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Predictors of smoking among Swedish adolescents
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Center for Clinical Research Dalarna Uppsala University, Nissers väg 3, SE-791 82 Falun, Sweden.
Uppsala Univ, Dept Publ Hlth & Caring Sci, SE-75122 Uppsala, Sweden.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
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2014 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, p. 1296-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Smoking most often starts in adolescence, implying that understanding of predicting factors for smoking initiation during this time period is essential for successful smoking prevention. The aim of this study was to examine predicting factors in early adolescence for smoking in late adolescence.

METHODS: Longitudinal cohort study, involving 649 Swedish adolescents from lower secondary school (12-13 years old) to upper secondary school (17-18 years old). Tobacco habits, behavioural, intra- and interpersonal factors and socio-demographic variables were assessed through questionnaires. Descriptive statistics, univariable and multivariable logistic regression were used to identify predicting factors.

RESULTS: Smoking prevalence increased from 3.3% among 12-13 year olds to 25.1% among 17-18 year olds. Possible predictors of smoking were: female sex, lower parental education, poorer family mood, poorer self-rated health, poorer self-esteem, less negative attitude towards smoking, binge drinking, snus use and smoking. In a multivariable logistic regression analysis, female sex (OR 1.64, CI 1.08-2.49), medium and low self-esteem (medium: OR 1.57, CI 1.03-2.38, low: 2.79, CI 1.46-5.33), less negative attitude towards smoking (OR 2.81, CI 1.70-4.66) and ever using snus (OR 3.43, CI 1.78-6.62) remained significant independent predicting factors.

CONCLUSIONS: The study stresses the importance of strengthening adolescents' self-esteem, promoting anti-smoking attitudes in early adolescence, as well as avoidance of early initiation of snus. Such measures should be joint efforts involving parents, schools, youth associations, and legislating authorities.

Place, publisher, year, edition, pages
2014. Vol. 14, p. 1296-
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-98496DOI: 10.1186/1471-2458-14-1296ISI: 000347855900001PubMedID: 25518992OAI: oai:DiVA.org:umu-98496DiVA, id: diva2:782838
Available from: 2015-01-22 Created: 2015-01-22 Last updated: 2020-04-20Bibliographically approved
In thesis
1. Health for future: self-rated health and social status among adolescents
Open this publication in new window or tab >>Health for future: self-rated health and social status among adolescents
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Hälsa för framtiden : Självskattad hälsa och social status bland ungdomar
Abstract [en]

The overall aim of this thesis was to explore self-rated health, subjective social status and smoking in adolescents.

This thesis consists of a qualitative and a quantitative study. The qualitative study was an interview study that included 58 participants in the 7th and 12th grades. The cognitive interviewing technique ‘think-aloud’ was employed to explore how adolescents interpret and reason when answering a question about self-rated health (‘A person may feel good sometimes and bad sometimes. How do you feel most of the time?’). Additionally, factors contributing to subjective social status in school and the different strategies adolescents used for positioning were explored. Qualitative content analysis and thematic network analyzes were used to analyze the data. The quantitative study was a cohort study involving 1046 adolescents who answered questionnaires about their health in the 7th, 8th, 9th and 12th grades. Data were used to investigate predicting factors in the 7th grade for smoking in the 12th grade, as well as to examine associations between subjective social status in school, socioeconomic status and self-rated health in boys and girls in the 12th grade. Data were analyzed using chi-square tests, binary logistic regression and ordinal logistic regression analyses.

The results from the interviews showed that participants interpreted the self-rated health question in holistic terms including social, mental and physical aspects. Results from the quantitative study showed that boys rated their health higher than girls at all ages. In a multivariable analysis lower selfesteem, a less negative attitude towards smoking and ever using snus in the 7th grade were significant predictors of smoking in the 12th grade. In addition, girls had an increased risk of becoming smokers. Cross-sectional analyses in the 12th grade revealed that adolescents’ self-rated health was positively associated with subjective social status in school, mood in the family and self-esteem in both girls and boys. Boys rated their subjective social status higher than girls. When exploring subjective social status in school further through interviews, status hierarchies in school were confirmed by the participants, which were strongly influenced by norms linked to gender, age, ethnicity and parental economy, but also expectations about how to look, act and interact.

In conclusion, this thesis demonstrates that the self-rated health question ‘How do you feel most of the time?’ is useful for capturing a multidimensional view of health. Early efforts to strengthen adolescents’ self-esteem, promote anti-smoking attitudes and avoid an early initiation of snus seem to be important components of smoking prevention in adolescence. The positive association between self-rated health and subjective social status in school indicates that the subjective social status question is a useful healthrelated measure of social position in adolescents. Because social desirability in the school hierarchy was defined by norms that left little room for diversity, the possible negative impact of status hierarchies on adolescents’ health should to be considered. Overall, gender differences in health and social status emphasize the need for a gender-sensitive understanding of factors that impact adolescents’ lives

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2020. p. 87
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2081
Keywords
Adolescent, health, self-rated health, smoking, self-esteem, social status, subjective social status, gender, social norms, think-aloud interview
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-169729 (URN)978-91-7855-245-0 (ISBN)978-91-7855-246-7 (ISBN)
Public defence
2020-09-04, Föreläsningssalen, Falu lasarett, Falun, 09:00 (Swedish)
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Supervisors
Available from: 2020-04-21 Created: 2020-04-20 Last updated: 2020-04-21Bibliographically approved

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Joffer, JuniaBergström, ErikStenlund, Hans

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