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      Socioeconomic differences in adolescents’ smoking: a comparison between Finland and Beijing, China

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          Abstract

          Background

          Various studies have demonstrated the associations between socioeconomic status (SES) and health and health behaviour among adolescents. However, few studies have compared the socioeconomic difference in adolescent smoking between countries with different stage of smoking. The purpose of this study was to examine and compare the relationship between socioeconomic status (SES) and adolescent smoking in Beijing, China and Finland through the Health Behaviour in School-aged Children (HBSC) study.

          Methods

          The data used in this study were derived from the Chinese HBSC linked project survey 2008 in Beijing and the Finnish HBSC survey 2006. The final sample included 2005 Chinese and 1685 Finnish 15-year-old schoolchildren. The associations between Family Affluence Scale (FAS), as the SES measure, and adolescents’ smoking behaviour, including ever smoked, weekly smoking and the early onset of smoking were examined separately in two countries through binary logistic regression.

          Results

          Compared to students from the high FAS group, Chinese boys from the low FAS group were more likely to report having ever smoked ( OR = 2.12, 95 % CI = 1.49–3.01) and being early onset of smoking ( OR = 2.17, 95 % CI = 1.44–3.26). Finnish girls from the low FAS group were more likely to report being weekly smokers ( OR = 1.68, 95 % CI = 1.07–2.65). No significant difference was found for Chinese girls and Finnish boys.

          Conclusions

          This study indicated different patterns of socioeconomic difference in smoking between Chinese and Finnish adolescents by gender and by smoking behaviour, which suggests that socioeconomic inequalities in smoking are different among adolescents in countries with different stage of smoking. Country specific policies and interventions for different target groups should be encouraged and designed for reducing the prevalence of adolescents’ smoking.

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          Most cited references34

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          Trends in smoking behaviour between 1985 and 2000 in nine European countries by education.

          To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000 differed by education group. Data of smoking behaviour and education level were obtained from national cross sectional surveys conducted between 1985 and 2000 (a period characterised by intense tobacco control policies) and analysed for countries combined and each country separately. Annual trends in smoking prevalence and the quantity of cigarettes consumed by smokers were summarised for each education level. Education inequalities in smoking were examined at four time points. Data were obtained from nine European countries: Norway, Sweden, Denmark, Finland, the United Kingdom, the Netherlands, Germany, Italy, and Spain. 451 386 non-institutionalised men and women 25-79 years old. Smoking status, daily quantity of cigarettes consumed by smokers. Combined country analyses showed greater declines in smoking and tobacco consumption among tertiary educated men and women compared with their less educated counterparts. In country specific analyses, elementary educated British men and women, and elementary educated Italian men showed greater declines in smoking than their more educated counterparts. Among Swedish, Finnish, Danish, German, Italian, and Spanish women, greater declines were seen among more educated groups. Widening education inequalities in smoking related diseases may be seen in several European countries in the future. More insight into effective strategies specifically targeting the smoking behaviour of low educated groups may be gained from examining the tobacco control policies of the UK and Italy over this period.
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            Educational differences in smoking: international comparison.

            To investigate international variations in smoking associated with educational level. International comparison of national health, or similar, surveys. Men and women aged 20 to 44 years and 45 to 74 years. 12 European countries, around 1990. Relative differences (odds ratios) and absolute differences in the prevalence of ever smoking and current smoking for men and women in each age group by educational level. In the 45 to 74 year age group, higher rates of current and ever smoking among lower educated subjects were found in some countries only. Among women this was found in Great Britain, Norway, and Sweden, whereas an opposite pattern, with higher educated women smoking more, was found in southern Europe. Among men a similar north-south pattern was found but it was less noticeable than among women. In the 20 to 44 year age group, educational differences in smoking were generally greater than in the older age group, and smoking rates were higher among lower educated people in most countries. Among younger women, a similar north-south pattern was found as among older women. Among younger men, large educational differences in smoking were found for northern European as well as for southern European countries, except for Portugal. These international variations in social gradients in smoking, which are likely to be related to differences between countries in their stage of the smoking epidemic, may have contributed to the socioeconomic differences in mortality from ischaemic heart disease being greater in northern European countries. The observed age patterns suggest that socioeconomic differences in diseases related to smoking will increase in the coming decades in many European countries.
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              Test-retest reliability of selected items of Health Behaviour in School-aged Children (HBSC) survey questionnaire in Beijing, China

              Background Children's health and health behaviour are essential for their development and it is important to obtain abundant and accurate information to understand young people's health and health behaviour. The Health Behaviour in School-aged Children (HBSC) study is among the first large-scale international surveys on adolescent health through self-report questionnaires. So far, more than 40 countries in Europe and North America have been involved in the HBSC study. The purpose of this study is to assess the test-retest reliability of selected items in the Chinese version of the HBSC survey questionnaire in a sample of adolescents in Beijing, China. Methods A sample of 95 male and female students aged 11 or 15 years old participated in a test and retest with a three weeks interval. Student Identity numbers of respondents were utilized to permit matching of test-retest questionnaires. 23 items concerning physical activity, sedentary behaviour, sleep and substance use were evaluated by using the percentage of response shifts and the single measure Intraclass Correlation Coefficients (ICC) with 95% confidence interval (CI) for all respondents and stratified by gender and age. Items on substance use were only evaluated for school children aged 15 years old. Results The percentage of no response shift between test and retest varied from 32% for the item on computer use at weekends to 92% for the three items on smoking. Of all the 23 items evaluated, 6 items (26%) showed a moderate reliability, 12 items (52%) displayed a substantial reliability and 4 items (17%) indicated almost perfect reliability. No gender and age group difference of the test-retest reliability was found except for a few items on sedentary behaviour. Conclusions The overall findings of this study suggest that most selected indicators in the HBSC survey questionnaire have satisfactory test-retest reliability for the students in Beijing. Further test-retest studies in a large and diverse sample, as well as validity studies, should be considered for the future Chinese HBSC study.
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                Author and article information

                Contributors
                docliuyang@hotmail.com
                may_wang@homtail.com
                jorma.tynjala@jyu.fi
                jari.villberg@jyu.fi
                lvyandatou@msn.com
                lasse.kannas@jyu.fi
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                17 August 2016
                17 August 2016
                2016
                : 16
                : 805
                Affiliations
                [1 ]School of Physical Education and Sport Training, Shanghai University of Sport, 200438 Shanghai, China
                [2 ]Shanghai Research Centre for Physical Fitness and Health of Children and Adolescents, Shanghai University of Sport, 200438 Shanghai, China
                [3 ]Mass Sport Research Centre, China Institute of Sport Science, 100061 Beijing, China
                [4 ]Research Centre for Health Promotion, Department of Health Sciences, University of Jyvaskyla, 40014 Jyväskylä, Finland
                [5 ]Zhejiang Institute of Sport Science, 310004 Hangzhou, China
                Author information
                http://orcid.org/0000-0003-1251-3025
                Article
                3476
                10.1186/s12889-016-3476-0
                4989516
                27534849
                be00c6ec-ccf3-4db2-a13e-5284140b82c6
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 20 January 2016
                : 10 August 2016
                Funding
                Funded by: FundRef http://dx.doi.org/http://dx.doi.org/10.13039/501100004037, Juho Vainion Säätiö;
                Funded by: The Finnish Foundation for Alcohol Studie
                Funded by: The Key Area Research Project from General Administration of Sport of China
                Award ID: 2014B070
                Award Recipient :
                Funded by: Shanghai Key Lab of Human Performance (Shanghai University of sport)
                Award ID: 11DZ2261100
                Award Recipient :
                Funded by: Shuguang Program by Shanghai Education Development Foundation and Shanghai Municipal Education Commission
                Award ID: 14SG46
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Public health
                adolescent,smoking,family affluence scale,socioeconomic inequalities
                Public health
                adolescent, smoking, family affluence scale, socioeconomic inequalities

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