National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Front Public Health. 2022 Feb 21;10:825585. doi: 10.3389/fpubh.2022.825585. eCollection 2022.
Health interventions may differently impact adolescents from diverse backgrounds. This study examined whether a smoking preventive intervention was equally effective in preventing cigarette smoking and use of alternative tobacco products (ATPs, i.e., snus, e-cigarettes, and waterpipe) among students from different socioeconomic backgrounds, i.e., occupational social classes (OSC).
Data was from the school-based intervention X:IT II targeting 13- to 15-year-olds Danes. The intervention focused on three main components: smoke-free school time, smoke-free curriculum, and parental involvement. In total, 46 schools were included at baseline ( = 2,307, response rate = 86.3%). Using a difference-in-differences approach, changes in current smoking and ever use of ATPs were estimated among students in high versus low OSC at second follow-up. Analyses were based on available cases ( = 826) and multiple imputations of missing data at the second follow-up ( = 1,965).
At baseline (age 13), 1.0% of students from high OSC and 4.8% from low OSC currently smoked cigarettes, while this was the case among 24.5 and 25.6%, respectively, at the second follow-up (age 15). Estimates indicated that social inequalities in current smoking diminished over time ( < 0.001). Regarding ATPs, 10.0% of high OSC students and 13.9% of low OSC students had ever used ATPs at baseline, while at second follow-up, 46.8 and 60.8%, respectively, had ever used ATPs. Estimates indicated that social inequalities in ever use of ATPs widened over time ( < 0.001).
The X:IT II intervention seemed to diminish socioeconomic disparities in smoking over the study period. Meanwhile, social inequalities in ever use of ATPs increased. Therefore, besides focusing on narrowing the social disparities in cigarette smoking, future efforts may, to a larger extent, focus on adolescents' use of ATPs.
健康干预措施可能对来自不同背景的青少年产生不同的影响。本研究旨在检验一项预防吸烟的干预措施在预防不同社会经济背景（即职业社会阶层，OSC）学生吸烟和使用替代烟草产品（ATP，即鼻烟、电子烟和水烟）方面是否同样有效。
数据来自针对 13 至 15 岁丹麦学生的基于学校的 X:IT II 干预研究。该干预措施侧重于三个主要组成部分：无烟课间时间、无烟课程和家长参与。共有 46 所学校在基线时被纳入（n=2307，响应率为 86.3%）。使用差异中的差异方法，在第二次随访时，根据 OSC 高低，评估学生中当前吸烟和曾经使用 ATP 的变化。分析基于可用病例（n=826）和第二次随访时缺失数据的多重插补（n=1965）。
在基线时（13 岁），来自高 OSC 的 1.0%的学生目前吸烟，而来自低 OSC 的这一比例为 4.8%，而在第二次随访时（15 岁），这一比例分别为 24.5%和 25.6%。估计表明，当前吸烟的社会不平等随着时间的推移而减少（<0.001）。关于 ATP，10.0%的高 OSC 学生和 13.9%的低 OSC 学生在基线时曾经使用过 ATP，而在第二次随访时，分别有 46.8%和 60.8%的学生曾经使用过 ATP。估计表明，ATP 曾经使用的社会不平等随着时间的推移而扩大（<0.001）。
X:IT II 干预似乎在研究期间缩小了吸烟方面的社会经济差距。与此同时，ATP 曾经使用的社会不平等有所增加。因此，除了关注缩小吸烟的社会差距外，未来的努力可能在更大程度上侧重于青少年对 ATP 的使用。
