Jaana M Kinnunen

Awareness and determinants of electronic cigarette use among Finnish adolescents in 2013: a population-based study

Background A wide range of electronic cigarettes (e-cigarettes) are now on the market. We studied e-cigarette awareness and use, determinants and sources of e-cigarettes, the e-liquids used in them and exposure to e-cigarette advertisements among adolescents in Finland. Among smokers, we studied the association of e-cigarette use and interest in smoking cessation. Method Data were obtained from a national survey of 12–18-year-old Finnish adolescents in 2013 (N=3535, response rate 38%). Descriptive statistics and logistic regression analysis were used. Results Of the respondents, 85.3% knew what e-cigarettes were; 17.4% had tried them. E-liquids with nicotine were used most often (65.7%); also those who had never tried conventional cigarettes had used them. Of e-cigarette ever users, 8.3% had never tried smoking. Parents’ high level of education, being in employment, and intact family protected against childrens e-cigarette use. In the final model, daily smoking (OR 41.35; 95% CI 25.2 to 67.8), snus use (2.96; 2.4–4.0), waterpipe use (2.21; 1.6–3.0), childrens vocational education (2.06; 1.4–3.1) and poor school performance (1.92; 1.4–3.0) were associated with e-cigarette experimentation. Those smokers with most experience of e-cigarettes were least likely to consider smoking cessation. Conclusions Awareness and experimentation with e-cigarettes are high among adolescents, especially in older age groups and boys. Nicotine e-liquids are easy to acquire for youth. Having similar risk factors, e-cigarette use seems to follow the model of conventional smoking initiation. Among adolescent smokers, use of e-cigarettes does not clearly relate to interest in smoking cessation. Preventive policies are needed to protect the youth.

Smoking in school-aged adolescents: design of a social network survey in six European countries

BackgroundIn Western countries, smoking accounts for a large share of socio-economic inequalities in health. As smoking initiation occurs around the age of 13, it is likely that school context and social networks at school play a role in the origin of such inequalities. So far, there has been little generic explanation of how social ties at school contribute to socio-economic inequalities in smoking. The SILNE (Smoking Inequalities – Learning from Natural Experiments) survey was designed to test the hypothesis that a combination of peer effect, homophilous social ties, and school context may explain how smoking inequalities are magnified at school – a theory known as network-induced inequality. In this paper, the survey theory and design are presented.FindingsThe social network survey was carried out in 2013 in six medium-sized European cities with average incomes similar to the national average: Namur (Belgium), Tampere (Finland), Hannover (Germany), Latina (Italy), Amersfoort (The Netherlands), and Coimbra (Portugal). In each city, 6 to 8 schools were selected in a stratified sampling procedure. In each school, two grades in secondary education, corresponding to 14-16-year-olds, were selected. All adolescents in these two grades were invited to participate in the survey. Social ties were reported using the roster approach, in which each adolescent had to nominate up to 5 friends from a directory.The survey collected information from 11,015 adolescents in 50 schools, out of a total of 13,870 registered adolescents, yielding a participation rate of 79%. The SILNE survey yielded 57,094 social ties, 86.7% of which referred to friends who also participated in the survey.DiscussionThe SILNE survey was designed to measure the association between adolescents’ social ties at school, their socio-economic background, and their smoking behaviour. Two difficulties were encountered, however: legal privacy constraints made it impossible to apply the same parental consent procedure in all countries, leading to somewhat lower participation rates in two cities: Hannover and Latina. It was also difficult to match the 6 cities in terms of both age and type of education.The SILNE survey provided a comparable database for the study of smoking inequalities across European cities from a social network perspective.

Changes in Electronic Cigarette Use from 2013 to 2015 and Reasons for Use among Finnish Adolescents

Electronic cigarettes are quite a new potential source of nicotine addiction among youth. More research is needed, particularly on e-liquid use and socioeconomic factors as potential determinants. We studied changes from 2013 to 2015 in adolescent e-cigarette awareness and ever-use, types of e-liquids, and determinants in Finland. In 2015, we studied weekly use and reasons for ever-use. Data were from two national surveys of 12–18-year-old Finns (2013, n = 3535, response rate 38%; 2015, n = 6698, 41%). Descriptive statistics and logistic regression analysis were used. Awareness and ever-use of e-cigarettes increased significantly from 2013 to 2015 in all age and gender groups. Ever-use increased from 17.4% to 25%, with half having tried nicotine e-liquids. In 2015, weekly use was rare (1.5%). Daily cigarette smoking was the strongest determinant (OR 51.75; 95% CI 38.18–70.14) for e-cigarette ever-use, as for e-cigarette weekly use, but smoking experimentation and ever-use of snus (Swedish type moist snuff) and waterpipes alongside parental smoking and poor academic achievement also increased the odds for ever-use. The most common reason behind e-cigarette ever-use was the desire to try something new. To conclude, adolescent e-cigarette ever-use is increasing, and also among never-smokers. Tobacco-related factors are stronger determinants for e-cigarette use than socioeconomic factors.

Immigrant status, gender, and school burnout in Finnish lower secondary school students: A longitudinal study

The aim of this longitudinal study among 9223 students from grade 7 and grade 9 (age 13–14 and 15–16) was to assess whether immigrant status and gender are associated with the level and change (slope) in school burnout among lower secondary school students in the Helsinki metropolitan area. Ninety-seven percent of the variation in school burnout was attributable to individual factors. Both the intercept (2.3, p < 0.001) and slope (0.5, p < 0.001) of school burnout were statistically significant. The slope showed increasing school burnout from grades 7–9. School burnout increased more in girls than in boys. Initially apparent higher school burnout among students who had immigrated to Finland within the last five years compared to Finnish native students was largely accounted for by sociodemographic and school-related factors. However, there was a persistent gender by immigrant status difference in the fully adjusted model: recently (< 5 years ago) immigrated boys experienced a larger increase in school burnout, especially due to increased cynicism, than recently immigrated girls.

A Longitudinal Study of Predictors for Adolescent Electronic Cigarette Experimentation and Comparison with Conventional Smoking

Little is known of the predictors of electronic cigarette (e-cigarette) use among adolescents, even though the use is increasing. We studied here the predictors for e-cigarette experimentation (tried and tried more than twice) and compared them with predictors for conventional smoking. A baseline school survey was conducted in the Helsinki metropolitan area, Finland, in 2011 for seventh graders (12 to 13-year-olds). Response rate was 73%. The same students were followed up in 2014 (9th grade, 15 to 16-year-olds), N = 5742. Generalized linear mixed models controlling for school clustering were used. In the follow-up, 43.3% of boys and 25.6% of girls had tried e-cigarettes and 21.9% and 8.1% correspondingly more than twice. The strongest predictors for both genders were conventional smoking, drunkenness and energy drink use. Furthermore, poor academic achievement predicted e-cigarette experimentation for both genders, and for boys, participation in team sports was a predictor. The predictors for experimenting and for experimenting more than twice were very similar, except for boys’ participation in team sports. They were also similar compared to the predictors of conventional smoking but the associations were weaker. To conclude, smoking and other addictive behaviors predict adolescents’ experimentation with e-cigarettes. Family’s socioeconomic background had little significance.

Transmission of Smoking across Three Generations in Finland.

The influence of parents’ smoking on children’s smoking is well known, but few studies have examined the association between grandparents’ and grandchildren’s smoking. We studied the association between paternal and maternal grandparents’ smoking and their grandchildren’s tobacco use and assessed whether parents’ smoking is a mediator in this process. Data were obtained from a national survey of 12–18-year-old Finns in 2013 (N = 3535, response rate 38%). Logistic regression and mediation analyses were used. Both boys and girls had higher odds for smoking experimentation, daily smoking and other tobacco or tobacco-like product use if their mother, father or any of the four grandparents were current or former smokers. When parents’ and grandparents’ smoking status were included in the same model, grandparents’ smoking generally lost statistical significance. In the mediation analysis, 73% of the total effect of grandparents’ smoking on grandchildren’s daily smoking was mediated through parents’ smoking, 64% on smoking experimentation and 63% on other tobacco or tobacco-like product use. The indirect effect of a mother’s smoking was higher than that of a father’s. To conclude, paternal and maternal grandparents’ smoking increases grandchildren’s tobacco use. The influence is mainly, but not completely, mediated through parents’ smoking.

Academic performance and adolescent smoking in 6 European cities: the role of friendship ties

Abstract Poor academic performance is a known risk factor for adolescent smoking, yet the association remains unclear, as the role of social ties has been rarely examined. Our study aims to investigate the role of friendship ties in this association. In a sample of 11,015 adolescents, aged 14 to17, in 50 schools within six European cities (SILNE-survey, 2013), we used multilevel models to analyse the mediating effect of the composition of friendship ties and school types on the association between academic performance and smoking. Results show smoking was more prevalent in adolescents with lower academic performance than with higher. This association was stronger in non-vocational schools than in vocational. Adolescents tended to have friendship ties with someone sharing the same smoking status and academic performance. Finally, friendship networks are patterned both on smoking and academic performance. This suggests the educational environment contributes to future socio-economic inequalities in smoking among young people.

Low schoolwork engagement and schoolwork difficulties predict smoking in adolescence

Abstract Background Low academic achievement has been associated with smoking but factors behind this association are poorly known. Such factors could include schoolwork disengagement and schoolwork difficulties. To assess the extent to which they contribute to the explanation of how health inequalities emerge, we study in a longitudinal design whether these have an independent effect on smoking or whether their effect is mediated through academic achievement. Methods Longitudinal data were collected in the Helsinki metropolitan area, Finland in 2011 and 2014. Participants were seventh-graders (12 − 13 years, N=9497). In the follow-up, 6534 students reported their smoking status in the ninth grade (15 − 16 years). Smoking, schoolwork behavioural engagement, i.e. participation in academic activities, and disengagement, schoolwork difficulties and cognitive competence were self-reported by adolescents. Academic achievement was obtained from the Finnish national application register on upper secondary education. A mediation analysis was executed with bootstrapped confidence intervals. Results Higher schoolwork behavioural engagement and cognitive competence in the seventh grade predicted that adolescents were more likely not to smoke in the ninth grade (all P<0.001) while higher schoolwork disengagement and schoolwork difficulties predicted adolescents’ smoking (all P<0.001). The effects were mediated through academic achievement. Conclusions Students’ behavioural disengagement with schoolwork and schoolwork difficulties are risks for smoking initiation. Their effect is mediated through poor school achievement. As smoking often continues in adulthood and poor school performance typically leads to lower education, schoolwork disengagement and difficulties in adolescence constitute potential pathways to inequalities in health.

Feasibility of Using a Multilingual Web Survey in Studying the Health of Ethnic Minority Youth

Background Monolingual Web survey is a common tool for studying adolescent health. However, national languages may cause difficulties for some immigrant-origin youths, which lower their participation rate. In national surveys, the number of ethnic minority groups is often too small to assess their well-being. Objective We studied the feasibility of a multilingual Web survey targeted at immigrant-origin youths by selection of response language, and compared participation in different language groups with a monolingual survey. Methods The Adolescent Health and Lifestyle Survey (AHLS), Finland, with national languages (Finnish/Swedish) was modified into a multilingual Web survey targeted at a representative sample of 14- and 16-year olds (N=639) whose registry-based mother tongue was other than the national languages. The survey was conducted in 2010 (16-year olds) and 2011 (14-year olds). The response rate of the multilingual survey in 2011 is compared with the AHLS of 2011. We also describe the translation process and the e-form modification. Results Of the respondents, 57.6% answered in Finnish, whereas the remaining 42.4% used their mother tongue (P=.002). A majority of youth speaking Somali, Middle Eastern, Albanian, and Southeast Asian languages chose Finnish. The overall response rate was 48.7% with some nonsignificant variation between the language groups. The response rate in the multilingual Web survey was higher (51.6%, 163/316) than the survey with national languages (46.5%, 40/86) in the same age group; however, the difference was not significant (P=.47). The adolescents who had lived in Finland for 5 years or less (58.0%, 102/176) had a higher response rate than those having lived in Finland for more than 5 years (45.1%, 209/463; P=.005). Respondents and nonrespondents did not differ according to place of birth (Finland/other) or residential area (capital city area/other). The difference in the response rates of girls and boys was nearly significant (P=.06). Girls of the Somali and Middle Eastern language groups were underrepresented among the respondents. Conclusions A multilingual Web survey is a feasible method for gathering data from ethnic youth, although it does not necessarily yield a higher response rate than a monolingual survey. The respondents answered more often in the official language of the host country than their mother tongue. The varying response rates by time of residence, ethnicity, and gender pose challenges for developing tempting surveys for youth.