Socioeconomic Differences in Cigarette Smoking and Alternative Tobacco Product Use Among Adolescents in a School-Based Smoking Preventive Intervention: Findings From the Second Year of the X:IT II Study

Abstract

BackgroundHealth interventions may differently impact adolescents from diverse backgrounds. This study examined whether a smoking preventive intervention was equally effective in preventing cigarette smoking and use of alternative tobacco products (ATPs, i.e., snus, e-cigarettes, and waterpipe) among students from different socioeconomic backgrounds, i.e., occupational social classes (OSC).MethodsData was from the school-based intervention X:IT II targeting 13- to 15-year-olds Danes. The intervention focused on three main components: smoke-free school time, smoke-free curriculum, and parental involvement. In total, 46 schools were included at baseline (N = 2,307, response rate = 86.3%). Using a difference-in-differences approach, changes in current smoking and ever use of ATPs were estimated among students in high versus low OSC at second follow-up. Analyses were based on available cases (N = 826) and multiple imputations of missing data at the second follow-up (N = 1,965).ResultsAt baseline (age 13), 1.0% of students from high OSC and 4.8% from low OSC currently smoked cigarettes, while this was the case among 24.5 and 25.6%, respectively, at the second follow-up (age 15). Estimates indicated that social inequalities in current smoking diminished over time (p < 0.001). Regarding ATPs, 10.0% of high OSC students and 13.9% of low OSC students had ever used ATPs at baseline, while at second follow-up, 46.8 and 60.8%, respectively, had ever used ATPs. Estimates indicated that social inequalities in ever use of ATPs widened over time (p < 0.001).ConclusionsThe X:IT II intervention seemed to diminish socioeconomic disparities in smoking over the study period. Meanwhile, social inequalities in ever use of ATPs increased. Therefore, besides focusing on narrowing the social disparities in cigarette smoking, future efforts may, to a larger extent, focus on adolescents' use of ATPs.

Conhecimento de Acadêmicos de Odontologia sobre os Riscos do Cigarro Eletrônico para a Saúde Bucal

“…Pesquisas indicam que padrões de consumo de CE variam por origem socioeconômica e aumentam com o tempo, enquanto exposição a informações e a ambientes sociais afetam as intenções de uso 31 . Além disso, gênero, raça, orientação sexual e status socioeconômico moldam a percepção dos riscos à saúde, destacando a necessidade de intervenções adaptadas a contextos específicos para prevenir e reduzir o uso de CE entre os jovens 32 .…”

Do school-based smoking preventive interventions have unintended effects? Post hoc analysis of the Focus cluster randomised controlled trial

“…Lorenc and Oliver’s framework of unintended effects of public health interventions18 describe several mechanisms which may be present in the Focus intervention and lead to unexpected effects which could counteract the purposes of the intervention 18. First, as an example of direct harms previous research has raised the concern that introduction of comprehensive smoking bans in school may lead to an increase in other substance use (also called substitution use), including alternative tobacco and nicotine products (smokeless tobacco, ie, snus, snuff and chewing tobacco, hookah and e-cigarettes) or cannabis 19. This may be ascribed to an increased focus on smoking and smoking-related harms20 21 and subsequently, students with a high degree of nicotine dependency may use alternative tobacco and nicotine products as means to quit smoking or alleviate nicotine withdrawal symptoms 22.…”

“… 18 First, as an example of direct harms previous research has raised the concern that introduction of comprehensive smoking bans in school may lead to an increase in other substance use (also called substitution use), including alternative tobacco and nicotine products (smokeless tobacco, ie, snus, snuff and chewing tobacco, hookah and e-cigarettes) or cannabis. 19 This may be ascribed to an increased focus on smoking and smoking-related harms 20 21 and subsequently, students with a high degree of nicotine dependency may use alternative tobacco and nicotine products as means to quit smoking or alleviate nicotine withdrawal symptoms. 22 Second, restricting smoking in school could potentially create psychological harms as it may negatively impact the well-being of students who smoke daily during school hours.…”