Snuff use and oral health among young ice-hockey players : Implications for oral health promotion

Abstract: Oral health is a part of general health and from a public health perspective it is necessary to find effective strategies for oral health promotion in different target groups. Tobacco usage constitutes the single largest health risk in Sweden. One of the most important activities in health promoting work is therefore to prevent and decrease tobacco usage.<br/>The overall aim of this thesis was to identify factors influencing early establishment of snuff use among young ice-hockey players and based on this knowledge create a foundation for developing effective health and especially oral health preventive measures. <br/>The tobacco habits were investigated among 252 ice-hockey playing boys, 12-19 years old, representing three different ice-hockey clubs in the county of Värmland, Sweden. An intervention programme was introduced to analyse whether health information could change the players' tobacco habits. The study was further extended to a more in-depth analysis of differences in background factors and snuff habits. The investigation also included a follow up of tobacco habits and actual sporting activities threee years after the original study. Data were collected using questionnaires. The effects of snuff on oral health status were studied in 80 adolescent males out of whom half were snuff users and half non-users matched according to age. Finally a qualitative study with a grounded theory design was performed, consisting of 16 young men between 15-32 years of age, in order to explore and describe why adolescent males who play ice-hockey start using snuff. <br/><br/>Snuff use was more prevalent than smoking. Thirty-one (12%) of the boys used snuff, 6 (2%) had used snuff but quit, while 79 (32%) had tried using snuff and 133 (54%) had never used snuff. There was a positive effect of the intervention programme on the boys' knowledge of tobacco but there was no change in their tobacco behaviour. The multivariate regression analyses showed an association between tobacco habits of family members and commencing snuff use. However "taking part in other sports" was the explanatory variable which showed the strongest association with the dependent variable. Thus snuff usage was more frequent among the boys who did not take part in another sport than ice-hockey.<br/>During the follow up period of 3 years, tobacco usage increased both regarding newly established users (16%) and in how earlier snuff users combined their snuff use with smoking. In the clinical examination, snuff-induced mucosal lesions were found in 35 out of 40 snuff users. Seventeen percent of the cases showed loss of periodontal attachment as gingival recessions. There were, however, no statistical differences in plaque and gingivitis between snuff users and non-users. In the in-depth interviews, "Socialization in and through psychosocial norms of the ice-hockey environment" was identified as a core category, describing the central meaning of the informants' experiences of snuff in the ice-hockey environment.