Susanna Raisamo

Sports activity and the use of cigarettes and snus among young males in Finland in 1999-2010

BackgroundStudies of the relationship between sports activity and smoking among adolescents and young adults report contradictory results. We examined the association between sports activity (intensity and type of sport) and the current use of snus (Swedish snuff), cigarette smoking, and the combined use of cigarettes and snus (dual use) among young males in Finland.MethodsData were collected from 16,746 male conscripts who completed a survey during the first days of their conscription during the years 1999-2010 (median age 19 years, response rate 95%). Main outcome measures were self-reported daily/occasional use of snus, cigarette smoking, and dual use. The association between sports activity, type of sport, and several sociodemographic background variables was assessed using logistic regression analysis.ResultsOver the study period (1999-2010), the prevalence of cigarette smoking decreased from 42% to 34%, while snus use increased from 5% to 12%, and dual use increased from 7% to 13% (p < 0.001). Compared with no physical activity, regular competitive sports activity (defined as high-intensity sports activity) was positively associated with use of snus (odds ratio [OR] 10.2; 95% confidence interval [CI]: 7.8-13.5) and negatively with cigarette smoking (OR 0.2; 95% CI: 0.1-0.3). When stratified by type of sport in multivariate models, ice hockey was most strongly associated with snus use (OR 1.6; 95% CI: 1.4-1.9) and dual use (OR 2.0; 95% CI 1.8-2.3) compared with those not playing ice-hockey, followed by other team sports for snus use (OR 1.5; 95% CI: 1.3-1.8) and dual use (OR 1.8; 95% CI: 1.6-2.0) compared with those not participating in other team-sports.ConclusionsOur results show a clear association between snus use and intensity and type of training. Team sports were associated with increased use of snus and dual use compared with no participation in team sports. These findings should be acknowledged when planning and implementing preventive strategies.

Do socioeconomic differences in tobacco use exist also in developing countries? A study of Ghanaian adolescents.

BackgroundIn Western countries, tobacco use is most prevalent among adolescents in lower socioeconomic groups. The association between socioeconomic status (SES) and tobacco use among adolescents in developing countries is unexplored. Using multiple SES measures, we investigated this association among adolescents in Ghana.MethodA school-based survey of a representative sample of 13-18-year-old Ghanaians (N = 1,165, response rate = 89.7%) was conducted in three regions, in 2008. Logistic regression analysis was used to evaluate the relationship of smoking, tawa (smokeless tobacco) use with familial SES (parental occupation and education, material affluence scale, family structure), an adolescents individual social position (school performance, plans after graduation) and inter-generational social mobility (predicted by the differences of familial and individual positions).ResultsSocioeconomic differences existed in tobacco use whether measured by familial SES or individual social position with higher prevalence in lower socioeconomic groups. Low fathers education and living in a non-nuclear family were associated with both forms of tobacco use while low material affluence was associated with tawa use only; individual social position measured by plans after graduation was the strongest predictor of both smoking and tawa use. Inter-generational downward social mobility and particularly staying in low SES was related to both forms of tobacco use.ConclusionsSimilar to Western countries, lower SES is related to an adolescents tobacco use also in developing countries. Cumulative socioeconomic disadvantage over generations increases the probability of tobacco use.

Attitudes towards gambling in Finland: a cross-sectional population study

BackgroundAttitudes towards gambling influence gambling behaviour but also reflect the existing gambling policy in a society. However, studies examining general attitudes towards gambling at the population level are scarce. The first aim of this study was to investigate general attitudes of the Finnish population towards gambling. The second aim was to explore the association of socio-demographics, gambling behaviours, being a concerned significant other (CSO) of a problem gambler and perceived health and lifestyle with attitudes towards gambling among the Finnish population.MethodsA cross-sectional study was performed by structured telephone interview on a random sample of 15-74-year-old Finns between October 2011 and January 2012. The data (n = 4484) was weighted based on age, gender and region of residence. Attitudes towards gambling were measured with the eight-item version of the Attitude Towards Gambling Scale (ATGS-8). A factor analysis was performed to test the structure of the Finnish version of the ATGS-8. The data were analysed using one-way ANOVA test, t-test and multiple regression analysis.ResultsOn average, attitudes of Finns towards gambling were negative. The most significant factors associated with positive attitudes towards gambling were male gender, young age, 12 years or more education and net income more than 2000€, low score on gambling severity, being a non-CSO of a problem gambler and high alcohol consumptionConclusionsThe association between young age, male gender, high net income and risky alcohol consumption, and favourable gambling attitudes was strong, and also reflects risky gambling behaviour. Experiencing gambling-related harms caused by one’s own or significant other’s excessive gambling seems to indicate unfavourable attitudes towards gambling.

The role of tobacco promoting and restraining factors in smoking intentions among Ghanaian youth

BackgroundIn Western countries, the relationship between smoking intentions and smoking behaviour is well established. However, youth smoking intentions and associated factors in developing countries are largely unexplored and the former may occur for a variety of reasons. We investigated youth smoking intentions in Ghana with regard to several tobacco promoting and restraining factors, including environmental, familial, attitudinal and knowledge measures.MethodsA school-based survey of a representative sample of 12-20-year-olds was conducted in 2008 in Ghana (N = 1338, response rate 89.7%).ResultsIn a bivariate model, both among ever and never smokers, allowing smoking on school compound, exposure to tobacco advertisement and parental smoking were associated with future intention to smoke. Compared to those who agreed that smoking is harmful to health, smoking is difficult to quit and that tobacco should not be sold to minors, those who disagreed or were not sure were more likely to have an intention to smoke. In the multivariate analyses, these associations persisted, except that the attitude measures concerning the difficulty of quitting smoking once started and tobacco sales ban were no longer significantly associated with smoking intentions.ConclusionsThese findings underscore the importance of school smoking policy, parental smoking behaviour and knowledge of the harmful effects of tobacco use in determining Ghanaian youths’ future smoking intentions. Because current high percentages of smoking intentions may turn into high smoking rates in the future, the introduction of effective tobacco control measures at all levels of society to prevent youth smoking in Ghana may be essential.

Persistence of socioeconomic differences in adolescents’ environmental tobacco smoke exposure in Finland: 1991–2009

Aims: Socioeconomic differences in children’s exposure to environmental tobacco smoke (ETS) in favour of those with higher positions are known, but research is scarce on whether differences have persisted when smoking restrictions have been tightened. We examined socioeconomic differences in adolescents’ ETS exposure from 1991 to 2009 in Finland where the tobacco law has gradually restricted smoking of population. Methods: National cross-sectional surveys (1991–2009) in 12–18-year-olds (N=72,726, response rate 77–56%). An outcome measure was self-reported exposure to ETS (≥1 hour/day). Parents’ socioeconomic and adolescent’s individual social position (school performance/career) were used as independent variables. Across four time periods, associations were studied by logistic regression. Results: Over the study period 1991–2009, the proportion of adolescents exposed to ETS decreased from 17% to 6% (p≤0.001). There were large and persistent differences between socioeconomic and parents’ smoking groups. The decrease occurred in all groups but was smaller among 16–18-year-olds whose father had a low education. A steeper decline occurred among 16–18-year-olds who were not in school or were in vocational school with poor school performance compared with those with more advanced educational career. Compared with other subgroups, the decline in ETS exposure was greater among those whose parents were smokers. Conclusions: Adolescents’ ETS exposure remarkably decreased over time, when tobacco control measures were tightened, particularly among children of smoking parents. Socioeconomic differences persisted although diminishing differences were observed between educational groups at age 16–18.

Tobacco use and exposure to tobacco promoting and restraining factors among adolescents in a developing country

OBJECTIVE With a long history of tobacco cultivation, adolescents in Ghana are at relatively high risk of the emerging tobacco epidemic in developing countries. This study explored exposure to tobacco promoting/restraining factors and their associations with smoking and tawa (traditional smokeless tobacco) use among 13-18-year-old Ghanaians. METHODS School-based representative data were collected in 2008 (n = 1165). RESULTS Prevalence rates of tobacco use, smoking and tawa use were 9.1% (11.5% boys and 6.4% girls), 6.6% (8.0% boys and 4.7% girls) and 5.7% (7.3% boys and 3.9% girls), respectively. Four percent of the respondents attended schools without a smoking ban, 66% had been taught about the harmful effects of smoking in the current school year, and 53% had been exposed to tobacco advertising. Fifty-three percent of adolescents who had tried to purchase tobacco products were not refused because of their age. Multivariate analyses found that attendance at a school where smoking was allowed, not having been taught about the harmful effects of smoking, exposure to tobacco advertising and parental smoking were positively associated with tobacco use, and knowledge that smoking is harmful to health and difficult to quit were negatively associated with tobacco use. CONCLUSIONS Both smoking and tawa use were relatively low among Ghanaian adolescents. Exposure to tobacco advertising was high. There is no tobacco legislation in Ghana, but societal norms or cultural values seem to restrict smoking in schools and access to tobacco products.

Changes in minors' gambling on slot machines in Finland after the raising of the minimum legal gambling age from 15 to 18 years: A repeated cross-sectional study

Aim The legal gambling age in Finland was raised from 15 to 18 years in 2010, but slot machines were given a transition period that ended with the full law coming into effect on 1 July 2011. The widespread accessibility of slot machines and their popularity among youth led us to consider how age limit was enforced in the Finnish gambling monopoly system and to analyse how underage gambling on slot machines changed after the raising of the minimum age. Methods Two nationwide cross-sectional surveys were conducted in 2011 and 2013 (12–18-year-olds; N=8101; average response rate 42%). The main measure was self-reported six-month prevalence of slot machine use overall and by venue (shops; kiosks; petrol stations; restaurants/cafés; ship travels to Sweden/Estonia; other). Changes from 2011 to 2013 were tested by using the χ2 tests and multivariate logistic regression analyses. As a reference group only, 18-year-olds were analysed, as they were of legal age to gamble. Results The six-month prevalence of slot machine use among 12–16-year-olds declined from 44% in 2011 to 13% in 2013 (p <.001). The decline was the most pronounced in shops. A significant interaction was found between age and survey year; slot machine use declined more sharply among 16-year-olds than among those aged 14 or 12. Conclusions These findings suggest that raising the legal age limit from 15 to 18 years significantly decreased the prevalence of slot machine use among minors, even in a policy context where the general availability of gambling products was not reduced.

Gambling, violent behaviour and attitudes towards violence among adolescent gamblers in Finland

Aims The purpose of this population-based study was to explore the relationship between gambling and violent behaviour and attitudes towards violence among 14- and 16-year-old adolescents. Design A national survey was conducted in Finland in 2011. The main measures in our study were gambling frequency and number of reported gambling-related harms. Their associations with violent behaviours and attitudes towards violence were studied using multinomial logistic regression and negative binomial regression. Results 47.1% of adolescents had gambled during the past six months and 13.2% of them had experienced gambling-related harms. Both gambling frequency and the number of gambling-related harms were linked to violent behaviour as well as to positive attitudes towards violence. Adolescents who engaged in gambling on a daily basis and/or experienced gambling harms had the highest risk. Conclusions Health promotion efforts among gamblers should take into account their increased risk for violent behaviour.

Does Self-Rated Addiction and the Heaviness of Smoking Index Predict Nicotine Replacement Therapy Product Use in Adolescent Smokers?

Few studies have examined predictors of nicotine replacement therapy (NRT) product use among adolescents. Using a population-based sample of 14- to 18-year-olds, we examined if self-rated addiction and Heaviness of Smoking Index (HSI) were associated with NRT use in 913 daily smokers. The ever-use prevalence of NRT was 24%. Boys smoked more cigarettes per day than girls and scored higher on HSI, but they perceived themselves to be less addicted. Compared to nonusers, a greater proportion of NRT users perceived themselves as addicted and demonstrated greater dependence on HSI. Perceiving oneself as addicted and having high HSI scores were associated with NRT use.

How much gambling is too much? Identifying potential problem gambling among adolescents

Abstract Aims: Using a population-based sample of Finnish 12–17 year olds, this study explored gambling behaviour limits for potential problem gambling [South Oaks Gambling Screen – revised for adolescents (SOGS-RA)]. Methods: Data were obtained from the Youth Gambling Survey 2006, which is a cross-sectional survey of a nationally representative random sample of 5000 adolescents. Adolescents who participated in gambling at least once a month were selected from the data (n=1827, 25.1% were girls). The limits for gambling behaviour were detected using receiver operating characteristic (ROC) analysis. Logistic regression was used to study associations between these behavioural limits and potential problem gambling. Results: For each of the gambling behaviour indicators plotted, the risk curves showed similar trends among boys and girls. The risk of being a potential problem gambler increased noticeably with increasing gambling intensity. The ROC analysis showed that the optimal behavioural cut-off values among 12–14 year olds for frequency was gambling more than 2–3 times a month, spending more than €2 per week on gambling, spending more than €8 in any 1 day on gambling, and gambling on more than two different games per year. For 15–17 year olds, cut-off values were gambling more than once a week, spending more than €4 per week and spending more than €12 in any 1 day on gambling. Cut-off for number of game types was same as it was for younger adolescents. Of the behavioural indicators those associated with money were the most robust. Conclusion: Behavioural indicators can be used as initial markers of possible problem gambling.