Objective: Alcohol and Other Drug (AOD) disorders cause substantial harm. Effective Substance Use Treatment (SUT) exists, but long-term outcomes remain inconclusive. This study used a 20-year prospective follow-up of 1248 service users entering SUT in Stockholm, Sweden, in 2000–2002 to elaborate on how different dimensions of long-term outcomes may be measured by register-based indicators. Baseline characteristics and attrition bias were explicated, and register-based outcomes were examined.Results: Register-based indicators are valuable, but they also have inherent limitations such as the lack of substance use data and inability to differentiate between un/met treatment needs and access. Significant variations in long-term outcomes were evident depending on which register-based indicator was used, and whether used in isolation or combinations. Six out of 10 service users were still alive after 20 years, but as many as 8 out of 10 of the survivors remained in treatment, and only two out of 10 had a stable economic situation. Hence, the register indicators identified only a few survivors, with stable economic and social situations, and without recent treatment contacts 20 years after treatment entry. The long-term outcomes were concerning and even more so when combining outcome dimensions.

How are adults who have a problematic use of alcohol and/or other substances integrated into the labour market? This question is the focal point of the Nordic project on integration into the labour market of adults with dependence or abuse.

Adults with substance use problems can sometimes be far removed from the labour market. They often need individual support to help them overcome their addiction, strengthen their potential, and find their place in society and on the labour market.

This report explores the labour market integration in the Nordic countries of individuals with substance use problems (including alcohol, illicit drugs, and prescription medications). The remit covers Denmark, Finland, Greenland, Iceland, Norway, and Sweden. While labour market integration of vulnerable groups has received significant attention in the Nordic region, there is a dearth of research focusing exclusively on individuals with alcohol and substance use problems.

Purpose - Health promotion strategies often attempt to change people’s behavior through targeting their risk perceptions. These perceptions may, however, be moderated by other factors. This study therefore aimed at investigating the trustworthiness and consistency of risk information, as well as respondent perceptions of the adequacy of amount received among a representative sample of former smokers, and how this information is related to gender, age, education level and whether using nicotine or not.

Design/methodology/approach - The respondents are part of a seven-year follow-up of former smokers in Sweden. Initially, 1400 respondents were contacted, whereof 705 (response rate 50%) answered a Web-survey. The majority (85 %) was still nicotine-free but some made use of nicotine in different forms. The data analysis includes descriptive statistics and logistic regressions.

Findings - Most respondents trusted risk information whether offered by the public authorities or came from other sources such as media, and generally perceived that there was an adequate amount. However, there were some differences between the products, where quite a few distrusted information on Nicotine Replacement Therapies (NRTs) and some perceived the information on snus and NRTs as contradictory and too little.

Originality/value - Knowledge about how former smokers perceive information regarding negative aspects of cigarette use may facilitate more effective risk communication with current smokers, and it may also be important for communicating information about other nicotine products to those who are trying to or who already have quit smoking.

Statistics made available by the Swedish Migration Agency (SMA) make it possible to follow first-decision outcomes in asylum cases concerning unaccompanied children (types of residence permits granted, percentage of rejections, etc.). Yet, we know little about differences in asylum decision outcomes for unaccompanied children coming to Sweden. Therefore, we wanted to find out how gender, country of origin, and asylum reports are associated with the likelihood of being granted residency. Asylum decisions concerning unaccompanied children were first coded inductively. These codes were later merged into larger categories that were analyzed quantitatively by logistic regression analysis. The data sample consisted of one calendar year of asylum decisions issued by the SMA. Results show that fewer girls than boys were granted asylum, and in fact, girls have an overall lower prospect of being granted residency. Results also display statistically significant gender differences in reported reasons for seeking asylum.

Objective: A school tobacco policy (STP) commonly is used to reduce smoking among adolescents, but the effectiveness of such programs is unclear. We evaluated the impact of an STP on tobacco use in 4 schools.

Methods: The study included 4 intervention and 4 control schools, located in the inner city of Stockholm, Sweden. Schools self-selected for assignment to either an intervention program or a comparison group. In total, the study was comprised of 2671 students in grades 9 and 11, ages 15 to 18, and 1998 students (75%) responded to the questionnaire. We used a repeated cross-sectional design with assessment of tobacco use prevalence before implementation of the STP in 2016 and after 2 years under the program, in 2018.

Results: Two years after the STP, the intervention school in grade 9 showed a lower prevalence (13.5% vs 1.6%) in the proportion of students who reported smoking (χ2 = 4.54; p < .05) whereas the proportion reporting snus use was practically unchanged. We found no statistically significant impact of the STP for grade 11.

Conclusions: The results are promising with regard to smoking, when the STP is implemented in early adolescence.

Background: Since smoking is the leading cause of preventable death, discouraging smoking initiation, encouraging smoking cessation, and exploring factors that help individuals to stay smoke free are immensely important. One such relevant factor may be the impact of lifestyle for long-term smoking cessation.

Method: A representative sample of successful quitters was recruited for a study about smoking cessation. These respondents are now part of a 7-year follow-up with the overall aim of revealing factors affecting long-term smoking cessation. Descriptive analyses were carried out at baseline and at follow-up, as well as a further two-step cluster analysis to explore profiles of long-term smoke-free individuals.

Results: A majority did not make any particular lifestyle changes, but among those who did, most adopted a healthier lifestyle and/or increased their quota of physical training, where permanent changes in this direction seem to promote a more enduring smoke-free life.

Conclusions: Individuals who want to quit smoking should be encouraged to increase their level of physical activity. Swedish health care institutions should be able to provide support for this both initially and over time to promote the long-term maintenance of a smoke-free lifestyle.

Background: Several studies have investigated the role of snus as an aid to become smoke-free, but few have focused on who use snus, how they perceive snus use, why and how they quit, and their perception of being nonsnus users. The purpose of this paper is to describe snus cessation patterns.

Methods: Respondents are part of a 7-year follow-up of former smokers in Sweden. Initially, 1400 respondents were contacted regarding participation and 705 answered a web-based survey (response rate 50%). Out of them, 118 had used snus. The analyses include percentage distributions, as well as factor analyses of inventories, and configural frequency analysis in order to examine configurations of snus-related patterns.

Results: Over 80% found snus of great importance to succeed with smoking cessation and half of them continued to use snus on a long term. Those who experienced both physical and psychological effects of switching to snus were the ones who continued and vice versa; those who did not experience such effects quit using snus. None made use of professional help but had their own strategies (60%), and most respondents who quit obtained psychological benefits (68%).

Conclusions: The distinction between the concepts smoke-free, tobacco-free, and nicotine-free contributes to nuances in the debate on snus as harm reduction. Continued snus use does not mean that snus is not an effective aid to become smoke-free. Snus cessation is mostly mentioned in relation to advices on how to succeed, but the cessation process has rarely been described; therefore, this study expands the knowledge on this quite neglected topic and contributes to a more nuanced picture of snus cessation.

Background:

Tobacco control (TC) in Sweden is being continuously strengthened.

Aims:

The study aimed to examine attitudes towards different TC policies among former smokers, the difference between nicotine-free former smokers and those who use nicotine in the form of snus or nicotine replacement therapies (NRTs), and whether different TC strategies tend to become more acceptable over time.

Methods:

Respondents are part of a seven-year follow-up of former smokers in Sweden. Initially, 1400 respondents were contacted regarding participation and 705 answered a survey (response rate 50%). The present study used cross-sectional data on attitudes towards different TC policies and respondent’s level of support were measured on a 4-point scale. Analyses consist of percentage distribution of level of agreement, in total and between nicotine-free individuals and users of nicotine in the form of snus or NRTs, as well as logistic regressions in order to predict the odds for supporting the different policies. In addition, a percentage distribution of support for different policies introduced during different time-periods is shown.

Results:

There is an overall support for smoke-free environments. Nicotine users are, however, overall slightly more opposed, especially to policies aiming at denormalising smoking. Public support is important for successful implementation but resistance can pass, and interventions tend to become more acceptable over time.

Conclusion:

While smoke-free indoor environments can be justified by scientific evidence of harm to others, bans against smoking outdoors might be experienced as intrusive. Policies need to rest on scientific arguments and be seen as appropriate actions, underlining the importance of information for successful implementations.

Aim: Previous research has concluded that the prevalence of smoking, as well as reasons to quit and strategies to become smoke-free, varies markedly by gender.  However, we lack a more comprehensive understanding of the process that leads to a quit attempt and a positive long-term outcome, and also the gender specific mechanism behind a successful cessation. The aim is therefore to investigate motives for, mechanism in, and factors behind smoking cessation, with special regard to gender differences.

Data/Method: During Oct 2009- May 2010 respondents were recruited via the so-called Monitor-project. By the turn of each month 1,500 individuals, aged 16-80, from a representative sample in the Swedish population (n=12 000) were interviewed via telephone. Via a screening process those who stated being previous daily smokers, but smoke-free for at last 12 months, were asked to answer a postal survey (n=1 683) concerning their process to a smoke-free life. The analyses consist of both descriptive statistics and factor analyses.

Results: The results indicate that women’s smoking filled several functions in life, that they often quit for the sake of others, and that the cessation process was quite complex. Men tended to experience smoking as quite unproblematic and often quit out of more self-oriented reasons. Moreover, even though a majority quit smoking without any professional help or other means the use among those who did was clearly gendered.

Conclusions: Gender differences were found in reasons to smoke, reasons to quit, and strategies to quit smoking why cessation strategies should be gender sensitive, taking special needs into account.