Use of snus, its association with smoking and alcohol consumption, and related attitudes among adolescents: the Finnish National School Health Promotion Study.
BACKGROUND
The relationship between the use of snus and lifestyle-related habits - especially in adolescence, when these behaviours begin and become established - is not widely studied. Our aim was to analyse associations between snus use and habits of and attitudes towards smoking and alcohol consumption among Finnish adolescents.


METHODS
The study is a part of the National School Health Promotion Study in Finland. The study population consisted of a representative sample of Finnish adolescents (n = 183 226). A questionnaire enquired about pupils' use of snus, habits of and attitudes towards smoking and alcohol consumption, as well as their (age, gender, school type) and their parents' (education and smoking) background factors. Chi-square tests and logistic regression models served in the statistical analyses.


RESULTS
Of the adolescents, 18 % had used snus (2 % daily, 16 % experimented) while 82 % never had. Snus use was more common among boys than girls (p < 0.05). Concerning smoking, 19 % were daily and 15 % occasional smokers. Regarding alcohol, 11 % consumed it weekly and 57 % monthly or less frequently. More than two thirds of the adolescents held positive attitudes towards smoking (71 %), and alcohol (67 %). Male gender (OR = 9.9; 95 % CI 9.4-10.4), current (OR = 32.8; 95 % CI 26.1-41.1) or former (OR = 10.1; 95 % CI 8.0-12.9) smoking, weekly consumption of alcohol (OR = 27.4; 95 % CI 21.0-35.8), positive attitude towards smoking (OR = 1.4; 95 % CI 1.3-1.6), and higher parental education (OR = 1.4; 95 % CI 1.3-1.4) associated significantly with adolescents' current snus use, whereas parental smoking did not.


CONCLUSIONS
Current snus use among adolescents may signal an accumulation of other lifestyle-related risky behaviours such as current or past smoking and alcohol consumption as well as a positive attitude towards smoking. In addition to these possible co-existing health-related risk factors, health promotion activities should take into account gender and school differences in order to target preventive messages to youth more effectively.
Dental Health Care, Division of Health and Substance Abuse Services, Department of Social Services and Health Care, City of Helsinki, FI-00099 Helsinki, Finland ; Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, FI-90014 Oulu, Finland ; Oulu University Hospital, FI-90029 Oulu, Finland.
Battsetseg
B
Tseveenjav
Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, FI-90014 Oulu, Finland ; Oulu University Hospital, FI-90029 Oulu, Finland.
Paula
P
Pesonen
Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, FI-90014 Oulu, Finland ; Oulu University Hospital, FI-90029 Oulu, Finland ; Medical Research Center (MRC Oulu), Oulu, Finland.
Jorma I
JI
Virtanen
Adolescents; Alcohol consumption; Non-conventional tobacco product; Parental education; Smokeless tobacco; Smoking; Use of snus