Use of snus, its association with smoking and alcohol consumption, and related attitudes among adolescents: the Finnish National School Health Promotion Study

Tobacco Induced Diseases

Jorma I. Virtanen¹  Paula Pesonen²  Battsetseg Tseveenjav² 

[1] Medical Research Center (MRC Oulu), Oulu, Finland;Oulu University Hospital, Oulu, FI-90029, Finland

关键词: Use of snus;    Smoking;    Parental education;    Smokeless tobacco;    Non-conventional tobacco product;    Alcohol consumption;    Adolescents;   

Others  :  1229913
DOI  :  10.1186/s12971-015-0058-3

 received in 2015-06-24, accepted in 2015-10-13,  发布年份 2015

【 摘 要 】

Background

The relationship between the use of snus and lifestyle-related habits – especially in adolescence, when these behaviours begin and become established – is not widely studied. Our aim was to analyse associations between snus use and habits of and attitudes towards smoking and alcohol consumption among Finnish adolescents.

Methods

The study is a part of the National School Health Promotion Study in Finland. The study population consisted of a representative sample of Finnish adolescents (n = 183 226). A questionnaire enquired about pupils’ use of snus, habits of and attitudes towards smoking and alcohol consumption, as well as their (age, gender, school type) and their parents’ (education and smoking) background factors. Chi-square tests and logistic regression models served in the statistical analyses.

Results

Of the adolescents, 18 % had used snus (2 % daily, 16 % experimented) while 82 % never had. Snus use was more common among boys than girls (p < 0.05). Concerning smoking, 19 % were daily and 15 % occasional smokers. Regarding alcohol, 11 % consumed it weekly and 57 % monthly or less frequently. More than two thirds of the adolescents held positive attitudes towards smoking (71 %), and alcohol (67 %). Male gender (OR = 9.9; 95 % CI 9.4–10.4), current (OR = 32.8; 95 % CI 26.1–41.1) or former (OR = 10.1; 95 % CI 8.0–12.9) smoking, weekly consumption of alcohol (OR = 27.4; 95 % CI 21.0–35.8), positive attitude towards smoking (OR = 1.4; 95 % CI 1.3–1.6), and higher parental education (OR = 1.4; 95 % CI 1.3–1.4) associated significantly with adolescents’ current snus use, whereas parental smoking did not.

Conclusion

Current snus use among adolescents may signal an accumulation of other lifestyle-related risky behaviours such as current or past smoking and alcohol consumption as well as a positive attitude towards smoking. In addition to these possible co-existing health-related risk factors, health promotion activities should take into account gender and school differences in order to target preventive messages to youth more effectively.

【 授权许可】

   
2015 Tseveenjav et al.

【 参考文献 】

• [1]Shafey O, Eriksen M, Ross H, Mackay J. The tobacco atlas. 3rd ed. American Cancer Society; 2010. Available from: http://www.cancer.org/aboutUs/GlobalHealth/CancerandTobaccoControlResources/the-tobacco-atlas-3rd-edition. Accessed 16.10.2015
• [2]Foulds J, Ramstrom L, Burke M, Fagerström K. Effect of smokeless tobacco (snus) on smoking and public health in Sweden. Tob Control. 2003; 12:349-59.
• [3]Øverland S, Tjora T, Hetland J, Aarø LE. Association between adolescent socioeducational status and use of snus and smoking. Tob Control. 2010; 19:291-6.
• [4]Pedersen W, von Soest T. Tobacco use among Norwegian adolescents: from cigarettes to snus. Addiction. 2014; 109:1154-62.
• [5]Raisamo S, Pere L, Lindfors P, Tiirikainen M, Rimpelä A. The Adolescent Health and Lifestyle Survey 2011, adolescent smoking, alcohol and substance use in 1977–2011. The Ministry of Social Affairs and Health, Helsinki; 2011.
• [6]Kinnunen JM, Ollila H, El-Amin SE-T, Pere LA, Lindfors PL, Rimpelä AH. Awareness and determinants of electronic cigarette use among Finnish adolescents in 2013: a population-based study. Tob Control. 2014. doi:10.1136/tobaccocontrol-2013-051512.
• [7]Kozlowski LT, O’Connor RJ, Edwards BQ, Flaherty BP. Most smokeless tobacco use is not a causal gateway to cigarettes: using order of product use to evaluate causation in a national US sample. Addiction. 2003; 98:1077-85.
• [8]Furberg H, Bulik CM, Lerman C, Lichtenstein P, Pedersen NL, Sullivan PF. Is Swedish snus associated with smoking initiation or smoking cessation. Tob Control. 2005; 14:422-4.
• [9]Ramström LM, Foulds J. Role of snus in initiation and cessation of tobacco smoking in Sweden. Tob Control. 2006; 15:210-4.
• [10]Tomar SL. Is use of smokeless tobacco a risk factor for cigarette smoking? The US experience. Nicotine Tob Res. 2003; 5:561-9.
• [11]Severson HH, Forrester KK, Biglan A. Use of smokeless tobacco is a risk factor for cigarette smoking. Nicotine Tob Res. 2007; 9:1331-7.
• [12]Grøtvedt L, Forsén L, Stavem K, Graff-Iversen S. Patterns of snus and cigarette use: a study of Norwegian men followed from age 16 to 19. Tob Control. 2013; 22:382-8.
• [13]Tomar SL, Fox BJ, Severson HH. Is smokeless tobacco use an appropriate public health strategy for reducing societal harm from cigarette smoking? Int J Environ Res Public Health. 2009; 6:10-24.
• [14]Boffetta P, Hecht S, Gray P, Gupta P, Straif K. Smokeless tobacco and cancer. Lancet Oncol. 2008; 9:667-75.
• [15]Hamari AK, Toljamo TI, Kinnula VL, Nieminen PA. Dual use of cigarettes and Swedish snuff (snus) among young adults in Northern Finland. Eur J Public Health. 2013; 23:768-71.
• [16]Wickholm S, Lahtinen A, Ainamo A, Rautalahti M. Adverse effects of Swedish smokeless tobacco “snus”. Duodecim. 2012; 128:1089-96.
• [17]Critchley JA, Unal B. Health effects associated with smokeless tobacco: a systematic review. Thorax. 2003; 58:435-43.
• [18]Luo J, Ye W, Zendehdel K, Adami J, Adami HO, Boffetta P et al.. Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study. Lancet. 2007; 369:2015-20.
• [19]Östenson CG, Hilding A, Grill V, Efendic S. High consumption of smokeless tobacco (“snus”) predicts increased risk of type 2 diabetes in a 10-year prospective study of middle-aged Swedish men. Scand J Public Health. 2012; 40:730-7.
• [20]Engström K, Magnusson C, Galanti MR. Socio-demographic, lifestyle and health characteristics among snus users and tobacco users in Stockholm County, Sweden. BMC Public Health. 2010; 10:619. BioMed Central Full Text
• [21]Galanti MR, Wickholm S, Gilljam H. Between harm and dangers. Oral snuff use, cigarette smoking and problem behaviours in a survey of Swedish male adolescents. Eur J Public Health. 2001; 11:340-5.
• [22]Mattila VM, Raisamo S, Pihlajamäki H, Mäntysaari M, Rimpelä A. Sports activity and the use of cigarettes and snus among young males in Finland in 1999–2010. BMC Public Health. 2012; 12:230. BioMed Central Full Text
• [23]Grøtvedt L, Stigum H, Hovengen R, Graff-Iversen S. Social differences in smoking and snuff use among Norwegian adolescents: a population based survey. BMC Public Health. 2008; 8:322. BioMed Central Full Text
• [24]Sæbø G. Cigarettes, snus and status. About life-style differences between users of various tobacco products. Norwegian J Social. 2013; 21:5-32.
• [25]Taleb ZB. Snus usage: Harm induction or harm reduction? Scand J Public Health. 2014; 42:225-6.
• [26]National Institute for Health and Welfare, 2014. Available from: http://www.thl.fi/fi/web/thlfi-en/research-and-expertwork/population-studies/school-health-promotion-study. Accessed 16.10.2015
• [27]Combs JL, Spillane NS, Caudill L, Stark B, Smith GT. The acquired preparedness risk model applied to smoking in 5th grade children. Addict Behav. 2012; 37:331-4.
• [28]Sihvola E, Rose RJ, Dick DM, Pulkkinen L, Marttunen M, Kaprio J. Early-onset depressive disorders predict the use of addictive substances in adolescence: a prospective study of adolescent Finnish twins. Addiction. 2008; 103:2045-53.
• [29]Wickholm S, Galanti MR, Söder B, Gilljam H. Cigarette smoking, snuff use and alcohol drinking: coexisting risk behaviours for oral health in young males. Community Dent Oral Epidemiol. 2003; 31:268-74.
• [30]Everett SA, Malarcher AM, Sharp DJ, Husten CG, Ciovino GA. Relationship between cigarette, smokeless tobacco, and cigar use, and other health risk behaviours among U.S. high school students. J Sch Health. 2000; 70:234-40.
• [31]Huhtala HS, Rainio SU, Rimpela AH. Adolescent snus use in Finland in 1981–2003: trend, total sales ban and acquisition. Tob Control. 2006; 15:392-7.
• [32]Smokeless tobacco and some tobacco-related N-nitrosamines. IARC Monog. Eval. Carcinog. Risk Chem. Hum. International Agency for Research on Cancer, Lyon; 2007.
• [33]The health consequences of using smokeless tobacco. A report of the Advisory Committee to the Surgeon General. U.S. Department of Health and Human Services, Public Health Service, Bethesda; 1986. NIH Publication No. 86–2874
• [34]Report on carcinogens. 1st ed. Department of Health and Human Services, Public Health Service, National Toxicology Program, Research Triangle Park, N.C., U.S; 2005.
• [35]Pennanen M. School achievement, family factors and smoking prevention. National Institute for Health and Welfare (THL), Helsinki; 2011. Research 78/2012
• [36]Rosendahl KI, Galanti MR, Gilljam H, Ahlbom A. Smoking mothers and snuffing fathers: behavioural influences on youth tobacco use in a Swedish cohort. Tob Control. 2003; 12:74-8.