Tobacco use by early adolescents in Norway.

BACKGROUND: This study examined trends in the prevalence of smoking and snuff use among Norwegian adolescents in lower secondary school (ages 13-15 years) from a national survey conducted every 5 years between 1975 and 1995. METHODS: Pupils completed a brief written questionnaire on tobacco use and related information. Local school administrators coordinated data collection and forwarded a sample of completed questionnaires to the National Council on Tobacco and Health for compilation and analysis. Effects for age, gender and survey year were examined using logistic regression analysis. Overall, 24,127 pupils in five different cohorts were included. RESULTS: Smoking was highest in 1975 when 45.5% of youth reported smoking either daily or occasionally (figures adjusted for age and gender). Smoking declined each year thereafter through to 1990 (23.6%) but increased in 1995 (26.0%), primarily due to an increase in occasional smoking. Like smoking, snuff use declined between 1985 and 1990 but increased in 1995. All changes across survey years were statistically significant. Smoking was higher among girls than boys, while snuff use was much higher among boys. CONCLUSION: Several hypotheses that might account for the recent increase were examined with the most likely factor being Norway's low allocation of resources for educational interventions and public information campaigns during the years studied. However, in the past 2 years Norway has undertaken a number of new tobacco control initiatives that may result in reversal of the most recent trends.     

Cigarette smoking and stages of change among men and women in Kiev,Ukraine

BACKGROUND: Assisting current smokers to progress towards stopping smoking entails identifying their readiness to stop and understanding the factors that may influence their readiness. Relations were established between certain predictor variables (intensity of smoking, age at initiation, duration of smoking, and gender) and stages of readiness to change smoking behaviour in Kiev, Ukraine. METHODS: Analysis was based on a convenient sample of 536 current smokers who completed a stages-of-change questionnaire in a public square in the centre of Kiev's business district, between 22 and 25 July 2000. Frequency distributions, odds ratios, the Kolmogorov-Smirnov test and the Wilcoxon rank-sum test were used to summarize and describe the data. Tests of significance were based on the 0.05 level. RESULTS: The majority of participants (56.1%) were categorized as precontemplative. Less than 20% of the subjects were prepared for action to change smoking behaviour. Later age at smoking initiation was associated with fewer cigarettes smoked per day. Females were more likely then males to seriously consider cutting down the number of cigarettes they smoked. However, males were more likely to have intentionally quit smoking for at least one day within the past year. CONCLUSION: Information on stages of readiness to stop smoking provided by this study may be useful for improving the effectiveness of smoking cessation programmes in Kiev.     

Socioeconomic group, occupation and incidence of breast cancer and genital cancer among women in Denmark

Most studies of occupational cancer have included only maleemployees. In Denmark more than 40% of the labour force havebeen women since the 1970s and a large proportion of Danishwomen may have had occupational exposures, including exposuresto carcinogens. In a register linkage study we investigatedcancer incidence in a cohort of 1.4 million women, categorizedby occupation in the 1970 census. Professionals, salaried employeesand unskilled workers all had a slightly increased overall cancerrisk. The risk of breast cancer was significantly increasedin several groups of professionals such as lawyers, medicaldoctors, dentists and physiotherapists, nurses and clerks, butin only 2 groups of blue-collar workers: skilled tobacco workersand bookbinders. Ovarian cancer incidence was significantlyelevated among clerks, while travelling saleswomen, furriers,hairdressers, nurses, and clerks had a significant excess ofuterine corpus cancer. Uterine cervix cancer was almost exclusivelyelevated in a variety of unskilled occupations. Women shouldbe included in studies of occupation and cancer. Although occupationalhazards cannot be excluded for some associations found in thisstudy, reproductive and lifestyle factors may also influencecancer risk and need to be considered in studies of occupationand cancer in women.     

The NorVold Abuse Questionnaire (NorAQ): validation of new measures of emotional, physical, and sexual abuse, and abuse in the health care system among women

BACKGROUND: In the literature about abuse, large variations in prevalence rates exist. Validated research instruments are scarce and are needed urgently. Our aim was to validate the 13 questions concerning the experiences of abuse among women in the NorVold Abuse Questionnaire against an interview and two validated questionnaires. METHOD: Data collection was in two parts. i) The NorVold Abuse Questionnaire was sent to a random sample of 2000 women in Osterg?tland. ii) A subsample of 64 women was interviewed, and filled in the Conflict Tactic Scale, the Sexual Abuse Questionnaire, and the NorVold Abuse Questionnaire for a second time. The interview had open questions about abuse and was considered our gold standard. RESULTS: The response rate was 61%. The abuse variables in The NorVold Abuse Questionnaire showed good test-retest reliability (84-95%). Specificity was 98% for all kinds of abuse except physical (85%). Sensitivity ranged from 75% (emotional) to 96% (physical). The likelihood ratio ranged from 38 to 43 for all kinds of abuse except physical (likelihood ratio 6). NorAQ performed better against the interview than against the Sexual Abuse Questionnaire and equally against the Conflict Tactic Scale. High lifetime prevalence rates of abuse were found: emotional 21.4%; physical 36.4%; sexual 16.9%; abuse in the health care 15.6%. Prevalence rates of abuse dropped considerably when a criterion of current suffering was added. CONCLUSIONS: The abuse variables in NorAQ have good reliability and validity.     

Aspects of alienation and symptom load among adolescents

Background: The purpose was to examine the association betweenaspects of alienation and symptom load among adolescents. Furthermorean integrated purpose was to construct and validate an indexof alienation. Methods: Cross-sectional data from 5205 schoolchildren aged 11–15 years from a random sample of schoolsin Denmark were used. Data stems from the Danish contributionto the cross-national study Health and Behaviour in School-agedChildren (HBSC). Alienation was measured with a new index fulfillingfour criteria: (i) theoretical foundation, (ii) inter-correlationbetween items, (iii) correlation between each of the index'sitems and the outcomes and (iv) no differential item functioning.The final index included three indicators of alienation: helplessness,feeling left out of things and lack of confidentiality withparents. Symptom load was measured by HBSC Symptom Checklistand divided into physical and psychological symptoms respectively.High symptom load was defined as experiencing at least one symptomon a daily basis. Results: The odds-ratio (OR) for high symptomload increased with the degree of alienation. For students withall three indicators of alienation, the OR for high physicalsymptom load was 2.49 (1.05–5.87). The OR for high psychologicalsymptom load for the corresponding degree of alienation was6.50 (3.11–13.56). Conclusion: The index of alienationfulfilled psychometric criteria for scalability. Furthermorethe analyses showed a graded and significant association betweenalienation and high symptom load. This suggests alienation tobe taken into account in future health interventions among adolescents.In school settings this may be done using principles of empowerment.     

High coronary heart disease rates among Dutch women of the baby boom, born 1945-1959: age-cohort analysis and projection

BACKGROUND: After a steep decline in older generations, coronary heart disease mortality is stagnating in female cohorts born after the Second World War. We analysed past trends and predicted future health care needs for coronary heart disease in the Dutch population. METHODS: A loglinear age-cohort model relates numbers of deaths and hospital admissions for coronary heart disease to sex, age, birth cohort and population size, and projects age-cohort changes over the future population. Population size, population forecasts and coronary heart disease mortality (period 1970-1999) are from vital statistics. Numbers of hospitalised acute coronary events are from the nationwide hospital register (period 1980-1999). RESULTS: Among men, the rate ratios of deaths and hospital admissions were, respectively, 0.21 (death) and 0.78 (survivors at discharge) in the cohorts born in the period 1948-1962 compared to the period 1918-1922. Among women, the same rate ratios were 0.41 and 1.89. The projection model predicts 22% less deaths from coronary heart disease and 22% more survivors of an infarction in 2015, among men. Among women, there will be 5% less deaths and 70% more survivors of an infarction, most of these being middle age members of the baby boom cohorts. CONCLUSIONS: Stagnating all-cause mortality is correlated with an upward trend in coronary heart disease risk in the female baby boomers. Heart health care needs among middle-aged women will increase sharply. These changes are correlated to high lung cancer mortality and high smoking rates in these cohorts.     

Influences on women's smoking status: The contribution of socioeconomic status in adolescence and adulthood

Background: Declining smoking prevalence is associated withwidening socioeconomic differentials in tobacco use. The studyinvestigates the influence of the adolescent and adult socioeconomicenvironment on the smoking status of adult women. Methods: Asecondary data analysis of a nationally representative surveyof households in Britain, the British Household Panel Survey,was undertaken of 2,678 non-Asian women aged 18–49 yearsin 1991. Multivariate analysis confirmed the significant andindependent effect of adolescent and adult SES on the odds ofbeing a current smoker. Results: With respect to adolescentSES, school-leaving age and school qualifications exerted anindependent effect. With respect to current SES, housing tenurewas the strongest predictor of smoking status. Along with livingin rented housing, other markers of current disadvantage alsoincreased the odds of being a current smoker, including livingin a household without access to a car and being dependent onmeans-tested benefits. Not living with a partner also increasedthe odds of smoking. Compared to Black women, White women wereover twice as likely to be a current smoker. Conclusions: Publichealth policies to reduce the socioeconomic gradient in smokingamong women should target both adolescence and adulthood. Investmentin the education of children heading towards early school leavingand minimum school qualifications could yield positive healthdividends in later life, in terms of higher SES and lower smokingprevalence. Interventions to raise the living standards of womenin lower socioeconomic groups may be required if they are tomatch the rates of decline achieved among women in more advantagedcircumstances.     

Individual, group and community risk and protective factors for alcohol and drug use among Swedish adolescents

BACKGROUND: A number of factors have been identified that protect adolescents or, alternatively, put them at risk for drug use and other high-risk behaviours. These factors concern different personal and environmental factors, e.g. the community, the school setting, family, peer group and individual characteristics.The aim of the present study was to examine the associations between risk and protective factors and adolescents' use of alcohol and drugs. METHODS: In both May 2003 and 2004, random samples of 4800 adolescents (a total of 9600) in Sweden were contacted and asked to fill out a questionnaire.It concerned use of alcohol and illicit drugs and a large number of adolescent risk and protective factors. A total of 5445 (57%) adolescents agreed to participate. RESULTS: About 44% of the adolescents in grade 9 (15-16 years of age) had been drunk on at least one occasion and nearly 80% of those in grade 11 (17-18 years of age). Almost 15% in grade 9 and 40% in grade 11 had been drinking heavily during the previous month, and 4% in grade 9 and 12% in grade 11 had used cannabis. Strong associations were found between elevated individual, family, school and community risk factors and use of alcohol and drugs. Conversely, protective factors were negatively related to the use of alcohol and drugs. CONCLUSIONS: This study confirms the importance of risk and protective factors within different domains in explaining alcohol and drug use among adolescents. The results support efforts targeting multiple risk and protective factors in alcohol and drug preventive interventions for adolescents.     

Trends in cigarette smoking habits in The Netherlands in relation to age, gender and educational level 1987-1991

The objective of the study was to obtain information on recenttrends in smoking habits in socioeconomic subgroups (gender,age and educational level) in The Netherlands. The data wereanalysed from the Monitoring Project on Cardiovascular DiseaseRisk Factors yearly cross-sectional surveys that were performedbetween 1987 and 1991. Each year a random sample of men andwomen aged 20–59 years in three towns in The Netherlandswas invited to participate in the study. The overall responserate was 50% for men and 57% for women. A total of over 36,000subjects participated in the study. The age-standardized prevalenceof current, former and never smoking was the outcome measure.Data on smoking habits were collected by means of a self-administeredquestionnaire. The age-standardized smoking prevalence between1987 and 1991 fell from 41.4 to 38.9% in men (–0.5 percentagepoints per year and 95% Cl: –1.0 to –0.02) and from42.0 to 38.2% in women (–0.8 percentage points per yearand 95% Cl: –1.3 to –0.3). The prevalence of currentsmoking decreased in men with low education and in women withlow and intermediate/high education. In the 1961–1970birth cohort of men with intermediate/high education a relativelylarge increase of 2.8 percentage points (95% Cl: 1.0–4.5)per year was observed. The decrease In smoking prevalence observedbetween 1987 and 1991 was small compared to the period before1987. Differences in the magnitude and direction of trends wereobserved between birth cohorts and educational levels. The resultsof the study emphasize the need for an approach that is targetedtoward specific sociodemographic subgroups.     

Socioeconomic status, psychosocial health and health behaviours among Hungarian adolescents

BACKGROUND: While socioeconomic differences in health, morbidity, and disability are highest among middle-aged persons, there is a certain level of 'equalization' during adolescence and young adulthood. Despite this equalization, however, there still are differences in psychosocial variables or health-related behaviours, often very subtle and sometimes difficult to measure. METHODS: Using data (n = 1114) on high school students (aged between 14 and 21 years) from the Southern Plain Region, Hungary, the present study looks at the role of multiple SES indicators (objective and subjective; occupation and education; family structure) in adolescents' psychosocial health (self-perceived health, psychosomatic, and depressive symptomatology) and health behaviour (substance use and sports activity). RESULTS: Based on the results of multivariate logistic regression analyses, findings suggest the following: (i) SES self-assessment proved to be a significant predictor of adolescents' psychosocial health and health behaviours; (ii) family structure (that is, living in a non-intact family) also significantly influenced adolescents' psychosocial health and health behaviours; (iii) parents' employment status and schooling had a limited influence on their children's health outcomes; (iv) in a word, SES gradients in adolescents' psychosocial health and health behaviour were inconsistent and sometimes irregular (that is, inverse). The subjective SES measurement plays an important role (positive association), whereas certain types of parents' inactive status (in terms of labour market, that is, unemployment or retirement) seem to act in a predictable way (negative association). CONCLUSIONS: Our results indicate that despite certain level of equalization during adolescence, some important relationships between SES variables and health outcomes may occur.     

Coverage of HIV testing among pregnant women in Catalonia, Spain: a comparison of self-reporting with medical records

BACKGROUND: to estimate the coverage of HIV testing during pregnancy in Catalonia, to identify factors associated with testing during pregnancy and to assess the recording of screening in medical records and the women's awareness about being tested. METHODS: A survey was carried out in 2000 among pregnant women attending hospital, with face-to-face interview 24-48 hours post-delivery, and review of the medical records. RESULTS: Out of 2,132 participants, 76% were from public and 24% from private hospitals. Medical records showed that 88.3% of the participants had a HIV test (94% in public, 71% in private hospitals), while for 3.7% and 18.5% in private and public, respectively, this information was not documented. Overall, 67% of women reported having been tested for HIV during that pregnancy, and unawareness of having been tested was detected in 10.7%. Educational level and prenatal care are determinants for being tested. CONCLUSION: Catalonia has a good coverage of HIV testing among childbearing women, although it is lower in private hospitals. Frequently prenatal HIV testing is not documented in medical records and women are unaware of it. Improving the prenatal care and tailoring these programmes to specific populations, like migrants or marginalized groups, will result in a better understanding of HIV prevention and in an increase in HIV testing before delivery.     

Decreasing the prevalence of smoking among Finnish physicians

A postal survey of smoking habits was conducted in a populationof Finnish physicians between October and December 1990. Amongthe 1,623 surveyed (1,231 responses, a 75.8% response rate)the prevalence of daily smoking among male physicians was 10%while in females it was 6%. Another 15% (6% of females) smokedoccasionally. Smoking was more prevalent among elderly physicians.Daily smoking among physicians has decreased since 1969, whenthe daily smoking prevalence was 24% among male respondentsand 17% among females. In addition, according to the survey,Finnish physicians often advice their patients to stop smokingif they have a disease, disorder or complaint for which theprognosis has already been reported to be associated with smoking.     

Use of provocative emotional appeals in a mass media campaign designed to prevent smoking among adolescents

This paper describes short-term reactions to the first of 3consecutive mass media campaigns designed to explore new approachesto prevent the onset of smoking among adolescents. Based onprovocative emotional appeals, the first campaign specificallytargeted girls aged 14 and 15 years. We hypothesized that throughactively provoking adolescents and thereby creating a discussionamong them, a process of interpersonal communication might influencesmoking behaviour. The mass media campaign consisted of 3 differentnewspaper advertisements, 1 poster and 1 TV and cinema spot.The study population consisted of all adolescents aged 14 and15 years in 1 county in Norway. A questionnaire, measuring short-termreactions to the first campaign, was mailed to the home addressesof the adolescents in the intervention county only (n=5, 051).The response rate was 80%. More than 60% recalled having beenexposed to the campaign. The campaign, which targeted smokinggirls in particular, obtained more attention and led to morediscussion and stronger negative emotional reactions among smokinggirls than among any other group. Positive behavioural reactionsto the campaign outnumbered negative behavioural reactions.‘Discussed the campaign with significant others’turned out to be the strongest predictor of positive behaviouralreactions both among smokers and non-smokers. Significant associationsbetween positive affective reactions and positive behaviouralreactions were also observed.     

Prevalence of HBsAg among parturient pregnant women in northwestern Romania

The objective of this study was to determine the hepatitis Bsurface antigen (HBsAg) prevalence in pregnant women in northwesternRomania in order to be able to formulate an adequate preventionpolicy on perinatal transmission of the hepatitis B virus. Across-sectional serological survey was carried out among parturientwomen in 18 hospitals in this area in September 1991. Out of2,354 parturient women, 90 (3.8%) were positive for HBsAg. Theprevalence did not differ significantly by age, parity, ruralversus urban residence or the district of residence. The prevalencedid differ significantly according to the level of medical care.Women who gave birth in level 3 and 4 hospitals had a higherprevalence (5.1%) than those women who gave birth in level 1and 2 hospitals (3.0%), supporting the assumption that iatrogenicinfection has played an important role in the spread of hepatitisB virus (HBV) infection in Romania. Incorporation of universalvaccination with hepatitis B vaccine into the routine childhoodimmunization programme in Romania would be the best strategyto prevent perinatal transmission of HBV. Further studies areneeded to validate the assumption that iatrogenic transmissionhas played an important role in the spread of HBV infectionin Romania.     

Factors contributing to sense of coherence among men and women

BACKGROUND: The purpose of this study was to examine the associations of four key areas of resistance resources (GRR), i.e. childhood living conditions, work and family life, and social relationships, with sense of coherence (SOC) among Finnish men and women. A particular interest was devoted to interactions between sex and GRR. METHODS: The data derived from a representative personal interview survey collected by Statistics Finland in 1994 (N=8650, response rate 73%). This study included ages 25-64 (N=6506, 49% women). The associations of age, educational attainment, childhood living conditions, work and family, and social relationships with SOC were analysed using ordinary regression analysis. RESULTS: Among both men and women, psycho-emotional resources rather than socio-economic circumstances were associated with SOC. These resources included the quality of the relationship with partner, social support, quality of work, and childhood living conditions. Although sex differences were small, the association of living without a partner with low SOC was stronger among men than women. CONCLUSION: SOC is strongly associated with the psycho-emotional resistance resources. In the Finnish context, the SOC scale was largely sex neutral.     

Tobacco use among Japanese schoolchildren: results from preliminary study of Japan adolescent smoking survey (JASS)

Over the past two decades many studies have shown associationsbetween smoking and increased health problems. Smoking amongchildren is especially a major public health concern. Preventingyoung people from developing a smoking habit is an importantgoal for school health education. In Japan, it is difficult to collect accurate data regardingadolescent smoking behaviour, because in Japan smoking underthe age of 20 is prohibited by law. Therefore, a large surveyof smoking habits of young Japanese people was overdue. Numeroussurveys have been carried out since the late 1970s, but thesehave been limited in sample size or geographic area. The Japan Adolescent Smoking Survey (JASS) is probably the largestnumerical survey of smoking behaviour and opinions of schoolchildrenever carried out in Japan. Here the authors show the preliminaryresults of JASS. The goals of the JASS study are to standardize the method ofmeasurement in the smoking behaviour of young children. We believeit is now possible to compare national and international smokingrates of young people, and further, to develop and evaluateteaching methods about smoking for schoolchildren on the basisof this standardization. This report presents the tobacco use among schoolchildren inJapan.     

Changes and determinants in cigarette smoking prevalence in southwestern France, 1985-1997

OBJECTIVE AND METHODS: Smoking trends were assessed in southwestern France for the period 1985-1997 using data from the MONICA population surveys conducted in the Toulouse region. RESULTS: Smoking prevalence decreased in men and remained stable in women, with the exception of age group 35-44 years (stabilization in men, increase in women). In both genders, prevalence of ex-smokers increased. Higher educational level was negatively associated with smoking in men and positively associated in women; in both genders, older age was negatively associated with smoking. CONCLUSIONS: In southwestern France, the decrease or stabilization in smoking prevalence is due to an increase in ex-smokers rather than in never smokers.     

中专生吸烟状况及其影响因素研究

了解中专生吸烟现状及其影响因素，方法：选择商校５６５名１４－１８岁中专生进行吸烟情况及相关问题的问卷调查。采用配对研究条件Ｌｏｇｉｓｔｉｃ回归分析。结果：中专生平均吸烟率为１５．０４％；初始吸烟平均年龄为１３．３４岁，最小１０岁，吸烟率随年龄增大产加。吸烟的动因主要为好奇和交际应酬需要。     

Influence of social environment in smoking among adolescents in Turkey

BACKGROUND: The aim of this study was to examine the social determinants of smoking among adolescents attending school and/or work. METHODS: A survey was carried out on 6012 adolescents aged between 13 and 17 years in 15 cities, recruited from schools, vocational training centres and work places. A self-completed questionnaire was used for data collection. Single- and multi-level regression analyses were run to estimate models. RESULTS: Ever smoking and current smoking rates were 41.1% and 10.5% among girls, and 57.5% and 25.2% among boys. These rates were 47.0% and 13.3% among those who only attended school, 62.2% and 31.7% among those who attended school and worked simultaneously, and 67.5% and 43.0% among those who worked and did not attend school. In multi-level analysis, the major predictors of current smoking were close friends smoking [odds ratio (OR) 3.48; 95% confidence interval (CI) 1.93-6.27], no knowledge of harmful effects of short-term smoking (OR 2.15; 95% CI 1.74-2.67), vulnerability to peer pressure (OR 1.90; 95% CI 1.48-2.46), negative self-perception (OR 1.69; 95% CI 1.31-2.18) and male sex (OR 1.68; 95% CI 1.30-2.16). Mothers higher education was a predictor for girls' smoking, while mother's lower education was a predictor for boys' smoking. At the school level, smoking prevalence was a predictor of current smoking (OR 1.07; 95% CI 1.05-1.08). CONCLUSIONS: Smoking patterns were similar to Western countries in several aspects, while male prevalence rates were higher and the impact of gender-related predictors was significant. Our findings suggest that youth smoking prevention policies should address personal, familial and educational environmental level requirements, taking into consideration the gender differences in addition to international guidelines.