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BackgroundMonolingual Web survey is a common tool for studying adolescent health. However, national languages may cause difficulties for some immigrant-origin youths, which lower their participation rate. In national surveys, the number of ethnic minority groups is often too small to assess their well-being. ObjectiveWe studied the feasibility of a multilingual Web survey targeted at immigrant-origin youths by selection of response language, and compared participation in different language groups with a monolingual survey. MethodsThe Adolescent Health and Lifestyle Survey (AHLS), Finland, with national languages (Finnish/Swedish) was modified into a multilingual Web survey targeted at a representative sample of 14- and 16-year olds (N=639) whose registry-based mother tongue was other than the national languages. The survey was conducted in 2010 (16-year olds) and 2011 (14-year olds). The response rate of the multilingual survey in 2011 is compared with the AHLS of 2011. We also describe the translation process and the e-form modification. ResultsOf the respondents, 57.6% answered in Finnish, whereas the remaining 42.4% used their mother tongue (P=.002). A majority of youth speaking Somali, Middle Eastern, Albanian, and Southeast Asian languages chose Finnish. The overall response rate was 48.7% with some nonsignificant variation between the language groups. The response rate in the multilingual Web survey was higher (51.6%, 163/316) than the survey with national languages (46.5%, 40/86) in the same age group; however, the difference was not significant (P=.47). The adolescents who had lived in Finland for 5 years or less (58.0%, 102/176) had a higher response rate than those having lived in Finland for more than 5 years (45.1%, 209/463; P=.005). Respondents and nonrespondents did not differ according to place of birth (Finland/other) or residential area (capital city area/other). The difference in the response rates of girls and boys was nearly significant (P=.06). Girls of the Somali and Middle Eastern language groups were underrepresented among the respondents. ConclusionsA multilingual Web survey is a feasible method for gathering data from ethnic youth, although it does not necessarily yield a higher response rate than a monolingual survey. The respondents answered more often in the official language of the host country than their mother tongue. The varying response rates by time of residence, ethnicity, and gender pose challenges for developing tempting surveys for youth.

IntroductionFinland's success in achieving the goal of its tobacco endgame largely depends on rectifying deficiencies in the delivery of smoking cessation services. One such weakness, which has not been documented with empirical data, is misuse of nicotine replacement therapy (NRT). This study's objective was to examine purchase patterns of NRT for estimating improper use of the medication. The study was based on the assumption that duration of a purchase episode is indicative of either proper use or misuse of NRT.MethodsThe participants (n=728), who purchased at least one NRT product in 2016 (mostly gum/lozenge), were selected through enrollment in a large customer loyalty program in Finland (LoCard). Participants were categorized into one of five groups according to their longest purchase episode of NRT, defined by purchases made in consecutive, 4-week intervals.ResultsMost participants, who did not adhere to NRT guidelines, either purchased the medication for too short (≤4 weeks, 63.5%) or too long (>24 weeks, 13.2%) of a purchase episode. Median purchases of NRT in the first month of use were one and four in the former and latter, respectively. In contrast to other groups, persistent users (>24 weeks) did not curtail purchases of NRT across several 4-week intervals, suggesting potential for dependence on NRT.ConclusionsThe observation that most purchase episodes were terminated prematurely is consistent with surveys reporting widespread NRT misuse. Given uncertainty of greater regulation of NRT sales through legislation, it would be prudent for Finnish retailers to promote proper use of the therapy.

BACKGROUND: The origin of inequalities in health outcomes has been explained by health selection and social causation models. Health selection processes operate particularly at school age. We study, if student allocation to teaching groups with aptitude tests (selective vs general class) differentiates adolescents by health behaviors and mental health. METHODS: Finnish schoolchildren 12‐13 years from 12 selective classes, n = 248; 41 general classes, n = 703 answered a questionnaire on addictive products (tobacco, snus, alcohol, and energy drinks), digital media use, and mental health (health complaints, anxiety, and depression). Structural equation modeling was conducted to identify structures between outcomes, SEP (socioeconomic position), class type, and academic performance. RESULTS: Students in the selective classes reported less addictive digital media and addictive products use than students in the general classes. Differences in academic performance or SEP between the class types did not solely explain these differences. Mental health was not related to the class type. SEP was indirectly associated with health behaviors via the class type and academic performance. CONCLUSIONS: Selecting students to permanent teaching groups with aptitude tests differentiates students according to risky health behaviors. The impact of education policies using student grouping should also be evaluated in terms of students' health. [ABSTRACT FROM AUTHOR]

Continual conduct problems from adolescence to adulthood comprise a societal concern. Knowledge of school-related triggers and contributors to persistent conduct problems is important but still limited. We explored the role of schoolwork difficulties and being bullied by peers at school in the development of conduct problems, controlling for vulnerability factors of low cognitive competence and low prosociality. The data covered two measuring points on a longitudinal cohort of Finnish students between the ages of 16 and 18 (N = 5,108). All measures were self-reported. The regression and moderation modeling were executed using Bayesian estimation. Among 18-year-old adolescents, 14% of conduct problems were explained by conduct problems at the age of 16. Schoolwork difficulties had a direct positive effect on later conduct problems. Being bullied moderated effects of low cognitive competence and earlier conduct problems on later conduct problems. The findings show that we should also focus on school when risk factors for continuity of adolescents' conduct problems are sought out.

Background: We studied school-level differences in academic achievement and well-being from 2002 to 2010 in the Helsinki Metropolitan Area, as well as the connection between academic achievement, well-being, and socioeconomic composition. Methods: The School Health Promotion Study covered 109 schools and 78% of schoolchildren (N = 100,413; aged 14 to 16 years). Depression was measured with the modified Beck Depression Scale and academic achievement with the grade-point average. Trajectory analysis identified groups of schools that were as heterogeneous over time as possible. Results: Six school trajectories differing in academic achievement and 3 in well-being were observed. Differences between the trajectories persisted over time. Academic achievement and well-being were related: schools on a poor achievement trajectory were more often on a low-well-being trajectory. The poor socioeconomic composition of students was more common in low-academic achievement and well-being trajectories. Conclusions: Academic achievement and well-being differed between schools and are closely related to each other and to the school's socioeconomic composition. Differences between the schools did not increase over time. Educational policies aimed at reducing differences should address both academic achievement and well-being.

The aim of this longitudinal study among 9223 students from grade 7 and grade 9 (age 13-14 and 15-16) was to assess whether immigrant status and gender are associated with the level and change (slope) in school burnout among lower secondary school students in the Helsinki metropolitan area. Ninety-seven percent of the variation in school burnout was attributable to individual factors. Both the intercept (2.3, p < 0.001) and slope (0.5, p < 0.001) of school burnout were statistically significant. The slope showed increasing school burnout from grades 7-9. School burnout increased more in girls than in boys. Initially apparent higher school burnout among students who had immigrated to Finland within the last five years compared to Finnish native students was largely accounted for by sociodemographic and school-related factors. However, there was a persistent gender by immigrant status difference in the fully adjusted model: recently (< 5 years ago) immigrated boys experienced a larger increase in school burnout, especially due to increased cynicism, than recently immigrated girls.

Background: Studies have shown a relationship between students' health and their academic achievements, but whether health of classmates and schoolmates impacts individual students' school achievement is less known. We studied these effects on students in lower secondary school in Finland. Methods: Students (seventh grade, age 12-13 years, N = 7779, 123 schools, 565 classes) participated in a classroom survey measuring health (externalizing and internalizing problems, daily health complaints, and long-term illness) and academic achievement. Academic achievement when leaving school (15-16 years) was obtained from the Finnish national application register on upper secondary education. Three-level (student, class, and school) multilevel regression analyses were executed. Results: All health variables predicted academic achievement at leaving school at the student level and externalizing and internalizing problems at the class level; better health predicted better achievement. Students' health at the school level was not related to academic achievement. The effect of class-level health on academic achievement was as strong as the effect of student-level health. Conclusion: Both student and classmates' health at the beginning of lower secondary school contribute to academic achievement when leaving school.

Engaging parents in school health examinations can promote adolescents' well-being. We examined parents' participation in universal school health examinations in Finland reported by adolescents in school surveys (14 to 16-year-olds, N = 58,232). Further we studied variation between service providers and schools, and student and school-level factors in participation. National data were analyzed using multilevel logistic regression models. Less than half of the adolescents reported parents' participation. The variation between service providers and schools was large. Non-participation was associated with mother's low education, students' immigrant background, daily health complaints, heavy drinking, and discussion difficulties with parents. Boys and those who did not live with both mother and father had a higher risk for parents' non-participation. Adolescents with a long-term illness or being bullied reported participation more often. Inviting parents and the school health nurse resource were not associated with participation. Our results raise the question of barriers to participation in health examinations. [ABSTRACT FROM AUTHOR]

Aims: Europe's Beating Cancer Plan set a goal of creating a Tobacco-Free Generation in Europe by 2040. Prevention is important for achieving this goal. We compare the Nordic countries' preventive tobacco policies, discuss the possible determinants for similarities and differences in policy implementation, and provide strategies for strengthening tobacco prevention. Methods: We used the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) to identify the key policies for this narrative review. We focused on Articles 6, 8, 9, 11, 13 and 16 of the WHO FCTC, and assessed the status of the required (core) and recommended (advanced) policies and their application to novel tobacco and nicotine products. Information on the implementation of strategies, acts and regulations were searched from global and national tobacco control databases, websites and scientific articles via PubMed and MEDLINE. Results: The WHO FCTC and European regulations have ensured that the core policies are mostly in place, but also contributed to the shared deficiencies that are seen especially in the regulations on smokeless tobacco and novel products. Strong national tobacco control actors have facilitated countries to implement some advanced policies – even as the first countries in the world: point-of-sale display bans (Iceland), outdoor smoking bans (Sweden), flavour bans on electronic cigarettes (Finland), plain packaging (Norway), and plain packaging on electronic cigarettes (Denmark). Conclusions: Collaboration and participation in reinforcing the European regulations, resources for national networking between tobacco control actors, and national regulations to provide protection from the tobacco industry's interference are needed to strengthen comprehensive implementation of tobacco policies in the Nordic countries. [ABSTRACT FROM AUTHOR]

Finnish national data sets on schools (N = 496) and pupils (N = 74,143; 14-16 years) were used to study whether a systematic documenting policy for the violations of school smoking bans was associated with pupils' smoking and their perceptions on the enforcement of smoking bans. Attending a school with a systematic documenting policy was associated with perceptions that smoking is prohibited and restrictions monitored, with lower levels of smoking in the vicinity of the school during the school day, but not with smoking prevalence. Findings suggest that a consistent documenting policy could be an effective tool for reducing pupils' smoking in schools.