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Legleye S, Bricard D, Khlat M. Roles of parental smoking and family structure for the explanation of socio-economic inequalities in adolescent smoking. Addiction 2023; 118:149-159. [PMID: 35971293 DOI: 10.1111/add.16026] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 08/03/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Among European countries, France is particularly concerned by adolescent tobacco smoking, especially in disadvantaged socio-economic backgrounds (SES). We measured the respective contributions of parental smoking and family living arrangement to social disparities in smoking during adolescence. DESIGN Secondary analysis of survey data. SETTING A cross-sectional nation-wide exhaustive 12-day survey in March 2017 of French youth aged 17-18.5 years participating in the national mandatory civic information day. PARTICIPANTS A total of 13 314 adolescents answering a pen-and-paper questionnaire about their own tobacco consumption and the smoking of their parents. MEASUREMENTS Risk ratios (RRs) were computed using modified Poisson regressions, and population-attributable fraction (PAF) was used as a measure of the explanatory roles of the different factors as mediators of SES. FINDINGS Adolescents living within very privileged and privileged SES were significantly less likely to report daily tobacco smoking (20.4 and 22.7%, respectively) than those within modest and disadvantaged ones (26.0 and 28.6%, respectively). Parental smoking and family living arrangement independently explained the smoking inequalities among adolescents. After adjusting for schooling factors, the risks associated with parental smoking ranged between RR = 1.64 [95% confidence interval (CI) = 1.50-1.79] when the father only smoked and RR = 2.17 (95% CI = 1.99-2.36) when both parents smoked, compared with non-smoking parents; the risk associated with living in a non-intact family was 1.35 (95% CI = 1.26-1.43) and that of living outside the parental home was 1.20 (95% CI = 1.10-1.30). Apprentices and adolescents out of school had higher risks than those at school (RR = 1.82, 95% CI = 1.68-1.98) and RR = 2.10, 95% CI = 1.92-2.29). The contribution of parental smoking to adolescent smoking (PAF = 32%) was greater than that of SES (PAF = 9%), family living arrangement (PAF = 17%) or schooling factors (14%). The share of SES decreased from 18 to 9% when considering these mediating factors. CONCLUSION In France, parental smoking appears to be the factor that most influences adolescent smoking, followed by family living arrangement; the role of family socio-economic status is small in comparison.
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Affiliation(s)
- Stéphane Legleye
- Université Paris-Saclay, Faculté de médecine UVSQ, Université Paris-Sud, Villejuif, France.,Institut national de la statistique et des études économiques, Montrouge, France
| | - Damien Bricard
- Institut de recherche et documentation en économie de la santé (Irdes), Paris, France
| | - Myriam Khlat
- Institut national d'études démographiques (INED), Aubervilliers, France
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Gagné T, Lapalme J, Ghenadenik AE, OLoughlin JL, Frohlich K. Socioeconomic inequalities in secondhand smoke exposure before, during and after implementation of Quebec's 2015 'An Act to Bolster Tobacco Control'. Tob Control 2021; 30:e128-e137. [PMID: 33115962 DOI: 10.1136/tobaccocontrol-2020-056010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/26/2020] [Accepted: 09/21/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND To better understand whether tobacco control policies are associated with changes in secondhand smoke (SHS) exposure across socioeconomic groups, we monitored differences in socioeconomic inequalities in SHS exposure in households and private vehicles among youth and adults before, during and after adoption of Quebec's 2015 An Act to Bolster Tobacco Control. METHODS Using data from the Canadian Community Health Survey, we examined the prevalence of daily exposure to SHS in households and private vehicles among youth (ages 12 to 17) and adults (ages 18+) across levels of household education and income (separately) in 2013/2014, 2015/2016 and 2017/2018. We tested differences in the magnitude of differences in outcomes over time across education and income categories using logistic models with interaction terms, controlling for age and sex. RESULTS We detected inequalities in SHS exposure outcomes at each time point, most markedly at home among youth (OR of SHS exposure among youth living in the 20% poorest households vs the 20% richest=4.9, 95% CI 2.7 to 6.2). There were decreases in SHS exposure in homes and cars in each education/income group over time. The magnitude of inequalities in SHS exposure in homes and cars, however, did not change during this period. CONCLUSIONS The persistence of socioeconomic inequalities in SHS exposure despite implementation of new tobacco control laws represents an increasingly worrisome public health challenge, particularly among youth. Policymakers should prioritise the reduction of socioeconomic inequalities in SHS exposure and consider the specific needs of socioeconomically disadvantaged populations in the design of future legislation.
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Affiliation(s)
- Thierry Gagné
- Epidemiology and Public Health, University College London, London, UK
| | - Josée Lapalme
- Centre de recherche en santé publique, Montreal, Quebec, Canada
- École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Adrian E Ghenadenik
- Centre de recherche en santé publique, Montreal, Quebec, Canada
- École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Jennifer L OLoughlin
- École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montré, Montreal, Quebec, Canada
| | - Katherine Frohlich
- Centre de recherche en santé publique, Montreal, Quebec, Canada
- École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
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Schreuders M, Linnansaari A, Lindfors P, van den Putte B, Kunst AE. Why staff at European schools abstain from enforcing smoke-free policies on persistent violators. Health Promot Int 2021; 35:1106-1115. [PMID: 31652317 PMCID: PMC7585527 DOI: 10.1093/heapro/daz111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Secondary schools in European countries increasingly implement comprehensive smoke-free school policies (SFSPs) that prohibit most or even all adolescents from smoking during school hours. Consistent enforcement of SFSPs is essential for realizing optimum effectiveness. A main challenge represents adolescents who persistently violate the rules. We studied how staff in European countries respond to these persistent violators and why they may turn a blind eye. We used interview transcripts from 69 staff members at 22 schools in 6 European countries to identify cases in which staff turned a blind eye. We then applied thematic analysis for identifying the considerations as to why they turn a blind eye. Turning a blind eye on persistent violators happened among school staff in all six countries. Three considerations were identified. First, staff believe their primary role and duty is to support all adolescents to develop into well-functioning adults, and sometimes it is best to accept smoking. Second, staff expect that applying stricter disciplinary measures will not stop persistent violators and is more likely to create more severe problems. Third, staff do not feel supported by relevant actors in society (e.g. parents) in influencing adolescent smoking. We conclude that staff’s considerations stress the need to support school staff in enforcing the increasingly comprehensive rules on the most persistent smokers.
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Affiliation(s)
- Michael Schreuders
- Department of Public Health, Amsterdam Public Health Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anu Linnansaari
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland
| | - Pirjo Lindfors
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland
| | - Bas van den Putte
- Department of Communication, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam Public Health Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Predicting the mortality of smoking attributable to cancer in Qingdao, China: A time-series analysis. PLoS One 2021; 16:e0245769. [PMID: 33493221 PMCID: PMC7833131 DOI: 10.1371/journal.pone.0245769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022] Open
Abstract
Smoking is the leading preventable cause of death and disability from cancer in China. To provide a scientific basis for tobacco control strategies and measures, this study investigated cancer deaths attributed to smoking from 2005 to 2017 and predicted mortality trends from 2018 to 2020 in Qingdao. We used time series analysis to evaluate the number of deaths attributed to smoking among residents over 35 years old in Qingdao and predicted mortality trends. The number of cancer deaths attributed to smoking in Qingdao from 2005 to 2016 was between 170 and 407, showing an upward trend and a certain periodicity. The best model is the ARIMA (2,1,0)×(3,1,0)12, with the lowest BIC (6.640) and the highest stationary R2 (0.500). The predicted cancer deaths curve attributed to smoking in 2017 is consistent with the actual curve, with an average relative error of 5.74%. Applying this model to further predict the number of cancer deaths attributed to smoking in Qingdao from January 2018 to December 2020, the predicted results were 5,249, 5,423 and 6,048, respectively. The findings emphasized the need to further strengthen tobacco control measures to reduce the burden of disease caused by tobacco.
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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] [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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Schreuders M, Kuipers MA, Mlinarić M, Grard A, Linnansaari A, Rimpela A, Richter M, Perelman J, Lorant V, van den Putte B, Kunst AE. The association between smoke-free school policies and adolescents' anti-smoking beliefs: Moderation by family smoking norms. Drug Alcohol Depend 2019; 204:107521. [PMID: 31476644 DOI: 10.1016/j.drugalcdep.2019.06.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/01/2019] [Accepted: 06/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Smoke-free school policies (SFSPs) may influence adolescents' smoking through the development of anti-smoking beliefs. We assessed which types of anti-smoking beliefs (health, social and societal) are associated with SFSPs and whether these associations were different for adolescents in smoking permissive versus prohibitive families. METHODS Survey data was collected in 2016-2017 from 10,980 adolescents between 14-16 years old and 315 staff in 55 schools from seven European cities. We separately measured adolescent-perceived SFSP and staff-reported SFSP at the school-level. Associations between SFSP and anti-smoking health, social and societal beliefs were studied using multi-level logistic regression, adjusting for demographics and school-level smoking prevalence. We tested for interactions between family norms and SFSP, and estimated associations for adolescents in permissive and prohibitive families, respectively. RESULTS Adolescent-perceived SFSP was not significantly associated with anti-smoking health (OR:1.08, 95%CI:0.94-1.25), social (OR:0.89, 95%CI:0.75-1.04) and societal beliefs (OR:1.15, 95%CI:0.99-1.33). Staff-reported SFSP were associated with anti-smoking health beliefs (OR:1.12, 95%CI:1.01-1.24), but not with social (OR:0.94, 95%CI:0.83-1.07) or societal beliefs (OR:1.02, 95%CI:0.90-1.14). Most results were comparable between adolescents in smoking prohibitive and permissive families. However, in smoking prohibitive families, adolescent-perceived SFSP were associated with societal beliefs (OR:1.24, 95%CI:1.06-1.46), but not in permissive families (OR:1.06, 95%CI:0.90-1.25). Also, in smoking permissive families, staff-reported SFSP were associated with more pro-smoking social beliefs (OR:0.83, 95%CI:0.72-0.96), but not in prohibitive families (OR:1.05, 95%CI:0.92-1.16). CONCLUSIONS We found evidence that SFSP are associated with some anti-smoking beliefs, but more so among adolescents from smoking prohibitive families than from permissive families.
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Affiliation(s)
- Michael Schreuders
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, the Netherlands.
| | - Mirte Ag Kuipers
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, the Netherlands
| | - Martin Mlinarić
- Institute of Medical Sociology, Medical Faculty, Martin Luther University, Halle-Wittenberg, Germany
| | - Adeline Grard
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Anu Linnansaari
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland
| | - Arja Rimpela
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland; Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin Luther University, Halle-Wittenberg, Germany
| | - Julian Perelman
- National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - Vincent Lorant
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Bas van den Putte
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, the Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, the Netherlands
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Waldhauer J, Kuntz B, Lampert T. [Differences in subjective health, mental health, and health behavior among 11- to 17-year-olds at secondary schools in Germany : Results of the German health interview and examination survey for children and adolescents: first follow-up (KiGGS Wave 1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:374-384. [PMID: 29470591 DOI: 10.1007/s00103-018-2704-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Social inequalities in health can already be found among children and adolescents to the disadvantage of socially deprived population groups. This paper aims to detect, whether differences in subjective health, mental health and health behavior among young people are due to the secondary school type attended and whether these associations exist independently of the family's socioeconomic position (SEP). METHODS The data basis was the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 1, 2009-2012). Data of 11- to 17-year-old girls and boys (n = 4665) who attend different types of secondary schools in Germany were analyzed. The dependent variables were self-rated health, findings of the Strengths and Difficulties Questionnaire (SDQ) for the detection of psychological abnormalities, as well as self-reported information regarding leisure sport, tobacco, and alcohol consumption. Prevalence and odds ratios (ORs) based on logistic regressions are shown. RESULTS For the majority of the examined indicators, it can be shown that adolescents in lower secondary schools are more likely to report worse self-rated health and mental problems and engage in unhealthy behavior than peers in grammar schools ("Gymnasium"). The differences decrease after controlling for family's SEP but mostly remain statistically significant. Adolescents who don't attend grammar schools are most strongly disadvantaged in terms of inattention/hyperactivity for both gender (OR: 2.29 [1.70-3.08]), smoking among girls (2.91 [1.85-4.57]) and physical inactivity (no leisure sport) among boys (OR: 2.71 [1.85-3.95]). DISCUSSION Unequal health opportunities should be viewed in relation to people's living conditions. For adolescents, school constitutes an important setting for learning, experience, and health. The results indicate divergent needs of school-based health promotion and prevention regarding differences among gender and type of school.
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Affiliation(s)
- Julia Waldhauer
- Fachgebiet Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland.
| | - Benjamin Kuntz
- Fachgebiet Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Thomas Lampert
- Fachgebiet Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
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Moor I, Kuipers MAG, Lorant V, Pförtner TK, Kinnunen JM, Rathmann K, Perelman J, Alves J, Robert PO, Rimpelä A, Kunst AE, Richter M. Inequalities in adolescent self-rated health and smoking in Europe: comparing different indicators of socioeconomic status. J Epidemiol Community Health 2019; 73:963-970. [DOI: 10.1136/jech-2018-211794] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 05/02/2019] [Accepted: 06/27/2019] [Indexed: 11/03/2022]
Abstract
BackgroundAlthough there is evidence for socioeconomic inequalities in health and health behaviour in adolescents, different indicators of socioeconomic status (SES) have rarely been compared within one data sample. We examined associations of five SES indicators with self-rated health (SRH) and smoking (ie, a leading cause of health inequalities) in Europe.MethodsData of adolescents aged 14–17 years old were obtained from the 2013 SILNE survey (smoking inequalities: learning from natural experiments), carried out in 50 schools in 6 European cities (N=10 900). Capturing subjective perceptions of relative SES and objective measures of education and wealth, we measured adolescents’ own SES (academic performance, pocket money), parental SES (parental educational level) and family SES (Family Affluence Scale, subjective social status (SSS)). Logistic regression models with SRH and smoking as dependent variables included all SES indicators, age and gender.ResultsCorrelations between SES indicators were weak to moderate. Low academic performance (OR=1.96, 95% CI 1.53 to 2.51) and low SSS (OR=2.75, 95% CI 2.12 to 3.55) were the strongest indicators of poor SRH after adjusting for other SES-indicators. Results for SSS were consistent across countries, while associations with academic performance varied. Low academic performance (OR=5.71, 95% CI 4.63 to 7.06) and more pocket money (OR=0.21, 95% CI 0.18 to 0.26) were most strongly associated with smoking in all countries.ConclusionsSocioeconomic inequalities in adolescent health were largest according to SES indicators more closely related to the adolescent’s education as well as the adolescent’s perception of relative family SES, rather than objective indicators of parental education and material family affluence. For future studies on adolescent health inequalities, consideration of adolescent-related SES indicators was recommended.
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Adolescent Smoking in Secondary Schools that Have Implemented Smoke-Free Policies: In-Depth Exploration of Shared Smoking Patterns. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122100. [PMID: 31200563 PMCID: PMC6616619 DOI: 10.3390/ijerph16122100] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/31/2019] [Accepted: 06/12/2019] [Indexed: 11/24/2022]
Abstract
Large numbers of adolescents smoke during school hours, despite the implementation of smoke-free school policies (SFSPs). Studies about SFSPs predominantly analyse smoking as individual behaviour, yet there is increasing recognition that smoking should be understood as social behaviour. We explored shared smoking patterns specifying where, when, and with whom, and social meanings about why groups of adolescents smoke in two Dutch schools that have implemented SFSPs. Surveys among adolescents were held to obtain contextual information about the schools. Four focus group discussions and fourteen individual interviews were held with adolescents to identify shared smoking patterns in each school. Two shared patterns were identified at a school where 17% of students smoked daily: Dependent smoking and Rebellious smoking. Both built on pro-smoking norms and underscored the benefits of smoking. Three shared patterns were identified at a school where 3% of students smoked daily: Social bonding smoking, Low-profile smoking and Smoking-friendly event smoking. These built on anti-smoking norms and helped smokers cope with negative social judgements related to smoking. We conclude that adolescent smoking during school hours is embedded in diverse shared smoking patterns. Future studies should develop more understanding about how to deal with adolescents’ shared smoking patterns that decrease the effectiveness of tobacco policies.
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Kuntz B, Waldhauer J, Moor I, Rathmann K, Richter M, Orth B, Piontek D, Kraus L, Zeiher J, Lampert T. [Trends in educational inequalities in smoking among adolescents in Germany : Evidence from four population-based studies]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:7-19. [PMID: 28980028 DOI: 10.1007/s00103-017-2636-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND In Germany, smoking prevalence among adolescents has significantly declined since the early 2000s. However, data show that adolescent smoking rates considerably differ between different types of secondary schools. The aim of our study was to examine how educational inequalities in adolescent smoking behaviour have developed over time. METHODS Data were used from four population-based studies (each consisting of repeated cross-sectional surveys from 2001-2015): the representative surveys of the Federal Centre for Health Education, the German Health Interview and Examination Survey for Children and Adolescents, the Health Behaviour in School-aged Children Study, and the European School Survey Project on Alcohol and Other Drugs. Each study comprised different age groups (within the age range of 11-17 years) and used different smoking measures. Adolescents' educational status was based on the attended type of secondary school. Absolute and relative educational inequalities were presented as prevalence differences and prevalence ratios, respectively. RESULTS Despite methodical differences, all four studies similarly reveal that adolescent smoking rates have significantly declined in all educational groups. However, lower smoking rates among secondary school students attending higher educational tracks could be observed. While absolute educational inequalities tended to decrease over time, relative inequalities between educational groups remained rather stable or even increased. DISCUSSION Declining adolescent smoking rates suggest that smoking may have lost some of its attractiveness for young people. Our findings further emphasize the importance of tobacco control measures such as raising cigarette taxes, smoking bans, and increasing minimum legal age for tobacco purchase. As relative educational inequalities in adolescent smoking rates did not diminish over time, setting- and target group-specific interventions should focus more on students in middle and lower secondary school tracks.
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Affiliation(s)
- Benjamin Kuntz
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland.
| | - Julia Waldhauer
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Irene Moor
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Katharina Rathmann
- Fakultät Rehabilitationswissenschaften, Technische Universität Dortmund, Dortmund, Deutschland
| | - Matthias Richter
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Boris Orth
- Bundeszentrale für gesundheitliche Aufklärung, Köln, Deutschland
| | | | - Ludwig Kraus
- IFT Institut für Therapieforschung, München, Deutschland.,Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Stockholm, Schweden
| | - Johannes Zeiher
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Thomas Lampert
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
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Nuyts PAW, Kuipers MAG, Willemsen MC, Kunst AE. Trends in age of smoking initiation in the Netherlands: a shift towards older ages? Addiction 2018; 113:524-532. [PMID: 28987013 DOI: 10.1111/add.14057] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/08/2017] [Accepted: 10/03/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM As smoking initiation generally occurs in adolescence, smoking prevention is targeted primarily at young adolescents (aged below 16 years). We hypothesize that, with the adoption of increasingly stronger youth access laws, a shift in the age of smoking initiation may have occurred. DESIGN Repeated cross-sectional survey. SETTING The Netherlands. PARTICIPANTS A total of 13 163 respondents born between 1980 and 1995. MEASUREMENTS In the 2010-15 National Health Survey we measured retrospectively self-reported initiation rates per year of age by birth cohort (1980-83, 1984-87, 1988-91, 1992-95). Logistic regression analyses were performed to assess differences between cohorts, per sex and educational level. FINDINGS Of those who started smoking, 67.2% initiated smoking between 12 and 16 years of age. Contrary to our hypothesis, no shift in initiation towards higher ages was observed. The peak age of initiation was 16 years for all cohorts. Initiation at ages 17-21 was lower in younger birth cohorts than in older birth cohorts [e.g. cohort 1993-95 versus 1980-83: odds ratio (OR) for initiating at 19-21 years = 0.45, 95% confidence interval (CI) = 0.31-0.64]. Trends in age of initiation were similar for males and females. Initiation at ages 15-17 decreased across cohorts for respondents in higher education levels, but not for those in lower education levels. CONCLUSIONS In the Netherlands, the peak age of smoking initiation did not shift throughour subsequent cohorts born between 1980 and 1995, suggesting that young adolescents remain the main target group for smoking initiation prevention policies.
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Affiliation(s)
- Paulien A W Nuyts
- Department of Public Health, Academic Medical Center, Amsterdam, the Netherlands
| | - Mirte A G Kuipers
- Department of Public Health, Academic Medical Center, Amsterdam, the Netherlands
| | - Marc C Willemsen
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, the Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center, Amsterdam, the Netherlands
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Maynard OM, Gage SH. Commentary on Nuyts et al. (2018): Education is the key to preventing growing inequalities in smoking prevalence. Addiction 2018; 113:533-534. [PMID: 29423988 DOI: 10.1111/add.14115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Olivia M Maynard
- MRC Integrative Epidemiology Unit, University of Bristol, UK.,UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, UK
| | - Suzanne H Gage
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, UK.,UK Centre for Tobacco and Alcohol Studies, Department of Psychological Sciences, University of Liverpool, UK
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13
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Jarlstrup NS, Juel K, Pisinger CH, Grønbæk M, Holm S, Andersen S. International Approaches to Tobacco Use Cessation Programs and Policy in Adolescents and Young Adults: Denmark. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0187-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Kuipers MAG, Haal S, Kunst AE. Socioeconomic Differences in Parenting Strategies to Prevent Adolescent Smoking: A Case Study from the Netherlands. Int J Behav Med 2017; 23:364-371. [PMID: 26883869 PMCID: PMC4863032 DOI: 10.1007/s12529-016-9543-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose This study aimed to identify possible socioeconomic differences in the use of anti-smoking parenting strategies. Methods In 2012, survey data of adolescents (N = 225) aged 13 to 17 years and their mothers (N = 122) and fathers (N = 105) were collected in Haarlem, the Netherlands. Questions on smoking behaviour and eleven anti-smoking parenting strategies were answered by adolescents, mothers and fathers. School tracks of adolescents and educational level of parents were measured as indicators of socioeconomic position. Linear multilevel regression analyses were applied to study the association between socioeconomic position (SEP) and standardised scores of anti-smoking strategies. Analyses were controlled for age, sex and smoking by parents and adolescents. Results We found no consistent socioeconomic differences in the use of anti-smoking parenting strategies. There were no statistically significant differences in relation to parental educational level or when using adolescent reports on parenting practices. However, when using parental reports, a few strategies varied significantly according to adolescent educational track. Adolescents in higher educational tracks were more likely to have no-smoking rules in the home (standardised regression coefficient (β) = 0.20, 95 % confidence interval (CI): 0.03; 0.37, p = 0.022) and more likely to have a no-smoking agreement (β = 0.17, 95 % CI: 0.00; 0.34, p = 0.048). However, they were less likely to frequently communicate about smoking with their parents (β = −0.25, 95 % CI: −0.41; −0.08, p = 0.004). Conclusion In this specific population, there was no consistent support for the hypothesis that anti-smoking parenting strategies contribute to socioeconomic inequalities in adolescent smoking. Parental factors that are more likely to contribute to these inequalities include parental smoking and parenting styles.
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Affiliation(s)
- Mirte A G Kuipers
- Department of Public Health, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Sylke Haal
- Department of Public Health, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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15
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Hu Y, van Lenthe FJ, Hoffmann R, van Hedel K, Mackenbach JP. Assessing the impact of natural policy experiments on socioeconomic inequalities in health: how to apply commonly used quantitative analytical methods? BMC Med Res Methodol 2017; 17:68. [PMID: 28427353 PMCID: PMC5397741 DOI: 10.1186/s12874-017-0317-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The scientific evidence-base for policies to tackle health inequalities is limited. Natural policy experiments (NPE) have drawn increasing attention as a means to evaluating the effects of policies on health. Several analytical methods can be used to evaluate the outcomes of NPEs in terms of average population health, but it is unclear whether they can also be used to assess the outcomes of NPEs in terms of health inequalities. The aim of this study therefore was to assess whether, and to demonstrate how, a number of commonly used analytical methods for the evaluation of NPEs can be applied to quantify the effect of policies on health inequalities. METHODS We identified seven quantitative analytical methods for the evaluation of NPEs: regression adjustment, propensity score matching, difference-in-differences analysis, fixed effects analysis, instrumental variable analysis, regression discontinuity and interrupted time-series. We assessed whether these methods can be used to quantify the effect of policies on the magnitude of health inequalities either by conducting a stratified analysis or by including an interaction term, and illustrated both approaches in a fictitious numerical example. RESULTS All seven methods can be used to quantify the equity impact of policies on absolute and relative inequalities in health by conducting an analysis stratified by socioeconomic position, and all but one (propensity score matching) can be used to quantify equity impacts by inclusion of an interaction term between socioeconomic position and policy exposure. CONCLUSION Methods commonly used in economics and econometrics for the evaluation of NPEs can also be applied to assess the equity impact of policies, and our illustrations provide guidance on how to do this appropriately. The low external validity of results from instrumental variable analysis and regression discontinuity makes these methods less desirable for assessing policy effects on population-level health inequalities. Increased use of the methods in social epidemiology will help to build an evidence base to support policy making in the area of health inequalities.
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Affiliation(s)
- Yannan Hu
- Erasmus MC, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
| | | | - Rasmus Hoffmann
- Erasmus MC, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
- European University Institute, Florence, Italy
| | - Karen van Hedel
- Erasmus MC, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
- Max Planck Institute for Demographic Research, Rostock, Germany
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16
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Kuipers MAG, Brandhof SD, Monshouwer K, Stronks K, Kunst AE. Impact of laws restricting the sale of tobacco to minors on adolescent smoking and perceived obtainability of cigarettes: an intervention-control pre-post study of 19 European Union countries. Addiction 2017; 112:320-329. [PMID: 27614109 DOI: 10.1111/add.13605] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/03/2016] [Accepted: 09/05/2016] [Indexed: 11/29/2022]
Abstract
AIMS To estimate the impact of introducing sales restriction laws in Europe by measuring changes in adolescent smoking prevalence and perceived obtainability of cigarettes over time in countries that have recently introduced sales restriction laws (intervention countries). These countries were compared with countries where such laws were already in force (control countries). The secondary aim was to test whether these trends differed between adolescents of higher and lower socio-economic position (SEP). DESIGN Repeated cross-sectional data were used in a quasi-experimental pre-post design. Intervention countries raised tobacco sales restrictions to 18 years in 2007, 2008 or 2009. Control countries have had sales restrictions of 18 years since at least 2004. SETTING Nineteen European Union (EU) countries in 2007 and 2011. PARTICIPANTS Data of 97 245 15- and 16-year-old adolescents from the 2007 and 2011 European Survey Project on Alcohol and other Drugs (ESPAD) surveys. MEASUREMENTS Dependent variables were smoking status (weekly smoking versus non-smoking or less than weekly smoking) and perceived obtainability of tobacco (easy versus difficult). Key independent variables were time (2007 or 2011), intervention exposure (intervention or control country) and their interaction (time × intervention). Covariates included sex, SEP, the tobacco control scale (TCS), gross domestic product (GDP) and adult smoking prevalence. FINDINGS We did not find a difference in the change in smoking prevalence between intervention and control countries [odds ratio (OR) = 1.00, 95% confidence interval (CI) = 0.93-1.07]. However, sales restrictions were associated with a significantly greater decrease in perceived ease of cigarette obtainability in intervention countries (OR = 0.75, 95% CI = 0.70-0.80). No significant differential effects between high and low SEP adolescents were found (OR = 1.01, 95% CI = 0.81-1.25). CONCLUSION Laws prohibiting the sales of tobacco to minors in Europe do not appear to be associated with a reduction in adolescent smoking rates, but lower the perceived obtainability of cigarettes irrespective of their socio-economic position.
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Affiliation(s)
- Mirte A G Kuipers
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Stephanie D Brandhof
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Karin Monshouwer
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands.,Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, the Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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17
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Jackson N, Denny S, Sheridan J, Fleming T, Clark T, Peiris-John R, Ameratunga S. Uneven reductions in high school students' alcohol use from 2007 to 2012 by age, sex, and socioeconomic strata. Subst Abus 2016; 38:69-76. [DOI: 10.1080/08897077.2016.1252827] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nicki Jackson
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
| | - Simon Denny
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
| | - Janie Sheridan
- School of Pharmacy and Centre for Addiction Research, Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
| | - Terry Fleming
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
| | - Terryann Clark
- School of Nursing, Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
| | - Roshini Peiris-John
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
| | - Shanthi Ameratunga
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
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18
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Wolters A. Lifestyle Vaccines and Public Health: Exploring Policy Options for a Vaccine to Stop Smoking. Public Health Ethics 2016; 9:183-197. [PMID: 27551304 PMCID: PMC4985897 DOI: 10.1093/phe/phw004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Experimental vaccines are being developed for the treatment of 'unhealthy lifestyles' and associated chronic illnesses. Policymakers and other stakeholders will have to deal with the ethical issues that this innovation path raises: are there morally justified reasons to integrate these innovative biotechnologies in future health policies? Should public money be invested in further research? Focusing on the case of an experimental nicotine vaccine, this article explores the ethical aspects of 'lifestyle vaccines' for public health. Based on findings from a qualitative study into a vaccine for smoking cessation, the article articulates possible value conflicts related to nicotine vaccination as an intervention in tobacco control. The 'vaccinization' of lifestyle disease piggybacks on the achievements of classic vaccines. Contrary to expectations of simplicity and success, quitting smoking with a vaccine requires a complex supportive network. Social justice and public trust may become important ethical challenges when deciding whether to use further public funds for research or whether to implement these innovative vaccines in the future.
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Affiliation(s)
- Anna Wolters
- Maastricht University, School CAPHRI, Department of Health, Ethics, and Society
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19
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Individual and contextual determinants of perceived peer smoking prevalence among adolescents in six European cities. Prev Med 2016; 88:168-75. [PMID: 27103335 DOI: 10.1016/j.ypmed.2016.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 04/13/2016] [Accepted: 04/16/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Young people perceiving a high peer smoking prevalence are more likely to initiate smoking. It is unclear which factors contribute to perceived peer smoking prevalence and if these factors vary according to education. This study aimed to assess the determinants of perceived smoking prevalence and assessed its variation at school and country-level. METHODS Data of 10,283 14-17-year-old students in 50 secondary schools in six European cities were derived from the 2013 SILNE survey. The outcome was the perceived smoking prevalence score among peers at school (0-10 scale, 10 represented 100% smoking prevalence). Multilevel linear regression models estimated the associations of factors with perceived prevalence score and variance at school and country-levels. Analyses were also stratified by academic achievement of the adolescent and parental education. RESULTS Determinants of a higher perceived prevalence score were female sex, ever smoking, having friends who smoke, low academic achievement, low parental educational level, and higher actual prevalence of smoking in the school. The perceived prevalence score was not associated with school policies or with the availability of cigarettes near the school. Determinants were very similar across levels of academic achievement and parental education. Perceived prevalence scores substantially varied between schools and countries: 10% and 11% of total variance was related to schools and countries respectively. CONCLUSION Across educational levels, perceptions of peer smoking are strongly determined by both individual characteristics and school and national contexts. Future studies should assess why perceived smoking prevalence varies between schools and countries and identify modifiable factors.
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20
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Pförtner TK, Hublet A, Schnohr CW, Rathmann K, Moor I, de Looze M, Baška T, Molcho M, Kannas L, Kunst AE, Richter M. Socioeconomic inequalities in the impact of tobacco control policies on adolescent smoking. A multilevel study in 29 European countries. Addict Behav 2016; 53:58-66. [PMID: 26454551 DOI: 10.1016/j.addbeh.2015.09.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 09/04/2015] [Accepted: 09/28/2015] [Indexed: 01/17/2023]
Abstract
INTRODUCTION There are concerns that tobacco control policies may be less effective in reducing smoking among disadvantaged socioeconomic groups and thus may contribute to inequalities in adolescent smoking. This study examines how the association between tobacco control policies and smoking of 15-year-old boys and girls among 29 European countries varies according to socioeconomic group. METHODS Data were used from the Health Behaviour in School-aged Children (HBSC) study conducted in 2005/2006 comprising 50,338 adolescents aged 15 years from 29 European countries. Multilevel logistic regression analyses were conducted to assess the association of weekly smoking with components of the Tobacco Control Scale (TCS), and to assess whether this association varied according to family affluence (FAS). Analyses were carried out per gender and adjusted for national wealth and general smoking rate. RESULTS For boys, tobacco price was negatively associated with weekly smoking rates. This association did not significantly differ between low and high FAS. Levels of tobacco-dependence treatment were significantly associated with weekly smoking. This association varied between low and high FAS, with higher treatment levels associated with higher probability of smoking only for low FAS boys. For girls, no tobacco policy was significantly associated with weekly smoking, irrespective of the FAS. CONCLUSIONS Results indicated that most tobacco control policies are not clearly related to adolescent weekly smoking across European countries. Only tobacco price seemed to be adequate decreasing smoking prevalence among boys, irrespective of their socioeconomic status.
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Affiliation(s)
- Timo-Kolja Pförtner
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany; Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Anne Hublet
- Department of Public Health, Ghent University, Ghent, Belgium
| | | | - Katharina Rathmann
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Irene Moor
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Tibor Baška
- Department of Public Health, Jessenius Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Michal Molcho
- Health Promotion Research Centre, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Lasse Kannas
- Department of Health Sciences, University of Jyväskylä, Finland
| | - Anton E Kunst
- Department of Public Health, AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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21
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Pförtner TK, Rathmann K, Moor I, Kunst AE, Richter M. [Social inequalities in adolescent smoking: A cross-national perspective of the role of individual and macro-structural factors]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 59:206-16. [PMID: 26631012 DOI: 10.1007/s00103-015-2280-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In an EU-funded project, we examined on the basis of international comparative analyses which factors were associated with and contributed to socioeconomic inequalities in adolescent smoking. This paper presents the results obtained and discusses their implications for policy and research. METHODS Analyses were based on the "Health Behaviour in School-aged Children (HBSC)" study in 2006 and included more than 50,000 adolescents from 37 countries. The focus was on the association between family affluence and weekly smoking (regularly, at least once a week) among adolescents. Explanatory variables at the individual level refer to psychosocial resources and burdens of school, family, and peers. At the country level, national income, various tobacco control policies, and an index of external differentiation of the educational system were used. RESULTS The psychosocial factors of school and family explained many of the inequalities in the smoking behavior of adolescents. In an international comparison, socioeconomic inequalities in smoking were stronger in richer countries. Absolute smoking rates were lower and inequalities in smoking smaller for boys in countries with higher tobacco prices. On the other hand, educational systems with higher degrees of external differentiation showed lower inequalities in smoking beahviour by girls, and relatively higher rates of smoking (for boys and girls). Stronger inequalities in smoking behaviour were demonstrated in countries with a greater range of preventative measures for tobacco dependence (for boys) and with higher levels of government spending on tobacco control (for girls). CONCLUSION Experiences in richer countries revealed that tobacco control needs to be strengthened for socially disadvantaged adolescents. The reduction of smoking prevalence and socioeconomic inequalities in smoking behavior should be based not only on a strengthening of psychosocial resources in the family and at school, but also on an increase in tobacco prices.
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Affiliation(s)
- Timo-Kolja Pförtner
- Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft, Universität zu Köln, Eupener Straße 129, 50933, Köln, Deutschland.
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - Katharina Rathmann
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Irene Moor
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Anton E Kunst
- Department of Public Health, AMC, University of Amsterdam, Amsterdam, Niederlande
| | - Matthias Richter
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
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22
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Kuipers MAG, Monshouwer K, van Laar M, Kunst AE. Tobacco Control and Socioeconomic Inequalities in Adolescent Smoking in Europe. Am J Prev Med 2015; 49:e64-e72. [PMID: 26164833 DOI: 10.1016/j.amepre.2015.04.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 04/10/2015] [Accepted: 04/10/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The strength of national tobacco control varies by country, but it is unclear how this relates to smoking in adolescents of high and low SES. This study examined the association between tobacco control policies and adolescent smoking and investigated the differences in this association between adolescents of high and low SES. METHODS Data of 90,351 adolescents aged 15-16 years from 13 European countries were obtained from the 2003, 2007, and 2011 European Survey Project on Alcohol and other Drugs databases. Logistic regression analyses were performed in 2014 with a random intercept at the country level and with daily smoking as the outcome. The Tobacco Control Scale was the score for national tobacco control policy. SES was based on parental education. RESULTS In all studied countries, except Portugal, adolescent smoking prevalence rates were highest among low-SES respondents. Stronger tobacco control policies were associated with lower smoking rates in all three survey waves (2003, OR=0.75, 95% CI=0.55, 1.01; 2007, OR=0.84, 95% CI=0.73, 0.98; 2011, OR=0.85, 95% CI=0.74, 0.98). The association was consistently stronger in high-SES than in low-SES individuals, but the difference was not statistically significant. CONCLUSIONS Countries with stronger tobacco control policies tend to have lower smoking rates. We are unable to demonstrate significant socioeconomic inequalities in the effect of tobacco control policies on adolescent smoking.
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Affiliation(s)
- Mirte A G Kuipers
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Karin Monshouwer
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands; Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, the Netherlands
| | - Margriet van Laar
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, the Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Kuipers MAG, de Korte R, Soto VE, Richter M, Moor I, Rimpelä AH, Perelman J, Federico B, Kunst AE, Lorant V. School smoking policies and educational inequalities in smoking behaviour of adolescents aged 14–17 years in Europe. J Epidemiol Community Health 2015; 70:132-9. [DOI: 10.1136/jech-2015-205831] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 08/09/2015] [Indexed: 11/04/2022]
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