Mathilde Vinther-Larsen

Social-Cognitive and School Factors in Initiation of Smoking among Adolescents: A Prospective Cohort Study

Aims: The aim of the present study was to examine the association between social-cognitive factors, school factors, and smoking initiation among adolescents who had never smoked. Methods: The study was based on longitudinal data on Danish adolescents attending randomly selected public schools. Adolescents enrolled in grade 7 (mean age, 13 years) who had never smoked (n = 912) were followed up for 6 months after baseline. Those who had still never smoked were followed up again 18 months after baseline, in grade 8 (n = 442). Social-cognitive factors were examined with five measures: self-efficacy, social influence (norms), social influence (behavior), social influence (pressure), and attitude. We used multilevel analyses to estimate the associations between social-cognitive factors at baseline and smoking initiation as well as the random effects of school, school class, and gender group in the school class. Results: At the first follow-up, we found significant associations between attitude, fathers smoking, best friends smoking, and smoking initiation. At the second follow-up, we found a significant association with pressure to smoke from friends. Of the school factors, gender group in the school class showed an effect at both first and second follow-up. Conclusion: Our results suggest that fathers smoking, best friends smoking, attitude, and pressure to smoke from friends affect smoking initiation. The results for school factors suggest an effect of classmates of the same gender, which has not previously been examined longitudinally. (Cancer Epidemiol Biomarkers Prev 2009;18(2):384–92)

The Danish Youth Cohort: Characteristics of participants and non-participants and determinants of attrition

Aims: The aim of this paper is to describe the design and methods used in the Danish Youth Cohort and to give a description of the study participants with special attention to a comparison between participants and non-participants regarding sociodemographic characteristics. Methods: A total of 1,945 schools were invited, out of which 506 participated. The participating 7th grades comprised a total of 12,498 responding adolescents. The response rate for the Danish Youth Cohort established in 2005 was 63%. The sample of 12,498 adolescents represents 18.2% of all pupils (n = 68,764) in the 7th grade (mean age: 13.4 years) in Danish schools in 2005. The cohort was followed up in spring 2006 and spring 2007, where the adolescents were in the 8th (mean age: 14.4 years) and 9th (mean age: 15.3 years) grades, respectively. Results: We found that compared with non-participants the participants were significantly more likely to be girls, to be of Danish ethnicity, and to live in one-family houses. Furthermore, participants more often came from families with two or three children, were more likely to have parents with a high occupational status, parents who were married and parents with a higher total income. Loss to follow-up was only associated with adolescents’ higher probability of drinking and use of tobacco, and none of the other factors were associated with attrition. Conclusions: The participants in the Danish Youth Cohort represent a great variety of different groups of socio-demographic factors, although they differ from non-participants as regards a range of socio-demographic factors. This should be taken into account in future analyses.

Alcohol use in Denmark: A descriptive study on drinking contexts

Using data from the National Health and Morbidity Survey from 2005, we examined the contexts of alcohol use in Denmark in relation to gender and age. Among the 21,832 subjects invited to participate, 14,566 completed the survey. For the entire study population and restricted to heavy users (>21 standard drinks per week for males; >14 for females), we computed the prevalence of each age and gender group who indicated to drink alcohol in different drinking contexts. To compare the contexts for heavy use between age groups, we estimated prevalence ratios for each group compared to the 16–20-year-old age group, with adjustments for gender. Results showed that more than 68% of the study population drank alcohol in social contexts, such as at home with/visiting family and friends, or in party contexts. We found similar patterns among males and females; however, there was a predominance of males for drinking alcohol during work and leisure-times. The majority of heavy users also drank alcohol in social and party contexts. Among heavy users, drinking at home alone was eight times more prevalent among those aged 45–64 compared with those aged 16–20 years. We concluded that drinking contexts varied in relation to gender and age. Our findings provided useful insight into contexts for alcohol use in Denmark and will enable us to understand better some of the many aspects associated with alcohol use.

Effects of school district factors on alcohol consumption: results of a multi-level analysis among Danish adolescents

BACKGROUND Area-level socio-economic factors are significantly related to a populations health. This study investigates how school district-level factors affect the initiation of alcohol drinking of Danish adolescents. METHODS A survey sample of 11,223 female and male pupils in the 7th grade from 447 schools across Denmark was analysed for the outcome variable drinking initiation and a number of individual level predictors. Aggregated variables on school district level were created from national registry data for education, occupational level and household savings of residents, type of housing and land use characteristics. RESULTS About 40% of all respondents (45.8% males and 35.2% females) had ever drunk more than one glass of alcoholic beverage. Mixed-effects logistic regression showed that significant individual level predictors for drinking initiation were male gender, a lower performance at school, perceived peer group drinking and the perceived daily drinking of the father. On school district level, adolescents were more likely to initiate alcohol consumption in school districts with higher farming land use and less likely in those with higher proportion of private apartment buildings. Other school district factors were not associated with drinking initiation when controlled for individual level factors. CONCLUSIONS The impact of socio-economic variables at school district level seems to be smaller in the welfare state of Denmark than known for other countries. However, residence in rural areas may be a direct disadvantage for youth, indicating a need for region-specific prevention programmes.

Are characteristics of the school district associated with active transportation to school in Danish adolescents

BACKGROUND This study sought to determine the influence of individual factors on active transportation to school among Danish seventh graders and whether school district factors are associated with such behaviour independently of individual factors. METHODS Mixed effects logistic regression models determined the effects of individual (gender, family affluence, enjoyment of school and academic performance) and school district factors (educational level, household savings, land use and size) on active transportation to school (by foot, bicycle or other active means) among 10 380 pupils aged 13-15 years nested in 407 school districts. RESULTS Of all students, 64.4% used active transportation to school daily. Boys, those with perceived higher school performance and those with lower family affluence were more likely to use active transportation to school. After adjustment for all individual factors listed above, high household savings at the school district level was associated with higher odds of active transportation to school. As factors of land use, low level of farming land use and high proportion of single houses were associated with active transportation to school. CONCLUSIONS Policies aiming at reducing social inequalities at the school district level may enhance active transportation to school. School districts with farming land use face barriers for active transportation to school, requiring special policy attention.

Critical discussion of social–cognitive factors in smoking initiation among adolescents

Abstract Social–cognitive models have often been used in research on prevention in adolescent populations, even though the models were designed to describe adult behavior. The aim of the study reported here was to examine critically and constructively the five social–cognitive factors in the ‘attitude, social influence, self-efficacy’ (ASE) model. Methods. The examination draws on the results of a qualitative follow-up study of smoking initiation based on semi-structured interviews and observations of 12 adolescents in two Danish school classes, grades 7 and 8. The qualitative study was conducted in connection with and sampled from a large quantitative study and the results of both studies are discussed. In the analyses, we explored the ASE constructs according to how they are described in the ASE theory. Furthermore, we examined contradictions and aspects which are not explained in the model and if relevant discussed these aspects using other theoretical frameworks. Results. The results showed that aspects other than those in the ASE model are also important. Smoking initiation was often situational and unplanned and was sometimes used in negotiating social relationships and identity. Furthermore, the social–cognitive models are based on the assumption that adolescents talk about smoking norms and have a high degree of individual reflexivity, which is not always characteristic of adolescent behavior. Conclusion. Applying theoretical models in health research should be a continuous process of both applying the model and discussing the theoretical assumptions of the model when applied to a specific sample. The results of the qualitative study provide some support for use of the ASE model, but the results also suggest that further studies are needed to explore how social–cognitive models can be expanded to be more comprehensive behavioral models.

Social-Cognitive and School Factors in Lifetime Smoking among Adolescents

Background: Smoking is a serious health threat and identifying risk factors for smoking is thus of great importance. The aim of the study was to examine the effects of social-cognitive factors and school factors on lifetime smoking status among adolescents. Methods: The study was based on cross-sectional data on 2,913 Danish adolescents in grade 7 attending 118 randomly selected public schools. Social-cognitive factors were examined with five measures: self-efficacy to resist pressure to smoke, social influence (norms), social influence (behavior), social influence (pressure), and attitude. We used multilevel analyses to estimate the associations between social-cognitive factors and lifetime smoking status as well as the group-level effects of school, school class, and gender group in the school class. Results: Each social-cognitive factor was significantly associated with lifetime smoking status, even when several potential confounders and the effects of school, school class, and gender group were taken into account. Of the three group-level school factors, gender group in the school class had the strongest effect on smoking status. Conclusion: We conclude that self-efficacy to resist pressure to smoke, attitude, and the three types of social influence are significantly associated with lifetime smoking status, even when the effects of group-level school factors are taken into account. The strong effect of gender group in school class on lifetime smoking status indicates that prevention actions should address the social context of adolescents. (Cancer Epidemiol Biomarkers Prev 2008;17(8):1862–71)

High and low levels of positive mental health: are there socioeconomic differences among adolescents?

Purpose – It is important within public health goals to promote adolescents’ mental health and to reduce socioeconomic inequalities in mental health. Among adults there are indications that the socioeconomic pattern of low positive mental health (PMH) differs from the socioeconomic pattern of high PMH. Knowledge regarding the social epidemiology of PMH among young people is lacking. The purpose of this paper is to examine the socioeconomic patterning of aspects of low and high PMH among adolescents. Design/methodology/approach – The Health Behaviour in School-aged Children Methodology Development Study 2012 provided data on 3,670 adolescents aged 11-15 in two municipalities in Denmark. Socioeconomic differences in aspects of low and high PMH (self-esteem, social competence and self-efficacy) were investigated by calculating sex-specific prevalence of PMH in socioeconomic groups measured by parents’ occupational social class. Using multi-level logistic regression analyses, odds ratios for low and high PMH ...