Abstract
Smoking is a major cause of health inequities. However, sociodemographic differences in adolescent tobacco use are unclear. In a territory-wide school-based anonymous survey in 2018/19, we investigated tobacco use and sociodemographic correlates in 33,991 students (mean age 14.8 ± 1.9 years) in Hong Kong. Tobacco use prevalence and current-ever use ratios by sociodemographic factors were calculated. Generalised linear mixed models were used in association analyses. Current use was highest for cigarettes (3.2%), closely followed by alternative tobacco products (3.0%). Current-ever use ratios were highest for heated tobacco products (HTPs, 0.60), followed by nicotine e-cigarettes (0.52), waterpipe (0.51), and cigarettes (0.35). Use prevalence and current-ever use ratios of all products showed curvilinear relations with perceived family affluence (P values < 0.01), being highest in the richest families. Tobacco use was also associated with more senior grades, the lowest parental education, and boys, but current-ever use ratios of HTPs and waterpipe were higher in girls (P values < 0.05). The results suggested that adolescent ever users of nicotine-containing alternative tobacco products were more likely to keep using them than cigarettes, and the richest adolescents were at the highest risks of tobacco use. Diverse tobacco control measures are needed to improve health equity, especially on alternative tobacco products.
Highlights
Smoking is a major cause of health inequities
We found only 1 study on the correlates of heated tobacco product (HTP) use—the Korea Youth Risk Behavior Web-based Survey, which showed that compared with the highest-socioeconomic status (SES) group, the prevalence of ever HTP use was 27% lower in the middle-SES group but similar in the lowest-SES group[20]
The current-ever use ratios were higher for HTPs (0.60), nicotine ECs (0.52), and waterpipe (0.51), but lower for cigarettes (0.35) and non-nicotine ECs (0.22)
Summary
Smoking is a major cause of health inequities. sociodemographic differences in adolescent tobacco use are unclear. Use prevalence and current-ever use ratios of all products showed curvilinear relations with perceived family affluence (P values < 0.01), being highest in the richest families. Disadvantaged people tend to initiate smoking at younger ages, smoke heavier, and be less successful in quitting[4] Diverting their limited disposable income to tobacco means lower expenditures on food, shelter, education, and h ealthcare[5,6], aggravating socioeconomic inequities. A study in 1,308 US adolescents showed that each level lower in household income and parental education was associated with 30% and 28% higher risks of adolescent smoking, respectively[9]. We found only 1 study on the correlates of heated tobacco product (HTP) use—the Korea Youth Risk Behavior Web-based Survey, which showed that compared with the highest-SES group, the prevalence of ever HTP use was 27% lower in the middle-SES group but similar in the lowest-SES group[20]. Waterpipe use was more common in youths who received the largest amount of spending money in most of the 60 countries in a secondary analysis based on the Global Youth Tobacco S urvey[21]
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