| 1. |
- Beeres, Dorien Tecla, et al.
(författare)
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Child–adult contract for prevention of tobacco use : "as-treated" analysis of a cluster randomized controlled trial (the TOPAS study) at 3-year follow-up
- 2024
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Ingår i: Prevention Science. - : Springer Nature. - 1389-4986 .- 1573-6695. ; 25, s. 175-192
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Tidskriftsartikel (refereegranskat)abstract
- To estimate the effect of a 3-year commitment to remain tobacco free on tobacco uptake among high school students in Sweden. The commitment is developed in the form of a contract between a child and a significant adult, constituting the core component of Tobacco-free Duo (T-Duo), a Swedish school-based tobacco prevention program. Secondary analysis of data from a cluster randomized controlled trial. Participants were 586 students in high schools assigned to the intervention arm of T-Duo. At inception, participants attended grade 7 (i.e., age 12–13). Only students who were tobacco naïve at baseline for the respective outcome and participated in all follow-ups were included. The exposure was defined as signing a 3-year contract with a significant adult, categorized as “stable contract” (3 years contract with the same contract partner), “unstable” (signed a contract sometime during follow-up but this was not sustained over time and/or with the same partner), and “no contract” at all during the intervention period. The primary outcome was having never tried cigarette smoking at the end of grade 9. Exposure and outcomes were self-reported in yearly questionnaires. Of 586 students, 321 (55%) held a stable contract, 204 (35%) an unstable contract, and 61 (10%) did not sign a contract at all. At the end of grade 9 (age 15–16), the relative risk (RR) to remain cigarette free was 1.11 (95% CI 1.00–1.22) (Number Needed to Treat = 10) among students in any type of contract compared to students that did not write a contract at all. The RRs for remaining tobacco free (secondary outcomes) ranged from 1.07 (0.98–1.16) for regular snus use to 1.16 (1.00–1.35) for any type of tobacco use. A commitment to remain tobacco free through a child–adult contract seems to exert a preventive effect on the uptake of tobacco use among Swedish adolescents over 3 school years. The current findings apply to a selected sample of both schools and students.Registration: Current Controlled Trials ISRCTN52858080 Date: January 4, 2019, retrospectively registered.
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| 2. |
- Galanti, Maria Rosaria, et al.
(författare)
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Tobacco-Free Duo Adult-Child Contract for Prevention of Tobacco Use Among Adolescents and Parents : Protocol for a Mixed-Design Evaluation
- 2020
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Ingår i: JMIR Research Protocols. - : JMIR Publications Inc.. - 1929-0748. ; 9:10
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Universal tobacco-prevention programs targeting youths usually involve significant adults, who are assumed to be important social influences. Commitment not to use tobacco, or to quit use, as a formal contract between an adolescent and a significant adult is a preventive model that has not been widely practiced or explored and has been formally evaluated even less. In this paper, we present the rationale and protocol for the evaluation of the Swedish Tobacco-free Duo program, a multicomponent school-based program the core of which rests on a formal agreement between an adolescent and an adult. The adolescent's commitment mainly concerns avoiding the onset of any tobacco use while the adult commits to support the adolescent in staying tobacco free, being a role model by not using tobacco themselves.OBJECTIVE: To assess (1) whether Tobacco-free Duo is superior to an education-only program in preventing smoking onset among adolescents and promoting cessation among their parents, (2) whether exposure to core components (adult-child agreement) entails more positive effects than exposure to other components, (3) the impact of the program on whole school tobacco use, (4) potential negative side effects, and (5) school-level factors related to fidelity of the program's implementation.METHODS: A mixed-design approach was developed. First, a cluster randomized controlled trial was designed with schools randomly assigned to either the comprehensive multicomponent program or its educational component only. Primary outcome at the adolescent level was identified as not having tried tobacco during the 3-year junior high school compulsory grades (12-15 years of age). An intention-to-treat cohort-wise approach and an as-treated approach complemented with a whole school repeated cross-sectional approach was devised as analytical methods of the trial data. Second, an observational study was added in order to compare smoking incidence in the schools participating in the experiment with that of a convenience sample of schools that were not part of the experimental study. Diverse secondary outcomes at both adolescent and adult levels were also included.RESULTS: The study was approved by the Umeå Regional Ethics Review Board (registration number 2017/255-31) in 2017. Recruitment of schools started in fall 2017 and continued until June 2018. In total, 43 schools were recruited to the experimental study, and 16 schools were recruited to the observational study. Data collection started in the fall 2018, is ongoing, and is planned to be finished in spring 2021.CONCLUSIONS: Methodological, ethical, and practical implications of the evaluation protocol were discussed, especially the advantage of combining several sources of data, to triangulate the study questions. The results of these studies will help revise the agenda of this program as well as those of similar programs.TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN) 52858080; https://doi.org/10.1186/ISRCTN52858080.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/21100.
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| 3. |
- Giannotta, Fabrizia, 1978-, et al.
(författare)
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Short-Term Mediating Factors of a School-Based Intervention to Prevent Youth Substance Use in Europe
- 2014
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Ingår i: Journal of Adolescent Health. - New York : Elsevier. - 1054-139X .- 1879-1972. ; 54:5, s. 565-573
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To investigate factors mediating the effects of a European school-based intervention (Unplugged) based on a social influence approach to youths' substance use.Methods: Schools in seven European countries (n = 143, including 7,079 pupils) were randomly assigned to an experimental condition (Unplugged curriculum) or a control condition (usual health education). Data were collected before (pretest) and 3 months after the end of the program (posttest). Multilevel multiple mediation models were applied to the study of effect mediation separately for tobacco, alcohol, and cannabis use. Analyses were conducted on the whole sample, and separately on baseline users and nonusers of each substance.Results: Compared with the control group, participants in the program endorsed less positive attitudes toward drugs; positive beliefs about cigarettes, alcohol, and cannabis; and the normative perception of peers using tobacco and cannabis. They also increased in knowledge about all substances and refusal skills toward tobacco. Decreased positive attitudes toward drugs, increase in refusal skills, and reappraisal of norms about peer using tobacco and cannabis appeared to mediate the effects of the program on the use of substances. However, mediating effects were generally weak and some of them were only marginally significant.Conclusions: This study lends some support to the notion that school-based programs based on a social influence model may prevent juvenile substance use through the modification of attitudes, refusal skills, and normative perceptions. (C) 2014 Society for Adolescent Health and Medicine. All rights reserved.
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| 4. |
- Hansson, Jenny, et al.
(författare)
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Use of snus and acute myocardial infarction: pooled analysis of eight prospective observational studies
- 2012
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Ingår i: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 1573-7284 .- 0393-2990. ; 27:10, s. 771-779
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Tidskriftsartikel (refereegranskat)abstract
- The use of snus (also referred to as Scandinavian or Swedish moist smokeless tobacco), which is common in Sweden and increasing elsewhere, is receiving increasing attention since considered a tobacco smoke "potential reduction exposure product". Snus delivers a high dose of nicotine with possible hemodynamic effects, but its impact on cardiovascular morbidity and mortality is uncertain. The aim of this study was to investigate whether snus use is associated with risk of and survival after acute myocardial infarction (AMI). Data from eight prospective cohort studies set in Sweden was pooled and reanalysed. The relative risk of first time AMI and 28-day case-fatality was calculated for 130,361 men who never smoked. During 2,262,333 person-years of follow-up, 3,390 incident events of AMI were identified. Current snus use was not associated with risk of AMI (pooled multivariable hazard ratio 1.04, 95 % confidence interval 0.93 to 1.17). The short-term case fatality rate appeared increased in snus users (odds ratio 1.28, 95 % confidence interval 0.99 to 1.68). This study does not support any association between use of snus and development of AMI. Hence, toxic components other than nicotine appear implicated in the pathophysiology of smoking related ischemic heart disease. Case fatality after AMI is seemingly increased among snus users, but this relationship may be due to confounding by socioeconomic or life style factors.
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| 5. |
- Nilsson, Maria, 1957-, et al.
(författare)
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Topas - tobakspreventivt arbete i skolan. Slutrapport : en utvärdering av det ANDT-förebyggande programmet Tobaksfri duo
- 2022
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I Sverige har tobaksförebyggande program med ungdomar som målgrupp under många år initierats, utvecklats och drivits av kommuner, regioner, och den ideella sektorn. Antalet vetenskapliga studier om tobaksförebyggande arbete i landet som publicerats i vetenskapliga tidskrifter är mycket få och har främst genomförts med en kvasiexperimentell design. Tobaksfri duo (T-Duo) har spridits i landet och önskemål har uttryckts om en utvärdering med metodik som ger högre evidensgrad jämfört med de studier som genomförts tidigare. Genom Topasprojektet har en sådan utvärdering av användningen av programmets kärnkomponenter möjliggjorts. Studien har genomförts av Umeå universitet och Karolinska Institutet på uppdrag av Folkhälsomyndigheten. Den hade en blandad design: 1) en klusterrandomiserad kontrollerad studie (CRCT) där skolor tilldelades programmet T-Duos sex kärnkomponenter eller en minimal komponent i form av Strukturerad undervisning, 2) en observationsstudie där programskolor jämfördes med skolor i en extern referensgrupp samt 3) en hälsoekonomisk utvärdering av programmets kostnadseffekt.Studiens övergripande syfte var att utvärdera effekterna och kostnaderna av programmet T-Duos sex kärnkomponenter genom att besvara följande specifika frågeställningar:Påverkas ungas tobaksdebut och tobaksanvändning av programmet? - d.v.s. är den förebyggande effekten större om man arbetar med programmet jämfört med en minimal komponent, alternativt ordinarie ANDT-undervisning i skolan?Påverkar deltagande i programmet vårdnadshavares tobaksbruk?Har graden av implementering av programmet betydelse för effekten?Är effekterna sådana att programkostnaderna är motiverade?Resultaten från studien visar att det fullständiga programmet T-Duo förknippas med en måttlig förebyggande effekt på högstadieelevers tobaksdebut (cirka 8 % större sannolikhet att förbli rökfria efter tre år), jämfört med om man enbart bedrev undervisning om tobak enligt programmet som ingick i Topas kontrollgrupp Undervisningsskolor (U-skolor). Resultaten kan dock ha påverkats av vissa systematiska fel, dels bortfall, dels beroende på självrapportering.Kontraktet som skrevs mellan ett barn och en vuxen 18 år eller äldre som barnet själv valde som vuxenpartner i T-Duo visade sig vara en effektiv komponent om kontraktet kunde upprätthållas under samtliga år. Komponenten innehåller tre delar kopplat till kontraktet, i) dels en möjlighet till stöd från en vuxen som barnet själv valt, att barnet ii) vid kontraktsskrivning gör ett åtagande inför andra om att man inte ska använda tobak under de kommande tre åren och slutligen iii) möjligheten för barnet att delta i utlottning av mindre priser och till rabatter (på till exempel skolfiket).Resultaten indikerade också att T-Duo kan påverka tobaksbruk på gruppnivå, det vill säga på skolnivå, på ett positivt sätt över tid. Med andra ord att alla elever på en skola som jobbade med T-Duo påverkades av programmet och inte bara de som deltog.Vad gällde vårdnadshavare (VH) i T-skolor sågs en möjlig effekt avseende tobaksstopp, det vill säga att de få deltagare som använde tobak i början av studien och som var kvar i slutet slutade använda tobak i större utsträckning än föräldrar i skolor lottade till enbart undervisningskomponenten. Dock måste resultaten tolkas med stor försiktighet på grund av det låga antalet VH som svarade på enkäten. Av denna anledning är det inte möjligt att säga om VH som tecknade kontrakt med sina barn hade större sannolikhet att förbli tobaksfria eller inte, eftersom andelen tobaksbrukare i gruppen som tecknade kontraktet med sina barn redan från början var mycket låg och betydligt lägre än bland resterande VH.Mycket få skolor hade implementerat programmet T-Duo helt enligt manualen för studien. Implementeringen var oftast måttlig, dvs att man hade genomfört mer än två kärnkomponenter enligt manualen, dock inte alla. Graden av implementering påverkade dock inte resultaten.I beräkningen av kostnadseffektivitet relaterades skillnaden i kostnader mellan T-skolor och U-skolor till den beräknade effekten i termer av hur många fler barn som förblev rökfria på grund av programmet. Det treåriga programmet kostade 785 kr per exponerat barn på T-skolorna och endast strukturerad undervisning kostade 491 kr per barn på U-skolorna. T-Duo kostade därmed 294 kr mer per barn jämfört med endast Strukturerad undervisning och kostnadseffektiviteten uppskattades till 5 066 kr för varje ytterligare barn som var rökfri i slutet på årskurs nio. Om effekten kvarstår fram till vuxen ålder representerar T-duo en mycket bra användning av resurserna i förhållande till framtida konsekvenser på hälsan som vuxen. Osäkerheten rörande programeffekten och om effekten kommer att bestå är avgörande för denna slutsats.
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| 6. |
- Andersson, Filip, et al.
(författare)
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Prevalence of cannabis use among young adults in Sweden comparing randomized response technique with a traditional survey
- 2023
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Ingår i: Addiction. - 0965-2140 .- 1360-0443. ; 118:9, s. 1801-1810
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aims: The prevalence of cannabis use based on self-reports is likely to be underestimated in population surveys, especially in contexts where its use is a criminal offence. Indirect survey methods ask sensitive questions ensuring that answers cannot be identified with an individual respondent, therefore potentially resulting in more reliable estimates. We aimed to measure whether the indirect survey method ‘randomized response technique’ (RRT) increased response rate and/or increased disclosure of cannabis use among young adults compared with a traditional survey.Design: We conducted two parallel nation-wide surveys during the spring and the summer of 2021. The first survey was a traditional questionnaire-based one (focusing on substance use and gambling). The second survey applied an indirect survey method known as ‘the cross-wise model’ to questions related to cannabis use. The two surveys employed identical procedures (e.g. invitations, reminders and wording of the questions)Setting and Participants: The participants were young adults (aged 18–29 years) living in Sweden. The traditional survey had 1200 respondents (56.9% women) and the indirect survey had 2951 respondents (53.6% women).Measurements: In both surveys, cannabis use was assessed according to three time-frames: life-time use; use during the past year; and use during the past 30 days.Findings: The estimated prevalence of cannabis use was two- to threefold higher on all measures when estimated using the indirect survey method compared with the traditional survey: use during life-time (43.2 versus 27.3%); during the past year (19.2 versus 10.4%); and during the past 30 days (13.2 versus 3.7%). The discrepancy was larger among males and individuals with an education shorter than 10 years, who were unemployed, and who were born in non-European countries.Conclusions: Indirect survey methods may provide more accurate estimates than traditional surveys on prevalence of self-reported cannabis use.
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| 7. |
- Araghi, Marzieh, et al.
(författare)
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No association between moist oral snuff (snus) use and oral cancer : pooled analysis of nine prospective observational studies
- 2021
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Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 49:8, s. 833-840
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Worldwide, smokeless-tobacco use is a major risk factor for oral cancer. Evidence regarding the particular association between Swedish snus use and oral cancer is, however, less clear. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess the association between snus use and oral cancer.Methods: A total of 418,369 male participants from nine cohort studies were followed up for oral cancer incidence through linkage to health registers. We used shared frailty models with random effects at the study level, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for confounding factors.Results: During 9,201,647 person-years of observation, 628 men developed oral cancer. Compared to never-snus use, ever-snus use was not associated with oral cancer (adjusted HR 0.90, 95% CI: 0.74, 1.09). There were no clear trends in risk with duration or intensity of snus use, although lower intensity use (<= 4 cans/week) was associated with a reduced risk (HR 0.65, 95% CI: 0.45, 0.94). Snus use was not associated with oral cancer among never smokers (HR 0.87, 95% CI: 0.57, 1.32).Conclusions: Swedish snus use does not appear to be implicated in the development of oral cancer in men.
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| 8. |
- Araghi, Marzieh, et al.
(författare)
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Smokeless tobacco (snus) use and colorectal cancer incidence and survival : Results from nine pooled cohorts
- 2017
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 45:8, s. 741-748
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Although smoking is considered to be an established risk factor for colorectal cancer, the current evidence on the association between smokeless tobacco and colorectal cancer is scant and inconclusive. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess this association.METHODS: A total of 417,872 male participants from nine cohort studies across Sweden were followed up for incidence of colorectal cancer and death. Outcomes were ascertained through linkage to health registers. We used shared frailty models with random effects at the study level to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).RESULTS: During 7,135,504 person-years of observation, 4170 men developed colorectal cancer. There was no clear association between snus use and colorectal cancer overall. Exclusive current snus users, however, had an increased risk of rectal cancer (HR 1.40: 95% CI 1.09, 1.79). There were no statistically significant associations between snus use and either all-cause or colorectal cancer-specific mortality after colorectal cancer diagnosis.CONCLUSIONS: Our findings, from a large sample, do not support any strong relationships between snus use and colorectal cancer risk and survival among men. However, the observed increased risk of rectal cancer is noteworthy, and in merit of further attention.
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| 9. |
- Araghi, Marzieh, et al.
(författare)
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Use of moist oral snuff (snus) and pancreatic cancer : Pooled analysis of nine prospective observational studies
- 2017
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Ingår i: International Journal of Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 141:4, s. 687-693
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Tidskriftsartikel (refereegranskat)abstract
- While smoking is a well-established risk factor for pancreatic cancer, the effect of smokeless tobacco is less well understood. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess the association between Swedish snus use and the risk of pancreatic cancer. A total of 424,152 male participants from nine cohort studies were followed up for risk of pancreatic cancer through linkage to health registers. We used shared frailty models with random effects at the study level, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for confounding factors. During 9,276,054 person-years of observation, 1,447 men developed pancreatic cancer. Compared to never-snus use, current snus use was not associated with risk of pancreatic cancer (HR 0.96, 95% CI 0.83-1.11) after adjustment for smoking. Swedish snus use does not appear to be implicated in the development of pancreatic cancer in men. Tobacco smoke constituents other than nicotine or its metabolites may account for the relationship between smoking and pancreatic cancer. What's new? While smoking is a well-established risk factor for pancreatic cancer, the effect of smokeless tobacco is less well understood. Smokeless tobacco like snus yields lower exposure to tobacco carcinogens compared with smoking, because it does not undergo combustion, but delivers an equivalent dose of nicotine. Using pooled individual data from the Swedish Collaboration on Health Effects of Snus Use, here the authors show that Swedish snus use does not appear to be implicated in the development of pancreatic cancer in men. Tobacco smoke constituents other than nicotine or its metabolites may account for the relationship between smoking and pancreatic cancer.
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| 10. |
- Byhamre, Marja Lisa, et al.
(författare)
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Swedish snus use is associated with mortality : a pooled analysis of eight prospective studies
- 2020
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Ingår i: International Journal of Epidemiology. - : Oxford University Press. - 0300-5771 .- 1464-3685. ; 49:6, s. 2041-2050
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The health consequences of the use of Swedish snus, including its relationship with mortality, have not been fully established. We investigated the relationship between snus use and all-cause and cause-specific mortality (death due to cardiovascular diseases, cancer diseases and all other reasons, respectively) in a nationwide collaborative pooling project.METHODS: We followed 169 103 never-smoking men from eight Swedish cohort studies, recruited in 1978-2010. Shared frailty models with random effects at the study level were used in order to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of mortality associated with snus use.RESULTS: Exclusive current snus users had an increased risk of all-cause mortality (aHR 1.28, 95% CI 1.20-1.35), cardiovascular mortality (aHR 1.27, 95% CI 1.15-1.41) and other cause mortality (aHR 1.37, 95% CI 1.24-1.52) compared with never-users of tobacco. The risk of cancer mortality was also increased (aHR 1.12, 95% CI 1.00-1.26). These mortality risks increased with duration of snus use, but not with weekly amount.CONCLUSIONS: Snus use among men is associated with increased all-cause mortality, cardiovascular mortality, with death from other causes and possibly with increased cancer mortality.
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