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Saetta S, Frohlich KL, Le Dref G, Kivits J, Minary L. The (De)normalisation of Smoking Among Apprentices: Plurality of Settings, Norms and Vulnerability Levels. QUALITATIVE HEALTH RESEARCH 2024; 34:473-486. [PMID: 37173861 DOI: 10.1177/10497323231166796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
When it comes to smoking, apprentices are considered a 'vulnerable' population. They have been the subject of targeted approaches based on the assumption of common characteristics. In contrast to most public health studies, that assume homogeneity of vulnerable groups, this article, based on Lahire's 'theory of the plural individual', aims to examine inter- and intra-individual variability in relation to tobacco exposure. It is based on a secondary analysis of 30 interviews with apprentices in France on the stigma attached to their use in their different living environments. Our study confirms that the family and the Centre de Formation des Apprentis, as a whole, encourage smoking. It also provides a better understanding of the mechanisms by which inequalities are perpetuated (permissive rules, loans and gifts of cigarettes, spillover effects, lack of incentives to quit). Nevertheless, it allows us to observe that, in some families and in some companies, smoking is denormalised, even stigmatised. Several apprentice profiles emerge: those who are protected from tobacco and seem to be able to quit easily; those who are permanently confronted with it and for whom it is difficult to consider quitting or reducing; and those who are confronted with a plurality of norms, who seem ambivalent and whose consumption varies significantly. These results will allow us to adapt the interventions according to the profile of the apprentices and by including their entourage. In particular, it will be necessary to propose a 'go-to' approach that goes beyond the school setting and involves the family and the workplace.
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Affiliation(s)
- Sébastien Saetta
- ENSEIS Recherche, ENSEIS, Villeurbanne, France
- UMR 5283 Centre Max Weber, Lyon, France
- EA4360 APEMAC, University of Lorraine, Nancy, France
| | - Katherine L Frohlich
- School of Public Health, University of Montréal, Montréal, QC, Canada
- CReSP, University of Montréal, Montréal, QC, Canada
| | | | - Joëlle Kivits
- EA4360 APEMAC, University of Lorraine, Nancy, France
- Université Paris Cité, Inserm, ECEVE, F-75010 Paris, France
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Kjeld SG, Homberg T, Andersen S. Relationship between smoking and mental health in educational settings with high smoking rates: a cohort study among Danish youth. Scand J Public Health 2024:14034948241227305. [PMID: 38342989 DOI: 10.1177/14034948241227305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2024]
Abstract
BACKGROUND Smoking and poor mental health in youth represent important public health priorities. This study aimed to (i) compare tobacco-related behaviors and mental health in two educational settings with high smoking rates: vocational education and training (VET) schools and preparatory basic education (PBE) schools, and (ii) examine associations between smoking at school start and mental health 5 months later. METHODS Data were obtained from baseline (N = 1843) and follow-up (N = 1039) assessments conducted as part of a school-based trial in two rounds (baseline in August 2018 and August 2019). Students' characteristics were presented by adjusted prevalences. Logistic regression analyses assessed associations between smoking and measures of mental health: school-related well-being, overall loneliness, and stress. RESULTS More PBE students than VET students reported daily smoking (40% vs. 27%), nicotine dependence, perceived benefits of smoking (e.g., stress reduction: 41% vs. 33%), low smoking-related self-efficacy (e.g., ability to resist smoking if offered by a friend: 20% vs. 32%), school-related loneliness, and low school connectedness (25% vs. 11%). Daily smokers at VET and PBE schools had lower odds of school-related loneliness (AOR = 0.51, 95% CI: 0.35-0.74) and higher odds of stress (AOR = 2.75, 95% CI: 2.00-3.80). Smoking was associated with better classmate relations in VET schools but not in PBE schools. CONCLUSIONS Our study suggested that students in PBE schools constitute a more vulnerable group in terms of smoking and mental health compared with students in VET schools. Smoking seemed to prevent loneliness in school but was associated with heightened stress levels.
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Affiliation(s)
- Simone G Kjeld
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Susan Andersen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Kjeld SG, Thygesen LC, Danielsen D, Jensen MP, Krølner RF, Pisinger C, Andersen S. Do school-based smoking preventive interventions have unintended effects? Post hoc analysis of the Focus cluster randomised controlled trial. BMJ Open 2024; 14:e070176. [PMID: 38191253 PMCID: PMC10806711 DOI: 10.1136/bmjopen-2022-070176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/27/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES Public health interventions are designed to improve specific health-related outcomes; however, they may also produce negative side effects, such as substitution use, psychological or social harms. Knowledge about the unintended effects of school-based smoking preventive interventions is sparse. Hence, this study examined these potential unintended effects of the smoking-reducing intervention, Focus, among students in the vocational education and training setting. DESIGN Cluster randomised controlled trial stratified by school type with 5 months follow-up. SETTING AND PARTICIPANTS Across Denmark, eight schools were randomised to the intervention group (n=844 students, response proportion 76%) and six schools to the control group (n=815 students, response proportion 75%). This study focused solely on students who smoked at baseline (N=491). INTERVENTIONS The intervention was developed systematically based on theory and a thoroughly mixed-methods needs assessment. Intervention components included a comprehensive school tobacco policy (smoke-free school hours) supported by a 3-day course for school staff and launched by an edutainment session for students; class-based lessons and a quit-and-win competition; and individual telephone smoking cessation support. OUTCOMES Alternative tobacco and nicotine products (regular use of smokeless tobacco, hookah and e-cigarettes), regular cannabis use, boredom and loneliness at school, stress and perceived stigmatisation among smokers. RESULTS We found no statistically significant unintended effects of the intervention. Nonetheless, insignificant findings indicated that students in the intervention group were less likely to be bored during school hours (OR 0.59, 95% CI 0.32 to 1.10) and experience stress (OR 0.62, 95% CI 0.35 to 1.10), but more likely to report feeling stigmatised compared with the control group (OR 1.55, 95% CI 0.71 to 3.40). CONCLUSIONS Overall, findings suggested no unintended effects of the Focus trial with respect to substitution use, psychological, nor group or social harms. Future research is encouraged to report potential harmful outcomes of smoking preventive interventions, and interventions should be aware of the possible stigmatisation of smokers. TRIAL REGISTRATION NUMBER ISRCTN16455577.
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Affiliation(s)
- Simone G Kjeld
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Lau C Thygesen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Dina Danielsen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Marie P Jensen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Rikke F Krølner
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Charlotta Pisinger
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Frederiksberg University Hospital, Frederiksberg, Denmark
- Tryg Foundation, Virum, Denmark
| | - Susan Andersen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
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Psonka Y, Vannimenus C. [Perception of ENDS among French high school students in Nord and Pas-de-Calais]. Rev Mal Respir 2023; 40:743-750. [PMID: 37633810 DOI: 10.1016/j.rmr.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/13/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION Electronic nicotine delivery systems (ENDS) have been gaining popularity for over a decade, particularly among young people. The aim was to understand how these devices were perceived, in general and according to different characteristics: gender, smoking status, experimentation or possession of SEDEN. METHODS A cross-sectional observational study was conducted by an online questionnaire to 15 high schools between 14 May and 23 October 2021. Perception was assessed by a constructed score. RESULTS In total, 772 responses from 10 high schools were analysed; 44.7% had already experimented with ENDS. The main reason for use was pleasure (33.8%). Only 15% of smokers or former smokers reported using ENDS to stop smoking as their main reason. The majority of ENDS (72.8%) are perceived as harmful. This negative perception is more important among women, non-smokers, non-experimenters and non-owners of ENDS. More than 50% of the respondents consider ENDS as distinct from tobacco. CONCLUSIONS ENDS are perceived as potentially harmful and their use is often motivated by pleasure. Their perception as a practice distinct from smoking, combined with unknown long-term consequences, justifies increased vigilance in the face of the emergence of these new uses.
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Affiliation(s)
- Y Psonka
- Unité tabacologie, clinique de pneumologie, institut cœur-poumon, CHU de Lille, boulevard du Pr-Jules-Leclercq, 59000 Lille, France.
| | - C Vannimenus
- Unité tabacologie, clinique de pneumologie, institut cœur-poumon, CHU de Lille, boulevard du Pr-Jules-Leclercq, 59000 Lille, France
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Nargis N, Xue Z, Asare S, Bandi P, Jemal A. Declining trend in cigarette smoking among U.S. adults over 2008-2018: A decomposition analysis. Soc Sci Med 2023; 328:115982. [PMID: 37269745 DOI: 10.1016/j.socscimed.2023.115982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023]
Abstract
The United States (U.S.) witnessed considerable reduction in cigarette smoking prevalence in the recent past. While the correlates of smoking prevalence and related disparities among U.S. adults are well documented, there is limited information on how this success was shared among different population sub-groups. Based on data from the National Health Interview Surveys, 2008 and 2018, representative of non-institutionalized U.S. adults (18 years and above), we applied the threefold Kitawaga-Oaxaca-Blinder linear decomposition analysis. We decomposed the trends in cigarette smoking prevalence, smoking initiation, and successful cessation into changes in population characteristics holding smoking propensities constant (compositional change), changes in smoking propensities by population characteristics holding population composition constant (structural change), and the unmeasured macro-level changes affecting smoking behavior in different population sub-groups at differential rates (residual change) to quantify the shares of population sub-groups by sex, age, race/ethnicity, education, marital status, employment status, health insurance coverage, family income, and region of residence in the overall change in smoking rates. The analysis shows that decreases in smoking propensities regardless of the changes in population composition accounted for 66.4% of the reduction in smoking prevalence and 88.7% of the reduction in smoking initiation. The major reductions in smoking propensity were among Medicaid recipients and young adults (ages 18-24 years). The 25-44-year-olds experienced moderate increase in successful smoking cessation, while the overall successful smoking cessation rate remained steady. Taken together, consistent reduction in smoking among U.S. adults by all major population characteristics, accompanied by disproportionately larger reduction in smoking propensities among the population sub-groups with initially higher smoking propensity compared to the national average, characterized the decline in overall cigarette smoking. Strengthening proven tobacco control measures with targeted interventions to reduce smoking propensities among underserved populations is key to continued success in reducing smoking overall and remedying inequities in smoking and population health.
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Affiliation(s)
- Nigar Nargis
- American Cancer Society, 3380 Chastain Meadows Pkwy NW Suite 200, Kennesaw, GA, 30144, USA.
| | - Zheng Xue
- American Cancer Society, 3380 Chastain Meadows Pkwy NW Suite 200, Kennesaw, GA, 30144, USA
| | - Samuel Asare
- American Cancer Society, 3380 Chastain Meadows Pkwy NW Suite 200, Kennesaw, GA, 30144, USA
| | - Priti Bandi
- American Cancer Society, 3380 Chastain Meadows Pkwy NW Suite 200, Kennesaw, GA, 30144, USA
| | - Ahmedin Jemal
- American Cancer Society, 3380 Chastain Meadows Pkwy NW Suite 200, Kennesaw, GA, 30144, USA
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Kjeld SG, Thygesen LC, Danielsen D, Jakobsen GS, Jensen MP, Holmberg T, Bast LS, Lund L, Pisinger C, Andersen S. Effectiveness of the multi-component intervention 'Focus' on reducing smoking among students in the vocational education setting: a cluster randomized controlled trial. BMC Public Health 2023; 23:419. [PMID: 36864450 PMCID: PMC9979485 DOI: 10.1186/s12889-023-15331-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 02/27/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Social inequality in smoking remains an important public health issue. Upper secondary schools offering vocational education and training (VET) comprise more students from lower socioeconomic backgrounds and have higher smoking prevalence than general high schools. This study examined the effects of a school-based multi-component intervention on students' smoking. METHODS A cluster randomized controlled trial. Eligible participants were schools offering VET basic courses or preparatory basic education in Denmark, and their students. Schools were stratified by subject area and eight schools were randomly allocated to intervention (1,160 invited students; 844 analyzed) and six schools to control (1,093 invited students; 815 analyzed). The intervention program comprised smoke-free school hours, class-based activities, and access to smoking cessation support. The control group was encouraged to continue with normal practice. Primary outcomes were daily cigarette consumption and daily smoking status at student level. Secondary outcomes were determinants expected to impact smoking behavior. Outcomes were assessed in students at five-month follow-up. Analyses were by intention-to-treat and per protocol (i.e., whether the intervention was delivered as intended), adjusted for covariates measured at baseline. Moreover, subgroup analyses defined by school type, gender, age, and smoking status at baseline were performed. Multilevel regression models were used to account for the cluster design. Missing data were imputed using multiple imputations. Participants and the research team were not blinded to allocation. RESULTS Intention-to-treat analyses showed no intervention effect on daily cigarette consumption and daily smoking. Pre-planned subgroup analyses showed statistically significant reduction in daily smoking among girls compared with their counterparts in the control group (OR = 0.39, 95% CI: 0.16, 0.98). Per-protocol analysis suggested that schools with full intervention had higher benefits compared with the control group (daily smoking: OR = 0.44, 95% CI: 0.19, 1.02), while no marked differences were seen among schools with partial intervention. CONCLUSION This study was among the first to test whether a complex, multicomponent intervention could reduce smoking in schools with high smoking risk. Results showed no overall effects. There is a great need to develop programs for this target group and it is important that they are fully implemented if an effect is to be achieved. TRIAL REGISTRATION https://www.isrctn.com/ISRCTN16455577 , date of registration 14/06/2018.
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Affiliation(s)
- Simone G Kjeld
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark.
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Dina Danielsen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Gitte S Jakobsen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Marie P Jensen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Teresa Holmberg
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Lotus S Bast
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Lisbeth Lund
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Denmark
- Faculty of Health Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Danish Heart Foundation, Copenhagen, Denmark
| | - Susan Andersen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
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Social network analysis to study health behaviours in adolescents: A systematic review of methods. Soc Sci Med 2022; 315:115519. [PMID: 36403351 DOI: 10.1016/j.socscimed.2022.115519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/04/2022] [Accepted: 11/05/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Our objectives were (i) to systematically review how SNA is used in studies investigating adolescent health behaviours (i.e., the purpose of using SNA, methods used for network data collection and analysis), and (ii) to develop methodological guidelines to help researchers use SNA in studies on adolescent health behaviours. METHODS Five databases were searched using keywords related to "social network analysis" and "adolescents". We extracted data from included articles pertaining to the choice of methods for network data collection and analysis. We used these data to develop a 5-step decision tree to help researchers make methodological decisions most appropriate to their research objectives. RESULTS A total of 201 articles were included. Most investigated tobacco (50%) or alcohol use (48%). SNA was used most often to examine processes related to peer selection or influence (37%) and/or to examine the effect of sociometric position on health behaviours (34%). 181 studies (90%) used a sociocentric approach for SNA, 16 studies (8%) used an egocentric approach, and 4 studies (2%) used both. We identified five decision-making steps in SNA including the choice of: (i) network boundary, (ii) SNA approach, (iii) methods for name generators, (iv) methods for name interpreters, and (iv) SNA indicators. CONCLUSION This study provides insights and guidance in a 5-step decision tree on practical and methodological considerations in using SNA to explore adolescent health behaviours.
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Zhao Y, Di X, Li S, Zeng X, Wang X, Nan Y, Xiao L, Koplan J, Chen Z, Liu S. Prevalence, frequency, intensity, and location of cigarette use among adolescents in China from 2013-14 to 2019: Findings from two repeated cross-sectional studies. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 27:100549. [PMID: 35923777 PMCID: PMC9340429 DOI: 10.1016/j.lanwpc.2022.100549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The burden of disease caused by tobacco use is a grave public health concern in China. Preventing smoking initiation among adolescents will lower the prevalence of adult tobacco use later. Surveillance of tobacco use among adolescents helps set priorities in developing tobacco control policies. We aim to ascertain the prevalence and differences of cigarette use across sex, grade, and region among middle and high school students in 2019 and associated changes from 2013-14 to 2019 among middle school students. METHODS Using a multistage stratified cluster-randomized sampling design with national and provincial representativeness, we conducted two school-based cross-sectional surveys in 2013-14 and in 2019. A total of 155 117 middle school students in grades 7-9 in 2013-14 and 288 192 middle and high school students in grades 7-12 in 2019 were interviewed. Self-reported experimental and current (past 30-day) cigarette use among middle school and high school students; frequent use (≥20 days in the past 30 days) and intensity (>20 cigarettes per day) of smoking among current cigarette users; and location of smoking among current cigarette users were investigated. All estimates were weighted based on the complex sampling design. FINDINGS The 2013-14 survey (overall response rate: 98.1%) included 155 117 middle school students (47.1% girl). The 2019 survey (overall response rate: 98.7%) included 147 270 middle school students (46.5% girl), 106 432 academic high school students (50.8% girl) and 34 490 vocational high school students (43.8% girl). In 2019, the prevalence rate of experimental and current cigarette use was 12.9% and 3.9% for middle school students, 21.6% and 5.6% for academic high school students, and 30.3% and 14.7% for vocational high school students, respectively, with large sex and regional differences. The prevalences of smoking on 20 or more days and daily cigarette use in the past 30 days were higher in vocational high school (5.9%, 4.1%) than in academic high school (1.8%, 1.2%) and middle school (0.7%, 0.5%), and higher among boys than girls. The proportions of current cigarette users smoking more than 20 cigarettes per day in the past 30 days for girls were higher than for boys in academic high school. Students usually smoke at school and at home. Boys were more likely to use cigarettes in an internet cafe, while girls often smoked at social venues. From 2013-14 to 2019, the prevalences of experimental and current cigarette use declined by 5.0% and 2.0% (percentage points), respectively, among middle school students but increased by 1.4% and 0.5% (percentage points) among rural girls. Among current cigarette users in middle school students, the proportions of heavy cigarette use (>20 cigarettes per day) have increased by 1.8 percentage points, mainly among boys, by 2.2% (percentage points). INTERPRETATION From 2013-14 to 2019, the prevalences of experimental and current cigarette use among middle school students decreased overall but increased among rural girls, while the intensity of cigarette use rose among boys. Cigarette use among Chinese adolescents differs across sex and regions, with higher rates among boys, in rural areas, and in the Western region (low socioeconomic status). Smoking is much more prevalent in vocational high schools than the other settings. Effective targeted tobacco control interventions among adolescents are urgently needed in China. FUNDING Dr. Zhuo Chen is supported by National Natural Science Foundation (Grant#: 72174098) through the University of Nottingham Ningbo China.
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Affiliation(s)
- Yan Zhao
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, 27# Nanwei Road, Xicheng District, Beijing 100050, China
- Department of Public Health, School of Public Health, Inner Mongolia Medical University, Huhehot, Inner Mongolia 010110, China
| | - Xinbo Di
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, 27# Nanwei Road, Xicheng District, Beijing 100050, China
| | - Sixuan Li
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, 27# Nanwei Road, Xicheng District, Beijing 100050, China
- Ningbo Municipal Center for Disease Control and Prevention, 237# Yongfeng Road, Haishu District, Ningbo, Zhejiang Province 315010, China
| | - Xinying Zeng
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, 27# Nanwei Road, Xicheng District, Beijing 100050, China
| | - Xiaofeng Wang
- Information Center, Chinese Center for Disease Control and Prevention, 155# Changbei Road, Changping District, Beijing 102206, China
| | - Yi Nan
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, 27# Nanwei Road, Xicheng District, Beijing 100050, China
| | - Lin Xiao
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, 27# Nanwei Road, Xicheng District, Beijing 100050, China
| | - Jeffrey Koplan
- Emory Global Health Institute, Emory University, Atlanta 30322 Georgia, USA
| | - Zhuo Chen
- College of Public Health, University of Georgia, Athens 30602 Georgia, USA
- School of Economics, University of Nottingham Ningbo China 315100 Ningbo, Zhejiang Province, China
| | - Shiwei Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, 27# Nanwei Road, Xicheng District, Beijing 100050, China
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Kim N, Jacobson M. Comparison of catastrophic out-of-pocket medical expenditure among older adults in the United States and South Korea: what affects the apparent difference? BMC Health Serv Res 2022; 22:1202. [PMID: 36163016 PMCID: PMC9511719 DOI: 10.1186/s12913-022-08575-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical spending rises sharply with age. Even with universal health insurance, older adults may be at risk of catastrophic out-of-pocket medical spending. We aimed to compare catastrophic out-of-pocket medical spending among adults ages 65 and older in the United States, where seniors have near-universal coverage through Medicare, versus South Korea, where all residents have national health insurance. METHODS We used the 2016 Health and Retirement Study and the Korean Longitudinal Study of Aging. The study population were adults ages 65 and over in the US (n = 9,909) and South Korea (n = 4,450; N = 14,359). The primary outcome of interest was older adults' exposure to catastrophic out-of-pocket medical expenditure, defined as out-of-pocket medical spending over the past two years that exceeded 50% of annual household income. To examine the factors affecting catastrophic out-of-pocket medical spending of older adults in both countries, we performed logistic regression analyses. To compare the contribution of demographic factors versus health system-level factors to catastrophic out-of-pocket medical spending, we performed a Blinder-Oaxaca decomposition. RESULTS The proportion of respondents with catastrophic out-of-pocket medical expenditure was 5.8% and 3.0% in the US and South Korea, respectively. A Blinder-Oaxaca decomposition showed that the difference in the rate of catastrophic out-of-pocket medical expenditure spending between the two countries was attributable largely to unobservable system-level factors, rather than observed differences in the sociodemographic characteristics. CONCLUSIONS Exposure to catastrophic out-of-pocket medical spending is considerably higher in the US than South Korea. Most of the difference can be attributed to unobserved health system-level factors.
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Affiliation(s)
- Narae Kim
- University of Southern California Leonard Davis School of Gerontology, 3715 McClintock Ave., Los Angeles, California, 90089, USA.
| | - Mireille Jacobson
- University of Southern California Leonard Davis School of Gerontology, 3715 McClintock Ave., Los Angeles, California, 90089, USA
- Leonard D. Schaeffer Center for Health Policy & Economics, 635 Downey Way Verna & Peter Dauterive Hall (VPD), Los Angeles, California, 90089, USA
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Coledam DHC, Frotta BM, Ré AHN. General Versus Vocational Education in High School: Cross-Sectional Associations with Student's Health. THE JOURNAL OF SCHOOL HEALTH 2022; 92:570-580. [PMID: 35259777 DOI: 10.1111/josh.13165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/12/2022] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The aim of the present study was to analyze the association between course type and health among high school students. METHODS A cross-sectional study with 675 Brazilian high school students. The independent variable was course type (general or vocational) and dependent variables were health characteristics. All information was obtained by a self-report questionnaire and the following health characteristics were analyzed: mental health, physical activity, sedentary behavior, food consumption, daytime sleepiness, tobacco use, alcohol consumption, aggression, and musculoskeletal symptoms. The prevalence ratio (PR) was estimated by Poisson regression. RESULTS Vocational students presented a higher prevalence in 7 of the 20 mental health symptoms analyzed (PR = 1.21-1.64), daytime sleepiness (PR = 1.39-1.71), and musculoskeletal symptoms in neck, shoulders, low back, and knees (PR = 1.31-1.41), and a lower likelihood of being physically active (PR = 0.59-0.70). Conversely, vocational students showed lower sedentary behavior on TV and videogames during the week (PR = 0.35-0.46), consumption of snacks, cookies, and crackers (PR = 0.56-0.72), and experiences of aggression (PR = 0.13-0.17), all P < .05. CONCLUSIONS High school can affect students' health distinctly, indicating that intervention programs and health monitoring should be specific to course type.
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Affiliation(s)
- Diogo Henrique Constantino Coledam
- Federal Institute of Education, Science and Technology of São Paulo-IFSP, 100 Zélia de Lima Rosa Boituva, São Paulo-SP, 18552252, Brazil
| | - Beatriz Marinho Frotta
- Federal Institute of Education, Science and Technology of São Paulo-IFSP, 100 Zélia de Lima Rosa Boituva, São Paulo-SP, 18552252, Brazil
| | - Alessandro Hervaldo Nicolai Ré
- School of Arts, Sciences and Humanities, University of São Paulo-USP, 1000 Arlindo Bettio, Vila Guaraciaba, São Paulo-SP, 03828000, Brazil
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O’Rourke T, Dale R, Humer E, Probst T, Plener P, Pieh C. Health Behaviors in Austrian Apprentices and School Students during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1049. [PMID: 35162076 PMCID: PMC8834496 DOI: 10.3390/ijerph19031049] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/11/2022] [Accepted: 01/15/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND The COVID-19 pandemic has disrupted our daily lives, which in turn has impacted health behaviors. Young people have been particularly affected. This study aimed to assess health behaviors in Austrian apprentices and high school students during the COVID-19 pandemic and whether vaccination willingness is affected by health behaviors. METHODS Two online surveys were conducted via REDCap with 1442 apprentices (female: 53.5%, male: 45.4%) from 29 March to 18 May 2021 and 563 school students (female: 79.6%, male: 18.6%) from 19 June to 2 July 2021. The two samples were matched to account for sociodemographic differences and analyses were run on the matched sample. Besides the health behaviors, namely, smoking, alcohol consumption, cannabis consumption, and exercise, health status and vaccination willingness were also assessed. RESULTS Health behaviors were affected by both education group and gender. Apprentices reported significantly more smoking than high school students and this difference was more pronounced in women (all p < 0.01). Alcohol consumption was higher in apprentices than school students, but only in women (p < 0.01). There was a trend for the two education groups to differ in their cannabis use as well (p = 0.05). Apprentices took part in more weekly exercise (p < 0.0001), but high school students reported better average health status (p < 0.001). When included in the same model, health behaviors did not affect vaccine willingness, but education group did, with high school students showing a higher willingness to receive the COVD-19 vaccine than apprentices. CONCLUSIONS These findings support the argument that education type is an important factor for health behaviors, but this is also mediated by gender. Appropriate interventions for adolescents are needed to prevent adverse health behavior changes following the COVID-19 pandemic.
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Affiliation(s)
- Teresa O’Rourke
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (R.D.); (E.H.); (T.P.); (C.P.)
| | - Rachel Dale
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (R.D.); (E.H.); (T.P.); (C.P.)
| | - Elke Humer
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (R.D.); (E.H.); (T.P.); (C.P.)
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (R.D.); (E.H.); (T.P.); (C.P.)
| | - Paul Plener
- Department of Child and Adolescence Psychiatry, Medical University of Vienna, 1090 Vienna, Austria;
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, 89075 Ulm, Germany
| | - Christoph Pieh
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (R.D.); (E.H.); (T.P.); (C.P.)
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12
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Zeng X, Di X, Liu S, Xie H, Meng Z, Xiao L. Smoking Behavior Among Secondary School Students — China, 2021. China CDC Wkly 2022; 4:441-447. [PMID: 35686047 PMCID: PMC9167609 DOI: 10.46234/ccdcw2022.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/24/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Xinying Zeng
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xinbo Di
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shiwei Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huiyu Xie
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zida Meng
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lin Xiao
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
- Lin Xiao,
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13
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Jakobsen GS, Danielsen D, Jensen MP, Vinther JL, Pisinger C, Holmberg T, Krølner RF, Andersen S. Reducing smoking in youth by a smoke-free school environment: A stratified cluster randomized controlled trial of Focus, a multicomponent program for alternative high schools. Tob Prev Cessat 2021; 7:42. [PMID: 34131598 PMCID: PMC8171329 DOI: 10.18332/tpc/133934] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/24/2022]
Abstract
Youth smoking remains a major challenge for public health. Socioeconomic position influences the initiation and maintenance of smoking, and alternative high school students are at particularly high risk. The school environment is an important setting to promote health, however there is a lack of evidence-based school intervention programs. This article presents the Focus study, which aims to test the implementation and effectiveness of a school-based intervention integrating1 a comprehensive school smoking policy [i.e. smoke-free school hours (SFSH)]2, a course for school staff in short motivational conversations3, school class-based teaching material4, an edutainment session5, a class-based competition, and6 access to smoking cessation support. Together these intervention components address students' acceptability of smoking, social influences, attitudes, motivation, and opportunities for smoking. The setting is alternative high schools across Denmark, and the evaluation design is based on a stratified cluster randomized controlled trial comparing the intervention group to a control group. Outcome data is collected at baseline, midway, and at the end of the intervention period. Moreover, a detailed process evaluation, using qualitative and quantitative methods, is conducted among students, teachers, and school principals. The results from this trial will provide important knowledge on the effectiveness of a smoke-free school environment. The findings will lead to a better understanding of which policies, environments, and cognitions, contribute to preventing and reducing cigarette use among young people in a diverse and high-risk school setting, and illuminate which complementary factors are significant to achieve success when implementing SFSH.
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Affiliation(s)
- Gitte S Jakobsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Dina Danielsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Marie P Jensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Johan L Vinther
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Charlotta Pisinger
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg University Hospital, Copenhagen, Denmark
| | - Teresa Holmberg
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Rikke F Krølner
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Susan Andersen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Multiple Health Risk Factors in Vocational Education Students: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020637. [PMID: 33451108 PMCID: PMC7828627 DOI: 10.3390/ijerph18020637] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/06/2021] [Accepted: 01/09/2021] [Indexed: 12/13/2022]
Abstract
Health risk factors such as tobacco smoking, inadequate fruit intake, inadequate vegetable intake, risky alcohol consumption, physical inactivity, obesity, anxiety and depression often commence during adolescence and young adulthood. Vocational education institutions enrol many students in these age groups making them an important setting for addressing multiple health risk factors. This systematic review examined (i) co-occurrence of health risk factors, (ii) clustering of health risk factors, and (iii) socio-demographic characteristics associated with co-occurrence and/or clusters of health risks among vocational education students. MEDLINE, PsycINFO, EMBASE, CINAHL and Scopus were searched to identify eligible studies published by 30 June 2020. Two reviewers independently extracted data and assessed methodological quality using the National Heart, Lung and Blood Institute Quality Assessment Tool. Five studies assessed co-occurrence and three studies clustering of health risks. Co-occurrence of health risk factors ranged from 29–98% and clustering of alcohol use and tobacco smoking was commonly reported. The findings were mixed about whether gender and age were associated with co-occurrence or clustering of health risks. There is limited evidence examining co-occurrence and clustering of health risk factors in vocational education students. Comprehensive assessment of how all these health risks co-occur or cluster in vocational education students is required.
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