Smoking behavior among 15-year-old pupils in the Republic of Karelia, Russia and North-Karelia, Finland, from 1995 to 2013
Author(s):
Annamari Aura (submitting) Kerttu Tossavainen (presenting) Kirsi Bykachev Tiina Laatikainen
Conference:
ECER 2014
Network:
08. Research on Health Education
Format:
Paper

Session Information

08 SES 08, Health Behaviours and its Determinants

Paper Session

Time:
2014-09-04
09:00-10:30
Room:
B101 Sala de Aulas
Chair:
Patricia Mannix McNamara

Contribution

Smoking rates have traditionally been high in Russia (1) as well as in former Soviet Union states (2). Among 15-year-old adolescents, the smoking rates are 15 % for boys and 9 % for girls (3). After the dissolution of Soviet Union, the smoking prevalence of women has strongly increased and smoking has become more common among young women (2, 4). However, Russia is a geographically widely spread and heterogenic area where the prevalence of smoking varies strongly between areas and only some regions offer up-to-date information about smoking, particularly for adolescents (5, 6). Adolescents in Eastern Europe smoke more than their counterparts in Finland (1). However, in Finland, adolescent smoking rates are reasonably high despite the fact that adolescent smoking has decreased in Finland among girls since the 2000s and among boys since the 1990s and this trend seems to continue (7).

Previous studies have indicated that smoking behaviors begin to develop during early adolescence (8). It has been pointed out that the younger one starts smoking, the greater the risk for habitual smoking later in life (9). This leads to serious dependence on nicotine and extensive health problems and has far-reaching consequences on later life and health (10). Therefore, it is important to prevent experimenting with smoking and initiation to smoke in the early stages of adolescence and thus prevent inequalities in later health.

The study is a part of a more extensive project "Addressing challenging health inequalities of children and youth between two Karelias (AHIC)", which is administered by the University of Eastern Finland and receives funding from the Karelia ENPI CBC program. The aim of this study was to compare and find out how smoking prevalence has changed during the time between the years 1995-2013 in North Karelia, Finland and the Pitkyaranta district, Republic of Karelia, Russia, and between the genders. Moreover, the study aim was to find out how easy it is to smoke in the school area during the school day. These results provide new valuable information on the currents smoking situation among the pupils of local schools in North-Karelia, Finland and Republic of Karelia, Russia.

The following study questions were formulated:

  1. How have adolescents’ smoking tendencies changed in North Karelia, Finland and the Republic of Karelia, Russia from 1995 to 2013? 
  2. How easy is it to smoke in the school area during the school day?

Method

The whole data consisted of 4 separate cross-sectional survey studies from years 1995 (11-14) and 2013. The target group was 15-year-old pupils. Samples consisted of all pupils in every school in the Pitkyaranta region (1995: n=385, response rate 95 %; 2013: n=182, response rate 98 %) and in selected schools in North Karelia (1995: n=2098, response rate 93 %; 2013: 635, response rate 93 %). The latest data were collected in April 2013 from local schools by the means of a standardized self-administrative questionnaire concerning health behavior. The adolescents filled in the questionnaire anonymously in classrooms according to standard instructions given by a researcher. Schools represented both urban and rural schools in both areas. The results were expressed by using descriptive statistics (percentages and chi square test) and general linear model (GLM) was used to analyze the statistical significance of the relationships between factors and joint effects of the changes in smoking prevalence between countries, genders, and research years.

Expected Outcomes

In both countries, the daily smoking prevalence has not changed from 1995 to 2013. However, the results revealed significant gender-related differences between the countries. Among the Finnish boys, the prevalence of daily smoking was lower compared to the Russian boys in 1995 (p=0.001) as well as in 2013 (p=0.021). Finnish girls’ daily smoking was significantly higher in both years (p=0.001) compared to their counterparts in Russia. The joint effect of gender, research year, and country pointed out significant differences by country (p=<0.001), as the Finnish adolescents smoked more than Russians. In Russia, among adolescents who smoked on daily basis, more than half thought it was easy to smoke in the school area. This prevalence has not changed from 1995 to 2013. In Finland, smoking in the school area seemed to be more difficult in 2013 than it had been in 1995. To increase equity in health, it is important to influence structural inequalities, school policies, school culture, and adolescents’ attitudes. Our results suggest that the differences between genders and cultural aspects should be noted more carefully when implementing and promoting health strategies and health promotion programs in local schools in cross-border areas. Furthermore, the overall anti-smoking climate of these neighboring societies should be discussed in close collaboration. These results suggest evaluating the used strategies and to develop more effective actions to establish a decrease in smoking among adolescents.

References

(1) WHO (2013) WHO report on the global tobacco epidemic. Enforcing bans on tobacco advertising, promotion and sponsorship. http://apps.who.int/iris/bitstream/10665/85380/1/9789241505871_eng.pdf (2) Gilmore A, Pomerlau J, McKee M et al (2004) Prevalence of smoking in 8 countries of the former Soviet Union. Results from the living conditions, lifestyles and health studies. Addiction 99(12):1577-2187. (3) WHO (2013) WHO Report on the Global Tobacco Epidemic Country profile Russian Federation http://www.who.int/tobacco/surveillance/policy/country_profile/rus.pdf (4) Bayard R, Gilmore A, Sticley A (2012) Changes in smoking prevalence in 8 countries of the former Soviet Union between 2001 and 2010. Am J of Public Health 102(7):1320-1328. (5) Global adult tobacco survey (GATS) (2009), Russian Federation Country Report. http://www.who.int/tobacco/surveillance/en_tfi_gats_russian_countryreport.pdf (6) Perlman F, Bobak M, Gilmore A et al (2007) Trends in the prevalence of smoking in Russia during the transition to a market economy. Tob Control 16(5).299-305. (7) Kinnunen JM, Lindfors P, Pere L et al (2013) Adolescent Health and Lifestyle Survey 2013. Ministry of Social Affairs and Health, Finland 2013:16. http://www.stm.fi/c/document_library/get_file?folderId=6511574&name=DLFE-26851.pdf (8) Jarvis J (2004) Why people smoke? BMJ 382(7434):277-279. (9) Hu MC, Davies M, Kandel DB (2006) Epidemiology and correlates of daily smoking and nicotine dependence among young adults in the United States. Am J Public Health 96:299–308. (10) Glover ED, Glover PD, Payne TJ (2003) Treating nicotine dependence. Am J Med Sci 326:183-186. (11) Kemppainen U, Tossavainen K, Vartiainen E et al (2006) Environmental factors as predictors of smoking among ninth-grade adolescents in Pitkäranta (Russian Karelia) and in Eastern Finland. Res Nursing Health 29(6):543–555. (12) Kemppainen U, Tossavainen K, Vartiainen E et al (2002) Smoking patterns among ninth-grade adolescents in the Social determinants of adolescent smoking in Russia in Pitkäranta District (Russia) and in Eastern Finland. Public Health Nursing 19(1):30–39. (13) Kemppainen U, Tossavainen K, Vartiainen E et al (2004) An integrative model to predict adolescents` alcohol use: A cross-national study in the Pitkäranta district (Russian Karelia) and in eastern Finland. Diversity in Health and Social Care 1:81-92. (14) Kemppainen U, Tossavainen K, Vartiainen E et al (2007) Identifying Russian and Finnish adolescents´ problem behaviors. Health Education 107(1):81-98. (15) Lopez AD, Collishaw MD, Piha TA (1994) The descriptive model of cigarette epidemic in developed countries. Tob Control 3:242-247.

Author Information

Annamari Aura (submitting)
University of eastern Finland
Department of Nirsing Science
Kuopio
Kerttu Tossavainen (presenting)
University of Eastern Finland
Department of Nursing Science
Kuopio
Kirsi Bykachev
University of Eastern Finland
Department of Nursing Science
Kuopio
Tiina Laatikainen
University of eastern Finland, Finland; National Institute for Health and Welfare

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