Investigating current and temporal variation in municipal youth smoking rates in the Netherlands: A multivariable
Sophie J A Jooren1,2, Jeroen Bommelé2, Ben Wijnen3
1Department of Health Promotion, School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
Introduction:
Variations in smoking prevalence rates exist across different regions. While most research tends to study demographic, cultural or social determinants of smoking, few studies have looked into whether municipal-level variables are associated with smoking rates, especially among the younger population. We examined which municipal-level factors explain differences in youth smoking rates in the Netherlands.
Methods:
We conducted linear regression analyses to examine municipal-level smoking behavior among the population aged 12-16 years. Main outcomes were the proportion of youth within municipalities that had ever smoked or weekly smoked in 2021, and trend differences in ever smoking and weekly smoking between 2015 and 2021. Independent variables were population density, level of urban density, proportion of people with a migration background, proportion of elderly residents, and proportion of adults with a low level of education. We examined municipalities' involvement in the Smoke-free Generation campaign, their tobacco control policies, the number of smoke-free outdoor areas implemented, and their self-assessed tobacco control scores.
Results:
Dutch municipalities show great variation in smoking prevalence (2021: ever smoking 3.0-21.8% and weekly smoking 1.4-11.1%). Smoking has decreased in almost all municipalities in recent years; 108 of the 113 municipalities had a decrease in ever smoking, while 89 of the 100 municipalities showed a decrease in weekly smoking prevalence. Municipalities with a higher proportion of individuals with a migration background had lower ever (β= -0.08, p=0.021) and weekly (β= -0.06, p=0.013) youth smoking prevalence rates in 2021.
Conclusions:
Considering that municipality-specific variables were not associated with levels of youth smoking prevalence, the question remains why some municipalities have much higher smoking rates than others, after having been exposed to the same national level tobacco control policy measures.
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