Tobacco use : studies of onset and cessation
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AbstractSmoking prevalence in Norway declines while the use of smokeless tobacco (snus) increases. 17% smoked daily and 8% used snus daily in 2011 (age 16-74). Young people are often dual users of cigarettes and snus. The use of snus is known to be less harmful than cigarette smoking, but the evidence of health risks is not consistent. Effective tobacco prevention is still required, including knowledge about factors facilitating cessation. The knowledge of the social distribution of tobacco and the pattern of transitions between snus and cigarettes is important for further reduction policy. The aim of this thesis is to explore factors contributing to initiation and cessation of tobacco use during life course.
The thesis is based on three health surveys. In the Akershus Survey 1998 (7697 adults, 65%) reasons for smoking cessation were assessed from 1,715 ex-smokers. In the school based Youth Study 2000-04 in six counties 15,931 10th graders (87%) participated, and in two counties 3317 (58%) of the 10th graders participated three years later, constituting the cohort Youth 2004. Linear binomial, multinomial and multivariate logistic regressions were applied.
Important reasons to have quit smoking were concern for own health, disliking addiction, wanting to improve physical fitness and reasons related to own children. Men were more likely to quit to improve physical fitness, while women rather quit because of their children. Adolescent tobacco use was positively associated with planned vocational education, living in a single parent family, and poor family economy. Daily smoking and dual use were stronger associated with these factors than occasional smoking and snus use. Using tobacco at age 16 strongly predicted tobacco use at age 19. Among 16 year old boys using snus only, there was an elevated risk of dual use, but not of smoking only, at age 19. The results illustrate the need for preventive efforts and professional interventions for both snus and cigarettes.
List of papers. Paper I is removed from the thesis due to copyright restrictions.
Paper I: Grøtvedt L, Stavem K. Association between age, gender and reasons for smoking cessation. Scandinavian Journal of Public Health, 2005; 33:72-76 doi:10.1080/14034940410028361
Paper II: Grøtvedt L, Stigum H, Hovengen R, Graff-Iversen S. Social differences in smoking and snuff use among Norwegian adolescents: a population based survey. BMC Public Health, 2008; 8:322. doi:10.1186/1471-2458-8-322 Published under a Creative Commons Attribution License.
Paper III: Grøtvedt L, Forsén L, Stavem K, Graff-Iversen S. Patterns of snus and cigarette use: a study of Norwegian boys followed from age 16 to 19 This article has been accepted for publication in Tobacco Control following peer review. The definitive copyedited, typeset version is available online at Tobacco Control, Online First 26 May 2012 doi:10.1136/tobaccocontrol-2011-050158