Towards a tobacco-free generation. A study on the tobacco habits of adolescents: when, why and who?

Abstract: Why adolescents are using tobacco is a large and complex issue. There are factors on society, group and individual levels that affect the youngsters. The norms and attitudes in their surrounding, as well as the tobacco habits of parents and friends, are important when it comes to affecting adolescents to start using tobacco or abstain from it. Counteracting the use of tobacco requires a combination of actions at different levels. Among other things, it is known that it is effective to use various political actions, such as price increases and legislation whereby the age limit for purchase of tobacco is obeyed and more smoke-free environments are created. Offering adult tobacco users tobacco cessation, and thereby reducing the number of tobacco users, is also an investment that has an effect to make fewer adolescents start smoking or using snus. The overall aim of this dissertation work was to increase the knowledge on adolescent tobacco habits and explore the factors that may be used for health promotion work among adolescents to make them tobacco-free. The thesis consists of four parts, three quantitative studies and one qualitative study. All the studies were carried out among adolescents in the Kronoberg County in southern Sweden. The first two studies were based on data collection with repeated annual surveys for three and seven years, respectively. The first study made an attempt to evaluate a more simple intervention by A Non Smoking Genera-tion through class visits to pupils in grade 6. A baseline measurement in grade 6 found no significant difference in smoking habits between the inter-vention group and the comparison group. Two years after the intervention, a new survey was conducted. When the analysis was based on pupil responses from the survey about whether they had been visited by an inspiring person or not, a significant difference in smoking habits was found in favour of the intervention group. But when the analysis was done as a comparison between schools that the pupil said he/she had attended, and whether these schools had been visited or not, no significant difference was found. In the second study, a grade of pupils in an open cohort was followed with regard to development of smoking habits and any possible sex differences. The results showed that the largest increase in tobacco use was found between grade 7 (age 13) and upper secondary grade 1 (age 16), but it subsided during the last two upper secondary years. Snus were introduced later than smoking in the adolescents' lives. Girls smoked more than boys, and boys used far more snus than the girls did. From grade 8 (age 14), the boys were at a higher level than the girls, with regard to total tobacco consumption. In the third study, which was qualitative, adolescents in upper secondary school were interviewed about their use of snus. The snus had an important role in the adolescents' identity and group affiliation. Primarily, it was important to boys, who felt manly when they used snus. The adolescents were not aware that they developed an addiction and did not recognize abstinence symptoms that appeared at an early stage. Suddenly, they had to face the fact that they had become addicted, and then it was difficult to quit. In the final study, factors associated with being smoke- and/or snus-free were studied using a survey to pupils in grade 2 of upper secondary school. Surrounding people being tobacco-free affected the adolescents to remain tobacco-free. Girls appeared to be more prone than boys to be affected by a smoke free surrounding. Boys were affected by male (father and brother) snus-free role models, while girls were affected by a mother and sister being snus-free. Today's public health work needs to cover both preventive and health promotion efforts. Interventions at a local level, for example with NSG, are important at an individual level for choosing a tobacco-free life. Develop-ment of health promotion work with for example a health promoting- school, a supportive tobacco-free environment, is a good investment for the health of our adolescents. Here, we have the possibility to introduce tobacco-free school hours, i.e. that nobody is using any form of tobacco during school hours. Then, the adult world really demonstrates that the norm is to be tobacco-free.