Awareness and determinants of electronic cigarette use among Finnish adolescents in 2013: a population-based study.

BACKGROUND: A wide range of electronic cigarettes (e-cigarettes) are now on the market. We studied e-cigarette awareness and use, determinants and sources of e-cigarettes, the e-liquids used in them and exposure to e-cigarette advertisements among adolescents in Finland. Among smokers, we studied the association of e-cigarette use and interest in smoking cessation. METHOD: Data were obtained from a national survey of 12-18-year-old Finnish adolescents in 2013 (N=3535, response rate 38%). Descriptive statistics and logistic regression analysis were used. RESULTS: Of the respondents, 85.3% knew what e-cigarettes were; 17.4% had tried them. E-liquids with nicotine were used most often (65.7%); also those who had never tried conventional cigarettes had used them. Of e-cigarette ever users, 8.3% had never tried smoking. Parents' high level of education, being in employment, and intact family protected against children's e-cigarette use. In the final model, daily smoking (OR 41.35; 95% CI 25.2 to 67.8), snus use (2.96; 2.4-4.0), waterpipe use (2.21; 1.6-3.0), children's vocational education (2.06; 1.4-3.1) and poor school performance (1.92; 1.4-3.0) were associated with e-cigarette experimentation. Those smokers with most experience of e-cigarettes were least likely to consider smoking cessation. CONCLUSIONS: Awareness and experimentation with e-cigarettes are high among adolescents, especially in older age groups and boys. Nicotine e-liquids are easy to acquire for youth. Having similar risk factors, e-cigarette use seems to follow the model of conventional smoking initiation. Among adolescent smokers, use of e-cigarettes does not clearly relate to interest in smoking cessation. Preventive policies are needed to protect the youth.

The role of parents, friends and teachers in adolescents' cigarette smoking and tombak dipping in Sudan.

OBJECTIVE: To assess the influence of smoking and tombak (local smokeless tobacco) dipping by parents, teachers and friends on cigarette smoking and tombak dipping by school-going Sudanese adolescents. METHODS: This was a school-based cross-sectional survey was conducted in 2005-2006. Logistic regression was used for the analysis. A total of 4277 Sudanese school-going adolescents (aged 11-17 years) from 23 schools who completed an anonymous self-administered questionnaire on the use of tobacco products. Main outcome measures were self-reported tobacco use during the previous month defined current tobacco use. Ever smoking, tombak dipping and other tobacco products were also considered as outcomes. RESULTS: After adjusting for sex, age and school grade, adolescents' smoking habits were strongly associated with the habit in their parents and friends and, more weakly, with tombak dipping by teachers. When adjusted for each other, the association with smoking in friends was unaffected and remained significant (prevalence OR (POR) of having ever smoked was 1.94, 95% CI 1.64 to 2.29; OR of being current smoker was 3.77, 95% CI 2.80 to 5.07). Tobacco smoking in friends was positively associated with adolescents ever tombak dipping (POR 1.81, 95% CI 1.41 to 2.33) and current dipping (OR 3.33, 95% CI 2.20 to 5.05). The association with parental habits was reduced but still significantly elevated. Tombak dipping by teachers was only associated with adolescents ever tobacco smoking. CONCLUSIONS: Tobacco use by parents, teachers and friends was associated with adolescents' tobacco habits. The influence of friends was the strongest. In developing programmes against adolescents' tobacco habits, there is need to target the influence of these 'significant others'. Sudan needs to develop and implement comprehensive anti-smoking and anti-tombak dipping legislation to reduce the growing prevalence of such habits.

School Smoking Policies and Health Science Students' Use of Cigarettes, Shisha, and Dipping Tombak in Sudan.

The relationship between school smoking policies and students' tobacco use is ambiguous, and little is known about the effect of these policies in low- and middle-income countries. This study was designed to assess the effects of schools' smoking policies and the exposure to residential smoking on cigarette smoking and the use of different kinds of tobacco products by Health Science students. Self-reports of cigarette smoking, use of shisha (smoking of fruits-mixed tobacco using a bowl and a connected hose); dipping tombak (local smokeless tobacco that users usually place inside oral cavity in the groove behind the lower lip), and tobacco use on school premises are analyzed. A cross-sectional survey was carried out using a modified self-report questionnaire, originally developed by WHO, among a representative sample of 1,590 third-year HSS from 25 schools drawn from 13 universities, using a multi-stages sampling technique. The response rate was 100% for schools and 68% for students. A multilevel analysis was performed by nesting student-level in school-level variables. Results from the adjusted models revealed that, when students reported awareness of smoking restriction, they were more likely to be current smokers (OR = 2.91; 95% CI: 1.68-5.02; p = 0.021) and shisha users (OR = 2.17; 95% CI: 1.54-3.06; p = 0.021). Results from additional analysis performed among tobacco users only, showed increased risk of smokers and tombak dippers who smoked or dipped on school premises (OR = 2.38; 95% CI: 1.34-4.25; p = 0.003, OR = 2.60; 95% CI: 1.22-5.56; p = 0.013, respectively). Current smokers (OR = 3.12; 95% CI: 1.98-4.92; p = ≤ 0.001), ever smokers (OR = 1.66; 95% CI: 1.31-2.10; p = ≤ 0.001) and shisha users (OR = 1.73; 95% CI: 1.36-2.21; p = ≤ 0.001) were exposed to residential smoking on one or more days during the previous 7 days. High percentages of those who used any kind of tobacco products reported being aware of school smoking policies, indicating no clear evidence that school smoking policies had an effect on use of any of the mentioned tobacco products. The lack of compliance with school policies shows the need for further policy enforcement and sustainability, taking into account the effect of residential smoking and social influences.