| Summary: | Introduction
High rates of smoking among adolescents remain a public health
concern. This study investigates smoking behavior and use of smokeless tobacco
among Danish high-school students and assesses how smoking and use of smokeless
tobacco cluster in schools and school classes. We estimate the trend in cigarette
smoking from 1997 to 2014.
Methods
We used data on 70 243 students, from 3 214 school classes in 119 high
schools, who participated in the Danish National Youth Study from 2014. We had
information on 87% of all Danish high schools and 85% of eligible students. We
also used data from 1997 on 26 644 high-school students from a similar data set to assess the chronological trend in smoking. We calculated prevalences and intraclass correlation coefficients (ICCs) to estimate between-school and between-school class clustering in smoking and use of smokeless tobacco.
Results
In all, 14% of boys and 11% of girls were daily smokers. A large fraction of the
variation in smoking and the use of smokeless tobacco was attributable to the school
and school-class level (ICC of 0.19, 0.12, 0.16 and 0.27, for daily smoking, waterpipe
smoking, use of electronic cigarettes and snuff/chewing tobacco, respectively). Daily
smoking decreased from 15% in 1997 to 12% in 2014, while more students were
occasional smokers in 2014 than in 1997 (30% vs 18%).
Conclusions
The prevalence of smoking was high among Danish high-school students
and had changed little since 1997. The school and class environment accounted for a
large part of the variation in smoking behavior.
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