Socioeconomic differences in second-hand smoke exposure among children in Scotland after introduction of the smoke-free legislation.

BACKGROUND: To examine the impact of the Scottish smoke-free legislation on social inequalities in secondhand smoke (SHS) exposure among primary school children. METHODS: Comparison of nationally representative, cross-sectional, class-based surveys carried out in the same schools before and after legislation. Participants were 2532 primary school children (primary 7; aged around 11 y) surveyed in January 2006 (before legislation) and 2389 in January 2007 (after legislation). Outcome measures were salivary cotinine concentrations, self-reported family socioeconomic classification (family SEC) and family affluence scale (FAS). RESULTS: After adjusting for number of smoking parents, mean cotinine concentration varied significantly across both family SEC and FAS groups, and increased significantly stepwise from high to low family SEC/FAS. Mean cotinine fell in all family SEC/FAS groups after legislation. The relative drop in mean cotinine was equal across all family SEC/FAS groups. Adding an interaction term between survey-year and family SEC/FAS to the model showed an increase in inequalities over time, but was only significant at the 93% level using FAS and 73% using family SEC. CONCLUSION: Inequalities in SHS exposure exist among 11-year-old children in Scotland. Smoke-free legislation has reduced exposure to SHS among all children. Although the greatest absolute reduction in cotinine is observed in the lowest SEC/FAS group, cotinine levels remain highest for this group and there is a suggestion of possible increases in inequalities, which may warrant longer-term monitoring.

Parental occupation, family affluence and adolescent health behaviour in 28 countries.

OBJECTIVES: We explored the association between socioeconomic position and four different aspects of adolescent health behavior in a wide range of European countries, the US, Canada and Israel. METHODS: Data were collected from the Health Behaviour in School-aged Children (HBSC) study in 2002. Representative samples of 13 and 15 year olds completed a standardised questionnaire during school hours in each country. Logistic regression analyses were used to investigate the independent effect of parental occupation and family affluence on tobacco and alcohol use, vegetable consumption and TV viewing. RESULTS: Family affluence showed no significant association with regular smoking in most countries, whereas an increase in smoking with decreasing occupational status was found in half of the countries. For alcohol consumption a positive association was found with family affluence in half of the countries, while no relationship with parental occupation was observed. Both measures of socioeconomic position were strong independent predictors for vegetable consumption and television viewing in almost all countries. CONCLUSIONS: The findings suggest that health behaviours that begin to develop in adolescence are less strongly influenced by parental socioeconomic position. Preventive intervention strategies should take the different socioeconomic patterns of health behaviour into account.

Changes in child exposure to environmental tobacco smoke (CHETS) study after implementation of smoke-free legislation in Scotland: national cross sectional survey.

OBJECTIVE: To detect any change in exposure to secondhand smoke among primary schoolchildren after implementation of smoke-free legislation in Scotland in March 2006. DESIGN: Comparison of nationally representative, cross sectional, class based surveys carried out in the same schools before and after legislation. SETTING: Scotland. PARTICIPANTS: 2559 primary schoolchildren (primary 7; mean age 11.4 years) surveyed in January 2006 (before smoke-free legislation) and 2424 in January 2007 (after legislation). OUTCOME MEASURES: Salivary cotinine concentrations, reports of parental smoking, and exposure to tobacco smoke in public and private places before and after legislation. RESULTS: The geometric mean salivary cotinine concentration in non-smoking children fell from 0.36 (95% confidence interval 0.32 to 0.40) ng/ml to 0.22 (0.19 to 0.25) ng/ml after the introduction of smoke-free legislation in Scotland-a 39% reduction. The extent of the fall in cotinine concentration varied according to the number of parent figures in the home who smoked but was statistically significant only among pupils living in households in which neither parent figure smoked (51% fall, from 0.14 (0.13 to 0.16) ng/ml to 0.07 (0.06 to 0.08) ng/ml) and among pupils living in households in which only the father figure smoked (44% fall, from 0.57 (0.47 to 0.70) ng/ml to 0.32 (0.25 to 0.42) ng/ml). Little change occurred in reported exposure to secondhand smoke in pupils' own homes or in cars, but a small decrease in exposure in other people's homes was reported. Pupils reported lower exposure in cafes and restaurants and in public transport after legislation. CONCLUSIONS: The Scottish smoke-free legislation has reduced exposure to secondhand smoke among young people in Scotland, particularly among groups with lower exposure in the home. We found no evidence of increased secondhand smoke exposure in young people associated with displacement of parental smoking into the home. The Scottish smoke-free legislation has thus had a positive short term impact on young people's health, but further efforts are needed to promote both smoke-free homes and smoking cessation.

Cross-national study of fighting and weapon carrying as determinants of adolescent injury.

OBJECTIVES: We sought to (1) compare estimates of the prevalence of fighting and weapon carrying among adolescent boys and girls in North American and European countries and (2) assess in adolescents from a subgroup of these countries comparative rates of weapon carrying and characteristics of fighting and injury outcomes, with a determination of the association between these indicators of violence and the occurrence of medically treated injury. DESIGN AND SETTING: Cross-sectional self-report surveys using 120 questions were obtained from nationally representative samples of 161082 students in 35 countries. In addition, optional factors were assessed within individual countries: characteristics of fighting (9 countries); characteristics of weapon carrying (7 countries); and medically treated injury (8 countries). PARTICIPANTS: Participants included all consenting students in sampled classrooms (average age: 11-15 years). MEASURES: The primary measures assessed included involvement in physical fights and the types of people involved; frequency and types of weapon carrying; and frequency and types of medically treated injury. RESULTS: Involvement in fighting varied across countries, ranging from 37% to 69% of the boys and 13% to 32% of the girls. Adolescents most often reported fighting with friends or relatives. Among adolescents reporting fights, fighting with total strangers varied from 16% to 53% of the boys and 5% to 16% of the girls. Involvement in weapon carrying ranged from 10% to 21% of the boys and 2% to 5% of the girls. Among youth reporting weapon carrying, those carrying handguns or other firearms ranged from 7% to 22% of the boys and 3% to 11% of the girls. In nearly all reporting countries, both physical fighting and weapon carrying were significantly associated with elevated risks for medically treated, multiple, and hospitalized injury events. CONCLUSIONS: Fighting and weapon carrying are 2 common indicators of physical violence that are experienced by young people. Associations of fighting and weapon carrying with injury-related health outcomes are remarkably similar across countries. Violence is an important issue affecting the health of adolescents internationally.

Persistent socio-demographic differences in physical activity among Scottish schoolchildren 1990-2002.

BACKGROUND: Regular participation in physical activity can have significant health gains in terms of physical and psychological wellbeing but there is evidence to suggest that many young people are not sufficiently active to benefit their health. This paper examines the socio-demographic patterning of leisure-time vigorous physical activity among Scottish schoolchildren between 1990 and 2002. METHODS: The Health Behaviour in School-Aged Children survey of 11-, 13- and 15-year-old schoolchildren has been carried out in Scotland since 1990 at four-yearly intervals. Levels of vigorous physical activity were measured in relation to gender, age and socio-economic status (SES). RESULTS: Girls reported lower levels of vigorous physical activity than boys and this gender difference persisted throughout the four survey years, irrespective of changes in overall levels of physical activity. Vigorous physical activity was also consistently lower among lower SES groups and older adolescents. The effect of gender was greatest, with high-SES girls reporting lower levels of vigorous activity than low-SES boys, and low-SES girls being the least active overall. CONCLUSION: Scottish adolescent females, especially those from low SES groups, may be at particular risk of the adverse health effects associated with low levels of physical activity. Health promotion programmes to promote physical activity need to address these persistent gender and socio-economic inequalities.

International survey of self-reported medicine use among adolescents.

OBJECTIVE: To examine gender, age, and country variations in adolescents' self-reported medicine use. DESIGN: Cross-sectional school surveys of representative samples of 11- to 15-year-old girls and boys were used. The 1997/1998 Health Behaviour in School-aged Children study was referenced. A standardized questionnaire was completed during school hours. SETTING: Canada, US, Greenland, Israel, and 24 European countries. PARTICIPANTS: 123 227 participants equally distributed by gender and by 3 age groups (mean 11.7, 13.6, 15.6 y). MAIN OUTCOME MEASURES: Self-reported medicine use for headache, stomachache, difficulties in getting to sleep, and nervousness during the past month. RESULTS: The magnitude of the adolescents' medicine use for headache, stomachache, difficulties in getting to sleep, and nervousness varied substantially across countries. In each of the 28 countries, more girls than boys used medicine for pain. Use of medicine for headache increased by age; use of medicine for stomachache increased by age among girls, but decreased among boys; and use of medicine for difficulties in getting to sleep and nervousness decreased from the age of 11 to 15 years. There was an increase in the crude girl versus boy ratios for medicine use by age for all 4 symptoms. Multivariate logistic regression analyses, adjusting for age group and country, revealed the following odds ratios (95% CI) for girls' versus boys' medicine use: headache 1.56 (1.53 to 1.60), stomachache 2.16 (2.10 to 2.22), difficulties in getting to sleep 0.96 (0.91 to 1.00), and nervousness 1.04 (0.99 to 1.08). CONCLUSIONS: Substantial proportions of adolescents used medicine for common health problems. The prevalence of use differed between type of symptom for which the medicine was used, between countries, and between gender and age groups. We suggest that young people's medicine use should be addressed in public health policy.