Use and Determinants of Various Types of Tobacco Products: Study Among Finnish and Sudanese Adolescents and Young Adults

Salma El Amin

Research output: Book/ReportDoctoral thesisCollection of Articles


Tobacco use remains one of the most serious health hazards worldwide. As developed nations take measures to reduce tobacco use, the populations of developing nations are at increased risk of targeting by tobacco companies. Youth are a highly vulnerable target audience and are susceptible to being attracted to a variety of tobacco-containing products. Extensive research has focused on understanding the causes, health impacts, and remedies related to the smoking of cigarettes by young people. Much less attention has been given to other types of tobacco products. The main aim of this study was to investigate the determinants and the use of five different kinds of tobacco products among adolescents and university age students. The study, comprised of four discrete research sub-studies, examined young people from the Sudan and Finland at various points in time. The framework applied to examine the influences on individual behaviour regarding tobacco use is organized from the perspective of family factors to community norms to societal policies. Three data sets were used in the four research sub-studies: the first two Sudanese data sets were drawn from the Sudanese Youth Tobacco Survey (SYTS) and the Sudanese Health Professional Student Survey (SHPSS). The third Finnish data set was drawn from the Adolescent Health and Lifestyle Survey (AHLS) and the Finnish registration system. Basic and advanced analyses were performed, including logistic regression models, Mediation and multi-level analyses using different methodologies and software.

The main findings highlight the importance of the influences of tobacco use by parents, maternal and paternal grandparents, friends, and teachers on the use of cigarettes, water-pipe, tombak, snus, and electronic cigarettes by adolescents. This study revealed that parents’ smoking and their use of tombak and snus were strong influences on the adolescents’ tobacco use, with a higher risk of smoking initiation among both the Sudanese and Finnish adolescents. The conclusions emerging from this study are that parents’ tobacco use is a key factor on youth smoking, and that the likelihood of youth smoking is significantly increased when both parents smoke, with more effect of the mother. In addition, the Finnish grandparents’ smoking was found to be transmitted directly and indirectly to their grandchildren and influences them to smoke and to use other kinds of tobacco products as well as vaping. This study also highlights the effects of exposure to residential smoking and school smoking policies on the tobacco use by young adult university-level students. The findings point to the pivotal role of the school environment, including the role of teachers’ use of tobacco on students’ tobacco use in general together with smoking on school premises.

From contextual evidence and findings, the results of the study provide information for decision-makers and health providers to create effective policies and programs and to adapt prevention strategies for different kinds of tobacco products, particularly those targeted at youth and adolescents. More effective interventions at home and at school, with stricter policy actions and enforcement, are needed, to stop youth use of cigarettes and e-cigarettes, as well as to prevent or stop use of snus and tombak dipping, in order to reach the objective of a society free of tobacco and its harmful health effects.
Original languageEnglish
Place of PublicationTampere
PublisherTampere University
ISBN (Electronic)978-952-03-1920-5
ISBN (Print)978-952-03-1919-9
Publication statusPublished - 2021
Publication typeG5 Doctoral dissertation (articles)

Publication series

NameTampere University Dissertations - Tampereen yliopiston väitöskirjat
ISSN (Print)2489-9860
ISSN (Electronic)2490-0028


  • conflicts
  • experiences
  • institutional arrangements
  • institutionalization
  • public services
  • service ecosystems
  • systemic change


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