title: Smoking and associated factors among adolescents in Tallinn, Helsinki and Moscow: a multilevel analysis.
abstract: 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.
authors.affiliation: Department of Public Health, University of Helsinki, Finland. kerstip@ut.ee
authors.forename: Kersti
authors.initials: K
authors.lastname: Pärna
authors.forename: Kaja
authors.initials: K
authors.lastname: Rahu
authors.forename: Krista
authors.initials: K
authors.lastname: Fischer
authors.forename: Helena
authors.initials: H
authors.lastname: Mussalo-Rauhamaa
authors.forename: Irina
authors.initials: I
authors.lastname: Zhuravleva
authors.forename: Triin
authors.initials: T
authors.lastname: Umbleja
authors.forename: Mati
authors.initials: M
authors.lastname: Rahu
mesh_terms: 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