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Background: Fundamental to supporting hazardous alcohol users are the rationales for reducing alcohol intake highlighted by the users themselves. This study analyses the relative importance of beliefs about pros and cons of drinking in relation to having an intention to reduce intake among both hazardous and moderate alcohol users., Methods: Intention to change was assessed in a representative sample of Stockholm's population (n = 4278, response rate 56.5%). Alcohol use was assessed using the Alcohol Use Disorders Identification Test measure. A decisional balance inventory was used to examine various beliefs about the pros and cons of drinking, which covered affect changes, social gains and losses, and possible adverse effects. Independent correlations were determined by logistic regression using a backward exclusion procedure (P > 0.05)., Results: Higher ratings of importance were generally related to intent, whether or not the contrast was with having no intent or already having made a reduction. This was especially true for hazardous users. Only two beliefs were independently correlated with change among hazardous users: 'Drinking could get me addicted' and 'Drinking makes me more relaxed/less tense' (pseudo-R2 < 0.1). Among moderate users, there was no uniform pattern in the relationships., Conclusions: Unexpectedly, hazardous users with an intent to change rated pro arguments as more important than those with no intent to change. Of the investigated pros and cons, only a few were independently related to intention to change drinking behaviour. These arguments provide interesting topics in consultations. Little support was found for any rational decision making behind the intention to reduce alcohol intake., (© The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association.)

Objective: To assess the relative cost-effectiveness of a high-intensity treatment (HIT) and a low-intensity treatment (LIT) for smoking cessation., Methods: The societal and health care perspective economic evaluation was based on the reported number of quitters at 12-month follow-up (point prevalence) from a randomized controlled trial of 2 smoking cessation programs in Sweden. Future disease-related costs (in Swedish kronor [SEK] 2004; SEK7.35 = USD1) and health effects (in quality-adjusted life-years [QALYs]) were estimated via a Markov model comprising lung cancer, chronic obstructive pulmonary disease, and cardiovascular disease including stroke with costs and QALYs discounted 3% annually., Results: HIT was more effective than LIT (23% vs. 16% quitters), but at a considerably higher intervention cost: SEK26,100 versus 9,100 per quitter. The model-estimated societal costs avoided did not balance the higher intervention costs, so the incremental cost-effectiveness ratio (ICER) amounted to SEK100,000 per QALY for HIT versus LIT. All sensitivity analyses indicated an ICER below SEK300,000 and that HIT is the preferred option if the decision maker willingness-to-pay exceeds SEK50,000 per QALY. Compared with no intervention, LIT was cost saving, whereas HIT was estimated at SEK8,400 per QALY., Conclusions: Compared with no smoking cessation program, it is a societal waste not to implement the LIT as it is estimated to result in lower societal costs. The incremental cost per QALY gained of SEK100,000 for HIT is considered very cost-effective in Sweden. Thus, if smoking cessation programs are judged in the same manner as other Swedish health care measures, the high-intensity program should be chosen before the low-cost program.

Background: Today's children spend a great deal of time viewing electronic screen material, but the consequences of such behaviors, if any, are unknown. This study sought to identify (i) the magnitude of total daily electronic screen time and (ii) the relations between electronic screen use and mental well-being indicators, in a sample of 10-12-year-old children., Methods: We analysed cross-sectional, population-based data of 10-12-year-old children from the 2007 Youth in Iceland school survey (n = 10,829, response rate: 81.7%, boys: 50.5%). Logistic regression models with odds ratios and 95% confidence intervals were conducted to assess the odds of each selected mental well-being indicator, depending on the number of daily hours spent on each electronic screen-based activity. All analyses were conducted separately for boys and girls and adjusted for family structure., Results: The prevalence of self-reported screen use of 4 hours per day or more ranges from 2.8% to 6.6% among boys and from 1.0% to 3.8% among girls. All five screen-based activities were significantly associated with all seven well-being indicators (P < 0.001) with symptoms being more common with increased time spent on screen use., Conclusions: This study is the first of its kind to demonstrate a dose-response relationship between electronic screen use and mental well-being in 10-12-year-old children. Further research is needed to assess the validity and potential implications of these findings.

This cross-sectional study assessed changes between 1999 and 2003 in attitudes among Swedish general practitioners (GPs) toward smoking cessation activities and also assessed the effect of a nationwide quitline on GPs' smoking cessation activities. A random sample of 621 Swedish GPs answered a questionnaire mailed to their home addresses in spring 2003. When possible, the results of the present study were compared with results from a similar study conducted in 1999. Main outcome measures were GPs' self-reported activities, perceived barriers to engaging in smoking cessation, and referrals to the quitline. Between 1999 and 2003, GPs increased their overall smoking cessation activities and were more aware of the complexity of smoking cessation support. Significantly more GPs experienced smoking cessation support as "too time consuming" and preferred to refer smokers to counselors specializing in smoking cessation. GPs referring patients to the quitline were more likely to be active in other smoking cessation activities. One out of five GPs had advised their patients to use oral smokeless tobacco as a means to stop smoking. A paradigm shift regarding awareness of the complexity of smoking cessation support may be ongoing amongst Swedish GPs. The nationwide smoking cessation quitline appears to have had a positive effect on GPs' engagement in smoking cessation.

Background: The aims of the present study were to assess changes between 1995 and 2001 in the prevalence of child exposure to environmental tobacco smoke (ETS), attitudes towards ETS among parents of small children and awareness among parents regarding the potential hazards of passive smoking to children., Method: A questionnaire, along with a stamped, addressed envelope, was sent to a stratified random sample of 1000 households in Norway containing children aged 3 years old at the time of the investigation (May 1995 and August 2001)., Results: The prevalence of households containing smokers was similar in the two study periods. However, households reporting exposure of children to ETS fell from 32% in 1995 to 18% in 2001. Health-risk awareness had significantly increased in households containing smokers. In both surveys, the probability of children being exposed to ETS was positively correlated with the number of parents smoking, and inversely correlated to strength of health-risk awareness, negative attitudes towards ETS and length of household education., Conclusions: Increasing parents' awareness of the health risk of ETS exposure to children may significantly reduce children's ETS exposure.

Background: Studies indicate that shortage of cessation counsellors may be a major barrier for tobacco prevention among physicians. Telephone helplines (quitlines) may be an option. The effectiveness of the Swedish quitline and factors related to abstinence from smoking 12 months after the first contact were assessed., Method: Subjects included 694 smokers calling a reactive (no contact initiated by the counsellors) and 900 smokers calling a proactive (four or five contacts initiated by the counsellors after the first call) quitline for smoking cessation. The subjects were followed up 12 months after the first call using a mailed questionnaire assessing current abstinence, stages of change and factors potentially related to abstinence rates., Results: The questionnaire was returned by 70% of the subjects. Women receiving the proactive treatment reported 34% abstinence rates compared with 27% for those receiving the reactive treatment (p=0.03). For men the abstinence rates were 27% and 28%, respectively (p=0.80). Factors significantly related to abstinence in the adjusted analysis included no nicotine use at base-line, the adjusted odds ratio with 95% confidence interval being 6.4 (2.1-19.4), additional support from a health care professional 3.5 (1.0-12.3), additional social support 3.1 (1.6-6.1), stress or depressive mood 2.7 (1.6-4.7), nicotine replacement therapy for five weeks or more 2.1 (1.1-4.0), and exposure to second-hand smoke 1.9 (1.1-3.3). The use of oral tobacco did not significantly increase current abstinence., Conclusion: Quitlines are effective as an adjunct to the health care system. For women a proactive treatment may be more effective than a reactive treatment.

The effectiveness of a short-duration presentation of the educational material 'You and Your Skin' was tested on 184 adolescents (age 13-15) at the Year 7 and 8 levels. A non-equivalent control group design was used with pre-testing and post-testing 3 months after the intervention. The intervention increased the students' knowledge of known risks factors for skin cancers. However, the students' attitudes to abstaining from sunbathing and tanning was not significantly affected. The effect of the intervention on the stage of change was primarily a progression from the precontemplation stage to the contemplation stage regarding avoiding the mid-day sun. We conclude that a brief presentation of the educational kit 'You and Your Skin' can be used to increase knowledge, but there is a need for a more extensive intervention effort to affect students' readiness to change their behavior and attitude towards sunbathing and tanning. Therefore, it is important to emphasize the necessity of using the educational kit as a multi-lesson programme with its several group exercises.

Aims: To assess attitudes towards environmental tobacco smoke (ETS) and health-risk awareness regarding the potential hazards of ETS for children among parents of young children in the Nordic countries. Also to investigate to what extent these factors are related to ETS exposure of the children., Design: A cross-sectional community-based survey using an anonymous mailed questionnaire., Participants: Parents of children aged 3 years at the time of selection from a random sample of 5500 households in the Nordic countries (Sweden, Norway, Denmark, Iceland and Finland)., Main Outcome Measures: Smoking status of parents, weekly ETS exposure of children within and outside the home, health-risk awareness and attitudes regarding the potential hazards of passive smoking., Findings: Two in three parents who smoked did not recognize the increased risk for an inner ear infection and approximately 50% were not aware of the role of parental smoking in recruiting smokers. One in two smokers tended to agree or agreed that an act should be passed which forbids all indoor smoking in the vicinity of children. After adjustment for covariates, the level of health-risk awareness about ETS was significantly related to no ETS exposure within and outside the home., Conclusion: The main findings indicate that educating parents about the established health risks of ETS for their children may significantly reduce children's exposure to ETS. An increased effort is needed to educate parents who smoke on the potential health risks of ETS for their children.

Relevant information for clinical decision-making in a wide spectrum of diseases includes the extent to which sexual function is intact, how important it is to preserve sexual capacity and whether waning sexual function causes distress. Little information is available on elderly men. We aimed to obtain this basic information. Radiumhemmet's Scale of Sexual Function was posted to 435 randomly selected men aged 50-80 years. Assessments included sexual desire, erectile capacity, orgasm and ejaculation and to what extent waning sexual function distressed the men. The questions were answered anonymously. Information was obtained from 319 men (73%). Of these, 83% stated that sex was 'very important', 'important' or a 'spice to life'. Physiological potency for men aged 50-59, 60-69 and 70-80 amounted to 97%, 76% and 51% respectively. Among the oldest men (70-80 years), 46% reported orgasm at least once a month. Over 80% of all men who reported some level of erection stated that it was of importance to them to maintain the present level of erection stiffness. Most men who reported waning sexual function (compared with their youth) stated that this distressed them. Sex is important to elderly men. Even among the 70-80-year-olds, an intact sexual desire, erection and orgasm are common and it is considered important to preserve them. Sexual function should be considered in the clinical assessment of elderly men.