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.
Highlights
Smoking remains one of the leading causes of years of life lost and increased morbidity in Denmark and worldwide [1, 2]
More students from a low and medium occupational social classes (OSC), who currently smoke, and who have ever used Alternative tobacco products (ATPs) did not respond to the second follow-up
No marked differences are seen between baseline cases and imputed cases in relation to gender as well as current smoking and ever use of ATPs at baseline; more students currently smoke (23.8 vs. 8.4%) and have ever used ATPs (49.7 vs. 25.4%) at second follow-up in the imputed cases compared with the baseline cases
Summary
Smoking remains one of the leading causes of years of life lost and increased morbidity in Denmark and worldwide [1, 2]. Individuals initiating a tobacco use in their teenage years are more likely to continue smoking in adulthood, be addicted to nicotine, have issues with smoking cessation, and have higher risks of health adversities in later life [4–6]. Preventing smoking uptake in adolescence and limiting the exposure of smoking in adolescents’ everyday lives may have crucial public health benefits. In Denmark and internationally, there seems to be a stagnation or even an increase in smoking prevalence among youths from lower socioeconomic backgrounds [11, 14]. Social disparities in smoking have not diminished, quite research indicates increasing socioeconomic differences in smoking during the last decades [11, 15]. This study examined whether a smoking preventive intervention was 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)
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