The association between socioeconomic position and vigorous physical activity among adolescents: a cross-sectional study in six European cities.

BACKGROUND: The relationship between socioeconomic position (SEP) and adolescent physical activity is uncertain, as most evidence is limited to specific settings and a restricted number of SEP indicators. This study aimed to assess the magnitude of socioeconomic differences in adolescent vigorous physical activity (VPA) across various European countries using a wide range of SEP indicators, including family-based (education, family affluence, perceived social standing, parents' employment, housing tenure) and adolescent-based (academic performance and pocket money) ones. METHODS: We used data from a survey among 10,510 students aged 14-17 from 50 schools in six European cities: Namur (BE), Tampere (FI), Hannover (DE), Latina (IT), Amersfoort (NL), Coimbra (PT). The questionnaire included socio-demographic characteristics and the amount of time spent in VPA. RESULTS: The mean time spent practicing VPA was 60.4 min per day, with lower values for Namur (BE) and Latina (IT), and higher values for Amersfoort (NL). In the multivariable analysis, both categories of SEP indicators (family-based and adolescent based indicators) were independently associated with VPA. For each SEP indicator, lower levels of VPA were recorded in lower socioeconomic groups. In the total sample, each additional category of low SEP was associated with a decrease in mean VPA of about 4 min per day. CONCLUSIONS: This study showed that across European cities adolescent VPA is positively related to both family-based SEP and adolescents' own SEP. When analysing socioeconomic differences in adolescent VPA, one should consider the use of multiple indicators of SEP.

Nicotine dependence among adolescents in the European Union: How many and who are affected?

BACKGROUND: Nicotine dependence during adolescence increases the risk of continuing smoking into adulthood. The magnitude of nicotine dependence among adolescents in the European Union (EU) has not been established. We aimed to estimate the number of nicotine dependent 15-year-old adolescents in the EU, and identify high-risk groups. METHODS: The number of nicotine dependent 15-year-olds in the EU was derived combining: (i) total number of 15-year-olds in the EU (2013 Eurostat), (ii) smoking prevalence among 15-year-olds (2013/2014 HBSC survey) and (iii) proportion of nicotine dependent 15-year-olds in six EU countries (2013 SILNE survey). Logistic regression analyses identified high-risk groups in the SILNE dataset. RESULTS: We estimated 172 636 15-year-olds were moderately to highly nicotine dependent (3.2% of all 15 years old; 35.3% of daily smokers). In the total population, risk of nicotine dependence was higher in males, adolescents with poor academic achievement, and those with smoking parents or friends. Among daily smokers, only lower academic achievement and younger age of smoking onset were associated with nicotine dependence. CONCLUSION: According to our conservative estimates, more than 172 000 15-year-old EU adolescents were nicotine dependent in 2013. Prevention of smoking initiation, especially among adolescents with poor academic performance, is necessary to prevent a similar number of adolescents getting addicted to nicotine each consecutive year.

Tobacco use and exposure to tobacco promoting and restraining factors among adolescents in a developing country.

OBJECTIVE: With a long history of tobacco cultivation, adolescents in Ghana are at relatively high risk of the emerging tobacco epidemic in developing countries. This study explored exposure to tobacco promoting/restraining factors and their associations with smoking and tawa (traditional smokeless tobacco) use among 13-18-year-old Ghanaians. METHODS: School-based representative data were collected in 2008 (n = 1165). RESULTS: Prevalence rates of tobacco use, smoking and tawa use were 9.1% (11.5% boys and 6.4% girls), 6.6% (8.0% boys and 4.7% girls) and 5.7% (7.3% boys and 3.9% girls), respectively. Four percent of the respondents attended schools without a smoking ban, 66% had been taught about the harmful effects of smoking in the current school year, and 53% had been exposed to tobacco advertising. Fifty-three percent of adolescents who had tried to purchase tobacco products were not refused because of their age. Multivariate analyses found that attendance at a school where smoking was allowed, not having been taught about the harmful effects of smoking, exposure to tobacco advertising and parental smoking were positively associated with tobacco use, and knowledge that smoking is harmful to health and difficult to quit were negatively associated with tobacco use. CONCLUSIONS: Both smoking and tawa use were relatively low among Ghanaian adolescents. Exposure to tobacco advertising was high. There is no tobacco legislation in Ghana, but societal norms or cultural values seem to restrict smoking in schools and access to tobacco products.

Questionnaire-assessed moderate to vigorous physical activity of the Finnish youth in 1979-2005.

The purpose of the study was to investigate the time trend of questionnaire-assessed moderate to vigorous physical activity (MVPA) among 12-18-year-old Finnish boys and girls from 1979 to 2005. The MVPA was defined as "at least moderately breathtaking and sweating in leisure time physical activities more than 3 times week." Data were based on the Adolescent Health and Lifestyle Survey, which is a biannual, nation-wide survey on adolescent health and health-related lifestyle in Finland. The nationally representative samples were drawn from the Finnish Population Register Centre. The numbers of participants varied from 2832 to 8390 and the response rates from 91% (girls, 1981) to 58% (boys, 2005). The main results showed that the participation rate in MVPA increased during the study period. The increase was not continuous, but showed an upward trend during the years 2001-2005. The study also revealed that boys participated in MVPA more than girls. However, the gender difference decreased during the study period. Age differences in MVPA were rather small and they decreased during the study period. However, perceived intensity of physical activity was higher among older than younger groups, whereas participation in MVPA was more frequent in younger than older groups. The results supported the findings of some previous studies that reported that especially in Finland the vigorous physical activity among young people had consistently increased. This study gave more information about this phenomenon because the study period was longer, 26 years, and the sample also included older, 16- and 18-year-old boys and girls.

Anabolic-androgenic steroid use among young Finnish males.

The aim of the present study was to describe the lifetime occurrence and associated factors of anabolic-androgenic steroids (AAS) among young Finnish males. Of the 10 829 male conscripts (median age 19), 10 396 (96%) answered a questionnaire during the first days of their conscription in the years 2001-2007. The main outcome was lifetime AAS use. We also studied associations between 13 socioeconomic, health, and health behavioral background variables and AAS use by logistic regression. Eighty-nine (0.9%) respondents reported having used AAS. In addition, 26 (0.3%) respondents reported that they would use AAS if they could obtain them. In multivariate analysis, which included all significant variables and age, the strongest associated factors were weight training at fitness centers more than three times a week [odds ratio (OR) 11.8; 95% confidence interval (CI): 7.1-19.6], low educational status (OR 3.7; 95% CI: 2.0-7.0), and weekly drunkenness as drinking style (OR 2.4; 95% CI: 1.4-4.5). Sports other than weight training were not associated with AAS in our sample. The use of AAS is relatively uncommon among Finnish males. It is strongly associated with weight training at fitness centers but also with lower educational status and a drunkenness-oriented lifestyle. Prevention should be targeted at those males participating in weight training.

Participation in sports clubs is a strong predictor of injury hospitalization: a prospective cohort study.

The aim of this prospective cohort study was to investigate the nature and risk factors of injuries leading to hospitalization. A cohort of 57 407 Finns aged 14-18 years was followed in the Hospital Discharge Register for an average of 10.6 years, totaling 608 990 person-years. We identified 5889 respondents (10.3%) with injury hospitalization. The most common anatomical location was the knee and shin (23.9%), followed by the head and neck (17.8%), and the ankle and foot (16.7%). Fractures (30.4%) and distortions (25.4%) were the most common injury types. The strongest risk factor for injury hospitalization was frequent participation in sports clubs [hazard ratio (HR) in males 1.8; 95% confidence interval (CI): 1.7-2.0 and in females 2.3; 95% CI: 1.9-2.7], followed by recurring drunkenness (HR 1.6; 95% CI: 1.4-2.7 in males and 1.4; 95% CI: 1.2-1.6 in females) and daily smoking (HR 1.4; 95% CI: 1.3-1.5 in males and 1.43 95% CI: 1.2-1.5 in females). The association between injuries and sports clubs participation remained after adjusting for sociodemographic background, health, and health behaviors. Health behavior in adolescence, particularly sports club activity, predicted injury hospitalization. Preventive interventions directed toward adolescents who participate in sports clubs may decrease injury occurrence.

Do maternal knowledge and paternal knowledge of children's whereabouts buffer differently against alcohol use? A longitudinal study among Finnish boys and girls.

BACKGROUND: Previous research suggests that parental knowledge of the child's activities and whereabouts prevents adolescents' alcohol use. However, evidence on whether the positive effects of maternal and paternal knowledge are distinctive for boys' and girls' alcohol use is inconclusive. We examined whether perceived parental knowledge at age 13 prevents alcohol use at age 16, whether the effect of maternal and paternal knowledge was the same for both genders, and whether paternal knowledge had as strong an effect as maternal knowledge. METHOD: Adolescents answered a school survey in 2011 (age 13) and 2014 (age 16) in Finland (N = 5742). Perceived maternal and paternal knowledge was measured separately using a Parents' Monitoring Scale. The data were analysed via moderation regression modelling using Bayesian estimation. RESULTS: Perceived maternal and paternal knowledge at age 13 predicted boys' and girls' lower alcohol use at age 16. For those who had not used alcohol at age 13, parental knowledge protected against an increase of alcohol use at age 16. Both maternal and paternal knowledge had a shielding effect against the increase of boys' and girls' alcohol use, but maternal knowledge had a stronger shielding effect than paternal knowledge. CONCLUSIONS: Both maternal and paternal perceived knowledge at age 13 buffers against the adverse development of alcohol use at age 16 for both genders. Underlining the importance of parent-child communication and knowledge about the child's activities should be a part of family health counselling and school health services.

The risk for a cruciate ligament injury of the knee in adolescents and young adults: a population-based cohort study of 46 500 people with a 9 year follow-up.

OBJECTIVES: The knee joint is the most common site for injury among younger people, the injury often resulting in expensive (surgical) treatment, long-term rehabilitation and permanent functional impairment and disability. METHODS: We investigated the incidence and risk factors for a major knee-ligament injury in an adolescent Finnish population. A population-based cohort of 46 472 adolescents was followed for an average of 9 years. All patients hospitalised with the diagnosis of anterior or posterior cruciate ligament injury (ACL or PCL injury) were included in the analysis. RESULTS: 265 (0.6%) people (194 male and 71 female subjects) from the total cohort of 46 472 were treated for a cruciate ligament injury of the knee during the follow-up period, giving an injury incidence of 60.9 (95% CI 53.6 to 68.2) per 100 000 person-years. When the socioeconomic, health and lifestyle background variables were taken into account, the adjusted hazard ratio for a cruciate ligament injury of the knee was 8.5 (95% CI 4.3 to 16.4) for female and 4.0 (95% CI 2.7 to 6.1) for male subjects who participated in organised sports > or =4 times/week. CONCLUSIONS: The general risk for a cruciate ligament injury of the knee is relatively low among adolescents and young adults, but participation in organised sports increases the risk significantly. The risk is especially high in active young women. Preventive measures should be adopted to decrease the short-term and long-term burden of these severe injuries.

Health inequality in adolescence. Does stratification occur by familial social background, family affluence, or personal social position?

BACKGROUND: Two new sets of stratification indicators--family's material affluence and adolescent's personal social position- were compared with traditional indicators of familial social position based on parental occupation and education for their ability to detect health inequality among adolescents. METHODS: Survey data were collected in the Adolescent Health and Lifestyle Survey in 2003 from nationally representative samples of 12-, 14- and 16-year-old Finns (number of respondents 5394, response rate 71%). Indicators of the familial social position were father's socio-economic status, parents' education, parents' labour market position. Indicators of material affluence were number of cars, vacation travels, and computers in the family, own room and amount of weekly spending money. Adolescent's personal social position was measured as school performance. Measures of health were long-standing illness, overweight, use of mental health services, poor self-rated health and number of weekly health complaints. Ordinal logistic regression analysis was applied to study the associations between stratification indicators and health variables. RESULTS: All three groups of indicators of social stratification showed inequality in health, but the strongest associations were observed with the adolescent's personal social position. Health inequality was only partly identifiable by the traditional indicators of familial social position. The direction of the inequality was as expected when using the traditional indicators or personal social position: adolescents from higher social positions were healthier than those from lower positions. The indicators of family's material affluence showed mainly weak or no association with health and some of the indicators were inversely associated, although weakly. CONCLUSION: In addition to traditional indicators describing the socio-structural influences on the distribution of health among adolescents, indicators of family's material affluence should be further developed. Adolescents' personal social position should be included in the studies of health inequalities.

Radiation dose and leukemia risk in patients treated for cancer of the cervix.

To quantify the risk of radiation-induced leukemia and provide further information on the nature of the relationship between dose and response, a case-control study was undertaken in a cohort of over 150,000 women with invasive cancer of the uterine cervix. The cases either were reported to one of 17 population-based cancer registries or were treated in any of 16 oncologic clinics in Canada, Europe, and the United States. Four controls were individually matched to each of 195 cases of leukemia on the basis of age and calendar year when diagnosed with cervical cancer and survival time. Leukemia diagnoses were verified by one hematologist. Radiation dose to active bone marrow was estimated by medical physicists on the basis of the original radiotherapy records of study subjects. The risk of chronic lymphocytic leukemia, one of the few malignancies without evidence for an association with ionizing radiation, was not increased [relative risk (RR) = 1.03; n = 52]. However, for all other forms of leukemia taken together (n = 143), a twofold risk was evident (RR = 2.0; 90% confidence interval = 1.0-4.2). Risk increased with increasing radiation dose until average doses of about 400 rad (4 Gy) were reached and then decreased at higher doses. This pattern is consistent with experimental data for which the down-turn in risk at high doses has been interpreted as due to killing of potentially leukemic cells. The dose-response information was modeled with various RR functions, accounting for the nonhomogeneous distribution of radiation dose during radiotherapy. The local radiation doses to each of 14 bone marrow compartments for each patient were incorporated in the models, and the corresponding risks were summed. A good fit to the observed data was obtained with a linear-exponential function, which included a positive linear induction term and a negative exponential term. The estimate of the excess RR per rad was 0.9%, and the estimated RR at 100 rad (1 Gy) was 1.7. The model proposed in this study of risk proportional to mass exposed and of risk to an individual given by the sum of incremental risks to anatomic sites appears to be applicable to a wide range of dose distributions. Furthermore, the pattern of leukemia incidence associated with different levels of radiation dose is consistent with a model postulating increasing risk with increasing exposure, modified at high doses by increased frequency of cell death, which reduces risk.

Radiation dose and second cancer risk in patients treated for cancer of the cervix.

The risk of cancer associated with a broad range of organ doses was estimated in an international study of women with cervical cancer. Among 150,000 patients reported to one of 19 population-based cancer registries or treated in any of 20 oncology clinics, 4188 women with second cancers and 6880 matched controls were selected for detailed study. Radiation doses for selected organs were reconstructed for each patient on the basis of her original radiotherapy records. Very high doses, on the order of several hundred gray, were found to increase the risk of cancers of the bladder [relative risk (RR) = 4.0], rectum (RR = 1.8), vagina (RR = 2.7), and possibly bone (RR = 1.3), uterine corpus (RR = 1.3), cecum (RR = 1.5), and non-Hodgkin's lymphoma (RR = 2.5). For all female genital cancers taken together, a sharp dose-response gradient was observed, reaching fivefold for doses more than 150 Gy. Several gray increased the risk of stomach cancer (RR = 2.1) and leukemia (RR = 2.0). Although cancer of the pancreas was elevated, there was no evidence of a dose-dependent risk. Cancer of the kidney was significantly increased among 15-year survivors. A nonsignificant twofold risk of radiogenic thyroid cancer was observed following an average dose of only 0.11 Gy. Breast cancer was not increased overall, despite an average dose of 0.31 Gy and 953 cases available for evaluation (RR = 0.9); there was, however, a weak suggestion of a dose response among women whose ovaries had been surgically removed. Doses greater than 6 Gy to the ovaries reduced breast cancer risk by 44%. A significant deficit of ovarian cancer was observed within 5 years of radiotherapy; in contrast, a dose response was suggested among 10-year survivors. Radiation was not found to increase the overall risk of cancers of the small intestine, colon, ovary, vulva, connective tissue, breast, Hodgkin's disease, multiple myeloma, or chronic lymphocytic leukemia. For most cancers associated with radiation, risks were highest among long-term survivors and appeared concentrated among women irradiated at relatively younger ages.

Toothbrushing as part of the adolescent lifestyle predicts education level.

Socio-economic differences in health and health behavior are well-known. Our hypothesis was that toothbrushing frequency in adolescents predicts their education level in adulthood. The aim was also to study the role of toothbrushing in adolescents' health-related lifestyle. Data from nationally representative samples of 12- to 16-year-olds (N = 11,149) were linked with register data on the highest level of education attained at age 27-33 years. Adolescents with a low toothbrushing frequency reached only the lowest education levels. School achievement or sociodemographic background only partly accounted for the association. Exploratory factor analysis found four dimensions of health behaviors. At age 12, a low toothbrushing frequency was loaded highly with "street-oriented" behaviors, concentrated around smoking and alcohol use. At ages 14 and 16, it was associated with a "traditional" lifestyle of the less-well-educated. Altogether, a low toothbrushing frequency indicated selection into the less-well-educated stratum of society. This is likely to be reflected in socio-economic health differences in adulthood.

The trend and risk factors of perceived toothache among Finnish adolescents from 1977 to 1997.

Toothache is a subjective oral health indicator that should become uncommon when oral health is improving. The aim of this study was to assess changes in perceived toothache between 1977 and 1997 among Finnish adolescents. In the Adolescent Health and Lifestyle Survey, a self-administered questionnaire was mailed to a representative sample of 12-, 14-, 16-, and 18-year-old Finns every second year. The sample sizes in the surveys varied from 2422 to 11,105, making a total of 35,349 subjects in the entire study. The incidence of toothache during the previous 2 years was requested in 1977, 1985, 1991, 1995, and 1997, and the prevalences were 31%, 25%, 28%, 29%, and 37%, respectively. The increase between 1995 and 1997 was highest among 16- and 18-year-olds. There was no tendency for perceived toothache to decline over the study period, despite the decrease in caries experience. Toothache varied by age, socioeconomic status (SES), place of residence, and toothbrushing frequency. The increase in the incidence of toothache reported after 1995 could be a warning signal that economic recession in Finland has caused changes in the dental care system.

Trends in drinking habits among Finnish adolescents from 1977 to 1999.

AIMS: Trends in adolescent drinking habits in Finland from 1977 to 1999 are studied with special attention to the onset of problem use and gender differences. DESIGN AND SETTING: Biennial cross-sectional mailed surveys (Adolescent Health and Lifestyle Survey). PARTICIPANTS: Representative samples of 12, 14, 16 and 18-year-olds. The number of respondents varied from 2832 to 8390 and the response rate from 88% to 76%. MEASUREMENTS: The frequencies of alcohol use and perceived drunkenness obtained from self-administered questionnaires. FINDINGS: Alcohol use remained rare among 12-year-olds. The overall trends in the frequencies of alcohol use and drunkenness increased considerably over time among the 14-18-year-olds. Age-adjusted monthly drunkenness among 14, 16 and 18-year-olds rose from 13% (1981) to 27% (1999) among boys and 6% to 22% among girls. Throughout the study period, the drinking style among boys became more drunkenness-orientated with age, but the opposite was true among girls. Birth cohort investigation showed that the onset of drunkenness moved towards an earlier age. Earlier onset predicted higher prevalence of problem use at the age of 18. Boys developed a regular pattern of drunkenness steadily increasing between ages 14-18 while among girls the increase of drunkenness started to level off between ages 16 and 18. CONCLUSIONS: Alcohol use among 12-year-olds remained rare, but became more prevalent and drunkenness-orientated among 14-18 year-olds. Gender differences in problem use diminished. Nevertheless, notable differences persist in the onset and development of drunkenness-orientated use.

Health related lifestyle in adolescence predicts adult educational level: a longitudinal study from Finland.

OBJECTIVE: To assess the relative importance of perceived health and health related lifestyle in adolescence in the production of educational differences. DESIGN: A longitudinal study: survey data from 1981 and 1985 linked with Educational Registry data from 1993. SETTING: The whole of Finland. PARTICIPANTS: A representative sample of 4761, 16 and 18 year olds. The follow up rate was 82%. MEASUREMENTS AND MAIN RESULTS: The outcome variable was the attained educational level at age 24 to 30. Predictive variables described health related lifestyle and health at the age of 16 and 18. Those whose educational level was low at follow up, had in adolescence, a more health compromising lifestyle than those who had reached higher levels. They had placed less emphasis on health promoting behaviours like not smoking, physical exercise, good diet, and dental hygiene. Smoking was the outstanding predictor of attained educational level. Among the health variables, only psychosomatic symptoms predicted high educational levels in girls, and both psychosomatic symptoms and height in boys. CONCLUSION: Those who reach a high level of education in adulthood, have had a health enhancing lifestyle already in adolescence, while those reaching only a low level, have had a health compromising lifestyle. Health plays only a small part in the prediction of adult educational level. The results suggest that a health compromising lifestyle, adopted already in adolescence, is an important mechanism from which educational health differences originate.

Health status: does it predict choice in further education?

STUDY OBJECTIVE: To study the significance of a young person's health to his or her choice of further education at age 16. DESIGN: A cross sectional population survey SETTING: The whole of Finland. PARTICIPANTS: A representative sample of 2977 Finnish 16 year olds. The response rate was 83%. MEASUREMENTS AND MAIN RESULTS: The three outcome variables reflected successive steps on the way to educational success: school attendance after the completion of compulsory schooling, the type of school, and school achievement for those at school. Continuing their education and choosing upper secondary school were most typical of young people from upper social classes. Female gender and living with both parents increased the probability of choosing to go on to upper secondary school. Over and above these background variables, some health factors had additional explanatory power. Continuing their education, attending upper secondary schools, and good achievement were typical of those who considered their health to be good. Chronically ill adolescents were more likely to continue their education than the healthy ones. CONCLUSIONS: School imposes great demands on young people, thus revealing differences in personal health resources. Adaptation to the norms of a society in which education is highly valued is related to satisfying health status. In a welfare state that offers equal educational opportunities for everyone, however, chronically ill adolescents can add to their resources for coping through schooling. Health related selection thus works differently for various indicators of health and in various kinds of societies. Social class differences in health in the future may be more dependent on personally experienced health problems than on medically diagnosed diseases.

Bar coding--a functional tool in survey research.

STUDY OBJECTIVE: The aim was to assess the value of bar coding, together with developed microcomputer programs, as a tool to speed up mailing and handling of return responses of a survey where over 4000 adolescents received a mailed questionnaire. DESIGN: Bar codes were used for displaying the identification number of a questionnaire, as well as each response alternative and number of the question. These bar codes were read by a wand, a handhold scanner, connected to a microcomputer and the data were automatically entered into a computer data file. RESULTS AND CONCLUSIONS: Compared with previous similar surveys, the use of bar codes did not seem to affect a manner of responding. Bar coding saved human steps in handling of return responses, reduced an error rate, and helped to control the process of work. Bar coding is recommended as a new technical tool for preparations of future large scale surveys.

Social mobility and health related behaviours in young people.

STUDY OBJECTIVE: To assess the influences related to social mobility, particularly health related behaviours, as one potential explanation for the social class variation in health among adults. DESIGN: The study is based on questionnaire data from the Adolescent Health and Lifestyle Surveys of 1985, 1987, and 1989. SETTING: The whole of Finland. PARTICIPANTS: A representative sample of 8355 adolescents. The response rate was 79%. MEASUREMENT AND MAIN RESULTS: The relation between social mobility and health related behaviours among 16 and 18 year old young people was studied. The measure of social mobility was based on a combination of the social class of origin and achieved social position measured by the present educational status, educational attainment, and labour market position. Three mobility groups were constructed: the downwardly mobile, the upwardly mobile and the stable. Health related behaviours in an upwardly or downwardly mobile group were compared with a stable group from the same social class of origin by calculating relative risks (RR). RRs were assessed by calculating age and sex adjusted rate ratios approximating a Mantel-Haenszel estimate. In logistic regression analyses the independent effects of the social class of origin and the achieved social position were investigated. Most of the nine behaviours studied (smoking, alcohol use, heavy intoxication, coffee drinking, tooth brushing, consumption of sweets, lack of physical exercise, choice of bread spread, and consumption of milk) were related to the direction of mobility so that health compromising behaviours were more frequent among downwardly mobile and less frequent among upwardly mobile young people than their stable peers. Achieved social position proved to determine health related behaviours more strongly than class of origin, thus emphasising the way education facilitates both health values and behaviours as well as the future social position. CONCLUSIONS: The close relation between social mobility and health related behaviours is concluded to be a part of an explanation of social class differences in health observed among adults.

Sociodemographic differences in the occurrence of teenage pregnancies in Finland in 1987-1998: a follow up study.

STUDY OBJECTIVE: To analyse sociodemographic differences in the occurrence of pregnancies to 14 to 19 year olds and changes in these differences from 1987 to 1998. DESIGN: Follow up of adolescent survey respondents using registers. SETTING AND SUBJECTS: The dataset includes information on all registered pregnancies (abortions, births, and miscarriages, n=2743) of the female respondents (n=28 914) to the Adolescent Health and Lifestyle Survey (AHLS) from 1987 to 1998. In the AHLS, self administered questionnaires were mailed every second year to independent samples of 12, 14, 16, and 18 year olds representative for Finland. MAIN OUTCOME MEASURE: Relative risk (hazard) of becoming pregnant at teenage. MAIN RESULTS: Girls from lower socioeconomic background had a higher pregnancy risk. Girls who did not live with both parents at the baseline survey had higher pregnancy risk than those who did, and girls who lived in a stepfamily had a higher risk than those who lived in a one parent family. Swedish speaking girls had a lower pregnancy risk than the Finnish speaking girls. There was no systematic change from 1987 to 1998 in most sociodemographic differentials in the teenage pregnancy risk, however, there was some increase in the differences by family structure. Changes in the sociodemographic structure did not explain the levelling off of the downward trend in teenage pregnancy risk, nor did the regional socioeconomic differences explain regional differentials in teenage pregnancy risk. CONCLUSION: Although the reduction of socioeconomic and regional differences has been a general objective in Finnish social and health policies, the relative differences in teenage pregnancies have not decreased.

Socio-regional context as a determinant of adolescents' health behaviour in Finland.

Until recently, the role of socio-regional context as a determinant of adolescents' health behaviour has been largely neglected in health studies. Usually the focus is on characteristics of individuals, while the potentially equally strong effect of the context is left unanalysed. Using multi-level data we studied whether socio-regional context influences health behaviour and whether it modifies differences by socio-economic background of adolescents. The individual level data derive from the (Finnish) Adolescent Health and Lifestyle Survey. In the survey, nationally representative data of 16- and 18-year old Finns were collected in 1991 and 1993 by mailed questionnaires (total n = 9121, response rate = 76%). These data were linked with a database that included socio-economic characteristics of municipalities. Three dimensions of the socio-regional context were measured: level of services, occupational structure and self-sufficiency of employment. In a series of logistic regression models, factors related to daily smoking, weekly alcohol use, use of high milk fat products and frequent physical activity were analysed. Socio-economic background of the adolescent was a strong determinant of all four health behaviours. Drinking and use of high milk fat products were, however, also related to the socio-regional context. The relationship between socio-regional context and these behaviours was dissimilar, so that the dimensions of the socio-regional context that were related to the behaviours were different among boys than among girls. Our study shows that socio-regional context associates with adolescents' alcohol use and use of high milk fat products, while the more detailed nature of this relationship remains unclear.