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. Conclusion: 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.