Gambling Among Finnish 14-16-Year-Old Adolescents Before (2008-2009), During (2010-2011), and After (2013-2017) Setting the Legal Age Limit of 18 for Gambling and the Role of Socio-Economic Status.

Legislation prohibiting minors from engaging in gambling is a gambling policy measure set to protect adolescents from the harmful effects of gambling. The Finnish gambling system is based on a state monopoly, regulated by the Lotteries Act. After an amendment to the Lotteries Act, the new minimum legal gambling age was raised to 18 years old between 2010 and 2011. The main purpose of this study was to discover how the amendment to the act altered adolescents' gambling (14-16-year-olds) and to examine whether the amendment decreased socio-economic differences. Adolescents gambling was studied before (2008-2009), during (2010-2011), and after (2013-2017) the age limit of gambling was raised in Finland. The study based on five waves (2008-2009, 2010-2011, 2013, 2015, 2017) of the national repeated cross-sectional School Health Promotion Study. Cross-tabulations where gambling was studied by study year and socio-economic status (SES) were formulated, and the statistical differences were studied by using χ2-tests. Percentage change in gambling frequency was also examined by study year and SES. Study years were analyzed separately to model the weekly gambling via logistic regression models. Adolescent gambling significantly decreased over time. It appears that raising the legal gambling age had a permanent effect on under-aged gambling. However, differences in gambling by adolescents' family's SES increased during the study period, indicating widening inequalities in gambling among adolescents. Diminishing inequalities in adolescent gambling is likely to require both societal action and consensus on adolescent gambling being a significant social and public health concern.

Adolescent Gambling, Gambling Expenditure and Gambling-Related Harms in Finland, 2011-2017.

Existing literature on recent trends in adolescent gambling is scarce. The rapidly changing landscape of gambling, together with the generally applied legal age limits, calls for the continuous monitoring of gambling also among the adolescent population. In Finland, the legal gambling age is 18. We examined changes in adolescents' gambling, gambling expenditure and gambling-related harms from 2011 to 2017. Comparable cross-sectional biennial survey data were collected in 2011, 2013, 2015 and 2017 among 12-18-year-olds (N = 18,857). The main measures were self-reported six-month gambling, average weekly gambling expenditure (€) and harms due to gambling. Data were analyzed using cross-tabulations, χ2-tests and linear regression analysis. A significant decline in gambling among minors (aged 12-16-year-olds) was found (ß = - 0.253), while no significant changes were observed among 18-year-olds (who are not targeted by the law). The mean gambling expenditure also declined from 2011 to 2017. Adolescent gamblers experienced significantly less (p = .003) gambling-related harms in 2017 (7.4%) compared to 2011 (13.5%). Adolescent gambling and its related negative consequences have become less prevalent in Finland between 2011 and 2017. Further monitoring is necessary to ascertain whether the positive direction will continue. Also, empirical analyses providing evidence of reasons for the observed trend are warranted.

The density of electronic gambling machines and area-level socioeconomic status in Finland: a country with a legal monopoly on gambling and a decentralised system of EGMs.

BACKGROUND: Electronic gambling machines (EGMs) are considered a risky form of gambling. Internationally, studies have reported that the density of EGMs tends to be higher in socioeconomically disadvantaged areas than in more advantaged ones. We examined whether this holds true in the Finnish context where a decentralised system of EGMs guarantees wide accessibility to this form of gambling. More precisely, we investigated the association between the density of EGMs and area-level socio-economic status (SES). METHODS: The primary measure was the EGM density, referring to the number of EGMs per 1000 adults. The area-level SES was defined on the basis of the median income of inhabitants, the proportion of unemployment in the area and educational attainment (% of those beyond primary education). Three additional area characteristics were used as control variables in the analyses; the overall population density, economic activity (the number of jobs in the area per employed inhabitant), and the mean age of the inhabitants. Analyses were based on linear regression. RESULTS: The EGM density was 3.68 per 1000 inhabitants (SD = 2.63). A lower area-level SES was correlated with a higher EGM density. In further analyses, this effect was mostly explained by the income of the inhabitants. Of the control variables, the population density had no detectable effect on the EGM density while areas with a higher mean age of the inhabitants, as well a higher density of jobs, had more EGMs. CONCLUSIONS: EGMs are unequally located in Finland, with more EGMs located in socio-economically less advantaged areas. The higher machine density in areas of social disadvantage is not in line with the aim of the Finnish gambling policy, which is to prevent and reduce harm caused by gambling. Changes in policy are required, especially with regard to the decisions on the placement of EGMs. This should not be made solely by gaming operators and/or from fiscal perspectives.

The extent and distribution of gambling harm in Finland as assessed by the Problem Gambling Severity Index.

BACKGROUND: Preventing gambling harm has become a policy priority in many European countries. Adverse consequences related to problem gambling are well known, but few studies have analyzed gambling-related harm in detail in general population samples. We determined the extent and distribution of gambling harm in Finland, as assessed by the Problem Gambling Severity Index (PGSI), and analyzed gambling involvement, demographics and their association with various types of harm. METHODS: A nationwide telephone survey was conducted among 4484 Finns aged 15-74 years in 2011-12. Gambling-related harms were based on the nine-item PGSI. Gambling involvement was measured by gambling frequency and weekly average gambling expenditure. Associations among harms, demographics and gambling involvement were examined in logistic regression. RESULTS: During the previous year, 13% of respondents experienced at least one gambling-related harm (males 18.1%, females 7.2%). The four commonest harms were 'chasing losses' (8.6%), 'escalating gambling to maintain excitement' (3.1%), 'betting more than could afford to lose' (2.8%), and 'feeling guilty' (2.6%). The harm profile in descending order was the same for both genders but differed in prevalence. Young age (<25 years) was associated with increased likelihood of reporting harms. Both monthly and weekly gambling and spending over €21 per week on gambling were related to the harms. CONCLUSIONS: Our results provide support for the public health approach to gambling: harms were reported even at low gambling frequency-expenditure levels. In addition to the high-risk approach, adopting a population-level approach to preventing gambling harm could shift the population distribution of harm in a lower direction.

Persistence of socioeconomic differences in adolescents' environmental tobacco smoke exposure in Finland: 1991-2009.

AIMS: Socioeconomic differences in children's exposure to environmental tobacco smoke (ETS) in favour of those with higher positions are known, but research is scarce on whether differences have persisted when smoking restrictions have been tightened. We examined socioeconomic differences in adolescents' ETS exposure from 1991 to 2009 in Finland where the tobacco law has gradually restricted smoking of population. METHODS: National cross-sectional surveys (1991-2009) in 12-18-year-olds (N=72,726, response rate 77-56%). An outcome measure was self-reported exposure to ETS (≥ 1 hour/day). Parents' socioeconomic and adolescent's individual social position (school performance/career) were used as independent variables. Across four time periods, associations were studied by logistic regression. RESULTS: Over the study period 1991-2009, the proportion of adolescents exposed to ETS decreased from 17% to 6% (p ≤ 0.001). There were large and persistent differences between socioeconomic and parents' smoking groups. The decrease occurred in all groups but was smaller among 16-18-year-olds whose father had a low education. A steeper decline occurred among 16-18-year-olds who were not in school or were in vocational school with poor school performance compared with those with more advanced educational career. Compared with other subgroups, the decline in ETS exposure was greater among those whose parents were smokers. CONCLUSIONS: Adolescents' ETS exposure remarkably decreased over time, when tobacco control measures were tightened, particularly among children of smoking parents. Socioeconomic differences persisted although diminishing differences were observed between educational groups at age 16-18.

Attitudes towards gambling in Finland: a cross-sectional population study.

BACKGROUND: Attitudes towards gambling influence gambling behaviour but also reflect the existing gambling policy in a society. However, studies examining general attitudes towards gambling at the population level are scarce. The first aim of this study was to investigate general attitudes of the Finnish population towards gambling. The second aim was to explore the association of socio-demographics, gambling behaviours, being a concerned significant other (CSO) of a problem gambler and perceived health and lifestyle with attitudes towards gambling among the Finnish population. METHODS: A cross-sectional study was performed by structured telephone interview on a random sample of 15-74-year-old Finns between October 2011 and January 2012. The data (n = 4484) was weighted based on age, gender and region of residence. Attitudes towards gambling were measured with the eight-item version of the Attitude Towards Gambling Scale (ATGS-8). A factor analysis was performed to test the structure of the Finnish version of the ATGS-8. The data were analysed using one-way ANOVA test, t-test and multiple regression analysis. RESULTS: On average, attitudes of Finns towards gambling were negative. The most significant factors associated with positive attitudes towards gambling were male gender, young age, 12 years or more education and net income more than 2000€, low score on gambling severity, being a non-CSO of a problem gambler and high alcohol consumption CONCLUSIONS: The association between young age, male gender, high net income and risky alcohol consumption, and favourable gambling attitudes was strong, and also reflects risky gambling behaviour. Experiencing gambling-related harms caused by one's own or significant other's excessive gambling seems to indicate unfavourable attitudes towards gambling.

Socio-economic differences in adolescents' breakfast eating, fruit and vegetable consumption and physical activity in Ghana.

OBJECTIVE: Few studies have investigated the association between adolescents' socio-economic status (SES) and health behaviours in developing countries. Socio-economic differences in breakfast eating, fruit and vegetable consumption and physical activity were investigated among Ghanaian adolescents. DESIGN: A school-based survey of 12-18-year-olds (n 1195, response rate 89·7 %) was conducted in 2008. Logistic regression analyses were applied to study the associations between breakfast eating, fruit and vegetable consumption and physical activity, and SES. SETTING: Southern Ghana, West Africa. SUBJECTS: School pupils aged 12-18 years. RESULTS: Of all adolescents, 31 % took breakfast less than 4 d/week, over half (56 %) and 48 %, respectively, rarely ate fruits and vegetables. Younger adolescents (12-15-year-olds) consumed fruits and vegetables frequently compared with older ones (16-18-year-olds). Boys were more likely to participate in physical activity than girls. The probability of frequent breakfast eating was higher in adolescents from more affluent backgrounds than in those from less affluent ones. Compared with those whose mothers were illiterate, both tertiary and primary maternal educational attainment increased the probability of frequent fruit intake. Similarly, tertiary educational attainment increased the likelihood of frequent vegetable intake. Compared with those with unemployed mothers, mothers' low employment grade was related to higher probability of frequent fruit intake. High school performance was associated with frequent fruit intake, whereas high or medium school performance increased the likelihood of vegetable intake compared with low school performance. CONCLUSIONS: Interventions are needed to improve breakfast intake, fruit and vegetable consumption and physical activity in order to prevent degenerative diseases among Ghanaian adolescents.

Gambling-related harms among adolescents: a population-based study.

Internationally, and also in Europe, adolescent gambling is increasingly recognized as an important public health issue. Most research on adolescent gambling, however, is prevalence-focused and population-based studies are scarce. Few studies have examined gambling-related harms among adolescents. In a national sample, we examined self-experienced harms related to gambling and the relationship between reported harms and gambling behavior among Finnish adolescents. A national survey of 12-18-year-olds was conducted in Finland in 2011 (N = 4,566). Main measures were frequency of gambling and gambling-related harms reported during the past 6 months. The relationship between reported harms and gambling behavior was assessed using logistic regression analysis. Overall, 44% had gambled during the past 6 months. Of the sample, 12% were frequent gamblers (at least weekly) and 32% were occasional gamblers (monthly or less often). Compared to occasional gamblers, frequent gamblers were more likely to experience harms. The most commonly reported harms among frequent gamblers were "felt guilty or shameful due to gambling" (17%) followed by "problems with relationships" (13%) and "disruptions of daily rhythm" (10%). In age and gender-adjusted analysis, daily gamblers were significantly more likely to report all different types of harms when compared to other groups. These findings suggest that when planning and targeting youth gambling prevention and harm reduction strategies the nature and extent to which gambling may contribute to the different types of harms are important to consider.

Gambling Among Underage Alcohol Users Between 2008 and 2019: A National Cross-Sectional Study Among Finnish Adolescents.

PURPOSE: The aim of this study is to examine trends in the relationship between gambling, alcohol use, and drunkenness between genders in Finland from 2008 through 2019. METHODS: Data were based on six waves (2008-2009, 2010-2011, 2013, 2015, 2017, 2019) of a national cross-sectional School Health Promotion Study. The survey was conducted during a school day among eighth graders (14-15 years old) and ninth graders (15-16 years old) in Finland. The changes in gambling frequency among boys and girls were studied (regular gambling: at least once a week; occasional gambling: 2-3 times a month to less than once a month; no gambling during the previous year), alcohol use (at least once a month), and drunkenness (at least once a month). RESULTS: The prevalence of adolescent gambling was more than halved between 2008 and 2019. However, the difference between the adolescents with the most favorable outcome (those who were not gambling and used alcohol or were getting drunk less often than once a month) and the adolescents with the least favorable outcome (boys who gambled, used alcohol, or were getting drunk; girls who were gambling regularly and getting drunk or gambling occasionally, using alcohol, and getting drunk) was larger in 2019 than in 2008. DISCUSSION: These larger differences between adolescents indicate that there has been a polarization of problems between adolescents, and for some individuals, problems are clustering. There is a strong case to be made for protecting adolescents from these risk behaviors and their adverse consequences on multiple levels.

The role of tobacco promoting and restraining factors in smoking intentions among Ghanaian youth.

BACKGROUND: In Western countries, the relationship between smoking intentions and smoking behaviour is well established. However, youth smoking intentions and associated factors in developing countries are largely unexplored and the former may occur for a variety of reasons. We investigated youth smoking intentions in Ghana with regard to several tobacco promoting and restraining factors, including environmental, familial, attitudinal and knowledge measures. METHODS: A school-based survey of a representative sample of 12-20-year-olds was conducted in 2008 in Ghana (N = 1338, response rate 89.7%). RESULTS: In a bivariate model, both among ever and never smokers, allowing smoking on school compound, exposure to tobacco advertisement and parental smoking were associated with future intention to smoke. Compared to those who agreed that smoking is harmful to health, smoking is difficult to quit and that tobacco should not be sold to minors, those who disagreed or were not sure were more likely to have an intention to smoke. In the multivariate analyses, these associations persisted, except that the attitude measures concerning the difficulty of quitting smoking once started and tobacco sales ban were no longer significantly associated with smoking intentions. CONCLUSIONS: These findings underscore the importance of school smoking policy, parental smoking behaviour and knowledge of the harmful effects of tobacco use in determining Ghanaian youths' future smoking intentions. Because current high percentages of smoking intentions may turn into high smoking rates in the future, the introduction of effective tobacco control measures at all levels of society to prevent youth smoking in Ghana may be essential.

Sports activity and the use of cigarettes and snus among young males in Finland in 1999-2010.

BACKGROUND: Studies of the relationship between sports activity and smoking among adolescents and young adults report contradictory results. We examined the association between sports activity (intensity and type of sport) and the current use of snus (Swedish snuff), cigarette smoking, and the combined use of cigarettes and snus (dual use) among young males in Finland. METHODS: Data were collected from 16,746 male conscripts who completed a survey during the first days of their conscription during the years 1999-2010 (median age 19 years, response rate 95%). Main outcome measures were self-reported daily/occasional use of snus, cigarette smoking, and dual use. The association between sports activity, type of sport, and several sociodemographic background variables was assessed using logistic regression analysis. RESULTS: Over the study period (1999-2010), the prevalence of cigarette smoking decreased from 42% to 34%, while snus use increased from 5% to 12%, and dual use increased from 7% to 13% (p < 0.001). Compared with no physical activity, regular competitive sports activity (defined as high-intensity sports activity) was positively associated with use of snus (odds ratio [OR] 10.2; 95% confidence interval [CI]: 7.8-13.5) and negatively with cigarette smoking (OR 0.2; 95% CI: 0.1-0.3). When stratified by type of sport in multivariate models, ice hockey was most strongly associated with snus use (OR 1.6; 95% CI: 1.4-1.9) and dual use (OR 2.0; 95% CI 1.8-2.3) compared with those not playing ice-hockey, followed by other team sports for snus use (OR 1.5; 95% CI: 1.3-1.8) and dual use (OR 1.8; 95% CI: 1.6-2.0) compared with those not participating in other team-sports. CONCLUSIONS: Our results show a clear association between snus use and intensity and type of training. Team sports were associated with increased use of snus and dual use compared with no participation in team sports. These findings should be acknowledged when planning and implementing preventive strategies.

Treatment for the concerned significant others of gamblers: A systematic review.

BACKGROUND AND AIMS: Research recognizes the extent of harm experienced by concerned significant others (CSOs) of gamblers. This systematic review's aims are to examine the interventions for CSOs, evaluate potential benefits, and thematically describe treatment processes. The Stress-Strain-Coping-Support model (SSCS) served as the theoretical framework. METHODS: Database searches were conducted in: MEDLINE, CINAHL Complete, Web of Science Core Collection, Social Services Abstracts, Applied Social Science Index and Abstracts, Cochrane Central Register of Controlled Trials, and APA PsycInfo (between 01/Jan 2011-10/Jun 2021). Other search methods were also utilized. Inclusion criteria: interventions for CSOs with CSO specific outcomes. The Evidence Project Risk of Bias Tool was used for assessment. RESULTS: 19/768 records were included. Nine interventions were utilized: 3 CSO directed, 4 for couples, and 2 low threshold online interventions. A quantitative synthesis (N = 7 studies) of effect size estimates for depression and anxiety measures didn't indicate any intervention to have better outcomes than others. Core themes in the treatment process identified in the qualitative synthesis (N = 7) included: information and understanding, social support, coping skills, communication, and strain. Limitations in the evidence related to sampling, control-conditions and outcome measurements. DISCUSSION AND CONCLUSION: Several interventions were identified, yet no specific interventions appeared more beneficial than others. Using the SSCS model, commonalities and differences in intervention content were identified, along with themes that influence treatment processes. The need for tailored interventions is discussed. Future treatment efficacy research should carefully select study designs and outcome measurements. PROSPERO (CRD42021229408).

Do socioeconomic differences in tobacco use exist also in developing countries? A study of Ghanaian adolescents.

BACKGROUND: In Western countries, tobacco use is most prevalent among adolescents in lower socioeconomic groups. The association between socioeconomic status (SES) and tobacco use among adolescents in developing countries is unexplored. Using multiple SES measures, we investigated this association among adolescents in Ghana. METHOD: A school-based survey of a representative sample of 13-18-year-old Ghanaians (N = 1,165, response rate = 89.7%) was conducted in three regions, in 2008. Logistic regression analysis was used to evaluate the relationship of smoking, tawa (smokeless tobacco) use with familial SES (parental occupation and education, material affluence scale, family structure), an adolescent's individual social position (school performance, plans after graduation) and inter-generational social mobility (predicted by the differences of familial and individual positions). RESULTS: Socioeconomic differences existed in tobacco use whether measured by familial SES or individual social position with higher prevalence in lower socioeconomic groups. Low father's education and living in a non-nuclear family were associated with both forms of tobacco use while low material affluence was associated with tawa use only; individual social position measured by plans after graduation was the strongest predictor of both smoking and tawa use. Inter-generational downward social mobility and particularly staying in low SES was related to both forms of tobacco use. CONCLUSIONS: Similar to Western countries, lower SES is related to an adolescent's tobacco use also in developing countries. Cumulative socioeconomic disadvantage over generations increases the probability of tobacco use.

Gambling involvement, type of gambling and grade point average among 18-29-year-old Finnish men and women.

AIMS: This study explores the associations between gambling involvement, type of gambling, at-risk and problem gambling (ARPG) and register-based grade point average (GPA), among Finnish people aged 18-29 years (N = 676). It is assumed that high gambling involvement and engaging in certain types of gambling are linked to ARPG, and that low school achievement is positively associated with these measures. METHODS: A nationwide cross-sectional random sample was collected in 2015. The data were weighted based on gender, age and region. Analyses were carried out using logistic regression models. RESULTS: Frequent gambling, playing several game types, online gambling and ARPG were more common among men than women. Those with low GPA played fast and low-paced daily lottery games and used online casinos significantly more often than men and women with average/high GPA. Men with a low GPA were also more likely to gamble on a weekly basis and played casino games and online poker more often. For women with a low GPA online gambling and playing slot machines were more common than for women with an average/high GPA. When controlling for sociodemographic variables and gambling involvement, men's participation in daily lottery games and online poker was significantly associated with a low GPA, but among women none of the game types remained statistically significant. Among women, playing several different game types was linked with a low GPA. CONCLUSIONS: It seems that poorer school achievement is associated not only with frequent gambling, a large number of game types played and online gambling, but also, to some extent at least, with game type preferences.

How much gambling is too much? Identifying potential problem gambling among adolescents.

AIMS: Using a population-based sample of Finnish 12-17 year olds, this study explored gambling behaviour limits for potential problem gambling [South Oaks Gambling Screen - revised for adolescents (SOGS-RA)]. METHODS: Data were obtained from the Youth Gambling Survey 2006, which is a cross-sectional survey of a nationally representative random sample of 5000 adolescents. Adolescents who participated in gambling at least once a month were selected from the data (n=1827, 25.1% were girls). The limits for gambling behaviour were detected using receiver operating characteristic (ROC) analysis. Logistic regression was used to study associations between these behavioural limits and potential problem gambling. RESULTS: For each of the gambling behaviour indicators plotted, the risk curves showed similar trends among boys and girls. The risk of being a potential problem gambler increased noticeably with increasing gambling intensity. The ROC analysis showed that the optimal behavioural cut-off values among 12-14 year olds for frequency was gambling more than 2-3 times a month, spending more than €2 per week on gambling, spending more than €8 in any 1 day on gambling, and gambling on more than two different games per year. For 15-17 year olds, cut-off values were gambling more than once a week, spending more than €4 per week and spending more than €12 in any 1 day on gambling. Cut-off for number of game types was same as it was for younger adolescents. Of the behavioural indicators those associated with money were the most robust. CONCLUSION: Behavioural indicators can be used as initial markers of possible problem gambling.

Feasibility of using a multilingual web survey in studying the health of ethnic minority youth.

BACKGROUND: Monolingual Web survey is a common tool for studying adolescent health. However, national languages may cause difficulties for some immigrant-origin youths, which lower their participation rate. In national surveys, the number of ethnic minority groups is often too small to assess their well-being. OBJECTIVE: We studied the feasibility of a multilingual Web survey targeted at immigrant-origin youths by selection of response language, and compared participation in different language groups with a monolingual survey. METHODS: The Adolescent Health and Lifestyle Survey (AHLS), Finland, with national languages (Finnish/Swedish) was modified into a multilingual Web survey targeted at a representative sample of 14- and 16-year olds (N=639) whose registry-based mother tongue was other than the national languages. The survey was conducted in 2010 (16-year olds) and 2011 (14-year olds). The response rate of the multilingual survey in 2011 is compared with the AHLS of 2011. We also describe the translation process and the e-form modification. RESULTS: Of the respondents, 57.6% answered in Finnish, whereas the remaining 42.4% used their mother tongue (P=.002). A majority of youth speaking Somali, Middle Eastern, Albanian, and Southeast Asian languages chose Finnish. The overall response rate was 48.7% with some nonsignificant variation between the language groups. The response rate in the multilingual Web survey was higher (51.6%, 163/316) than the survey with national languages (46.5%, 40/86) in the same age group; however, the difference was not significant (P=.47). The adolescents who had lived in Finland for 5 years or less (58.0%, 102/176) had a higher response rate than those having lived in Finland for more than 5 years (45.1%, 209/463; P=.005). Respondents and nonrespondents did not differ according to place of birth (Finland/other) or residential area (capital city area/other). The difference in the response rates of girls and boys was nearly significant (P=.06). Girls of the Somali and Middle Eastern language groups were underrepresented among the respondents. CONCLUSIONS: A multilingual Web survey is a feasible method for gathering data from ethnic youth, although it does not necessarily yield a higher response rate than a monolingual survey. The respondents answered more often in the official language of the host country than their mother tongue. The varying response rates by time of residence, ethnicity, and gender pose challenges for developing tempting surveys for youth.

Adolescents' self-reported reasons for using nicotine replacement therapy products: a population-based study.

BACKGROUND: Available research provides evidence that adolescents use nicotine replacement therapy (NRT) products. Yet, little is known about reasons and motives behind their use. The present study examined the reasons for NRT use among 14-18-year-old Finnish adolescents. METHOD: A national Adolescent Health and Lifestyle Survey was conducted in Finland in 2009 (N=4834, response rate 55%). Main measures were prevalence of NRT use, self-reported reasons for using NRT and smoking status. RESULTS: Overall, 10% had used NRT. Boys used NRT more often than girls (11.5% versus 8.7%, p<.001). The three most commonly reported reasons were 'just try' (56%), 'to quit' (33%) and 'smoking not possible' (24%). "Just try" was the most common reason given by non-smokers/experimental smokers whereas daily/occasional smokers used NRT mainly for quitting purposes and when smoking was impossible. CONCLUSIONS: These findings suggest that when planning treatment plans for adolescent smokers, health care personnel should pay particular attention to adolescents' primary reasons and motives for using NRT before suggesting its use.