosocial development. Parental smoking has also been associated with smoking in adolescents.

OBJECTIVES

The aim of this study was to determine to what extent school nurses' concerns about adolescents' physical health and psychosocial development related to family characteristics are mediated through parents' and adolescents' own health behaviours (smoking).

DESIGN

A path model approach using cross-sectional data was used.

SETTINGS

In 2008-2009, information about health and well-being of adolescents was gathered at health examinations of the Children's Health Monitoring Study.

PARTICIPANTS

Altogether 1006 eighth and ninth grade pupils in Finland participated in the study.

METHODS

The associations between family characteristics, smoking among parents and adolescents and school nurses' concerns about adolescents' physical health and psychosocial development were examined using a structural equation model.

RESULTS

Paternal education had a direct, and, through fathers' and boys' smoking, an indirect association with school nurses' concerns about the physical health of boys. Paternal labour market status and family income were only indirectly associated with concerns about the physical health of boys by having an effect on boys' smoking through paternal smoking, and a further indirect effect on concerns about boys' health. In girls, only having a single mother was strongly associated with school nurses' concerns about psychosocial development through maternal and adolescent girl smoking.

CONCLUSIONS

Socio-economic family characteristics and parental smoking influence adolescent smoking and are associated with school nurses' concerns about adolescents' physical health and psychosocial development. The findings underline the importance of comprehensively taking into account adolescents' and parents' health behaviours and the family situation in health-care contacts when providing health counselling.

Loneliness and health risk behaviours among Russian and U.S. adolescents: a cross-sectional study

Background

For some adolescents feeling lonely can be a protracted and painful experience. It has been suggested that engaging in health risk behaviours such as substance use and sexual behaviour may be a way of coping with the distress arising from loneliness during adolescence. However, the association between loneliness and health risk behaviour has been little studied to date. To address this research gap, the current study examined this relation among Russian and U.S. adolescents.

Methods

Data were used from the Social and Health Assessment (SAHA), a school-based survey conducted in 2003. A total of 1995 Russian and 2050 U.S. students aged 13–15 years old were included in the analysis. Logistic regression was used to examine the association between loneliness and substance use, sexual risk behaviour, and violence.

Results

After adjusting for demographic characteristics and depressive symptoms, loneliness was associated with a significantly increased risk of adolescent substance use in both Russia and the United States. Lonely Russian girls were significantly more likely to have used marijuana (odds ratio [OR]: 2.28; confidence interval [CI]: 1.17–4.45), while lonely Russian boys had higher odds for past 30-day smoking (OR, 1.87; CI, 1.08–3.24). In the U.S. loneliness was associated with the lifetime use of illicit drugs (excepting marijuana) among boys (OR, 3.09; CI, 1.41–6.77) and with lifetime marijuana use (OR, 1.79; CI, 1.26–2.55), past 30-day alcohol consumption (OR, 1.80; CI, 1.18–2.75) and past 30-day binge drinking (OR, 2.40; CI, 1.56–3.70) among girls. The only relation between loneliness and sexual risk behaviour was among Russian girls, where loneliness was associated with significantly higher odds for ever having been pregnant (OR, 1.69; CI: 1.12–2.54). Loneliness was not associated with violent behaviour among boys or girls in either country.

Conclusion

Loneliness is associated with adolescent health risk behaviour among boys and girls in both Russia and the United States. Further research is now needed in both settings using quantitative and qualitative methods to better understand the association between loneliness and health risk behaviours so that effective interventions can be designed and implemented to mitigate loneliness and its effects on adolescent well-being.

Adolescents smoking in the crosslight of other substance use and parental and peers' smoking behaviors

This study investigates the connectedness of adolescents' smoking status, history of alcohol and cannabis use, and parental and peers' smoking, dimensions only rarely explored concurrently. Multinomial regression models that compared the smoking status of adolescents were estimated based on a representative sample of 3,560 adolescents aged 14–15 from Switzerland. While 49.0% of respondents had never smoked, 9.0% smoked on a daily basis and 12.0% occasionally; 32.6% had never drank alcohol and 74.7% had never used cannabis. Overall, parental and peers' smoking and other substance use factors are significantly associated with smoking status. Yet, history of substance use revealed less consistent associations with smoking status among current smokers (daily versus occasional smoking). The findings highlight the connectedness of adolescents' and other substance use behaviors and support the relevance of concurrent prevention initiatives targeting adolescents with specific substance use profiles and/or growing up in prosmoking social milieus.

The smoking habit of a close friend or family member--how deep is the impact? A cross-sectional study

OBJECTIVES

To assess the risk of becoming a smoker in adulthood associated with parental smoking as well as the smoking of siblings and close friends.

DESIGN

A cross-sectional study.

SETTING

4 oral healthcare centres in Finland and a follow-up.

PARTICIPANTS

An age cohort born in 1979 (n=2586) and living in four Finnish towns. Of those reached by the 2008 follow-up, 46.9% (n=1020) responded.

PRIMARY AND SECONDARY OUTCOME MEASURES

Smoking behaviour at the age of 29. Smoking behaviour at the age of 13 and smoking behaviour of family members and close friends.

RESULTS

Smoking of a current close friend was strongly associated with participants' own smoking (OR 5.6, 95% CI 3.6 to 8.8). The smoking of a close friend during schooldays was similarly associated (OR 2.9, 95% CI 1.8 to 4.5). Smoking among men was associated with the smoking behaviour of mothers and siblings while that among females was not.

CONCLUSIONS

The impact of a smoker as a close friend is greater than that of a smoking parent or sibling in school age when it comes to smoking behaviour in adulthood. This should be taken into consideration when attempting to prevent smoking initiation or continuation.

TRIAL REGISTRATION

At clinicaltrials.gov (NCT01348646).

Risk factors of future smoking among Thai youth: a secondary analysis of the Thai Global Youth Tobacco Survey

The study aimed to identify the risk factors for future smoking among Thai youth aged 13 to 15 years (seventh to ninth grade). Data from the nationally representative 2005 Thai Global Youth Tobacco Survey (n = 15 774) were analyzed using descriptive statistics and logistic regression. Among nonsmoking Thai youth, boys were much more likely to have intention of future smoking (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.37-0.84). Younger youth were more likely to be cigarette smokers in the future (OR = 0.70, 95% CI = 0.56-0.88). Youth having the intention of smoking from a friend's cigarette offer were 5.29 times more likely to have intention of future smoking, compared with those who did not (95% CI = 3.75-7.46). Understanding and targeting youth at higher risk for future smoking can provide for a lowering of the youth smoking rate in Thailand and contribute to the country's continued efforts in effective youth tobacco control.

Best friend's and family members’ smoking habits and parental divorce during childhood are associated with smoking in adulthood

Aims

Smoking initiation during childhood or adolescence is strongly associated with friends’ smoking. Likewise, adverse living conditions increase the likelihood of future deviant behaviour. We examine whether smoking by a best friend and family members during school years as well as adverse childhood experiences are associated with smoking in adulthood.

Data and Design

We have analysed the responses of Finnish working-aged respondents in 1998 (N=25901) and 2003 (N=20773) to questions on the smoking status of friends and family members during school years as well as their answers on a six-item scale of childhood adversities. A case-control study design was used to compare current cigarette smokers (1998 and 2003) to non-smokers (1998 and 2003).

Results

If a best friend during school years was a smoker, the subject s odds ratio (OR) of being a smoker in adulthood was 4.43 among females and 3.91 among males compared to those with a non-smoking best friend in multivariate models adjusted for smoking by family members during school years and by six childhood adversities. These associations did not differ by age. Smoking in adulthood was associated with childhood adversities, most strongly with parental divorce or separation during the subjects’ school years.

Conclusion

Smoking by a best friend and parental divorce or separation during school years appears to be a strong factor of smoking in later life.

Does mother's smoking influence girls' smoking more than boys' smoking? A 20-year review of the literature using a sex- and gender-based analysis

A systematic literature review was conducted to examine whether mother's smoking influences girls' smoking more than boys' smoking. Fifty-seven studies, published between 1989 and 2009, were analyzed using a sex and gender lens. Results indicate that mother's prenatal and postnatal smoking influences girls' smoking more than boys' smoking. Despite evidence that sex and gender are important determinants of smoking among adolescents when examined in relation to mother's smoking, the theoretical understanding of why girls are more likely to smoke if prenatally and postnatally exposed to mother's smoking remains unclear. Implications for future research are discussed.

The social determinants of adolescent smoking in Russia in 2004

OBJECTIVES

To determine the prevalence of adolescent smoking in the Russian Federation and examine what factors are associated with it.

METHODS

Data were drawn from Round 13 of the Russia Longitudinal Monitoring Survey (RLMS) carried out in 2004. The sample consists of 815 adolescents (430 boys, 385 girls) aged 14-17 years who answered questions about their health behaviours.

RESULTS

Smoking was more prevalent among boys than girls (26.1 vs. 5.7%). Maternal smoking and adolescent alcohol use were associated with smoking among both sexes. The self-assessment of one's socioeconomic position as unfavourable was associated with girls' smoking, while living in a disrupted family, physical inactivity and having a low level of self-esteem were predictive of boys' smoking.

CONCLUSIONS

The family environment appears to be an important determinant of adolescent smoking in Russia. In particular, boys and girls may be modelling the negative health behaviour lifestyles of their parents, with unhealthy behaviours clustering. Efforts to reduce adolescent smoking in Russia must address the negative effects emanating from the parental home whilst also addressing associated behaviours such as alcohol use.

Attitudes to new smoking restrictions and second-hand smoke among young Finnish males

Aims: Relatively little is known about the attitudes of young people to restrictions on smoking in public places and to environmental second-hand smoke in housing estates. The objective was to explore the attitudes of young male adults after the new smoke-free legislation was implemented in Finland. Methods: A survey of 1167 Finnish male military conscripts was performed. The main outcome variables were their attitudes to the new restrictions on smoking in public places and concerns about second-hand smoke in the home originating from their neighbours. Results: Almost half of the youths (43.5%) reported that they supported the more restrictive smoking regulations, with 44.8% having a neutral view. Only 16.0% of the respondents were irritated about the second-hand smoke entering to their house from outside and 48.6% were not concerned about smoking in their neighbourhood. A total of 555 (47.6%) conscripts were current smokers. Current smokers were more often totally opposed to the legislation and had less negative views about the exposure to second-hand smoke than non-smokers. Strong nicotine dependence increased the feelings of anxiety and stigmatisation when the new restrictions were introduced. Conclusions: Finnish young men do accept new smoking restrictions. However, smoking with high nicotine dependence was surprisingly common among these young men and the negative attitude to the legislation can be traced to this group of smokers. The repulsion felt towards second-hand smoke by non-smokers represents an opportunity for public health initiatives to guarantee a smoke-free environment in public and private places.

Key factors in smoking cessation intervention among 15-16-year-olds

The authors aimed to investigate factors associated with smoking cessation among adolescents after tobacco intervention. They examined smokers (n = 127) from one birth cohort (n = 545) in the city of Kotka in Finland. These smokers were randomized in 3 intervention groups the dentist (n = 44) and the school nurse (n = 42 groups), and a control group (n = 39). After 2 months, the authors sent a follow-up questionnaire to the initial smokers to find out who had quit.The authors found that those whose best friend was a nonsmoker were more likely to stop smoking (relative risk RR 7.0 95% Cl 4.6-10.7). Moreover, the nicotine-dependent participants (measured according to the Fagerström Test for Nicotine Dependence(36)) were less likely to stop (RR 0.1 95% Cl 0.08-0.11) compared to non-nicotine dependent participants. Last, of the diurnal types, the morning types found it easier to quit smoking than the evening types (RR 2.2 95% Cl 1.4-3.6). Thus, the authors concluded that the best friend''s influence, nicotine dependence, and diurnal type could be taken more into account in individual counseling on smoking cessation.

Environmental factors as predictors of alcohol use among ninth-grade adolescents in Pitkäranta (Russian Karelia) and in eastern Finland

Background: In Russia, tobacco and alcohol use by adolescents are serious problems. In Finland, as in many other European countries, alcohol use is a growing concern. Aims: This study aimed to find out whether similar environmental factors predict adolescents' alcohol use among 15-year old adolescents in two politically and economically different cultures: in the Pitkäranta district in Russian Karelia and in eastern Finland. Methods: Research data gathered by self-administered questionnaires from the second North Karelia Youth Study and the Pitkäranta Youth Study were analysed. Path models using the structural equation modelling (SEM) approach were constructed to test whether similar path structures fit for boys and girls in both countries, and to test whether regression coefficients are similar between the cultures and by gender. Results: The results showed that alcohol use by family members and best friend is positively related to adolescents' alcohol use both directly and indirectly. The best friend's alcohol use was the most important predictor of adolescents' own alcohol use in every sub-sample. When indirect influences were also identified, the significance of parents' and siblings' alcohol use, in addition to alcohol use by the best friends, was strongly supported. Conclusions: The results highlighted the importance of the process of peer selection for adolescents' choices, and the importance of offering support to the parents and to the health personnel working with children and adolescents.