Susanna Rainio

Socioeconomic Differences in Smoking Among Finnish Adolescents From 1977 to 2007

PURPOSE Persistence of socioeconomic differences in smoking among adolescents over time is unexplored. We investigated the changes in smoking among 12-18-year-old Finns from 1977 to 2007 using multiple indicators of socioeconomic status (SES) to determine whether differences between socioeconomic groups increase over time, with reduced smoking in higher socioeconomic groups. METHODS Nationwide biennial surveys were conducted since 1977 (response rate, 59%-88%; N = 96,747) using familial and individual social position (school performance/career) indicators. Associations between socioeconomic indicators and smoking were evaluated using logistic regression analysis. RESULTS Socioeconomic differences in smoking measured by familial SES or individual social position persisted over time, with higher rates in lower SES groups. Individual social position was more strongly related to smoking than familial SES. Differences between groups assessed by individual social position increased over time: the difference in smoking prevalence between groups with the lowest and highest individual social position among 12-14-year-old girls and boys, respectively, was 22% and 28% in 1977-1983, and 45% and 34% in 2001-2007; and in 16-18-year-old girls, 33% in 1977-1983 and 48% in 2001-2007. Smoking differences in relation to fathers education increased over time: the difference in 12-14-year-old girls and boys, respectively, between the lowest and highest SES groups was 6% and 5% in 1977-1983 and 9% and 8.5% in 2001-2007; and in 16-18-year-old girls and boys, respectively, 7% and 10% in 1977-1983 and 13% and 14.5% in 2001-2007. CONCLUSIONS Differences between socioeconomic groups among Finnish adolescents persisted or increased over 30 years, and predict differences in smoking-related diseases between socioeconomic groups in adulthood.

The effectiveness of tobacco sales ban to minors: the case of Finland

Objective: To evaluate the effects of the 1977 and 1995 tobacco sales bans on tobacco acquisition of minors. Design: Biennial nationwide postal surveys (adolescent health and lifestyle survey, AHLS) in 1977–2003; annual classroom surveys (school health promotion survey, SHPS) in 1996–2003. Setting and participants: Entire Finland—12, 14, 16, and 18 year olds (AHLS, n  =  80 282); eighth and ninth graders (14–16 year olds) (SHPS, n  =  226 681). Main outcome measures: Purchase of tobacco from commercial sources during the past month, purchase from different commercial (shop, kiosk, other outlet) and social sources, ease of buying tobacco, overall acquisition of tobacco products, daily smoking, tobacco experimenting. Results: Decrease in tobacco purchase from commercial sources was small and short term after 1977 but large and permanent after 1995: purchase rate among 14 year old smokers diminished from 90% to 67% in 2003, 16 year olds from 94% to 62%. Purchases in shops decreased most (14 year olds: from 39% to 14%; 16 year olds: from 76% to 27%); purchases in kiosks less. An increase was observed in obtaining tobacco from other outlets and friends (social sources). Only 2–3% of 14–16 year old smokers used commercial sources exclusively when obtaining tobacco. Daily smoking began to decrease after 2001, following an earlier decrease in those experimenting. No changes were observed among age groups not targeted by the ban. Conclusions: Legislation appears to have permanently changed tobacco sales practices and decreased purchases from commercial sources. Social sources need to be taken into account when controlling access to tobacco. Sales bans should be accompanied by other health promotion measures.

Home-based sourcing of tobacco among adolescents.

OBJECTIVE To study home-based sources of tobacco and associated family factors among Finnish adolescents. METHODS Nationwide surveys (1999, 2003, 2007) of 14-16-year-old daily (n=2355), occasional (n=708), and experimental (n=2763) smokers. The main outcome measure was home-based sourcing of tobacco (parents, siblings, taking from home) during the past month. Logistic regression was used for statistical analysis. RESULTS Home-based sources were used by 44% of daily, 11% of occasional, and 9% of experimental smokers; other social sources by 93%, 65%, and 51%; and commercial sources by 70%, 28%, and 10% respectively. Among daily smokers, home sources meant siblings (24%), parents (19%), and taking from home (19%). Parental smoking and absence of a home-smoking ban increased home-based sourcing. The odds ratio (OR) for obtaining tobacco from any home-based source was 6.96 (95% CI: 3.75-12.91) and from parents 7.44 (2.68-20.65) when both parents smoked versus nonsmoking parents. In the absence of a home-smoking ban, corresponding ORs were 2.21 (1.28-3.81) and 21.33 (2.84-60.30) versus those reporting having a ban. Obtaining tobacco from parents was more common in single-parent/reconstituted families than in families with two biological parents. CONCLUSIONS Parents should be provided with guidance about the consequences of home-based sourcing in the persistence of childrens smoking habit.

Adolescent snus use in Finland in 1981–2003: trend, total sales ban and acquisition

Objective: To study changes in adolescent snus use from 1981 to 2003, the effects of the total snus sales ban (1995) and snus acquisition. Design: Biennial postal surveys in 1981–2003. Setting and participants: Entire Finland; 12-, 14-, 16-, and 18-year-olds (n  =  73 946; 3105−8390 per year). Main outcome measures: Snus use (experimental, daily/occasionally), snus acquisition (2001, 2003). Results: Snus experimentation grew in popularity before the total sales ban in 16- and 18-year-old boys and after the ban in all age and sex groups. A decrease was seen between 2001 and 2003, except for 18-year-old boys. Daily/occasional use mainly followed the same pattern in boys while in girls the daily/occasional use was rare and no significant changes were observed. In 2003, boys experimented with snus more often than girls (12-year-olds 1% v 0%, 14-year-olds 9% v 4%, 16-year-olds 30% v 12%, 18-year-olds 44% v 18%). Hardly any girls used snus daily/occasionally, but 1% of 14-year-old boys, 7% of 16-year-olds, and 9% of 18-year-olds did. Of daily/occasional users, 84% acquired snus from friends or acquaintances, 55% from tourist trips to neighbouring countries (Estonia, Sweden), and 7% through sport teams; 24% obtained it from under-the-counter sources. For experimenters, the corresponding figures were 79%, 18%, 0.3%, and 5%. Conclusions: The total sales ban did not stop snus use; instead, the increase continued after the ban. Friends who travel to neighbouring countries act as go-betweens reselling snus. Snus is used even by the youngest adolescents, thus contributing to the nicotine dependence process.

Evolution of the association between parental and child smoking in Finland between 1977 and 2005

OBJECTIVES To study changes in the family smoking profile and in the association between parental and child smoking from 1977 to 2005. METHODS Data was based on biennial surveys using nationally-representative samples of 14-18-year-old Finns (n=58,279). Response rate ranged between 88% (1977) and 65% (2005). Parental smoking categories were: two smoking parents, smoking father, smoking mother, both currently non-smokers but one or both ex-smokers, and two never-smoking parents. Child smoking categories were: experimental, daily, and never. Associations between parental and child smoking were examined using multinomial logistic regression models. RESULTS Over the study period, the proportion of never-smoking families (child and parents never-smokers) increased (9% vs. 18%). Age, sex, family structure, and survey decade adjusted odds ratios for childs daily smoking were 6.9 (95% CI: 6.4, 7.5) when both parents smoked, 4.7 (95% CI: 4.3, 5.2) when mother smoked, 3.8 (95% CI: 3.5, 4.1) when father smoked, and 2.8 (95% CI: 2.6, 2.9) when one/both were ex-smokers compared with children of never-smoking parents. Only a few non-systematic interactions between parental smoking and survey decade were found. CONCLUSIONS The proportion of totally smoke-free families increased substantially. Association between parental and child smoking persisted strong and mainly similar over time.