Electronic cigarettes are quite a new potential source of nicotine addiction among youth. More research is needed, particularly on e-liquid use and socioeconomic factors as potential determinants. We ...studied changes from 2013 to 2015 in adolescent e-cigarette awareness and ever-use, types of e-liquids, and determinants in Finland. In 2015, we studied weekly use and reasons for ever-use. Data were from two national surveys of 12-18-year-old Finns (2013,
= 3535, response rate 38%; 2015,
= 6698, 41%). Descriptive statistics and logistic regression analysis were used. Awareness and ever-use of e-cigarettes increased significantly from 2013 to 2015 in all age and gender groups. Ever-use increased from 17.4% to 25%, with half having tried nicotine e-liquids. In 2015, weekly use was rare (1.5%). Daily cigarette smoking was the strongest determinant (OR 51.75; 95% CI 38.18-70.14) for e-cigarette ever-use, as for e-cigarette weekly use, but smoking experimentation and ever-use of snus (Swedish type moist snuff) and waterpipes alongside parental smoking and poor academic achievement also increased the odds for ever-use. The most common reason behind e-cigarette ever-use was the desire to try something new. To conclude, adolescent e-cigarette ever-use is increasing, and also among never-smokers. Tobacco-related factors are stronger determinants for e-cigarette use than socioeconomic factors.
The long-term effects of sleep on adolescent psychosocial well-being are mostly unknown, although insufficient sleep has been associated with emotional and behavioral difficulties in cross-sectional ...studies. With a five-year follow-up of Finnish adolescents (Time 1:
n
= 8834; Mean age = 13 years, 51.1% female, Time 2:
n
= 5315, Mean age = 15 years, 51.6% female, Time 3:
n
= 3712; Mean age = 17 years; 50.2% female), the purpose of this longitudinal study was to investigate the relations between self-reported sleep duration, sleep problems, and emotional and behavioral difficulties during adolescence. Emotional and behavioral difficulties were assessed using The Strengths and Difficulties Questionnaire (SDQ) measuring emotional symptoms, conduct problems, hyperactivity, peer problems and total difficulties. Sleep duration was calculated by counting the hours between self-reported bedtime and wake-up time. Sleep problems were assessed with a single question about the general sleep problems. According to the cross-lagged models for sleep and emotional and behavioral difficulties, the findings of this study indicate a developmental process during adolescence where, firstly, short sleep duration is a stronger predictor for current and prospective emotional and behavioral difficulties than vice versa. Secondly, increased emotional and behavioral difficulties expose adolescents to current and later sleep problems more strongly than reverse. Thus, the results show that short sleep duration predisposed to emotional and behavioral difficulties across adolescence, which then led to more prospective sleep problems. These findings suggest a developmental process where sleep and emotional and behavioral difficulties are intertwined in shaping adolescents’ health.
•Nicotine e-cigarette use raises the risk of daily smoking in never-smoking youth.•Nicotine e-cigarette use increases the risk of daily use of nicotine e-cigarettes.•Nicotine e-cigarettes may serve ...as a gateway to different nicotine product use.•Youths’ access to e-cigarettes should be limited to prevent nicotine addiction.
Several studies indicate an association between e-cigarette use and subsequent smoking among youth. However, most previous studies lack measures of the nicotine content of e-liquid and have not usually measured regular smoking.
We tested the association between e-cigarette use, with and without nicotine, and subsequent daily use of conventional cigarettes and nicotine e-cigarettes among study population of 3474 students. A survey was conducted in lower secondary schools of the Helsinki metropolitan area, Finland, with 15 − 16-year-olds in 2014 (baseline) and in upper secondary schools in 2016 when the cohort was 17 − 18-year-olds (follow-up). Firth logistic regression and generalized linear mixed models (GLMM) were used.
Of students, 25% had experimented with nicotine e-cigarettes at baseline and 40% at follow-up. Among baseline never-smokers, experimentation with or use of nicotine e-cigarettes predicted the uptake of daily smoking at follow-up (AOR 2.92; 95% CI 1.09–7.85), but baseline experimentation with non-nicotine e-cigarettes did not when compared with the non-e-cigarette experimenters. Nicotine e-cigarette experimentation at baseline predicted daily nicotine e-cigarette use at follow-up (AOR 2.96; 95% CI 1.22–7.22). Non-nicotine e-cigarette experimentation at baseline did not predict statistically significantly daily nicotine e-cigarette use at follow-up (AOR 3.13; 95% CI 0.98–10.02). The small number of cases may have diminished the statistical significance.
The findings suggest that experimentation with nicotine e-cigarettes serves as a gateway to subsequent use of conventional cigarettes as well as nicotine e-cigarettes. Our results support the actions to limit youths’ access to e-cigarettes in order to prevent nicotine addiction.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
Abstract
Background
Studies comparing adolescent e-cigarette use in different countries are scarce. We study students’ e-cigarette and conventional cigarette ever-use, their social correlates and ...e-liquid use in seven EU countries.
Methods
SILNE-R data (N=12 167, response rate 79.4%) of 14–17-year-olds from Amersfoort (NL), Coimbra (PT), Dublin (IR), Hanover (GE), Latina (IT), Namur (BE) and Tampere (FI) were used. E-cigarette and conventional cigarette ever-use, dual-use, type of e-liquid and social correlates were measured with a school survey and analyzed with cross-tabulations and multinomial logistic regression.
Results
About 34% had tried e-cigarettes, but the variation was large between the cities (Latina 50%; Hanover 23%). Of e-cigarette ever-users, 37% had used nicotine e-liquid, 43% exclusively non-nicotine liquid and 20% did not know the content. Nicotine e-liquid was more prevalent among monthly e-cigarette users and weekly smoking e-cigarette users. The social correlates were mainly the same for exclusive e-cigarette ever-use, exclusive conventional cigarette ever-use and dual-use. Boys had greater odds for exclusive e-cigarette and dual-use compared to girls. Of social correlates, low academic achievement and parental smoking were positively associated with all categories of use, but parental education and immigrant background were not. The strongest association was found between peer smoking (most/all best friends smoke) and dual-use (OR 34.29).
Conclusions
Students’ e-cigarette ever-use varies greatly between EU countries. E-cigarettes seem not to be a substitute for conventional cigarettes but more a complementary product. Tobacco control policies might also prevent e-cigarette use but specific regulations on e-cigarettes are needed to prevent nicotine addiction originating from them.
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NUK, OILJ, UL, UM, UPUK, VSZLJ
The aim of the study was to examine the construct validity of the Three-Factor Eating Questionnaire -R18 (TFEQ-R18), a measure of eating behaviour, and to evaluate cognitive restraint, uncontrolled ...eating and emotional eating in a sample of adolescent and young adult females of different weights.
Subjects were 2 997 females, aged 17 to 20 years, who participated in a phase III human papillomavirus vaccination trial in Finland in 2004 - 2009.Self-administered questionnaires and weight and height measurements were used. The factor structure of the TFEQ-R18 was verified by factor analysis. Connections between measured eating behaviour and Body Mass Index (BMI) were tested using analysis of variance.
The original factor structure of the TFEQ-R18 was replicated: six of the eighteen items measured cognitive restraint, nine measured uncontrolled eating, and three measured emotional eating. On average, higher BMI was associated with higher levels of cognitive restraint (p < 0.001) and emotional eating (p < 0.001), but not with uncontrolled eating.
Structural validity of the TFEQ-R18 was good in this sample of young Finnish females with a varying range of body weights. Use of the instrument as a measure of eating behaviour was thus corroborated. Connections of restrained and emotional eating with BMI were in accordance with previous findings from young females.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Abstract
Background
To address social inequalities in adolescent substance use and consequent disparities in health, it is important to identify the mechanisms of the association between substance ...use and academic performance. We study the role of health literacy (HL) in the association between academic performance and weekly smoking, monthly alcohol use and cannabis ever-use among adolescents in Europe.
Methods
SILNE-R school survey data, which was collected in 2016–17 with paper-and-pencil-method from Hanover (GE), Amersfoort (NL) and Tampere (FI), were used (N = 5088, age 13–19). Health Literacy for School-aged Children instrument was used to assess students’ HL. Logistic regression analyzed the association of substance use with academic performance and HL, separately and in the same model. Linear and multinomial logistic regression analyzed the association between academic performance and HL.
Results
Poor academic performance compared with high was associated with smoking odds ratio (OR) 3.94, 95% confidence interval (CI) 2.83–5.49, alcohol use (OR: 2.94, 95% CI: 2.34–3.68) and cannabis use (OR: 2.56, 95% CI: 1.89–3.48). Poor HL was also associated with each substance use (with ORs of 2.32, 1.85 and 1.29). HL was positively associated with academic performance (β = 1.04, 95% CI: 0.89–1.20). The associations between academic performance and substance use were only slightly attenuated after controlling for HL.
Conclusions
Academic performance and HL were both determinants of substance use, confirming their role in tackling the disparities in substance use. However, HL did not demonstrably mediate the association between academic performance and substance use. A wider set of factors needs to be tackled to address emerging social inequalities in adolescent substance use.
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Cyberbullying, threatening or harassing another via the internet or mobile phones, does not cause physically harm and thus the consequences are less visible. Little research has been performed on the ...occurrence of cyberbullying among adolescents or the perception of its seriousness. Only a few population-based studies have been published, none of which included research on the witnessing of cyberbullying. Here, we examined exposure to cyberbullying during the last year, and its frequency and perceived seriousness among 12 to 18-year-old adolescents in Finland. We studied four dimensions of cyberbullying: being a victim, bully, or both victim and bully of cyberbullying, and witnessing the cyberbullying of friends.
Self-administered questionnaires, including four questions on cyberbullying, were mailed to a representative sample of 12-, 14-, 16-, and 18-year-old Finns in 2009 (the Adolescent Health and Lifestyle Survey). The respondents could answer via the internet or paper questionnaire.
The number of respondents was 5516 and the response rate was 56%. Girls more often than boys reported experiencing at least one dimension of cyberbullying during the last year. The proportion was highest among 14-year-olds and lowest among 18-year-olds of both sexes. Among girls, the most commonly encountered dimension was witnessing the cyberbullying of friends (16%); and being a victim was slightly more common than being a bully (11% vs. 9%). Among boys, an equal proportion, approximately 10%, had been a victim, a bully, or had witnessed cyberbullying. The proportion of bully-victims was 4%. Serious and disruptive cyberbullying was experienced by 2% of respondents and weekly cyberbullying by 1%; only 0.5% of respondents had been bullied weekly and considered bullying serious and disruptive.
Adolescents are commonly exposed to cyberbullying, but it is rarely frequent or considered serious or disruptive. Cyberbullying exposure differed between sexes, such that girls more often than boys witness cyberbullying of friends and boys more often act as the bully than girls. In future studies, the witnessing of cyberbullying and its consequences should be taken into account.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Little is known of the predictors of electronic cigarette (e-cigarette) use among adolescents, even though the use is increasing. We studied here the predictors for e-cigarette experimentation (tried ...and tried more than twice) and compared them with predictors for conventional smoking. A baseline school survey was conducted in the Helsinki metropolitan area, Finland, in 2011 for seventh graders (12 to 13-year-olds). Response rate was 73%. The same students were followed up in 2014 (9th grade, 15 to 16-year-olds),
= 5742. Generalized linear mixed models controlling for school clustering were used. In the follow-up, 43.3% of boys and 25.6% of girls had tried e-cigarettes and 21.9% and 8.1% correspondingly more than twice. The strongest predictors for both genders were conventional smoking, drunkenness and energy drink use. Furthermore, poor academic achievement predicted e-cigarette experimentation for both genders, and for boys, participation in team sports was a predictor. The predictors for experimenting and for experimenting more than twice were very similar, except for boys' participation in team sports. They were also similar compared to the predictors of conventional smoking but the associations were weaker. To conclude, smoking and other addictive behaviors predict adolescents' experimentation with e-cigarettes. Family's socioeconomic background had little significance.
Existing literature on recent trends in adolescent gambling is scarce. The rapidly changing landscape of gambling, together with the generally applied legal age limits, calls for the continuous ...monitoring of gambling also among the adolescent population. In Finland, the legal gambling age is 18. We examined changes in adolescents’ gambling, gambling expenditure and gambling–related harms from 2011 to 2017. Comparable cross-sectional biennial survey data were collected in 2011, 2013, 2015 and 2017 among 12–18-year-olds (
N
= 18,857). The main measures were self-reported six-month gambling, average weekly gambling expenditure (€) and harms due to gambling. Data were analyzed using cross-tabulations, χ
2
-tests and linear regression analysis. A significant decline in gambling among minors (aged 12–16-year-olds) was found (β = − 0.253), while no significant changes were observed among 18-year-olds (who are not targeted by the law). The mean gambling expenditure also declined from 2011 to 2017. Adolescent gamblers experienced significantly less (
p
= .003) gambling–related harms in 2017 (7.4%) compared to 2011 (13.5%). Adolescent gambling and its related negative consequences have become less prevalent in Finland between 2011 and 2017. Further monitoring is necessary to ascertain whether the positive direction will continue. Also, empirical analyses providing evidence of reasons for the observed trend are warranted.
The health selection hypothesis suggests that poor health leads to low educational attainment during the life course. Adolescence is an important period as poor health might prevent students from ...making the best educational choices. We test if health in adolescence is associated with educational aspirations and whether these associations persist over and above sociodemographic background and academic achievement.
Using classroom surveys, a cohort of students (n = 5.614) from the Helsinki Metropolitan Region was followed from the 7th (12-13 years,) up to the 9th grade (15-16 years) when the choice between the academic and the vocational track is made in Finland. Health factors (Strengths and Difficulties Questionnaire (SDQ), self-rated health, daily health complaints, and long-term illness and medicine prescribed) and sociodemographic background were self-reported by the students. Students' educational aspirations (applying for academic versus vocational track, or both) and their academic achievement were obtained from the Joint Application Registry held by the Finnish National Agency for Education. We conducted multilevel multinomial logistic regression analyses, taking into account that students are clustered within schools.
All studied health factors were associated with adolescents' educational aspirations. For the SDQ, daily health complaints, and self-rated health these associations persisted over and above sociodemographic background and academic achievement. Students with better health in adolescence were more likely to apply for the academic track, and those who were less healthy were more likely to apply for the vocational track. The health in the group of those students who had applied for both educational tracks was in between. Inconsistent results were observed for long-term illness. We also found robust associations between educational aspirations and worsening health from grade 7 to grade 9.
Our findings show that selection by health factors to different educational trajectories takes place at early teenage much before adolescents choose their educational track, thus supporting the health selection hypothesis in the creation of socioeconomic health inequalities. Our findings also show the importance of adolescence in this process. More studies are needed to reveal which measures would be effective in helping students with poor health to achieve their full educational potential.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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