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Introduction While evaluations of indoor smoke-free legislation have demonstrated major public health benefits among adults, their impact on the smoking behavior of young people remains unclear. Therefore, we performed a systematic review of the association between smoke-free legislation in hospitality venues and smoking behavior of young people. Aims and Methods A systematic search was conducted in PubMed, Scopus, and Embase in June 2020. We searched for studies that assessed the association of any form of smoke-free legislation in any hospitality venue (eg, bar and restaurant) with a smoking behavior outcome (eg, initiation and current smoking) among young people (aged 10–24 years). . Results Our search yielded 572 articles of which 31 were screened based on full-text and 9 were included in the analysis. All studies were published between 2005 and 2016. The majority of studies used a quasi-experimental design. Four studies evaluated smoke-free legislation in hospitality venues specifically. Two studies reported that comprehensive, but not weaker, smoke-free legislation decreases progression to established smoking. Two other studies provided mixed results on which level of comprehensiveness of legislation would be effective, and which smoking outcomes would be affected. Five studies evaluated legislation that also included other workplaces. Out of these five studies, three studies found significant decreases in current smoking, smoking frequency, and/or smoking quantity, whereas two other studies did not. Conclusions Most of the studies found that smoke-free legislation in hospitality venues is associated with a decrease in smoking behavior among young people. Their results indicate the need for comprehensive smoke-free legislation without exemptions. Implications This is the first systematic review to provide insight into the relationship between smoke-free legislation in hospitality venues and smoking behavior of young people. Our findings show that there is a need for comprehensive smoke-free legislation without exemptions (such as designated smoking areas).

Children have the right to grow up free from the hazards associated with tobacco smoking. Tobacco smoke exposure can have detrimental effects on children’s health and development, from before birth and beyond. As a result of effective tobacco control policies, European smoking rates are steadily decreasing among adults, as is the proportion of adolescents taking up smoking. Substantial variation however exists between countries, both in terms of smoking rates and regarding implementation, comprehensiveness and enforcement of policies to address smoking and second-hand smoke exposure. This is important because comprehensive tobacco control policies such as smoke-free legislation and tobacco taxation have extensively been shown to carry clear health benefits for both adults and children. Additional policies such as increasing the legal age to buy tobacco, reducing the number of outlets selling tobacco, banning tobacco display and advertising at the point-of-sale, and introducing plain packaging for tobacco products can help reduce smoking initiation by youth. At societal level, health professionals can play an important role in advocating for stronger policy measures, whereas they also clearly have a duty to address smoking and tobacco smoke exposure at the patient level. This includes providing cessation advise and referring to effective cessation services.Conclusion: Framing of tobacco exposure as a child right’s issue and of comprehensive tobacco control as a tool to work towards the ultimate goal of reaching a tobacco-free generation can help accelerate European progress to curb the tobacco epidemic. What is Known:• Tobacco exposure is associated with a range of adverse health effects among babies and children.• Comprehensive tobacco control policies helped bring down smoking rates in Europe and benefit child health. What is New:• Protecting the rights and health of children provides a strong starting point for tobacco control advocacy.• The tobacco-free generation concept helps policy-makers set clear goals for protecting future generations from tobacco-associated harms.

BACKGROUND: Studies are needed to understand the association between self-reported home smoking bans and objective measures of in-home smoking according to smokers’ ethnicity/nativity. METHODS: Data came from a trial that used air particle monitors to reduce children’s secondhand smoke exposure in smokers’ households (N = 251). Linear regressions modeled (a) full home smoking bans by ethnicity/nativity, and (b) objectively measured in-home smoking events, predicted by main and interaction effects of self-reported home smoking bans and ethnicity/nativity. RESULTS: Among smokers reporting < a full ban, U.S.-born and foreign-born Latinos had fewer in-home smoking events than US-born Whites (p

Smoking among adolescent is prevalent and significant public health issue associated with premature death. Family has a vital role in smoking prevention and quit smoking; however, parents frequentl...

The question of whether e‑cigarettes are a useful tool for smoking cessation is part of an ongoing and highly controversial scientific debate. In practice, however, the number of people trying to quit tobacco consumption by using these products is steadily increasing. This discussion article provides an outline of the current state of research on the issue of whether and to what extent e‑cigarettes can help people quit smoking.Of course, e‑cigarettes also have a certain potential for harm, especially if nicotine dependence is unnecessarily prolonged. Nevertheless, it can make an important contribution to harm reduction in nicotine consumption. Hence, the product should get treated as a serious alternative to nicotine replacement therapies (NRTs) in the scientific discussion. Like NRTs, e‑cigarettes offer a less harmful way of consuming nicotine that greatly reduces many of the health risks associated with tobacco consumption, such as the absorption of carcinogenic substances. Recent studies and reviews suggest that the product can be at least as effective as nicotine replacement therapies in helping people quit smoking. Individual studies even demonstrate the increased effectiveness of e‑cigarettes in supporting smoking cessation.Nevertheless, the review of the current literature shows that more high-quality research is needed to further understand the product and its properties. In terms of the harm reduction approach, however, it would already be more appropriate to also rely on e‑cigarettes instead of trying to force immediate and complete nicotine abstinence. After all, in the process of quitting smoking, the fastest possible cessation of the more unhealthy consumption of tobacco should be prioritized in order to immediately minimize unnecessary health risks.Ob E‑Zigaretten ein nützliches Werkzeug zur Rauchentwöhnung sind, ist in der Wissenschaft bis heute hoch umstritten. In der Realität steigen aber kontinuierlich die Zahlen derer, die mithilfe dieses Produktes versuchen, sich den Tabakkonsum abzugewöhnen. Dieser Diskussionsbeitrag gibt einen Überblick über die aktuelle Forschung zur Frage, ob und inwiefern E‑Zigaretten tatsächlich beim Rauchausstieg helfen können.Zwar besitzt die E‑Zigarette auch ein gewisses Schadenspotenzial, insbesondere dann, wenn der Nikotinkonsum unnötig verlängert wird. Dennoch kann sie einen wichtigen Beitrag zur Schadensminimierung bei einer Nikotinabhängigkeit leisten. Daher sollte das Produkt auch in der wissenschaftlichen Diskussion als eine ernsthafte Alternative zu Nikotinersatztherapien (NET) behandelt werden. Denn die E‑Zigarette bietet eine weniger schädliche Aufnahmeform für Nikotin an, die viele gesundheitliche Risiken des Tabakkonsums wie die Aufnahme karzinogener Stoffe stark reduziert. Aktuelle Studien und Übersichtsarbeiten deuten darauf hin, dass das Produkt mindestens genauso effektiv helfen kann wie NET. Einzelne Studien weisen sogar eine erhöhte Effektivität der E‑Zigarette bei der Unterstützung eines Rauchausstiegs nach.Nichtsdestotrotz zeigt die Beschäftigung mit der aktuellen Literatur, dass weitere hochwertige Forschung notwendig ist, um das Produkt und seine Eigenschaften noch besser zu verstehen. Im Sinne des Ansatzes der Harm Reduction (Schadensminderung) wäre es allerdings schon heute vernünftiger, auch auf die E‑Zigarette zu setzen, anstatt die sofortige und vollständige Nikotinabstinenz erzwingen zu wollen. Denn beim Prozess des Rauchausstiegs ist eine schnellstmögliche Beendigung des stärker gesundheitsschädlichen Konsums von Tabak zu priorisieren, um unnötige gesundheitliche Risiken umgehend zu minimieren.

Background Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol formed by heating an e‐liquid. Some people who smoke use ECs to stop or reduce smoking, but some organizations, advocacy groups and policymakers have discouraged this, citing lack of evidence of efficacy and safety. People who smoke, healthcare providers and regulators want to know if ECs can help people quit and if they are safe to use for this purpose. This is an update conducted as part of a living systematic review. Objectives To examine the effectiveness, tolerability, and safety of using electronic cigarettes (ECs) to help people who smoke tobacco achieve long‐term smoking abstinence. Search methods We searched the Cochrane Tobacco Addiction Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO to 1 May 2021, and reference‐checked and contacted study authors. We screened abstracts from the Society for Research on Nicotine and Tobacco (SRNT) 2021 Annual Meeting. Selection criteria We included randomized controlled trials (RCTs) and randomized cross‐over trials, in which people who smoke were randomized to an EC or control condition. We also included uncontrolled intervention studies in which all participants received an EC intervention. Studies had to report abstinence from cigarettes at six months or longer or data on safety markers at one week or longer, or both. Data collection and analysis We followed standard Cochrane methods for screening and data extraction. Our primary outcome measures were abstinence from smoking after at least six months follow‐up, adverse events (AEs), and serious adverse events (SAEs). Secondary outcomes included the proportion of people still using study product (EC or pharmacotherapy) at six or more months after randomization or starting EC use, changes in carbon monoxide (CO), blood pressure (BP), heart rate, arterial oxygen saturation, lung function, and levels of carcinogens or toxicants or both. We used a fixed‐effect Mantel‐Haenszel model to calculate risk ratios (RRs) with a 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, we calculated mean differences. Where appropriate, we pooled data in meta‐analyses. Main results We included 61 completed studies, representing 16,759 participants, of which 34 were RCTs. Five of the 61 included studies were new to this review update. Of the included studies, we rated seven (all contributing to our main comparisons) at low risk of bias overall, 42 at high risk overall (including all non‐randomized studies), and the remainder at unclear risk. There was moderate‐certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine EC than in those randomized to nicotine replacement therapy (NRT) (risk ratio (RR) 1.53, 95% confidence interval (CI) 1.21 to 1.93; I2 = 0%; 4 studies, 1924 participants). In absolute terms, this might translate to an additional three quitters per 100 (95% CI 1 to 6). There was low‐certainty evidence (limited by very serious imprecision) that the rate of occurrence of AEs was similar (RR 0.98, 95% CI 0.80 to 1.19; I2 = 0%; 2 studies, 485 participants). SAEs were rare, but there was insufficient evidence to determine whether rates differed between groups due to very serious imprecision (RR 1.44, 95% CI 0.94 to 2.19: I2 = 0; 3 studies, 1183 participants). There was moderate‐certainty evidence, again limited by imprecision, that quit rates were higher in people randomized to nicotine EC than to non‐nicotine EC (RR 1.94, 95% CI 1.21 to 3.13; I2 = 0%; 5 studies, 1447 participants). In absolute terms, this might lead to an additional seven quitters per 100 (95% CI 2 to 16). There was moderate‐certainty evidence of no difference in the rate of AEs between these groups (RR 1.01, 95% CI 0.91 to 1.11; I2 = 0%; 3 studies, 601 participants). There was insufficient evidence to determine whether rates of SAEs differed between groups, due to very serious imprecision (RR 0.95, 95% CI 0.52 to 1.72; I2 = 0; 6 studies, 1033 participants). Compared to behavioural support only/no support, quit rates were higher for participants randomized to nicotine EC (RR 2.61, 95% CI 1.44 to 4.74; I2 = 0%; 6 studies, 2886 participants). In absolute terms this represents an additional six quitters per 100 (95% CI 2 to 15). However, this finding was of very low certainty, due to issues with imprecision and risk of bias. There was some evidence that non‐serious AEs were more common in people randomized to nicotine EC (RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%, low certainty; 4 studies, 765 participants), and again, insufficient evidence to determine whether rates of SAEs differed between groups (RR 1.51, 95% CI 0.70 to 3.24; I2 = 0%; 7 studies, 1303 participants). Data from non‐randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended to dissipate with continued use. Very few studies reported data on other outcomes or comparisons, hence evidence for these is limited, with CIs often encompassing clinically significant harm and benefit. Authors' conclusions There is moderate‐certainty evidence that ECs with nicotine increase quit rates compared to NRT and compared to ECs without nicotine. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain. More studies are needed to confirm the effect size. Confidence intervals were for the most part wide for data on AEs, SAEs and other safety markers, with no difference in AEs between nicotine and non‐nicotine ECs. Overall incidence of SAEs was low across all study arms. We did not detect evidence of harm from nicotine EC, but longest follow‐up was two years and the number of studies was small. The main limitation of the evidence base remains imprecision due to the small number of RCTs, often with low event rates, but further RCTs are underway. To ensure the review continues to provide up‐to‐date information to decision‐makers, this review is now a living systematic review. We run searches monthly, with the review updated when relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status.

Background/Objectives Smoking is the leading risk factor for many chronic diseases. The quantitative analysis of potential health gains from reduced smoking is important for establishing priorities in Mongolia’s health policy. This study quantifies the effect of tobacco-tax increases on future smoking prevalence and the associated smoking-related burden of disease in Mongolia. Methods The dynamic model for health impact assessment (DYNAMO-HIA) tool was used. The most recent data were used as input for evaluating tobacco-taxation scenarios. Demographic data were taken from the Mongolian Statistical Information Services. Smoking data came from a representative population-based STEPS survey, and smoking-related disease data were obtained from the health-information database of Mongolia’s National Health Center. Simulation was used to evaluate various levels of one-time price increases on tobacco products (25% and 75%) in Mongolia. Conservative interpretation suggests that the population will eventually adjust to the higher tobacco price and return to baseline smoking behaviors. Results Over a three-year period, smoking prevalence would be reduced by 1.2% points, corresponding to almost 40 thousand smokers at the population level for a price increase of 75%, compared to the baseline scenario. Projected health benefits of this scenario suggest that more than 137 thousand quality adjusted of life years would be gained by avoiding smoking-related diseases within a population of three million over a 30-year period. Discussion Prevention through effective tobacco-control policy could yield considerable gains in population health in Mongolia. Compared to current policy, tax increases must be higher to have a significant effect on population health. Implications Tobacco taxation is an effective policy for reducing the harm of tobacco smoking, while benefiting population health in countries where the tobacco epidemic is still in an early stage. Smoking prevalence and smoking behaviors in these countries differ from those in Western countries. Reducing the uptake of smoking among young people could be a particularly worthwhile benefit of tobacco-tax increases.

Objectives: Tobacco control in Indonesia is very lenient compared to international standards. This study explored the perspectives of tobacco control stakeholders (TCSs) on the likelihood of advancing tobacco marketing regulation in Indonesia.Methods: Data were collected from TCSs who were members of the Indonesia Tobacco Control Network group in a modified Delphi study. We collected the data in 2 waves using a questionnaire that comprised a set of closed and open-ended questions. For this paper, we analysed 2 of the 3 sections of the questionnaire: (1) tobacco advertising, promotions, and sponsorship (TAPS) bans, and (2) marketing and retailing regulations. We conducted a descriptive analysis of the scores using Stata/IC.13 and summarised the comments for each item.Results: The TCSs viewed the measures/strategies across all aspects of TAPS and tobacco marketing regulation as highly desirable, but provided varied responses on their feasibility. They rated political feasibility lower than technical feasibility for most measures. Advancing TAPS measures and prohibition of selling to minors were considered more attainable by sub-national governments, while prohibition of tobacco corporate social responsibility was considered as the least feasible measure in the next 5 years.Conclusions: Despite little optimism for substantial national-level change, there is a positive expectation that sub-national governments will strengthen their tobacco control regulation. It is paramount that the government reduce tobacco industry leverage by implementing Article 5.3 of the World Health Organization Framework Convention on Tobacco Control. Extending advocacy networks beyond tobacco control groups and framing tobacco control more effectively are necessary steps.

The aim of this descriptive and cross-sectional study was to evaluate smoking characteristics and smoking cessation behaviors among smoking coal miners according to the Health Belief Model (HBM). The population of this cross sectional study consisted of 582 coal miners, while the sample consisted of 473 miners who agreed to participate in the study. The miners working above ground obtained significantly higher scores compared to those who worked underground (p = 0.027). There was a significant positive correlation between smoking costs and perceived susceptibility (p

Tobacco use still represents a major threat to global public health and this calls for extensive efforts to control tobacco products and advocate harm-reduction policies. Recent global trends of prevalence rates in smoking are promising, as trajectories show a decline in all World Health Organization regions. Yet, this decline varies significantly at the national level. Jordan, as a country in the Eastern Mediterranean Region, has been in a long battle against tobacco. Despite that, the country is found to have one of the highest prevalence rates of tobacco use in the region and the world. Many challenges slow down effective and successful anti-tobacco policy implementation in Jordan, most notably cultural influences on smoking and the interference of the tobacco industry in tobacco policy making. Decision makers in Jordan should consider strengthening of anti-tobacco measures to avoid a public health catastrophe if tobacco use keeps rising at the current pace.

Summary Background Universally, smoking cessation rates among established smokers are poor. Preventing young people from starting use of and becoming addicted to tobacco products remains a key strategy to end the tobacco epidemic. Previous country-specific studies have found that initiation of smoking tobacco use occurs predominantly among young people and have found mixed progress in reducing the prevalence of smoking tobacco use among young people. Current and comparable estimates for all countries are needed to inform targeted interventions and policies. Methods We modelled two indicators: prevalence of current smoking tobacco use among young adults aged 15–24 years, and the age at which current smokers aged 20–54 years in 2019 began smoking regularly. We synthesised data from 3625 nationally representative surveys on prevalence of smoking and 254 on age at initiation. We used spatiotemporal Gaussian process regression to produce estimates of the prevalence of smoking and age of initiation by sex, for 204 countries and territories for each year between 1990 and 2019. Findings Globally in 2019, an estimated 155 million (95% uncertainty interval 150–160) individuals aged 15–24 years were tobacco smokers, with a prevalence of 20·1% (19·4–20·8) among males and 4·95% (4·64–5·29) among females. We estimated that 82·6% (82·1–83·1) of current smokers initiated between ages 14 and 25 years, and that 18·5% (17·7–19·3) of smokers began smoking regularly by age 15 years. Although some countries have made substantial progress in reducing the prevalence of smoking tobacco use among young people, prevalence in 2019 still exceeds 20% among males aged 15–24 years in 120 countries and among females aged 15–24 years in 43 countries. Interpretation The fact that most smokers start smoking regularly before age 20 years highlights the unique window of opportunity to target prevention efforts among young people and save millions of lives and avert health-care costs in the future. Countries can substantially improve the health of their populations by implementing and enforcing evidence-based tobacco control policies that prevent the next generation from initiating smoking. Funding Bloomberg Philanthropies.

Objectives: This article deals with the comparison of excise tax revenues from alcoholic beverages and tobacco products with public spending that are spent on treating diseases occurring in consumers of these commodities. Methods: Based on available data, the study estimates direct public expenditures on the treatment of tobacco-related diseases and very frequent alcohol consumption-related diseases in the Czech Republic. These partial results are evaluated in the context of tax revenues from consumption of the mentioned commodities. The analysis works with the data from 1998-2017, which was obtained from the Ministry of Health of the Czech Republic, the National Institute of Public Health, the Customs Administration of the Czech Republic, the Ministry of Finance of the Czech Republic, and the Czech Statistical Office. Results: Medical treatment costs of smoking-related diseases were 18.35-48.19 billion CZK per year in the analysed period. These expenditures in the period 1998-2011 exceeded the annual revenues from the tax on tobacco products (in 2002 by 12.08 billion CZK). Since 2012, the balance has been positive in favour of public spending. Expenditures on the treatment of alcohol-related diseases amounted to 9.66-25.36 billion CZK per year in the given period, the expenditures, except the year 1998, exceeded the revenues from alcoholic beverages taxes (by 14.63 billion CZK in 2009). Conclusions: The study shows that the excise tax revenues for tobacco products do not reach the level of healthcare spending for tobacco-related disease in the most of the analysed period, and this difference increases with the length of consumption, which can be interpreted in such a way that current excise tax revenues potentially mean public healthcare expenditures, which cumulatively exceed revenues from the relevant excise duties.

Objective: To map patterns and prevalence of daily smoking among employed Australians over time. Methods: Data from four waves of the triennial National Drug Strategy Household Survey (2007, 2010, 2013 and 2016) were used to assess daily smoking. Frequency analyses and significance testing examined smoking prevalence by sex, age, state, remoteness, Indigeneity, socioeconomic status (SES) and psychological distress. Logistic regression models estimated adjusted effects of demographics on smoking prevalence. Results: Workers’ daily smoking prevalence reduced by 32% between 2007 and 2016. The adjusted model showed the lowest smoking reductions among men and non‐metropolitan workers. Other interaction effects showed the highest daily smoking rates for: male workers aged 14–39 years; low SES non‐metropolitan workers; and low SES workers aged 40–59 years. Conclusions: Specific workplace policies, prevention and intervention strategies are warranted for male workers, especially those aged 14–39; non‐metropolitan workers, especially low SES rural workers; and low SES workers especially 40–59‐year‐olds. Implications for public health: In spite of significant smoking reductions among workers over time, reductions were unevenly distributed. Tailored, innovative workplace prevention and intervention strategies that apply principles of proportionate universalism and address individual, workplace settings and cultural factors are warranted to reduce smoking disparities among male, rural and low SES workers.

Background Launched in 2000, the truth campaign was one of the first health-related campaigns to embrace the building of a brand to further amplify its message, such as by building brand equity. Brand equity is an asset that represents the audience’s perception of the brand. Previous research supports that strong brand equity is associated with lower tobacco intentions and behaviors; however, brand equity and its change over time have not been studied as it relates to e-cigarettes. This study examines the effects of change in brand equity on e-cigarette attitudes, intentions, and behaviors among youth and young adults. Methods The sample (N = 6427) is from the Truth Longitudinal Cohort, a nationally representative, longitudinal cohort of youth and young adults, ages 15–24. Variables include brand equity tobacco scale, demographic characteristics, and e-cigarette use status. The outcomes included anti-e-cigarette attitudes, intentions to use e-cigarettes, and use of e-cigarettes. Multiple and logistic regression models determined the relationship between change in brand equity from respondents at Spring 2018 to Spring 2019 and respondent e-cigarette outcomes at Fall 2019. All models controlled for demographic characteristics and cigarette use. Results Mean brand equity scores in Spring 2018 were significantly associated with greater anti-e-cigarette attitudes (β = 0.17, 95% CI: 0.15, 0.19), lower odds of intention to use (OR = 0.75, 95% CI: 0.66, 0.85), and lower odds of current use (OR = 0.81, 95% CI: 0.72, 0.92). Change in brand equity from Spring 2018 to Spring 2019 was significantly associated with greater anti-e-cigarette attitudes (β = 0.09, 95% CI: 0.06, 0.11) and lower odds of intention to use (OR = 0.79, 95% CI: 0.67, 0.93), but not associated with current use behaviors. Conclusions Strengthening brand equity is an effective strategy for influencing anti-e-cigarette related attitudes and intentions, much like it is for anti-smoking campaigns. More research needs to be done on the relationship between change in brand equity and e-cigarette behavior to better understand how brand equity can be wielded to influence change in e-cigarette use behavior.

Latar Belakang: Jumlah remaja yang depresi dan merokok di Indonesia mengalami peningkatan yang cukup tajam. Literatur-literatur menunjukkan bahwa remaja yang merokok memiliki kemungkinan lebih tinggi untuk mengalami depresi dan remaja yang depresi memiliki kemungkinan lebih tinggi untuk merokok. Tujuan Penelitian: Penelitian ini bertujuan untuk mengetahui hubungan antara depresi dan merokok pada siswa SMPN 273. Metode: Penelitian analitik cross-sectional ini dilakukan di SMPN 273, Jakarta Pusat. Responden adalah 407 siswa SMPN 273 kelas 7, 8, dan 9 (47.9% siswa laki-laki dan 52.1% siswa perempuan) yang mengisi kuesioner depresi dan merokok. Depresi dinilai dengan menggunakan kuesioner BDI-II yang telah divalidasi ke dalam bahasa Indonesia, sedangkan merokok dinilai dengan satu pertanyaan yang membagi responden menjadi 4 kelompok yaitu perokok setiap hari, perokok kadang-kadang, mantan perokok, dan bukan perokok. Hasil: Terdapat hubungan yang bermakna antara depresi dan merokok pada siswa SMPN 273 (p = 0.000, OR = 2.502). Dari 30.2% siswa yang mengalami depresi, 2.5% siswa adalah perokok setiap hari, 5.4% siswa adalah perokok kadang-kadang, 10.8% siswa adalah mantan perokok, dan 11.5% siswa adalah bukan perokok. Kesimpulan: Depresi meningkatkan risiko remaja untuk merokok sebesar 2.5 kali. Hal ini mengindikasikan bahwa pencegahan merokok pada remaja perlu disertai dengan pencegahan dan tatalaksana terhadap depresi.

Introduction Young children are vulnerable to harm from tobacco smoke exposure (TSE). This study assessed the effect of Project Zero Exposure—an intervention program designed to help parents protect children from TSE—on children’s exposure. Methods Randomized controlled trial of a home-based, theory-driven intervention. Parents of young children ( Results Most enrolled families completed the trial (IG: 98.6%[68/69], RCG: 97.1%[68/70]). Log hair nicotine (LHN [ng/mg]) decreased in both the IG (Baseline: –1.78 ± 1.91, Follow-up: –2.82 ± 1.87, p = .003) and RCG (Baseline: –1.79 ± 1.54, Follow-up: –2.85 ± 1.73, p = .002), but did not differ between groups at study end (p = .635). Three of five parentally-reported outcomes showed improvement over time in the IG, and one in the RCG. Among IG participants, 90% found hair nicotine feedback useful. Conclusions No difference between the intervention and control groups was found on the objective biomarker, LHN. Child TSE decreased during the trial in intervention and control groups. Trial participation, which included hair nicotine monitoring, may have contributed to decreasing exposure in both groups. Concurrent control group improvements may partially explain lack of proven intervention benefit. Biomarker monitoring warrants further investigation for reduction of child TSE. Implications Project Zero Exposure is an intervention program designed to help parents protect their children from TSE. Results from the randomized controlled trial of the program showed no difference between groups at study end, but a clear and substantial reduction in child exposure to tobacco smoke from beginning to end of the trial, in both intervention and control groups. Biomarker monitoring, a key element of the trial, was used with all participants. Biomarker monitoring of child exposure to tobacco smoke may help parents become aware of their child’s exposure and better protect them, and should be explored as a means to reduce child TSE. Clinical Trial Registration: NCT02867241

This paper examines the immediate and long-term effects of public smoking bans on smoking prevalence, smoking regularity, smoking intensity, and secondhand tobacco smoke exposure. We supplement the extensive literature on the effects of various types of tobacco control legislation on smoking behavior in developed countries by studying the provincial smoking bans and more recent national ban of a middle-income country, Argentina. We focus on the difference between full and partial smoking bans, and take advantage of the time and province variation in ban implementation in order to determine the causal effects of each type of ban. We find that full bans reduce national smoking prevalence over time, especially among younger demographic groups, but have no significant impact on intensity of smoking among smokers. Full bans also benefit nonsmokers, as they are associated with a significant reduction in environmental tobacco smoke exposure. Partial bans do not significantly impact smoking prevalence, and are found to increase smoking intensity among individuals who smoke every day. These findings provide support for ratification of full bans by all provinces according to the National Tobacco Control Law of 2011.

This study aimed to estimate associations between adolescents' religiosity and their motivation to start and stop smoking. A school survey was carried out in Midwestern Brazil. Participants were never-smokers (n = 2073) and smokers (n = 116) aged 13-19 who answered a questionnaire. Religiosity was measured with the Duke Religion Index, and motivation with questions based on the Prime Theory of Motivation. Organizational, non-organizational, and intrinsic religiosity were associated with motivation to start smoking among never-smokers. Intrinsic religiosity was associated with smokers' motivation to quit. Findings indicate the protective role of religiosity in the motivational system that prompts smoking initiation and cessation during adolescence.

Introduction Tobacco-free college campuses refer to colleges and universities that have implemented policies prohibiting the use of tobacco products at all indoor and outdoor campus locations. We aimed to evaluate university students' smoking behaviors and their attitudes towards "Tobacco-Free Campus Policy". Materials and Methods A total of 10,383 university students were included in this cross-sectional study. The questionnaire was sent via web-based student information system. Demographical variables, the frequency of tobacco use, the addiction levels of the smoker students, and their perspective on the Tobacco-Free Campus Policy were evaluated. Result The study population consisted of 5461 (52.6%) males and their mean age was 22.1 ± 3.9 years. Among the students, 3992 (38.4%) were current smokers and the age of first smoking was 16.5 ± 2.78 years. According to FTND scores, 15.1% of participants have high dependence, and 7.5% of them have very high dependence. There was a significant difference among participants who finds unacceptable "Tobacco-Free Campus Policy" in terms of gender (70.7% males vs. 29.3% females, p

Smoking prevention among adolescents is a public health challenge that is even more significant in low- and middle-income countries where local evidence is limited and smoking rates remain high. Evidence-based interventions could be transferred to low- and middle-income country settings but only after appropriate cultural adaptation. This paper aims to describe the process of the cultural adaptation of two school-based smoking prevention interventions, A Stop Smoking in Schools Trial and Dead Cool, to be implemented in Bogotá, Colombia. A recognized heuristic framework guided the cultural adaptation through five stages. We conducted a concurrent nested mixed-methods study consisting of a qualitative descriptive case study and a quantitative pre- and post quasi-experiment without a control. Contextual, content, training, and implementation modifications were made to the programs to address cultural factors, to maintain the fidelity of implementation, and to increase the pupils’ engagement with the programs. Modifications incorporated the suggestions of stakeholders, the original developers, and local community members, whilst considering the feasibility of delivering the programs. Involving stakeholders, original program developers, and community members in the cultural adaptation of evidence-based interventions is essential to properly adapt them to the local context, and to maintain the fidelity of program implementation.

Purpose: This meta-analysis aimed to analyze the effects of smoking prevention programs for young adolescents at early smoking stages to identify the appropriate characteristics of prevention programs for this population.Methods: Searches of health-related databases and Google Scholar were conducted, and 23 randomized studies were included in the analysis. The main outcome variable was smoking behavior. The analysis was conducted using Comprehensive Meta-Analysis software (version 3.0).Results: Smoking prevention programs significantly reduced smoking behaviors (OR=0.85, 95% CI=0.77~0.93). School-based programs (OR=0.79, 95% CI=0.75~0.83), programs by trained teachers or educators (OR=0.77, 95% CI=0.71~0.83), high-intensity programs (OR=0.82, 95% CI=0.75~0.91), and programs in an in-school setting (OR=0.82, 95% CI=0.74~0.90) had the most significant effect on reducing smoking behavior.Conclusion: For young adolescents, smoking prevention programs are most effective when they are school-based or highintensity programs, and when conducted by teachers or educators with proper training. Further studies are required since there was insufficient research to explore the effect of web-based programs or family-centered programs on adolescent smokers.

Purpose To update a systematic review published in 2012 that identified predictors of cigarette smoking cessation among adolescents. Methods The PubMed and Web of Science databases were searched for relevant articles published between September 2010 and January 2018, using the following keywords: smoking OR tobacco OR cessation; quit OR stop; longitudinal OR prospective OR cohort. Our search identified 3,399 articles. Inclusion criteria included longitudinal studies (intervention and cohort studies) evaluating cigarette smoking cessation in young people (aged 10–24 years). After screening, in total, 34 articles were included in the review. Results In total, 63 predictors of smoking cessation among adolescents were identified, with 36 new predictors that were not identified in the previous review: nine sociodemographic factors, 13 psychosocial factors, five behavioral factors, 19 social influences factors, eight smoking related variables, six environmental factors, 2 health related variables, and one genetic factor. Conclusions To increase the probability of successful smoking cessation, strategies targeting young smokers should consider both individual and environmental predictors of cessation.

This study sought to assess the cost-effectiveness of population-based tobacco control interventions, which included health promotion and education, smoke-free models, cessation programs, warning on package, marketing bans, and raising tax. Standardized activity-based costing ingredient approach was applied with the provider perspective to calculate interventions cost from 2013 to 2017. The potential health impacts of the aforementioned interventions were calculated through a Microsoft Excel-based modeling adapted from Higashi et al and Ngalesoni et al. All six population-based tobacco control interventions were highly cost-effective with ranges from 1405 VND (Vietnamese Dong) to 135 560 VND per DALY (disability-adjusted life year) averted. It was identified that raising cigarette taxes and applying health warnings on tobacco packages are the most favorable, cost-effective interventions. The results from this study provide a robust message that calls for increased attention and efforts in developing an appropriate policy agenda, which jointly integrates both political and community-based interventions, to maximize intervention impact on tobacco use.

Lung cancer is one of the most common and deadliest cancers affecting millions of men and women worldwide. Historically, lung cancer predominantly affects men, but in recent years there have been significant changes in the epidemiology of lung cancer among women. Additionally, further understanding of lung cancer has changed our approach to the diagnosis and management of lung cancer. This article aims to discuss recent changes in lung cancer among women including incidence, mortality, risk factors, diagnosis, staging, treatment, and prognosis. The incidence of lung cancer among women is declining overall but at a significantly slower rate compared to men. The implementation of smoking prevention and cessation efforts has decreased the incidence of cigarette smoking of the past 50 years which has revealed other important risk factors for developing lung cancer. Additionally, new algorithms for diagnosis and staging have led to further changes in management strategies for lung cancer. Lung cancer among women is a growing concern with incidence rates decreasing significantly slower compared to men. Risk factors such as age, race, socioeconomic status, and geographic locations are becoming more apparent as important variables in the development of lung cancer among women. Lastly, new advancements in diagnosis, staging, and management are likely to result in improved short- and long-term prognosis in patients with lung cancer.

Introduction Cigarette smoking prevalence is higher among adults enrolled in Medicaid than adults with private health insurance. State Medicaid coverage of cessation treatments has been gradually improving in recent years; however, the extent to which this has translated into increased use of these treatments by Medicaid enrollees remains unknown. Aims and Methods Using Medicaid Analytic eXtract (MAX) files, we estimated state-level receipt of smoking cessation treatments and associated spending among Medicaid fee-for service (FFS) enrollees who try to quit. MAX data are the only national person-level data set available for the Medicaid program. We used the most recent MAX data available for each state and the District of Columbia (ranging from 2010 to 2014) for this analysis. Results Among the 37 states with data, an average of 9.4% of FFS Medicaid smokers with a past-year quit attempt had claims for cessation medications, ranging from 0.2% (Arkansas) to 32.9% (Minnesota). Among the 20 states with data, an average of 2.7% of FFS Medicaid smokers with a past-year quit attempt received cessation counseling, ranging from 0.1% (Florida) to 5.6% (Missouri). Estimated Medicaid spending for cessation medications and counseling for these states totaled just over $13 million. If all Medicaid smokers who tried to quit were to have claims for cessation medications, projected annual Medicaid expenditures would total $0.8 billion, a small fraction of the amount ($45.9 billion) that Medicaid spends annually on treating smoking-related disease. Conclusions The receipt of cessation medications and counseling among FFS Medicaid enrollees was low and varied widely across states. Implications Few studies have examined use of cessation treatments among Medicaid enrollees. We found that many FFS Medicaid smokers made quit attempts, but few had claims for proven cessation treatments, especially counseling. The receipt of cessation treatments among FFS Medicaid enrollees varied widely across states, suggesting opportunities for additional promotion of the full range of Medicaid cessation benefits. Continued monitoring of Medicaid enrollees’ use of cessation treatments could inform state and national efforts to help more Medicaid enrollees quit smoking.

Purpose: To evaluate sociodemographic differences in the relationship between state and national anti-smoking media campaigns and cessation behaviors among adult smokers in the U.S. Design: Repeated cross-sectional analysis. Setting: U.S. nationally representative survey of adults ages 18 and older, 2001-2015. Subjects: 76,278 year-ago smokers from the 2001-2015 Tobacco Use Supplement to the Current Population Survey. Measures: Area-level exposure to State-sponsored and “Tips from former smokers” anti-tobacco media campaigns was the primary predictor of this study. Outcome variables included: quit attempt in the past 12 months, past 30-day smoking cessation, and past 90-day smoking cessation among year-ago smokers. Analysis: We conducted modified Poisson regression models to examine the association between media campaign exposure and cessation behaviors. We also examined effect modification on the additive scale by sex, race/ethnicity, income, and education using average marginal effects. Results: Year-ago smokers with greater exposure to media campaigns were more likely to report 30-day (Prevalence Ratio [PR]: 1.18, CI: 1.03, 1.36) and 90-day cessation (PR: 1.18, CI: 1.00, 1.41) compared to respondents with less campaign exposure. We found no evidence of effect modification by sociodemographic variables. Conclusion: Exposure to anti-smoking media campaigns were associated with year-ago smokers’ cessation behaviors. However, there were no differences in the association by sex, race/ethnicity, income, or education, indicating that broadly focused media campaigns may be insufficient to reduce smoking cessation among priority populations, and thus health disparities generally.

Objective Many children experience tobacco smoke exposure (TSE) and parents may take preventive measures to reduce TSE. The study goal is to assess if these strategies are associated with lower cotinine values, an objective biological measure of TSE. Methods Families admitted to Children's Hospital Colorado from 2014 to 2018 who screened positive for TSE were invited to participate in a tobacco smoking cessation/reduction program. Caregivers were consented and asked about demographics, beliefs around smoking, and strategies to reduce TSE. Child urine samples were collected, tested for cotinine levels, and analyzed using geometric means. Bivariable comparisons and multivariable linear regression were completed using SAS v9.4 (SAS Institute, Cary, NC). Results Two hundred thirteen children (81.4%) are included in this analysis. The median ages of children and parents were 4 and 32 years respectively. Fifty-seven percent of children were male, 36% were Hispanic, and 55% were white. Fifty-six percent of parents had at least some college education and 69% had an annual income less than $50K. The median daily cigarettes smoked per day were 10. Eighty-eight percent reported using at least 1 type of protective measure to prevent TSE and 90% believed they protect other household members from TSE. None of the strategies had a significant relationship with lower cotinine levels on bivariable or multivariable analyses. Conclusions Parental strategies to decrease TSE did not result in lower cotinine levels. Many measures are not evidence-based and do not protect children. Parent's clothing and homes may create a reservoir for nicotine. Education should focus on exposure elimination and cessation rather than protective measures.

While studies have shown the importance of pictorial health warnings (PHW) as a tobacco control strategy, empirical evidence on the efficacy of PHW in prompting smoking behavior remains inconclusive. The study aimed to examine the association between PHW and cognitive reactions, emotional/affective reactions, and smoking behavior. We conducted a mixed-methods study, which included a cross-sectional face-to-face survey of 401 smokers in four cities (Jakarta, Bandung, Semarang, and Yogyakarta) and three focus group discussions among 24 participants in Jakarta. We applied multiple logit regression in STATA for quantitative data analysis and explanatory sequential design for qualitative data analysis. Quantitatively, we found high (63-84% of respondents) understanding about PHW objectives (cognitive reactions), including to remind health risks and encourage smoking cessation. With only 40% PHW, we found relatively low (32%-39%) negative emotional reactions, including feeling scared, annoyed and disgusted and relatively low proportions (33-40%) of respondents that reported quit attempt. Consistent with the quantitative findings, qualitative data provided contexts, including in explaining that the professional worker group was the least affected by PHW, while the student and non-professional groups were the most vulnerable. All this is supportive of governments in Indonesia and other countries to increase the PHW size.br /.

This paper focuses on the particular challenges in cancer prevention and control (CPC) in low- and middle-income countries (LMICs). In particular, this paper extrapolates challenges and opportunities in Armenia, which has the 2nd highest rate of cancer-related deaths in the world, the 11th highest smoking prevalence among men globally, and an evolving health system infrastructure for non-communicable disease (NCD) prevention and control, including CPC. Despite significant progress in enhancing research capacity in Armenia over the past decade, additional efforts are needed, particularly in CPC-related research. Key opportunities are to advance tobacco control and utilization of mHealth. Public health training programs remain insufficient in the area of CPC, and in-country research expertise regarding CPC and related areas (e.g., tobacco control, mHealth, policy) is limited, particularly given the need to address the diverse and complex determinants of onset, prevention, and management of cancer. Moreover, critical gaps in research dissemination and knowledge translation from evidence to policy and practice continue to exist. Thus, public health infrastructure must be enhanced, in-country CPC leaders across various relevant disciplines must be further developed and supported, and medical and public health training must more fully integrate CPC and research dissemination and translation to inform policy and practice.

According to the ‘hardening hypothesis’, average nicotine dependence will increase as less dependent smokers quit relatively easily in response to effective public health interventions, so that sustained progress in reducing smoking prevalence will depend on shifting the emphasis of tobacco control programs towards intensive treatment of heavily dependent smokers (who comprise an increasing fraction of continuing smokers). We used a system dynamics model of smoking behaviour to explore the potential for hardening in a population of smokers exposed to effective tobacco control measures over an extended period. Policy-induced increases in the per capita cessation rate are shown to lead inevitably to a decline in the proportion of smokers who are heavily dependent, contrary to the hardening hypothesis. Changes in smoking behaviour in Australia over the period 2001‒2016 resulted in substantial decreases in current smoking prevalence (from 23.1% in 2001 to 14.6% in 2016) and the proportion of heavily dependent smokers in the smoking population (from 52.1% to 36.9%). Public health interventions that have proved particularly effective in reducing smoking prevalence (tobacco tax increases, smoke-free environment legislation, antismoking mass media campaigns) are expected to also contribute to a decline in population-level nicotine dependence.

In the German context, there is hardly any quantitative data about the implementation of school tobacco polices that include the perspective of both teachers and students. The aim of the study is to investigate the associations between implemented school tobacco policies and the perceived prevalence of smoking at the level of school staff and adolescents.The repeated cross-sectional study (2013 and 2017) is based on pooled responses of 13- to 17-year-old adolescents (N = 2393) and school staff (N = 85) from 25 schools located in the West German metropolitan region of Hanover. In linear regression models, average marginal effects (AMEs) with 95% confidence intervals (CI95%) and robust standard errors for perceived tobacco prevalence are reported separately for school tobacco policies assessed by teachers and students (scale 0-6). All models were controlled for sociodemographic, school-, and smoking-specific covariates.On average, adolescents perceive a smoking prevalence of 30% ([Formula: see text]; s: 24.0) for their school. A comprehensive school tobacco policy is consistently associated with lower school smoking prevalence both from the point of view of teachers (AME: -3.54 CI95% -6.49 to -0.58) and students (AME: -1.69 CI95% -2.52 to -0.86). The number of smoking friends (e.g., "most of them are smokers" +14%: AME: 14.13 CI95% 10.46 to 17.80) and the type of school are the most relevant determinants of a high school smoking prevalence. School types with a nonacademic track report a 15% (AME: 15.03 CI95% 10.13 to 19.93) higher prevalence compared to grammar schools.Progressive school tobacco control policies should focus more on school types with nonacademic tracks, certain groups at risk, and those schools that do not strictly enforce school tobacco policies.HINTERGRUND: Für Deutschland sind kaum Daten zur Implementierung schulischer Tabakkontrolle bekannt, die sowohl die Perspektive von Lehrer- als auch von Schüler*innen einbeziehen. Ziel der Studie ist es, den Zusammenhang zwischen implementierter schulischer Tabakkontrollpolitik und der wahrgenommenen Raucherprävalenz auf den Ebenen des Schulpersonals und der Jugendlichen zu untersuchen.Die wiederholte Querschnittsstudie (2013 und 2017) basiert auf gepoolten Angaben von 13- bis 17-jährigen Jugendlichen (N = 2393) und Schulpersonal (N = 85) aus 25 Schulen in der westdeutschen Metropolregion Hannover. In linearen Regressionsmodellen werden durchschnittlich marginale Effekte (AMEs) mit 95 %-Konfidenzintervallen (KI95 %) und robuste Standardfehler für die wahrgenommenen Tabakprävalenzen getrennt für die von Lehrer- und Schüler*innen bewertete schulische Tabakkontrollpolitik (Skala 0–6) unter Kontrolle soziodemografischer, schul- und rauchspezifischer Variablen berichtet.Die Jugendlichen nehmen durchschnittlich eine Raucherprävalenz von 30 % ([Formula: see text]; s: 24,0) für ihre Schule wahr. Eine strikte schulische Tabakkontrolle ist konsistent mit einer geringeren schulischen Raucherprävalenz assoziiert, sowohl aus Sicht von Lehrer- (AME: −3,54 KI95 % −6,49 bis −0,58) als auch der Schüler*innen (AME: −1,69 KI95 % −2,52 bis −0,86). Die Anzahl rauchender Freunde (z. B. „die meisten“ +14 %: AME: 14,13 KI95 % 10,46–17,80) und der Schultyp sind die relevantesten Determinanten für eine hohe schulische Raucherprävalenz. Nichtgymnasiale Schulformen berichten eine 15 % (AME: 15,03 KI95 % 10,13–19,93) höhere Raucherprävalenz im Vergleich zu Gymnasien.Progressive schulische Tabakkontrollpolitiken sollten den Fokus auf nichtgymnasiale Schulformen, Risikogruppen und jene Schulen legen, die Tabakkontrolle nicht strikt durchsetzen.

Background There is debate around the composition of life years gained from smoking elimination. The aim of this study was to conduct a systematic review of the literature to synthesize existing evidence on the effect of smoking status on health expectancy and to examine whether smoking elimination leads to compression of morbidity. Methods Five databases were systematically searched for peer-reviewed articles. Studies that presented quantitative estimates of health expectancy for smokers and non-/never-smokers were eligible for inclusion. Studies were searched, selected and reviewed by two reviewers who extracted the relevant data and assessed the risk of bias of the included articles independently. Results The search identified 2491 unique records, whereof 20 articles were eligible for inclusion (including 26 cohorts). The indicators used to measure health included disability/activity limitations (n=9), health-related quality of life (EQ-5D) (n=2), weighted disabilities (n=1), self-rated health (n=9), chronic diseases (n=6), cardiovascular diseases (n=4) and cognitive impairment (n=1). Available evidence showed consistently that non-/never-smokers experience more healthy life years throughout their lives than smokers. Findings were inconsistent on the effect of smoking on the absolute number of unhealthy life years. Findings concerning the time proportionally spent unhealthy were less heterogeneous: nearly all included articles reported that non-/never-smokers experience relatively less unhealthy life years (e.g. relative compression of morbidity). Conclusions Support for the relative compression of morbidity due to smoking elimination was evident. Further research is needed into the absolute compression of morbidity hypothesis since current evidence is mixed, and methodology of studies needs to be harmonized.

ISSUE ADDRESSED Smoking near hospital entrances occurs frequently despite smoke-free policies, resulting in multiple issues including second-hand smoke exposure (SHS) to vulnerable populations. Primary school children were engaged through their health curriculum to produce antismoking audio recordings for broadcast over a hospital entrance loudspeaker system to determine if this reduced smoking. METHOD Students produced original recordings against hospital grounds smoking during class workshops, from which a collection (n = 16) was selected. Episodes of entrance smoking and total entrance traffic were recorded using security camera infrastructure over a 5-week period. A computer-controlled entrance loudspeaker played a message which was followed by silence until a new (different) message was played. Intensity of messaging was moderate in week 3 (every 5 minutes), increasing to high in week 4 (3 minutely) and compared to no messages (weeks 1-2 preintervention) and week 5 (postintervention). RESULTS Smokers presented 316 times, smoking 523 cigarettes over 155 hours of observation (patients 70.6%, visitors 29.4%). SHS exposure was high given 172 others used the entrance/hour. Smoking was highest in the preintervention period (weeks 1-2), median five cigarettes/hr [IQR,3-7 (min = 0, max = 12)], falling to four cigarettes/hr during 5-minutely broadcasts [IQR,2-5 (min = 1, max = 14)] (P = .06), but zero cigarettes/hr during 3-minutely broadcasts [IQR,0-1(min = 0, max = 7)] (P

Introduction Most smoking quit attempts end in relapse, and interventions focused on relapse prevention are lacking. Helpers Stay Quit (HSQ) is a novel behavioral relapse prevention intervention that teaches newly abstinent smokers to offer a “helping conversation” (HC) to help others quit tobacco. Methods Pre-post intervention feasibility study with state quitline participants ≥14 days abstinent. Measures at baseline, 3 months, and 6 months included smoking status, offering HCs, and cessation self-efficacy. Primary outcomes: self-reported 7-day point prevalence abstinence; offering HCs. Cox models explored association of HCs with relapse. Preliminary effects analysis using propensity score matching compared 30-day abstinence of quitline clients with study sample at 7 months. Results Participants (N = 104) were as follows: mean age of 53 years (SD 13.9 years), 48.1% male, mean of cigarettes smoked/day of 16.2 (SD 9.7). Compared with participants who remained abstinent (n = 82), relapsers (n = 22) had fewer HCs over 6 months (2.6 vs 7.2; 95% confidence interval [CI]: 1.4, 7.8, p = .006). Using adjusted Cox regression, the hazard ratio of relapse for each HC was 0.85 (95% CI: 0.74, 0.99, p = .03). Compared with a matched sample of quitline clients not exposed to HSQ, study participants were 49% more likely to report 30-day abstinence at 7-month quitline follow-up (95% CI: 40%, 59%, p < .0001). Conclusions HSQ, delivered to newly abstinent smokers who received standard quitline treatment, was associated with less self-reported relapse. These promising preliminary study results warrant further research to evaluate HSQ as a novel behavioral intervention to prevent smoking relapse. Implications To date, behavioral interventions for smoking relapse prevention that teach abstainers cessation skills to apply to themselves have not shown effectiveness. This feasibility study examines the preliminary efficacy of a conceptually novel, “help others” behavioral intervention approach for relapse prevention in newly abstinent smokers recruited from a state quitline. HSQ teaches the newly abstinent smoker communication and listening skills to encourage other smokers in their personal social network to quit. Exploratory analysis using propensity score matching suggests that participants exposed to HSQ were significantly more likely to self-report 30-day abstinence at quitline 7-month follow-up than other quitline clients.

Tobacco consumption is one of the major public health problems in the world. Annually, 27 100 premature deaths are attributed to tobacco-related diseases in Nepal. Despite enacting different policies and strategies, the prevalence of tobacco consumption is still high. This study aims to synthesize prevalence, factors associated with its consumption and the policy initiatives for prevention and control in Nepal. This review includes peer-reviewed studies retrieved from two databases (PubMed and EMBASE) and published from 2000 to 2018, and policy initiatives on tobacco prevention and regulations in Nepal. A total of 32 studies and 5 policy documents were reviewed. Findings suggest that tobacco consumption was higher among men, illiterates, older people, people living in rural and mountainous areas and those who initiated smoking as adolescents. Peer pressure and parental/family smoking were major contributing factors for tobacco initiation. Policy analysis showed that low excise tax, weak monitoring mechanisms, poor compliance to bans on the advertisement and promotion of tobacco, smoke-free zones and insufficient programs on tobacco cessation were the major factors behind weak implementation of tobacco-control policies. Hence, targeted and high-risk group tobacco-cessation interventions, increasing taxation and strict policy implementation are crucial for effective tobacco prevention and control in Nepal.

Aims: There are well-known gender differences in smoking, including the pattern of use and the effectiveness of smoking prevention programs. However, little is known about the differences between boys and girls in their attitudes towards smoking prevention interventions. This study explores gender differences in attitudes towards a school-based intervention to prevent smoking. Methods: We used data from the X:IT II intervention study conducted in 46 Danish elementary schools. Results: Compared to boys, girls were more positive towards smoke-free school time, both concerning rules for teachers smoking (odds ratio (OR) = 1.69, 95% confidence interval (CI): 1.35–2.12) and for students smoking (OR = 1.41, 95% CI: 1.13–1.76). No difference was observed in students signing the smoke-free agreement. However, a larger proportion of girls reported that the agreement was a good occasion to talk about smoking with their parents (OR = 1.36, 95% CI: 1.13–1.76). Girls were also more positive towards the smoke-free curriculum (OR = 1.52, 95% CI: 1.19–1.94). Conclusions: This study showed that girls were, overall, more positive towards the components of the smoking preventive intervention. Our findings highlight the importance of considering differences in intervention preferences for boys and girls in future health prevention initiatives.

Objective: Graphic warning labels (GWLs) are effective in communicating tobacco-related harms. Methods: In this mixed-methods study, we used purposive sampling to recruit 100 low-income smokers in the San Francisco Bay Area between October 2017 and February 2018 to participate in an intervention promoting smoke-free homes. We presented the 2009 Food and Drug Administration-proposed GWLs and explored perceptions of affect, efficacy, and appeal using questionnaires at baseline, 3- and 6-months follow-up. Because of participants' interest in this topic, we subsequently conducted a qualitative sub-study among 20 participants exploring perceived efficacy of GWLs on smoking cessation. Results: In all, 87.3% and 59.2% agreed that GWLs were useful and would motivate cessation behaviors, respectively, at baseline. We found that the most common responses were shock (61.8%) and disgust (55.3%), whereas anger (29.0%) and annoyance (19.7%) were less common. Participants also reported that GWLs unequivocally illustrating smoking's harmful effects were more appealing than non-specific images, as were images that depicted positive cessation-related effects. Conclusions: GWLs appear to be an important health communication among low-income smokers. Future studies on GWLs should examine the association of negative affect and cessation among this population.

Jacob Cohen developed two statistical measures for judging the magnitude of effects produced by an intervention, known as Cohen’s d, appropriate for assessing scaled data, and Cohen’s h, appropriate for assessing proportions. These have been widely employed in evaluating the effectiveness of alcohol, cigarette, marijuana, and other drug prevention efforts. I present two tests to consider the adequacy of using these statistics when applied to drug use prevention programs. I used student survey data from grades 6 through 12 (N = 1,963,964) collected by the Georgia Department of Education between 2015 and 2017 and aggregated at the school level (N = 1036). I calculated effect sizes for an imaginary drug prevention program that (1) reduced 30-day alcohol, cigarette, and marijuana prevalence by 50%; and (2) maintained 30-day prevalence at a pretest level for multiple years. While both approaches to estimating intervention effects represent ideal outcomes for prevention that surpass what is normally observed, Cohen’s statistics failed to reflect the effectiveness of these approaches. I recommend including an alternative method for calculating effect size for judging program outcomes. This alternative method, Relative Reduction in Prevalence (RRP), calculates ratio differences between treatment and control group drug use prevalence at posttest and follow-up, adjusting for differences observed at pretest. RRP allows researchers to state the degree to which an intervention could be viewed as efficacious or effective that can be readily understood by practitioners.

Implementing effective prevention programmes is critical to prevent tobacco use. Objectives. This study aims to assess the long-term effectiveness of the "SmokeOut-I" programme in the smoking prevention of school-aged adolescents, by gender. Methodology. A quasi-experimental study was conducted including a pre-test and a post-test, as well as a experimental group (N = 163) and a control group (N = 148) of adolescents attending the 6th grade at Braga schools in 2014/2015. A follow-up was conducted three years later. A self-report questionnaire was administered to both groups before and after the programme implementation, and at the follow-up. The programme was only administered to the experimental group. Results. The programme has shown long-term effectiveness in preventing smoking experimentation, and in enhancing smoking refusal skills. There was a lower prevalence of tobacco use and intention to smoke in the experimental group than in the control group, although not statistically significant. It was found that the experimental group maintained adequate knowledge about smoking over time. Conclusions. The positive effects on health and on the environment justify the broad implementation of this programme, which implies the involvement and commitment of governmental institutions.

Background The focus in occupational health check-ups is in work and health, but they offer also a possibility to assess health behavior and give guidance e.g. on weight control. We wanted to study whether having occupational health checks-up, receiving physicians’ advice to change health behavior or participation in health promotion programs had an effect on obesity in a five-year follow-up from 1998 to 2003 in asthmatic and non-asthmatic workers. Methods Altogether 23,220 individuals aged 20–54 years were picked up from a randomized Finnish population sample. Univariate and multivariate logistic regression analysis was used to calculate the risk for obesity in 2003. The variables used in the modelling were gender, age, smoking, asthma, depression, and physical workload. Results Both asthmatic and non-asthmatic workers gained weight during the follow-up. Of the asthmatics 48 and 47% of the non-asthmatics had occupational health-check-up in the last 5 years. Of the asthmatics 18 and 14% of the non-asthmatics had received physician’s advice to change their health behavior (p > 30) in 2003 were gender (men OR 1.19), older age (OR 1.25), smoking (OR 1.07) or depression (OR 1.44). Conclusions Results show that having occupational health checks-up or receiving physicians’ advice to change health behavior or participation in health promotion programs did not stop gain of weight during a five-year follow-up. Asthmatic workers did not differ from non-asthmatics. Male gender, older age, smoking, and depression were associated with obesity but not the physical workload.

We aimed at investigating the association between age at smoking onset and adult binge drinking among Korean adults. We cross-sectionally analyzed nationally representative secondary data obtained from 11,296 adults in 2013. We conducted survey data analyses to incorporate a complex sampling design in our analyses. Specifically, we conducted a multivariate logistic regression analysis to investigate the relationship of age at smoking onset with binge drinking. In our study, about 28% of adults were past 30-day binge drinkers. We found the greatest risks of past 30-day binge drinking among those who started smoking at 14 years or younger. Additionally, greater risk of adult binge drinking was significantly associated with the male sex, younger age, higher income, employed status, past 30-day smoking, exercise, higher anxiety, and depressive feelings. Smoking prevention strategies should be implemented in earlier adolescence because they may play pivotal roles in reducing both alcohol- and cigarette-related problems in adulthood.

Tobacco control requires a comprehensive approach. The present study aims to examine the incremental effectiveness of health systems intervention when combined with other interventions in enhancing knowledge and practices of physicians in tobacco cessation. Methods A randomized control trial was conducted among 437 physicians in 12 districts of two states of India in 2011-13. The interventions consisted of Health Systems (H), Community (C) and Youth intervention (Y). Administrative Blocks /Mandals were randomly assigned to one of the three interventions (HC /HCY/HY) and control units. The health system intervention consisted of training physicians and developing a system of patient support and supervision for tobacco cessation. The primary outcome was change in knowledge and practices of physicians in tobacco cessation. Logistic regression model was applied to assess the impact of single and combination of interventions. Results An increase in knowledge was observed on effects of tobacco on adverse birth outcomes, advice on NRT and, information provided on chronic disease management among physicians in HC, HY and HCY intervention units compared to control units from pre-intervention to post-intervention. Statistically significant change was observed in knowledge of physicians on effects of tobacco on adverse birth outcomes in HC (OR- 4.75, p-0.02) and HCY (OR- 5.08, p-0.04) intervention units. Conclusions HCY intervention was most effective in enhancing knowledge and practices of physicians in tobacco cessation. Our study suggests that individual tobacco control interventions when combined together has an incremental effect and increases the likelihood of provision of tobacco cessation services in primary care. .

Objective Studies have shown that smoke-free (SF) workplace policies can create an SF environment, but most of them have focused only on reducing secondhand smoke (SHS) exposure or changing smoking behavior. Our study aims to explore the effects of SF workplace policies and the pathway between workplace SF policies and SHS exposure. Method 14 195 employees from 79 companies in China participated in this survey. Binary logistic regression is used to examine the direct effects of SF workplace policies. Structured Equation Modeling approach is used to test other indirect effects. The Sobel test is used to estimate the mediation effect. Results Working in a company with SF policies was associated with lower SHS exposure (odds ratio = 0.56; 95% confidence interval = 0.51 to 0.60). Such policy were associated with lower smoking prevalence (Coef. = −0.05, p < .05) and positively associated with smoking harm awareness (Coef. = 0.07, p < .05) and SHS harm awareness (Coef. = 0.05, p < .05). Sobel test suggests that approximately 16.3% of the effects on SHS exposure reduction are mediated through the channel of lower smoking prevalence for males. For smokers, we did not identify a direct effect of such policies on quitting intentions, but a significant indirect effect via increased smoking harm awareness (Coef. = 0.07, p < .05) and lower smoking consumption (Coef. = −0.10, p < .05) were found. Conclusion This study finds that SF workplace policies are not only associated with lower SHS exposure but also related to some indirect effects. Further mediation analyses for males confirmed that the effect on SHS exposure reduction is mediated through the channel of lower smoking prevalence. Implications This study joins the debate in recent years on the effects of workplace SF policies and provides evidence with more comprehensive data from Asia Best Workplace Mainland China program. It shows that SF workplace policies not only can reduce SHS exposure but also are associated with lower smoking prevalence, fewer cigarettes smoked, and higher smoking harm-related awareness. These findings provide valuable evidence to promote such policies in all workplaces and underline the need for more stringent SF policies to be enacted in all countries.

Since the ratification of the World Health Organization Framework Convention on Tobacco Control in 2004, Pakistan has made modest but continued progress in implementing various tobacco control measures. By 2014, substantial progress was achieved in areas of monitoring, mass media antitobacco campaigns, and advertising bans. However, the findings from the 2014 Global Adult Tobacco Survey of Pakistan show significant differences in antitobacco campaign exposure among individuals of different educational attainment. Given this large variation in noticing antitobacco information, this paper analyzes how heterogeneity in treatment exposure may differentially impact tobacco‐use prevalence across household groups. Household‐level tobacco‐use prevalence in 2014 was, respectively, 56% and 48% for the low‐ and high‐education households. The gap in tobacco‐use prevalence between the two educational groups further widens post 2014. We find that, on average, individuals with higher than primary education are 14 percentage points and 6 percentage points more likely to notice anticigarette and antismokeless tobacco information in 2014, respectively. Subsequently, in 2016, high‐education households experienced a 3.6 percentage point higher reduction in tobacco‐use prevalence compared to the low‐education households. These findings motivate policies to enhance the outreach of tobacco control measures across different educational groups.

Background We sought to review qualitative evidence on how smokers in different socioeconomic groups engage with non-combustible nicotine products (NCNP), including electronic cigarettes and nicotine replacement therapies, in order to provide insight into how these products might impact on smoking inequalities. Methods We searched ten electronic databases in February 2017 using terms relating to NCNP and socioeconomic status. We included qualitative studies that were published since 1980 and were available in English. We used guidelines adapted from the Critical Appraisal Skills Programme for appraising qualitative research. Results The review only identified studies exploring the attitudes of socioeconomically disadvantaged smokers towards NCNP for harm reduction or cessation purposes (i.e. we did not identify any relevant studies of more advantaged socioeconomic groups). Using a lines-of-argument meta-ethnographic approach, we identified a predominantly pessimistic attitude to NCNP for harm reduction or cessation of smoking due to: wider circumstances of socioeconomic disadvantage; lack of a perceived advantage of alternative products over smoking; and a perceived lack of information about relative harms of NCNP compared to smoking. Optimistic findings, although fewer, suggested the potential of NCNP being taken up among smokers experiencing socioeconomic disadvantage. Conclusions Overall, our review highlights the importance of considering the social, cultural and economic circumstances that influence experiences of smoking and of alternative product use.

A "smoke-free" society is assumed if less than 5 % of a population smoke. We predict when this goal could be reached in Germany. To reduce the proportion of smokers in the population, the World Health Organization recommends a bundle of measures (MPOWER) that should minimize both the supply of and the demand for tobacco. The current level of implementation of these recommendations in Germany is presented.A total of 21 representative cross-sectional surveys of the Drug Affinity Study and the Epidemiological Survey of Substance Abuse since 2000/2001 with adolescents and adults show the smoking behavior of the population until 2018. Per capita consumption of factory-built and self-made cigarettes during the same period is used as an objective data basis. Regression analyses are used to model the date at which less than 5 % of the German population smoke. A selective literature review is carried out to describe the implementation of the MPOWER program.Before 2000 there was no trend in Germany towards non-smoking. After the implementation of various preventive measures such as price increases for tobacco products and the introduction of non-smoking protection laws, the spread of smoking among the population has steadily decreased since 2000. By 2018, the 5 % prevalence target among adolescents had almost been reached, as the relative proportion of adolescents who smoked fell by 20.9 percentage points to 6.6 %. The relative proportion of smoking in adult women fell by 12.1 percentage points to 18.5 %, the relative proportion of smoking in men by 14.8 percentage points to 24.2 %. Assuming a linear trend, the prevalence target of less than 5 % smoking adults can be reached by around 2043. Of the six recommended measures of the MPOWER program, Germany is currently only implementing the monitoring of tobacco consumption in society without compromises.After various tobacco prevention measures were implemented, a trend towards non-smoking began in Germany. The continual price increase recommended by the World Health Organization, the further restriction of availability, the ban on all tobacco advertising and promotion, the support of smoking cessation as well as the education of the population appear to be necessary to reinforce this trend and to achieve the health policy goal of a smoke-free society in 2040.Sobald weniger als 5 % einer Population rauchen, spricht man von einer „rauchfreien“ Gesellschaft. Es soll prognostiziert werden, ab welchem Zeitpunkt dieses Ziel in Deutschland erreicht werden könnte. Zur Verringerung des Raucheranteils in der Bevölkerung empfiehlt die Weltgesundheitsorganisation ein Bündel von Maßnahmen (MPOWER), das sowohl das Angebot von als auch die Nachfrage nach Tabak minimieren soll. Der derzeitige Umsetzungsgrad dieser Empfehlungen in Deutschland soll dargestellt werden.21 repräsentative Querschnittserhebungen der Drogenaffinitätsstudie sowie des Epidemiologischen Suchtsurveys ab 2000/2001 für Jugendliche sowie Erwachsene bilden das Rauchverhalten der Bevölkerung bis 2018 ab. Als objektiver Datensatz wurde der Pro-Kopf-Verbrauch von fabrikfertigen und selbsthergestellten Zigaretten im selben Zeitraum genutzt. Mittels Regressionsanalysen wurde modelliert, ab welchem Zeitpunkt weniger als 5 % der Bevölkerung in Deutschland rauchen. Zur Beschreibung der Umsetzung des MPOWER-Programms wird ein selektiver Literaturüberblick vorgenommen.In Deutschland gab es vor dem Jahr 2000 keinen Trend zum Nichtrauchen. Nach Umsetzung verschiedener Präventionsmaßnahmen wie Preiserhöhungen von Tabakprodukten und Einführung der Nichtraucherschutzgesetze ist ab dem Jahr 2000 die Verbreitung des Rauchens in der Bevölkerung kontinuierlich zurückgegangen. Bis 2018 wurde das 5 %-Prävalenzziel bei Jugendlichen nahezu erreicht, da der relative Anteil rauchender Jugendlicher um 20,9 Prozentpunkte auf 6,6 % gefallen ist. Der relative Anteil rauchender erwachsener Frauen fiel um 12,1 Prozentpunkte auf 18,5 %, der relative Anteil rauchender Männer um 14,8 Prozentpunkte auf 24,2 %. Unter der Annahme eines linearen Trends kann das Prävalenzziel von weniger als 5 % rauchender Erwachsener etwa 2043 erreicht werden. Von den 6 empfohlenen Maßnahmen des MPOWER-Programms setzt Deutschland derzeit lediglich das Monitoring des Tabakkonsums in der Gesellschaft ohne Abstriche um.Nach Umsetzung verschiedener Tabakpräventionsmaßnahmen setzte in Deutschland ein Trend zum Nichtrauchen ein. Die von der Weltgesundheitsorganisation empfohlene kontinuierliche Preiserhöhung, die weitere Einschränkung der Verfügbarkeit, das Verbot jeglicher Tabakwerbung und -promotion, die Unterstützung des Rauchstopps sowie die Aufklärung der Bevölkerung erscheinen erforderlich, um diesen Trend zu verstärken und das gesundheitspolitische Ziel einer rauchfreien Gesellschaft 2040 zu erreichen.