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It takes two: reducing adolescent smoking uptake through sustainable adolescent-adult partnership
Epidemiologi och global hälsa.ORCID iD: 0000-0003-3036-8546
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Epidemiologi och folkhälsovetenskap.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Epidemiologi och folkhälsovetenskap.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Epidemiologi och folkhälsovetenskap.ORCID iD: 0000-0003-3025-2690
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2006 (English)In: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 39, no 6, 880-886 p.Article in journal (Refereed) Published
Abstract [en]

Purpose To assess the effects of a long-term intervention for tobacco use prevention that targets adolescents (Tobacco Free Duo).

Methods School-based community intervention combined with repeated cross-sectional surveys over 7 years. The intervention was performed in the County of Västerbotten, Sweden, where survey data were collected in grade seven to nine schools on an annual basis for 7 years. Data for comparison were collected in grade nine on the national level in Sweden. In the intervention area, the annual number of seventh to ninth grade students participating in the study varied between 1300 and 1650. In the reference data, the number of participating ninth grade students approximated 4500 annually.

Results A significant decrease of nearly 50% was seen in smoking prevalence in the intervention area. The decrease was evident in grades eight and nine (ages 14–15 years) in both boys and girls. At the start of the intervention, smoking prevalence in grade nine was 16.1% in the intervention area and 23% in the national reference group. Although the prevalence in the national sample remained stable, there was a decrease to 9.0% in the intervention area at the end of the study period.

Conclusions These results suggest that the Tobacco Free Duo program contributed to a reduction in adolescent smoking among both boys and girls. Using a multi-faceted intervention that includes adolescent–adult partnership can reduce adolescent smoking uptake, and the intervention has been proven to be sustainable within communities.

Place, publisher, year, edition, pages
2006. Vol. 39, no 6, 880-886 p.
Keyword [en]
adolescent, child, cross-sectional studies, female, health promotion/methods/organization & administration, humans, male, mentors, prevalence, program evaluation, role, schools/statistics & numerical data, smoking/epidemiology/prevention & control, Sweden/epidemiology
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-14579DOI: 10.1016/j.jadohealth.2006.07.004PubMedID: 17116519OAI: oai:DiVA.org:umu-14579DiVA: diva2:154251
Available from: 2007-06-08 Created: 2007-06-08 Last updated: 2015-04-29Bibliographically approved
In thesis
1. Promoting health in adolescents: preventing the use of tobacco
Open this publication in new window or tab >>Promoting health in adolescents: preventing the use of tobacco
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

There is a robust evidence base for the negative health effects from smoking. Smoking is linked to severe morbidity and to mortality, and kills up to half of its regular users. Tobacco use and production also bring other negative consequences such as economic loss for countries, poverty for individuals, child labour, deforestation and other environmental problems in tobacco growing countries.

 A combination of comprehensive interventions at different levels is needed to curb the tobacco epidemic. Tobacco control strategies at national levels in the western world often include components of information/education, taxation, legislative measures and influencing public opinion. Two approaches have dominated at the meso and micro levels: cessation support for tobacco users and prevention activities to support young people refraining from tobacco use. Smoking uptake is a complex process that includes factors at the societal level as well as social and individual characteristics.  At national level, taxation and legislation can contribute to a societal norm opposing tobacco and creating a context for primary prevention aimed at tobacco free youth.  There is no magic bullet in primary prevention.  At the meso and micro levels, a continued development of knowledge on the underlying mechanisms and primary prevention methods is essential to prevent young people from starting to use tobacco.

 The overall aim of this thesis was to gain knowledge about factors that influence young people’s use of tobacco and of preventive mechanisms.  The specific aims included to study the relation between Tobacco Free Duo, an intervention program targeting youth in Västerbotten County, and tobacco use prevalence.  A specific interest was to explore the role adults can play in supporting young people to refrain from tobacco use.

 The thesis is based on four studies with three separate sets of data, two were quantitative and one was qualitative. The studies were conducted among adolescents (aged 13-15 yr) in Västerbotten County and on national level in Sweden (aged 13, 15 and 17 yr).

 Tobacco Free Duo is a school-based community intervention that started in 1993. An essential component of the intervention was to involve adults in supporting adolescents to stay tobacco free. Results showed decreased smoking in adolescents among both boys and girls in the intervention area during the study period of seven years.  There was no change in a national reference group during the same time period. A bonus effect was a decrease in adult tobacco use in the intervention area. One out of four adults who supported a young person taking part in the intervention stopped using tobacco. In a qualitative assessment of young smokers, starting to smoke was described as a means of gaining control of their feelings and their situation during early adolescence. They expected adults to intervene against their smoking and claimed that close relations with caring adults could be a reason for smoking less or trying to quit smoking.  In a quantitative study that used three decades of national data, over time adolescents became more positive toward parental action on children’s smoking. The adolescents strongly supported the idea of parental action, regardless of whether or not they themselves smoked. Adolescents preferred that actions from parents were dissuading their children from smoking, not smoking themselves, and not allowing their children to smoke at home.

 These results suggest that the Tobacco Free Duo program contributed to a reduction in adolescent smoking among both boys and girls.  Using a multi-faceted intervention that includes an adolescent-adult partnership can decrease adolescent smoking uptake.  Engaging adults as partners in tobacco prevention interventions that target adolescents has an important tobacco reducing bonus effect in the adults. The intervention has proven sustainable within communities.  A growing majority of adolescents support parental interventions to help them refrain from tobacco.  The findings dismiss the notion that adolescents ignore or even disdain parental practices concerning tobacco. A common and consequent norm against tobacco from both schools and parents using a supportive attitude can prevent tobacco use in young people.

Place, publisher, year, edition, pages
Umeå: Institutionen för folkhälsa och klinisk vetenskap, 2009. 77 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1263
Keyword
Smoking, tobacco, prevention, intervention, adolescents, schools, evaluation, parents
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-21239 (URN)978-91-7264-780-0 (ISBN)
Public defence
2009-05-08, Sal B, plan 9, byggnad 1 D, Norrlands universitetssjukhus, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-04-20 Created: 2009-04-08 Last updated: 2015-04-29Bibliographically approved

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Nilsson, MariaStenlund, HansBergström, ErikWeinehall, LarsJanlert, Urban

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