Smoking and associated factors among adolescents in Tallinn, Helsinki and Moscow: a multilevel analysis.
OBJECTIVE
To investigate variations in smoking and associated factors on individual and aggregate level among adolescents in Tallinn (Estonia), Helsinki (Finland) and Moscow (the Russian Federation).


METHODS
The data was collected in Tallinn (N=1268 in Estonian and N=901 in Russian schools), in Helsinki (N=1396) and in Moscow (N=618) from pupils aged 13-18 by self-administered questionnaire. Multilevel analysis was used to estimate the possible effects of background characteristics, of the proximity of other smokers and the school context on the tobacco use of pupils.


RESULTS
The prevalence rate of smoking among girls in Russian schools in Tallinn (34.6%), among girls in Helsinki (39.5%), and in Moscow (32.1%) was higher than that among girls in Estonian schools in Tallinn (17.6%). Smoking was slightly less prevalent among boys in Helsinki (27.5%), compared to boys in Estonian (33.6%) and Russian (35.6%) schools in Tallinn, and to boys in Moscow (32.8%). Smoking increased with age. Multilevel analysis showed that smoking differed by school among pupils. Individual determinants of smoking as study site, grade, friends', siblings' and parental smoking behaved differently depending upon school. Friends and siblings' smoking showed interaction with study site to the smoking among girls.


CONCLUSIONS
Strategies aimed at influencing smoking behaviour need to be directed not only towards the individual, but also towards the influences within the child's school environment.
Pärna
Kersti
K
Department of Public Health, University of Helsinki, Finland. kerstip@ut.ee
Rahu
Kaja
K
Fischer
Krista
K
Mussalo-Rauhamaa
Helena
H
Zhuravleva
Irina
I
Umbleja
Triin
T
Rahu
Mati
M
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D004957:Estonia / Q000453:epidemiology; D005190:Family; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D009031:Moscow / Q000453:epidemiology; D015995:Prevalence; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires