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J Adolesc Health. 2005 Sep;37(3):224-8.

Knowledge about tobacco and subsequent use of cigarettes and smokeless tobacco among Swedish adolescents.

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Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.



To investigate whether knowledge of the risks and properties of tobacco among adolescents influences their future use of cigarettes and smokeless tobacco in different directions.


A prospective cohort study of 2581 adolescents whose knowledge of tobacco was assessed in the sixth grade by means of a multi-item scale. Tobacco use was assessed by annual surveys up to the ninth grade.


Knowledge level was not associated with future use. Items dealing with addictive properties of nicotine were prospectively associated with smokeless tobacco ("snus") use only.


A high level of knowledge of the risks associated with tobacco is not a predictor of future nonuse or of a shift to smokeless tobacco rather than cigarettes. Attitudes and expectations may determine knowledge rather than vice versa.

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