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Background and aims Design Setting Participants Measurements Findings Conclusions Smokers typically have a lower body mass index (BMI) than non‐smokers, while smoking cessation is associated with weight gain. In pre‐clinical research, nicotine in tobacco smoking suppresses appetite and influences subsequent eating behaviour; however, this relationship is unclear in humans. This study measured the associations of smoking with different eating and dietary behaviours.A cross‐sectional analysis of data from health assessments conducted between 2004 and 2022.An independent healthcare‐based charity within the United Kingdom.A total of 80 296 men and women (mean ± standard deviation [SD]: age, 43.0 ± 10.4 years; BMI, 25.7 ± 4.2 kg/m2; 62.5% male) stratified into two groups based on their status as a smoker (n = 6042; 7.5%) or non‐smoker (n = 74 254; 92.5%).Smoking status (self‐report) was the main exposure, while the primary outcomes were selected eating and dietary behaviours. Age, sex and socioeconomic status (index of multiple deprivation [IMD]) were included as covariates and interaction terms, while moderate‐to‐vigorous exercise and sleep quality were included as covariates only.Smokers had lower odds of snacking between meals and eating food as a reward or out of boredom versus non‐smokers (all odds ratio [OR] ≤ 0.82; P < 0.001). Furthermore, smokers had higher odds of skipping meals, going more than 3 h without food, adding salt and sugar to their food, overeating and finding it hard to leave something on their plate versus non‐smokers (all OR ≥ 1.06; P ≤ 0.030). Additionally, compared with non‐smokers, smoking was associated with eating fried food more times per week (rate ratio [RR] = 1.08; P < 0.001), eating fewer meals per day, eating sweet foods between meals and eating dessert on fewer days per week (all RR ≤ 0.93; P < 0.001). Several of these relationships were modified by age, sex and IMD.Smoking appears to be associated with eating and dietary behaviours consistent with inhibited food intake, low diet quality and altered food preference. Several of these relationships are moderated by age, sex and socioeconomic status. [ABSTRACT FROM AUTHOR]

Background and aims Methods Results Conclusions Youth use of disposable vapes has increased markedly in the United Kingdom in recent years, yet little is known about the motivations, experiences and perceptions of young people themselves. This study aimed to explore young people’s experiences and use of disposable vapes.This was a qualitative study recruiting young people reporting regularly vaping disposables, collecting data via dyad guided, individual and group interviews. Data analysis was theoretically informed by the Social Ecological Model. Inductive and deductive coding approaches were used, with resolution of coded interpretations by consensus.Twenty‐nine young people aged 16–20 years participated in qualitative interviews. At the individual level, participants discussed how characteristics of disposable vapes were important to them—particularly price, accessibility and the attractive designs, colours, names and flavours. Young people frequently engaged in both vaping and tobacco smoking, seeing the behaviours as interchangeable dependent on context, and having inaccurate relative harm perceptions of vaping compared with smoking. Experimentation was widespread and many used vapes as a way of managing stress and anxiety. Vaping was positioned as a social behaviour, common among peers. Parental influence on vaping behaviour was minimal, although vaping initiation could be influenced by family vaping norms. Culturally, vaping was a widespread normalized behaviour. Young people were aware of media reports and potential harms, but were less aware of smoking related harms as a consequence.Disposable vapes appear to be attractive and accessible to young people in the United Kingdom. Vaping is normalized in this population, despite being seen as potentially damaging to health, and vaping and smoking are engaged in interchangeably. Underage sales of vapes are reportedly widespread. Strict regulation, such as banning products or increasing prices, may prompt UK youth to switch from vaping to smoking. [ABSTRACT FROM AUTHOR]

Background and aims: The ubiquity of tobacco retailers helps to sustain the tobacco epidemic. A tobacco retail reduction approach that has not been tried is transitioning tobacco sales to state‐controlled alcohol stores (TTS), which are limited in number and operate under some restrictions, e.g. regarding opening hours or marketing materials. This study summarizes policy experts' and advocates' views of TTS, including (1) advantages and disadvantages; (2) feasibility; and (3) potential implementation obstacles. Design: This study was a qualitative content analysis of semi‐structured interviews. Setting: Ten US states with alcoholic beverage control systems were included. Participants: The participants comprised a total of 103 tobacco control advocates and professionals, public health officials, alcohol policy experts and alcohol control system representatives, including two tribal community representatives. Measurements Interviewees' perspectives on their state's alcoholic beverage control agency (ABC, the agency that oversees or operates a state alcohol monopoly) and on TTS were assessed. Findings Interviewees thought TTS offered potential advantages, including reduced access to tobacco products, less exposure to tobacco advertising and a greater likelihood of successful smoking cessation. Some saw potential long‐term health benefits for communities of color, due to the smaller number of state alcohol stores in those communities. Interviewees also raised concerns regarding TTS, including ABCs' limited focus on public health and emphasis on revenue generation, which could conflict with tobacco use reduction efforts. Some interviewees thought TTS could enhance the power of the tobacco and alcohol industries, increase calls for alcohol system privatization or create difficulties for those in recovery. Conclusions: In the United States, transitioning tobacco sales to state‐controlled alcohol stores (TTS) could have a positive public health impact by reducing tobacco availability, marketing exposure and, ultimately, tobacco use. However, tensions exist between alcohol control system goals of providing revenue to the state and protecting public health. Should a state decide to pursue TTS, several guardrails should be established, including building into the legislation an explicit goal of reducing tobacco consumption. [ABSTRACT FROM AUTHOR]

Background and aims: Adolescent polysubstance use has been associated with adverse social and health outcomes. Our aim was to measure rates and transitions to polysubstance use during adolescence and identify factors associated with initiation and discontinuation of polysubstance use. Design: Prospective cohort study. Multistate Markov modelling was used to estimate rates and identify correlates of transitions between substance use states. Setting and participants: Adolescent‐parent dyads (n = 1927; adolescents in grade 7, age ≈13 years) were recruited from Australian schools during 2010/11 (Wave 1). Adolescents were surveyed annually until 2016/17 (n = 1503; age ≈19 years; Wave 7) and parents were surveyed annually until 2014/15 (Wave 5). Measurements Alcohol, tobacco, cannabis and 3,4‐methylenedioxymethamphetamine (MDMA) use outcomes were collected at Waves 3–7. Potential confounders were collected at Waves 1–6 and consisted of sex, anxiety and depression symptoms and externalizing problems, parental monitoring, family conflict and cohesion, parental substance use and peer substance use. Covariates were age and family socioeconomic status. Findings Few adolescents engaged in polysubstance use at earlier waves (Wave 3: 5%; Wave 4: 8%), but proportions increased sharply across adolescence (Waves 5–7: 17%, 24%, 36%). Rates of transitioning to polysubstance use increased with age, with few (<9%) adolescents transitioning out. More externalizing problems (odds ratio [OR] = 1.10; 99.6% confidence interval [CI] = 1.07–1.14), parental heavy episodic drinking (OR = 1.22; 99.6% CI = 1.07–1.40), parental illicit substance use (OR = 3.56; 99.6% CI = 1.43–8.86), peer alcohol use (OR = 5.68; 99.6% CI = 1.59–20.50) and peer smoking (OR = 4.18; 99.6% CI = 1.95–8.81) were associated with transitioning to polysubstance use. Conclusions: Polysubstance use in Australia appears to be rare during early adolescence but more common in later adolescence with low rates of transitioning out. Externalizing problems and greater parental and peer substance use are risk factors for adolescent polysubstance use that may be suitable intervention targets. [ABSTRACT FROM AUTHOR]

Aims Design Setting Participants Intervention and comparator Measurements Findings Conclusions The aim of this work was to measure the impact of P2P (i.e. peer‐to‐peer), a peer‐led smoking prevention intervention, on daily smoking prevalence of adolescents over 2 school years.A cluster‐randomized controlled trial was performed over a 16‐month follow‐up (trial status: closed to follow‐up). P2P was implemented 1–3 and 13–15 months after baseline. Assessments took place at baseline and 4, 10 and 16 months after baseline. The research team, assessors and adolescents were blinded to the study‐arm assignment only at baseline.Fifteen vocational high schools in France were randomized into two clusters, using a 1:1 allocation ratio per French department (n intervention = 7, n control = 8).Participants comprised a sample of 2010 students in year 11 (i.e. 15–16 years) in vocational high schools. A total of 437 students could not be assessed at baseline (absent or left school), yielding a total sample of 1573 students (n intervention = 749, n control = 824).The P2P programme trained voluntary students to become peer educators and design smoking prevention actions for their schoolmates in the intervention group (n = 945 students), compared with a passive control group (n = 1065 students).The primary outcome was change from baseline in the prevalence of self‐reported daily smoking (i.e. at least one cigarette per day) at 16 months.The ‘time × group’ interaction indicated that, compared with the control group, the intervention group had statistically significantly fewer daily smokers after 16 months [odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.20, 0.53]. Similarly, compared with the control group, the intervention group had statistically significantly fewer daily smokers after 4 months (OR = 0.50, 95% CI = 0.30, 0.82) and 10 months (OR = 0.60, 95% CI = 0.37, 0.98). No adverse events of P2P2 were reported.A cluster‐randomized trial found evidence that the peer‐led P2P (peer‐to‐peer) smoking prevention intervention reduced the uptake of daily smoking among high school students in France over 16 months. [ABSTRACT FROM AUTHOR]

Background and Aims: Nicotine vaping products (NVPs) can potentially help adult tobacco users quit smoking. This study evaluated how adult consumers compare the costs between NVPs and cigarettes. Method: We used data from the US arm of the 2016–2020 International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) surveys to perform a multinomial logit model with two‐way fixed effects to measure how perceived cost comparisons are associated with NVP and cigarette taxes, use patterns, NVP device types and individual sociodemographic factors. Results: Higher cigarette taxes are associated with a greater likelihood of perceiving NVPs and cigarettes as costing the same for the overall population and among people who exclusively smoke, and a lower likelihood of perceiving NVPs as more expensive among people who exclusively vape, compared with lower cigarette taxes. Pre‐filled cartridge and tank users are more likely to perceive NVPs as less expensive than cigarettes, compared with people who use other types of NVPs. The associations between taxes and perceived cost comparison were more pronounced among males, younger and low‐income populations. Conclusions: Higher cigarette taxes are associated with perceived financial incentives for nicotine vaping products (NVPs) over cigarettes, whereas NVP taxes are not associated with perceived cost comparison between NVPs and cigarettes. [ABSTRACT FROM AUTHOR]

Background and aims: Smoking is considered the main cause of preventable death world‐wide. This study aimed to review the efficacy and safety of cytisine for smoking cessation. Methods: This review included an exhaustive search of databases to identify randomized controlled trials (RCTs) in health centers of any level with smokers of any age or gender investigating the effects of cytisine at standard dosage versus placebo, varenicline or nicotine replacement therapy (NRT). Results: We identified 12 RCTs. Eight RCTs compared cytisine with placebo at the standard dose covering 5922 patients, 2996 of whom took cytisine, delivering a risk ratio (RR) of 2.25 [95% confidence interval (CI) = 1.42–3.56; I2 = 88%; moderate‐quality evidence]. The greater intensity of behavioral therapy was associated directly with the efficacy findings (moderate‐quality evidence). The confirmed efficacy of cytisine was not evidenced in trials conducted in low‐ and middle‐income countries. We estimate a number needed to treat (NNT) of 11. Two trials compared the efficacy of cytisine versus NRT, and the combination of both studies yields modest results in favor of cytisine. Three trials compared cytisine with varenicline, without a clear benefit for cytisine. Meta‐analyses of all non‐serious adverse events in the cytisine group versus placebo groups yielded a RR of 1.24 (95% CI = 1.11–1.39; participants = 5895; studies = 8; I2 = 0%; high‐quality evidence). Conclusions: Cytisine increases the chances of successful smoking cessation by more than twofold compared with placebo and has a benign safety profile, with no evidence of serious safety concerns. Limited evidence suggests that cytisine may be more effective than nicotine replacement therapy, with modest cessation rates. [ABSTRACT FROM AUTHOR]

Background and Aims: Standard approaches to smoking cessation may not be as effective for certain populations, and tailoring on cultural factors could improve their effectiveness. This systematic review measured the effectiveness of culturally tailoring smoking cessation interventions on quitting or reducing smoking combustible tobacco. Method: We searched MEDLINE, PsychInfo, Embase and Cochrane Central Register from inception to 21 June 2023 for randomized controlled trials (RCTs) of community‐based, primary care or web‐based interventions for smoking cessation in adults who smoked tobacco, with measurement of smoking abstinence or reduction at least 3 months following baseline. We examined comparisons between either an intensity‐matched culturally tailored intervention and a non‐tailored intervention or a standard non‐tailored intervention and the same intervention plus a culturally tailored adjunct. We sub‐grouped studies according to the level of tailoring and performed subgroup analyses where appropriate. We assessed risk of bias and certainty of evidence. Results: We identified 43 studies, 33 of which were meta‐analyzed (n = 12 346 participants). We found moderate certainty evidence, limited by heterogeneity, that intensity‐matched culturally tailored cessation interventions increased quit success when compared with non‐tailored interventions at 3‐month follow‐up or longer (n = 5602, risk ratio [RR] = 1.29 95% confidence interval [CI] 1.10, 1.51, I2 = 47%, 14 studies). We found a positive effect of adding a culturally tailored component to a standard intervention compared with the standard intervention alone (n = 6674, RR = 1.47, 95% CI 1.10, 1.95, I2 = 74%, 18 studies), but our certainty in this effect was low due to imprecision and substantial statistical heterogeneity. Conclusion: Culturally tailored smoking cessation interventions may help more people to quit smoking than a non‐tailored intervention. Adapting or adding cultural components to smoking cessation interventions originally developed for majority populations could improve cessation rates in populations who do not fully identify with majority cultural norms. [ABSTRACT FROM AUTHOR]

Aims: The aims of this study were to measure whether household bans on vaping were associated with lower odds of youth past‐month vaping when compared with (1) otherwise similar youth whose households did not have a vaping ban (using coarsened exact matching); and (2) themselves in waves when their household did not have a ban (using hybrid panel models). We used the same analytical strategies to examine cross‐sectional associations between household smoking bans and adolescents' past‐month cigarette smoking. Design: This was a longitudinal study using data from a nationally representative sample of youth (age 12–17 years) in the Population Assessment of Tobacco and Health Study. Setting: United States of America. Participants: A total of 16 214 adolescents followed over 48 103 total observations (approximately three waves). Measurements Measurements comprised youth past‐month e‐cigarette and cigarette use and parent‐reported household bans on vaping and smoking. Potential confounders were prior adolescent smoking, vaping, and other nicotine product use; parent current smoking, vaping, and other nicotine use; adolescent peer e‐cigarette/cigarette use; parental monitoring; and demographic characteristics. Findings Before matching, smoking bans were associated with 46% lower odds of youth smoking [odds ratio (OR) = 0.54; 95% confidence interval (CI) = 0.41–0.70] and vaping bans with 37% lower odds of youth e‐cigarette use (OR = 0.63; 95% CI = 0.50–0.80). However, households with and without bans differed significantly on all confounders before matching. After matching, household vaping bans were associated with 56% lower odds of youth vaping (OR = 0.44; 95% CI = 0.33–0.58). Results from hybrid panel models also revealed 37% lower odds of vaping in waves when youth lived in a vape‐free household compared to waves when they did not (OR = 0.63; 95% CI = 0.50–0.78). Associations between smoking bans and youth smoking were not statistically significant after matching or when using hybrid panel models. Conclusions: Household vaping bans appear to be associated with lower odds of past‐month vaping among US adolescents, compared with similar youth whose households did not have a ban and to themselves in waves when their households did not have a ban. [ABSTRACT FROM AUTHOR]

Aims, Design and Setting: The aim of this study was to determine which combination(s) of five e-cigarette-orientated intervention components, delivered on-line, affect smoking cessation. An on-line (UK) balanced five-factor (2 x 2 x 2 x 2 x 2 = 32 intervention combinations) randomized factorial design guided by the multi-phase optimization strategy (MOST) was used. Participants: A total of 1214 eligible participants (61% female; 97% white) were recruited via social media. Interventions: The five on-line intervention components designed to help smokers switch to exclusive e-cigarette use were: (1) tailored device selection advice; (2) tailored e-liquid nicotine strength advice; (3): tailored e-liquid flavour advice; (4) brief information on relative harms; and (5) text message (SMS) support. Measurements: The primary outcome was 4-week self-reported complete abstinence at 12 weeks post-randomization. Primary analyses were intention-to-treat (loss to follow-up recorded as smoking). Logistic regressions modelled the three- and two-way interactions and main effects, explored in that order. Findings: In the adjusted model the only significant interaction was a two-way interaction, advice on flavour combined with text message support, which increased the odds of abstinence (odds ratio = 1.55, 95% confidence interval = 1.13-2.14, P = 0.007, Bayes factor = 7.25). There were no main effects of the intervention components. Conclusions: Text-message support with tailored advice on flavour is a promising intervention combination for smokers using an e-cigarette in a quit attempt. [ABSTRACT FROM AUTHOR]

Background and Aims: Previous studies have found that job satisfaction is closely associated with various health outcomes of workers. Our study measured the association between job satisfaction and current smoking and change in smoking behavior. Design: Data from the longitudinal Korea Labor and Income Panel Study (KLIPS) that consist of nationally representative samples were used. The repeated measures analysis was conducted. Setting: South Korea, 2005-2021. Participants: In total, 21 154 workers in Korea followed from 2005 to 2021 (145 120 observations) were included as study participants. Measurements: The main predictor variable, job satisfaction, was assessed using a five-item general job satisfaction questionnaire. Job satisfaction was classified into 'dissatisfied', 'neutral' and 'satisfied', according to the tertiles of the sum of scores. The outcomes of interest were current smoking and initiation and cessation of smoking in the subsequent year. Findings: Compared with those with a neutral level of job satisfaction, those who reported dissatisfaction with their job had an increased risk of smoking initiation [odds ratio (OR) = 1.11, 95% confidence interval (CI) = 1.01-1.22)]. Workers satisfied with their jobs were associated with a decreased likelihood of current smoking (OR = 0.96, 95% CI = 0.94--0.98) and smoking initiation (OR = 0.90, 95% CI = 0.81-0.99). There was a positive relationship between cumulative years of job dissatisfaction and smoking risk: > 4 years of experiencing job dissatisfaction was positively related to current smoking (OR = 1.14, 95% CI = 1.06-1.24) and smoking initiation (OR = 1.22, 95% CI = 1.00-1.49) and negatively related to smoking cessation (OR = 0.84, 95% CI = 0.72-0.99). Conclusions: In Korea, job dissatisfaction appears to be associated with an increased risk of smoking initiation. [ABSTRACT FROM AUTHOR]

The Cochrane Tobacco Addiction Group has created risk of bias tools, which are topic‐agnostic. In 2012 the Cochrane Tobacco Addiction Group created guidance specific to considerations for reviews of randomized controlled trials of tobacco cessation interventions, building on existing Cochrane tools. The guidance covers issues relating to selection bias, performance bias, detection bias, attrition bias and selective reporting. In this paper, we set out to make this guidance publicly available, so that others can use and cite it. We provide advice for using this tool to appraise trials critically as a systematic reviewer. We also provide guidance for triallists on ways to use this tool to improve trial design and reporting. [ABSTRACT FROM AUTHOR]

Background and Aims: Treatment of depression‐related psychological factors related to smoking behavior may improve rates of cessation among adults with major depressive disorder (MDD). This study measured the efficacy and safety of 12 weeks of behavioral activation for smoking cessation (BASC), varenicline and their combination. Design, Setting, Participants: This study used a randomized, placebo‐controlled, 2 × 2 factorial design comparing BASC versus standard behavioral treatment (ST) and varenicline versus placebo, taking place in research clinics at two urban universities in the United States. Participants comprised 300 hundred adult smokers with current or past MDD. Interventions: BASC integrated behavioral activation therapy and ST to increase engagement in rewarding activities by reducing avoidance, withdrawal and inactivity associated with depression. ST was based on the 2008 PHS Clinical Practice Guideline. Both treatments consisted of eight 45‐min sessions delivered between weeks 1 and 12. Varenicline and placebo were administered for 12 weeks between weeks 2 and 14. Measurements: Primary outcomes were bioverified intent‐to‐treat (ITT) 7‐day point‐prevalence abstinence at 27 weeks and adverse events (AEs). Findings No significant interaction was detected between behavioral treatment and pharmacotherapy at 27 weeks (χ2(1) = 0.19, P = 0.67). BASC and ST did not differ (χ2(1) = 0.43, P = 0.51). Significant differences in ITT abstinence rates (χ2(1) = 4.84, P = 0.03) emerged among pharmacotherapy arms (16.2% for varenicline, 7.5% for placebo), with results favoring varenicline over placebo (rate ratio = 2.16, 95% confidence interval = 1.08, 4.30). All significant differences in AE rates after start of medication were higher for placebo than varenicline. Conclusion: A randomized trial in smokers with major depressive disorder found that varenicline improved smoking abstinence versus placebo at 27 weeks without elevating rates of adverse events. Behavioral activation for smoking cessation did not outperform standard behavioral treatment, with or without adjunctive varenicline therapy. [ABSTRACT FROM AUTHOR]

Background and Aims: Previous studies have focused on the role of perioperative nicotine replacement therapy (NRT) in improving the success rate of long‐term smoking cessation in tobacco smokers. This study aimed to measure the effectiveness of high‐dose NRT in alleviating postoperative pain for male abstinent smokers receiving abdominal surgery. Design: This was a parallel‐group, randomized, double‐blind and controlled pilot trial. Setting and participants: In total, 101 male smoking‐abstinent patients from the Eastern Hepatobiliary Surgery Hospital, Shanghai, China, from 8 October 2018 to 10 December 2021. Interventions: Patients started smoking cessation on admission to the hospital ward. Patients received 24‐hour transdermal nicotine patches (n = 50) or placebo (n = 51) every day from admission until 48 hours after surgery. Measurements The primary outcomes were pre‐surgery pain thresholds and total consumption of analgesics within the first 48 hours after surgery. Secondary outcomes included postoperative pain and sedation scores, nausea, vomiting and fever frequency within the treatment period. Findings Both pre‐surgery electrical and mechanical pain thresholds in the NRT group were higher than those in the placebo group (P = 0.004 and P = 0.020, respectively). The 48‐hour postoperative analgesic consumption was significantly lower for smoking‐abstinent patients receiving NRT than those receiving placebo (standardized morphine equivalent requirement, median [interquartile range], 1.80 [1.47, 2.32] mg/kg vs 2.22 [1.62, 2.82] mg/kg, P = 0.011). Postoperative pain intensity was significantly lower in the NRT group than that in the placebo group at 1st hour and 24th hour post‐surgery (P < 0.001 and P = 0.012, respectively). The incidence of treatment‐related adverse events was not significantly different between groups. Conclusions: Perioperative high‐dose nicotine replacement therapy may help to relieve postoperative pain among male smoking‐abstinent patients undergoing abdominal surgery. [ABSTRACT FROM AUTHOR]

Background and Aims: Heated tobacco products (HTPs) are electronic devices that heat process tobacco to release an aerosol containing nicotine and other chemicals. Limited data exist on world‐wide HTP use prevalence. This meta‐analytic review estimated the prevalence of HTP use by country, World Health Organization (WHO) region, year, sex/gender and age. Methods: Five databases (Web of Science, Scopus, Embase, PubMed and PsycINFO) were searched between January 2015 and May 2022. Included studies reported the prevalence of HTP use in nationally representative samples post‐modern HTP device market entry (2015). A random‐effects meta‐analysis was used to estimate overall prevalence for life‐time, current and daily HTP use. Results: Forty‐five studies (n = 1 096 076) from 42 countries/areas from the European Region (EUR), Western Pacific Region (WPR), Region of the Americas (AMR) and African Region (AFR) met inclusion criteria. Estimated pooled prevalence for life‐time, current and daily HTP use was 4.87% [95% confidence interval (CI) = 4.16, 5.63], 1.53% (95% CI = 1.22, 1.87) and 0.79% (95% CI = 0.48, 1.18), respectively, across all years (2015–22). Life‐time HTP use prevalence significantly increased by 3.39% for WPR [0.52% (95% CI = 0.25, 0.88) in 2015 to 3.91% (95% CI = 2.30, 5.92) in 2019] and 5.58% for EUR [1.13% (95% CI = 0.59, 1.97) in 2016 to 6.98% (95% CI = 5.69, 8.39) in 2020]. Current HTP use increased by 10.45% for WPR [0.12% (95% CI = 0, 0.37) in 2015 to 10.57% (95% CI = 5.59, 16.88) in 2020] and 1.15% for EUR [0% (95% CI = 0, 0.35) in 2016 to 1.15% (95% CI = 0.87, 1.47) in 2020]. Meta‐regression revealed higher current HTP use in WPR [3.80% (95% CI = 2.88, 4.98)] compared with EUR [1.40% (95% CI = 1.09, 1.74)] and AMR [0.81% (95% CI = 0.46, 1.26)] and for males [3.45% (95% CI = 2.56, 4.47)] compared with females [1.82% (95% CI = 1.39, 2.29)]. Adolescents had higher life‐time HTP use prevalence [5.25% (95% CI = 4.36, 6.21) than adults [2.45% (95% CI = 0.79, 4.97)]. Most studies scored a low risk of sampling bias due to their nationally representative sampling. Conclusion: The prevalence of HTPs use increased in the EUR and WPR between 2015 and 2020, with nearly 5% of the included populations having ever tried HTP and 1.5% identifying as current users during the study period. [ABSTRACT FROM AUTHOR]

The article discusses a study by O. A. Wackowski et al which suggested opportunities that exist to educate adult smokers on the relative risks of tobacco products, particularly e-cigarettes. Topics include variation in the regulation of tobacco and nicotine products across countries, factors to consider when developing and implementing strategies to educate adult smokers on the risks of tobacco products, and opportunities that exist to educate adult smokers about the risks of tobacco products.

Background and Aims: Electronic nicotine delivery systems (ENDS) can help people to quit smoking combusted tobacco products (CTPs), but most current and former smokers who use ENDS also intend to quit ENDS. This analysis measured whether ENDS cessation among current and former CTP smokers is associated with changes in CTP smoking or abstinence. Design: Regression analysis of a nationally representative cohort from waves 4 (W4) and 5 (W5) of the Population Assessment of Tobacco and Health Study (December 2016–November 2019). Setting: United States. Participants: Adults (n = 1525) who reported W4 current or former use of ≥ 1 CTP and either currently using ENDS or quitting ENDS in the past year were included. Measurements Logistic regressions were performed separately among W4 current and former CTP smokers, controlling for demographic and tobacco use characteristics. First, we analyzed proximal outcomes by testing the association between ENDS quit status and CTP abstinence, both occurring during W5. Next, we analyzed long‐term outcomes by testing W4 ENDS quit status as a predictor of CTP abstinence at W5, approximately 1 year later. Findings Among W4 current CTP smokers, there was no evidence that CTP smoking abstinence differed between those quitting or continuing using ENDS, both in our proximal [adjusted odds ratio (aOR) = 1.37, 95% confidence interval (CI) = 0.90, 2.10] and long‐term (aOR = 0.90, 95% CI = 0.52, 1.53) analyses. Among former CTP smokers, quitting ENDS was associated with less CTP abstinence in our proximal analysis (aOR = 0.42, 95% CI = 0.20, 0.89), but there was no evidence that CTP smoking abstinence differed between those quitting or continuing using ENDS in our long‐term analysis (aOR = 0.86, 95% CI = 0.44, 1.67). Conclusions: There is no evidence that ENDS cessation is associated with CTP abstinence among current smokers, although mixed findings among former smokers indicate a possible risk for relapse to smoking associated with quitting ENDS. [ABSTRACT FROM AUTHOR]

Aims: To estimate associations between e‐cigarette flavour and smoking cessation and study product use at 6 months or longer. Methods: Secondary analysis of data from a living systematic review, with meta‐analyses and narrative synthesis, incorporating data up to January 2022. Included studies provided people who smoked combustible cigarettes with nicotine e‐cigarettes for the purpose of smoking cessation compared with no treatment or other stop smoking interventions. Measurements included smoking cessation and study product use at 6 months or longer reported as risk ratios (RR) with 95% confidence intervals (CI); and flavour use at any time‐points. Results: We included 16 studies (n = 10 336); 14 contributed to subgroup analyses and 10 provided participants with a choice of e‐cigarette flavour. We judged nine, five and two studies at high, low and unclear risk of bias, respectively. Subgroup analyses showed no clear associations between flavour and cessation or product use. In all but one analysis, tests for subgroup differences resulted in I2 values between 0 and 35%. In the comparison between nicotine e‐cigarettes and nicotine replacement therapy (NRT) (I2 = 65.2% for subgroup differences), studies offering tobacco flavour e‐cigarettes showed evidence of a greater proportion of participants still using at 6 months or longer (RR = 3.81; 95% CI = 1.45–10.05; n = 1181; I2 = 84%), whereas there was little evidence for greater 6‐month use when studies offered a choice of flavours (RR = 1.44; 95% CI = 0.80–2.56; n = 454; I2 = 82%). However, substantial statistical heterogeneity within subgroups makes interpretation of this result unclear. In the 10 studies where participants had a choice of flavours, and this was tracked over time, some switching between flavours occurred, but there were no clear patterns in flavour preferences. Conclusions: There does not appear to be a clear association between e‐cigarette flavours and smoking cessation or longer‐term e‐cigarette use, possibly due to a paucity of data. There is evidence that people using e‐cigarettes to quit smoking switch between e‐cigarette flavours. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence that an addictive‐eating phenotype may exist. There is significant debate regarding whether highly processed foods (HPFs; foods with refined carbohydrates and/or added fats) are addictive. The lack of scientifically grounded criteria to evaluate the addictive nature of HPFs has hindered the resolution of this debate. Analysis: The most recent scientific debate regarding a substance's addictive potential centered around tobacco. In 1988, the Surgeon General issued a report identifying tobacco products as addictive based on three primary scientific criteria: their ability to (1) cause highly controlled or compulsive use, (2) cause psychoactive (i.e. mood‐altering) effects via their effect on the brain and (3) reinforce behavior. Scientific advances have now identified the ability of tobacco products to (4) trigger strong urges or craving as another important indicator of addictive potential. Here, we propose that these four criteria provide scientifically valid benchmarks that can be used to evaluate the addictiveness of HPFs. Then, we review the evidence regarding whether HPFs meet each criterion. Finally, we consider the implications of labeling HPFs as addictive. Conclusion: Highly processed foods (HPFs) can meet the criteria to be labeled as addictive substances using the standards set for tobacco products. The addictive potential of HPFs may be a key factor contributing to the high public health costs associated with a food environment dominated by cheap, accessible and heavily marketed HPFs. [ABSTRACT FROM AUTHOR]

Aims: Most extant evidence has addressed between‐person differences, short‐term or cross‐sectional associations of electronic nicotine delivery systems (ENDS) use with other substance use, the majority focusing on current rather than escalated use. The present study aimed to examine within‐person changes in escalated ENDS use and their associations with individual and combined substance use over a 6‐year period. Design, Setting and Participants: This study used a longitudinal cohort design with US young adults. A generalized linear mixed‐model approach was employed to fit a series of weighted logistic regression models. Data were drawn from waves 1–5 of the Population Assessment of Tobacco and Health (PATH) study in the United States. Of the 9110 young adults at baseline, aged 18–24 years, a total of 5042 individuals had matched data across all five waves of assessments. Measurements: Escalated ENDS use was computed by subtracting the number of days of ENDS use within the past 30 days at wave w−1 from that at wave w and coded as 1 = escalated, if the value was greater than zero (otherwise, coded as 0 = not escalated). Findings Escalated ENDS use gradually decreased over time, with the lowest prevalence at wave 4 (4.0%) but sharply increasing at wave 5 (8.4%). Escalated ENDS use was associated with increased odds of using each substance (binge drinking, marijuana use, marijuana vaping, prescription and illicit drugs) and different combinations of polysubstance use between cigarette smoking, binge drinking and marijuana use (Ps < 0.05). In addition, sweet/fruit flavor use (versus menthol/mint) was associated with increased likelihood of reporting co‐use of cigarettes and marijuana. Conclusions: In the United States, the prevalence of young adults using electronic nicotine delivery systems appears to have increased steadily between 2013 and 2019, although the rate of increase may have started to accelerate in recent years. Escalated electronic nicotine delivery systems use and time‐lagged established electronic nicotine delivery systems use appear to be prospectively associated with individual and combined substance use, particularly between cigarettes, alcohol and marijuana. Among established electronic nicotine delivery systems users, sweet/fruit flavor appears to be associated with increased risk of co‐using cigarettes and marijuana. [ABSTRACT FROM AUTHOR]

Aims: Exposure to tobacco products and advertising at the point of sale may be associated with pro‐smoking cognitions. However, previous studies on this topic measured exposure based on self‐report and did not include European countries. The aim of this study was to assess the association between objectively measured exposure to tobacco outlets and non‐smoking adolescents' smoking attitudes, beliefs and norms. Design: This cross‐sectional study combined survey data with Global Positioning Systems data using geographic information system. Setting: The four Dutch cities of Amsterdam, Eindhoven, Haarlem and Zwolle. Participants: We retrieved data of 308 13 to 17‐year‐old non‐smoking adolescents, mainly girls (61%), adolescents attending pre‐university secondary education (71%) and without smoking friends (58%). Measurements Exposure was measured with a smartphone app registering for 2 weeks how often participants were within 10 m of a tobacco outlet. We distinguished between outlets without visible tobacco promotion (i.e. supermarkets), with only internal visibility and with both internal and external visibility. Participants' reported smoking cognitions were dichotomised into pro‐smoking or anti‐smoking. We applied multi‐level logistic regression analyses and adjusted for age, sex, educational level and smoking friends. Findings On average, adolescents were exposed to 1.18 (SD = 1.23) tobacco outlets per day. Higher exposure to tobacco outlets was associated with higher odds of pro‐smoking injunctive norm (OR = 1.35, 95% CI = 1.04–1.75). Associations with attitude (OR = 1.12, 95% CI = 0.91–1.38), social beliefs (OR = 1.15, 95% CI = 0.93–1.43), health beliefs (OR = 1.18, 95% CI = 0.97–1.44) and descriptive norm (OR = 1.15, 95% CI = 0.91–1.44) were also positive, but non‐significant. Overall, associations were strongest for outlets with internal visibility, for instance, for injunctive norm (OR = 1.37, 95% CI = 1.03–1.81). Conclusions: Global Positioning Systems‐measured exposure to tobacco outlets was associated with pro‐smoking cognitions among non‐smoking adolescents in the Netherlands. [ABSTRACT FROM AUTHOR]

Background and Aims: Smoking fewer cigarettes per day may increase the chances of stopping smoking. Capping the number of cigarettes per pack is a promising policy option, but the causal impact of such a change is unknown. This study aimed to test the hypothesis that lowering cigarette pack sizes from 25 to 20 reduces the number of cigarettes smoked. Design: This randomized controlled cross‐over trial had two 14‐day intervention periods with an intervening 7‐day period of usual behaviour. Participants purchased their own cigarettes. They were instructed to smoke their usual brand from either one of two sizes of pack in each of two 14‐day intervention periods: (a) 25 cigarettes and (b) 20 cigarettes. Participants were randomized to the order in which they smoked from the two pack sizes (a–b; b–a). Setting: Canada. Participants: Participants were adult smokers who smoked from pack sizes of 25, recruited between July 2020 and June 2021. Of 252 randomized, 240 (95%) completed the study and 236 (94%) provided sufficient data for the primary analysis. Measurements Cigarettes smoked per participant per day. Findings Participants smoked fewer cigarettes per day from packs of 20 cigarettes [n = 234, mean = 15.7 standard deviation (SD) = 7.1] than from packs of 25 (n = 235, mean = 16.9, SD = 7.1). After adjusting for pre‐specified covariates (baseline consumption and heaviness of smoking), modelling estimated that participants smoked 1.3 fewer cigarettes per day [95% confidence interval (CI) = −1.7 to −0.9], equivalent to 7.6% fewer (95% CI = −10.1 to −5.2%) from packs of 20 cigarettes. Conclusions: Smoking from packs of 20 compared with 25 cigarettes reduced the number of cigarettes smoked per day. [ABSTRACT FROM AUTHOR]

Aims: This study aims to compare biomarkers of potential harm between people switching from smoking combustible cigarettes (CC) completely to electronic cigarettes (EC), continuing to smoke CC, using both EC and CC (dual users) and using neither (abstainers), based on behaviour during EC intervention studies. Design: Secondary analysis following systematic review, incorporating inverse variance random‐effects meta‐analysis and effect direction plots. Setting: This study was conducted in Greece, Italy, Poland, the United Kingdom and the United States. Participants: A total of 1299 adults smoking CC (nine studies) and provided EC. Measurements Measurements were conducted using carbon monoxide (CO) and 26 other biomarkers. Findings In pooled analyses, exhaled CO (eCO) was lower in EC versus EC + CC [mean difference (MD) = −4.40 parts per million (p.p.m.), 95% confidence interval (CI) = −12.04 to 3.24, two studies] and CC (MD = −9.57 p.p.m., 95% CI = −17.30 to −1.83, three studies). eCO was lower in dual users versus CC only (MD = −1.91 p.p.m., 95% CI = −3.38 to −0.45, two studies). Magnitude rather than direction of effect drove substantial statistical heterogeneity. Effect direction plots were used for other biomarkers. Comparing EC with CC, 12 of 13 biomarkers were significantly lower in EC users, with no difference for the 13th. Comparing EC with dual users, 12 of the 25 biomarkers were lower for EC, and five were lower for dual use. For the remaining eight measures, single studies did not detect statistically significant differences, or the multiple studies contributing to the outcome had inconsistent results. Only one study provided data comparing dual use with CC; of the 13 biomarkers measured, 12 were significantly lower in the dual use group, with no statistically significant difference detected for the 13th. Only one study provided data on abstainers. Conclusions: Switching from smoking to vaping or dual use appears to reduce levels of biomarkers of potential harm significantly. [ABSTRACT FROM AUTHOR]

Background and aims: The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) seeks to realize the right to health through national tobacco control policies. However, few states have met their obligations under Article 14 of the FCTC to develop evidence‐based policies to support tobacco cessation. This article examines how human rights obligations could provide a legal and moral basis for states to implement greater support for individuals to overcome their addiction to tobacco. Analysis: The United Nations (UN) has a well‐established legal framework for promoting human rights, looking to the right to health to realize health autonomy. Where addiction undermines autonomy, it is widely acknowledged that addiction presents a significant barrier to cessation for individuals who use tobacco, undermining the right to health. The UN human rights system could, therefore, provide a complementary basis for monitoring state obligations under Article 14 of the FCTC, identifying challenges to FCTC implementation and motivating states to support tobacco cessation. Conclusions: The United Nations' human rights system offers a mechanism that could be used to monitor Framework Convention on Tobacco Control implementation in national policy, facilitating accountability for the progressive realization of cessation support. [ABSTRACT FROM AUTHOR]

Aims: To estimate recent trends in cigarette use and health insurance coverage for United States adults with and without mental health and substance use disorders (MH/SUD). Design: Event study analysis of smoking and insurance coverage trends among US adults with and without MH/SUD using 2008–19 public use data from the National Survey on Drug Use and Health, an annual, cross‐sectional survey. Setting: USA. Participants: A nationally representative sample of non‐institutionalized respondents aged 18–64 years (n = 448 762). Measurements Outcome variables were three measures of recent cigarette use and one measure of past‐year health insurance coverage. We compared outcomes between people with and without MH/SUD (MH disorder: past‐year mental illness, predicted from Kessler‐6 and the World Health Organization–Disability Assessment Schedule impairment scale; SUD: met survey‐based DSM‐IV criteria for past‐year alcohol, cannabis, cocaine or heroin use disorder) and over time. Findings Comparing pooled data from 2008 to 2009 and from 2018 to 2019, current smoking rates of adults with MH/SUD decreased from 37.9 to 27.9% while current smoking rates of adults without MH/SUD decreased from 21.4 to 16.3%, a significant difference in decrease of 4.9 percentage points (pts) [95% confidence interval (CI) = 3.3–6.6 pts]. Daily smoking followed similar patterns (difference in decrease of 3.9 pts (95% CI = 2.3–5.4 pts). Recent smoking abstinence rates for adults with MH/SUD increased from 7.4 to 10.9%, while recent smoking abstinence rates for adults without MH/SUD increased from 9.6 to 12.0%, a difference in increase of 1.0 pts (95% CI = −3.0 to 0.9 pts). In 2018–19, 11% of net reductions in current smoking, 12% of net reductions in daily smoking and 12% of net increases in recent smoking abstinence coincided with greater gains in insurance coverage for adults with MH/SUD compared to those without MH/SUD. Conclusions: Improvements in smoking and abstinence outcomes for US adults with mental health and substance use disorders appear to be associated with increases in health insurance coverage. [ABSTRACT FROM AUTHOR]

Aims: There is a growing body of literature exploring the types of substance‐related content and their portrayals on various social media platforms. We aimed to summarize how content related to substances is portrayed on various social media platforms. Methods: This systematic review was pre‐registered on PROSPERO (ref: CRD42021291853). A comprehensive search was conducted in the databases of PubMed, Scopus, PsycINFO and Web of Science in April 2021. Original qualitative studies published post‐2004 that included thematic and sentiment analyses of social media content on tobacco, alcohol, psychostimulant, e‐cigarette, cannabis, opiate, stimulant/amphetamine, inhalant and novel psychoactive substance were included. Social media platforms were defined as online web‐ or application‐based platforms that allowed users to generate content and interact via 'liking', comment or messaging features. Only studies that included summative and/or thematic content analyses of substance‐related social media content were included. Results: A total of 73 studies, which covered 15 905 182 substance‐related posts on Twitter, YouTube, Instagram, Pinterest, TikTok and Weibo, were identified. A total of 76.3% of all substance‐related content was positive in its depiction of substance use, with 20.2% of content depicting use negatively. Sentiment regarding opiate use however was commonly negative (55.5%). Most studies identified themes relating to Health, Safety and Harms (65.0%) of substance use. Themes relating to Promotions/Advertisements (63.3%), Informative content (55.0%) and Use behaviours (43.3%) were also frequently identified. Conclusions: Substance‐related content that promotes engagement with substance use or actively depicts use appears to be widely available on social media. The large public presence of this content may have concerning influences on attitudes, behaviours and risk perceptions relating to substance use, particularly among the most vulnerable and heaviest users of social media—adolescents and young adults. [ABSTRACT FROM AUTHOR]

Background and aims: Ontologies are ways of representing information that improve clarity and the ability to connect different data sources. This paper proposes an initial version of an ontology of tobacco, nicotine and vaping products with the aim of reducing ambiguity and confusion in the field. Methods: Terms related to tobacco, nicotine and vaping products were identified in the research literature and their usage characterised. Basic Formal Ontology was used as a unifying upper‐level ontology to describe the domain, and classes with definitions and labels were developed linking them to this ontology. Labels, definitions and properties were reviewed and revised in an iterative manner until a coherent set of classes was agreed by the authors. Results: Overlapping, but distinct classes were developed: 'tobacco‐containing product', 'nicotine‐containing product' and 'vaping device'. Subclasses of tobacco‐containing products are 'combustible tobacco‐containing product', 'heated tobacco product' and 'smokeless tobacco‐containing product'. Subclasses of combustible tobacco‐containing product include 'cigar', 'cigarillo', 'bidi' and 'cigarette' with further subclasses including 'manufactured cigarette'. Manufactured cigarettes have properties that include 'machine‐smoked nicotine yield' and 'machine‐smoked tar yield'. Subclasses of smokeless tobacco product include 'nasal snuff', 'chewing tobacco product', and 'oral snuff' with its subclass 'snus'. Subclasses of nicotine‐containing product include 'nicotine lozenge' and 'nicotine transdermal patch'. Subclasses of vaping device included 'electronic vaping device' with a further subclass, 'e‐cigarette'. E‐cigarettes have evolved with a complex range of properties including atomiser resistance, battery power, properties of consumables including e‐liquid nicotine concentration and flavourings, and the ontology characterises classes of product accordingly. Conclusions: Use of an ontology of tobacco, nicotine and vaping products should help reduce ambiguity and confusion in tobacco control research and practice. [ABSTRACT FROM AUTHOR]

The article highlights the health effect of smoking from the U.S. Surgeon General report in 1964. Topics mentioned include the method use in the creation of the advisory committee to the U.S. Surgeon General, the criteria used in the assessment of the epidemiology of the link of smoking and a disease, the definition of causality, the mortality ratios for smokers, and the impact on tobacco smokers' beliefs and behavior.

Background and Aims: Although over half of United States states have passed taxes on electronic nicotine delivery systems (ENDS), recent evidence links ENDS tax rates to increases in smoking, suggesting potentially substantive health costs. Overall health implications will depend on how these taxes affect transitions from experimentation to regular smoking and vaping. Current analyses have not assessed ENDS tax rates' effects in young adulthood (ages 18–25). This study measures the relationship between ENDS and cigarette tax rates and ENDS use and smoking in young adulthood, a key period for initiation of regular tobacco use. Design: Observational study of data from the Current Population Survey's 2010–2019 Tobacco Use Supplements. Setting: The United States. Participants/Cases: A total of 38 906 18 to 25 year‐olds Measurements: Multivariable linear regressions estimated two‐way fixed effects analyses to assess ENDS and cigarette tax rates' relationships to recent and daily smoking and vaping, adjusting for an array of potential sociodemographic and policy confounders along with state and year fixed effects. Findings A $1 increase in ENDS taxes yielded significant reductions in young adults' daily vaping (β̂ = −0.025; 95% CI, −0.037, −0.014) alongside increases in recent smoking (β̂ = 0.037; 95% CI, 0.013, 0.061), primarily reflecting greater dual use (β̂ =2.078; 95% CI, 0.890, 4.852; P = 0.09). A $1 cigarette tax increase yielded 2.1 and 2.5 percentage point increases in recent and daily vaping, with 95% CIs of (0.004, 0.038) and (0.018, 0.032) respectively. Conclusions: In the United States, higher ENDS tax rates are associated with decreased ENDS use but increased cigarette smoking among 18‐ to 25‐year‐olds, with associations reversed for cigarette taxes. [ABSTRACT FROM AUTHOR]

The article revisits the question of the impact of the COVID-19 pandemic on addictive disorders. Topics covered include consumption of opioid, alcohol and cannabis, levels of gambling problem, and mortality rate. It also discusses the need for studies on harms among people who use stimulant drugs and have underlying respiratory or cardiovascular disease, particularly during the pandemic.

Background and Aims: Representative data on e‐cigarette use among European adolescents are scant. This study reports current vaping and tobacco smoking individual and country‐specific correlates among European students. Design: Cross‐sectional survey: 2019 European School Survey Project on Alcohol and Other Drugs (ESPAD) collecting data on risk behaviours on a representative sample of 16‐year‐old students. Setting: A total of 35 European countries, 25–30 with Tobacco Control Scale (TCS) and TCS components Participants: A total of 99 648 students (49.1% males) turning 16 years in the survey year. Measurements Data on current cigarette and e‐cigarette use were gathered through a self‐administered questionnaire which also collected socio‐demographics and individual and family characteristics. ESPAD data were integrated with country‐level data on TCS and selected TCS parameters to assess their association with the prevalence of current cigarette and e‐cigarette use. Findings Of the 99 648 participating students, 12.4% were current e‐cigarette users, from 5.5% in Serbia to 41.4% in Monaco; 19.3% current smokers, from 5.1% in Iceland to 32.4% in Italy. Compared with non‐users, current e‐cigarette users less frequently came from an average well‐off family [odds ratio (OR) = 0.85, 95% confidence interval (CI) = 0.80–0.90] and lived in countries with higher cigarette prices (OR = 0.71, 95% CI = 0.50–0.99), restrictive measures on tobacco advertising and promotion (OR = 0.79, 95% CI = 0.63–0.99) and intermediate implementation of tobacco control measures (OR = 0.57, 95% CI = 0.38–0.85). Current vapers were more frequently life ever smokers (OR = 7.31, 95% CI = 6.47–8.25), were early smokers (OR = 4.35, 95% CI = 3.66–5.17), males (OR = 1.61, 95% CI = 1.55–1.67), from non‐traditional families (OR = 1.43, 95% CI = 1.34–1.53), with relatively low parental education (OR = 1.15, 95% CI = 1.10–1.20). Compared with non‐smokers, current smokers had similar family characteristics to vapers, and were less likely to live in countries with higher cigarette prices (OR = 0.70, 95% CI = 0.49–0.99) and higher spending on public anti‐tobacco media campaigns (OR = 0.23, 95% CI = 0.10–0.50). Conclusions: E‐cigarette use among European adolescents is associated with weaker tobacco control measures, particularly on tobacco price, advertising and promotion. Besides preventing tobacco smoking, the adoption of governmental tobacco control policies in European countries also seems to contribute to the prevention of vaping among adolescents. [ABSTRACT FROM AUTHOR]

Aim: To measure the cost‐effectiveness of adding text message (TMB), exercise (EB) and abstinent‐contingent financial incentive‐based (CFIB) stop smoking interventions to standard smoking cessation support for pregnant women in England. Design: Modelling cost‐effectiveness outcomes by separately adding three cessation interventions to standard cessation care offered to pregnant women in England. English National Health Service Stop Smoking Services (NHS SSS) statistics from 2019 to 2020 were used for estimating the base quit rate. Intervention effectiveness and cost data for interventions were taken from trial reports. Cost‐effectiveness was derived using the economics of smoking in pregnancy (ESIP) model from a health service and personal social services perspective. Interventions were compared with each other as well as against standard cessation care. Setting English NHS SSS. Participants/cases: A total of 13 799 pregnant women who accessed NHS SSS. Interventions and comparator; comparator: standard stop smoking support comprising behavioural intervention and an offer of nicotine replacement therapy (NRT). Three additive interventions were TMB, EB and CFIB. Measurements Incremental cost‐effectiveness ratios per quality‐adjusted life‐years gained for both mothers and offspring over their life‐times; return on investment (ROI); and cost‐effectiveness acceptability curves (CEACs). Findings The addition of any of the interventions compared with standard care alone was preferred, but only significant for the addition of CFIB, with the CEAC suggesting an at least 90% chance of being favoured to standard care alone. When compared against each other CFIB appeared to yield the largest returns, but this was not significant. The estimated ROI for CFIB was £2 [95% confidence interval (CI) = £1–3] in health‐care savings for every £1 spent by the NHS on the cessation intervention. Conclusions: For a health system which currently provides behavioural support and an offer of nicotine replacement therapy as standard stop smoking support for pregnant women, the greatest economic gains would be provided by operating an abstinent‐contingent financial incentives scheme alongside this. [ABSTRACT FROM AUTHOR]

Background and Aims: Non‐invasive brain stimulation (NIBS) methods have showed promising results for the treatment of tobacco use disorder, but little is known about the efficacy of NIBS on sustained tobacco abstinence. We aimed to assess its effectiveness for long‐term smoking cessation. Methods: Systematic review and meta‐analysis of randomized controlled trials (RCT). PubMed, Cochrane library, Embase, PsycINFO and clinical trials registries were systematically searched for relevant studies up to May 2021. Relevant studies included adult smokers seeking smoking cessation, included in an RCT using NIBS [specifically repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS)], and with follow‐up of more than 4 weeks. There were no restrictions on location. Abstinence rates in the active NIBS groups were compared with abstinence rates in sham NIBS or in usual treatment groups, from 4 weeks to 12 months following the quit attempt. Smoking abstinence was measured on an intention‐to‐treat basis and we used risk ratios (RRs) as measures of effect size. Results: Seven studies were included (n = 699 patients). In all included studies, the control groups were receiving sham NIBS and only data from 3 to 6 months were analysable. By pooling the seven included studies, the RR of sustained abstinence of any form of NIBS relative to sham NIBS was 2.39 [95% confidence interval (CI) = 1.26–4.55; I2 = 40%]. Subgroup analyses found that the RR was even higher when excitatory rTMS was used on the left dorsolateral prefrontal cortex (RR = 4.34; 95% CI = 1.69–11.18; I2 = 0%) or when using deep rTMS targeting the lateral prefrontal cortex and insula bilaterally (RR = 4.64; 95% CI = 1.61–13.39; I2 = 0%). A high risk of bias was found in four included studies. We also determined, using grades of recommendation, assessment, development and evaluation, that overall there was a low level of confidence in the results. Conclusion: Non‐invasive brain stimulation (NIBS) may improve smoking abstinence rates from 3 to 6 months after quitting smoking, compared with sham NIBS or usual treatment. [ABSTRACT FROM AUTHOR]

Background and Aims: Previous economic evaluations of smoking cessation interventions for pregnant women are limited to single components, which do not in isolation offer sufficient potential impact to address smoking cessation targets. To inform the development of more appropriate complex interventions, we (1) describe the development of the Economics of Smoking in Pregnancy: Household (ESIP.H) model for estimating the life‐time cost‐effectiveness of smoking cessation interventions aimed at pregnant women and (2) use a hypothetical case study to demonstrate how ESIP.H can be used to identify the characteristics of optimum smoking cessation interventions. Methods: The hypothetical intervention was based on current evidence relating to component elements, including financial incentives, partner smoking, intensive behaviour change support, cigarettes consumption and duration of support to 12 months post‐partum. ESIP.H was developed to assess the life‐time health and cost impacts of multi‐component interventions compared with standard National Health Service (NHS) care in England. ESIP.H considers cigarette consumption, partner smoking and some health conditions (e.g. obesity) that were not included in previous models. The Markov model's parameters were estimated based on published literature, expert judgement and evidence‐based assumptions. The hypothetical intervention was evaluated from an NHS perspective. Results: The hypothetical intervention was associated with an incremental gain in quitters (mother and partner) at 12 months postpartum of 249 [95% confidence interval (CI) = 195–304] per 1000 pregnant smokers. Over the long‐term, it had an incremental negative cost of £193 (CI = –£779 to 344) and it improved health, with a 0.50 (CI = 0.36–0.69) increase in quality‐adjusted life years (QALYs) for mothers, partners and offspring, with a 100% probability of being cost‐effective. Conclusions: The Economics of Smoking in Pregnancy: Household model for estimating cost‐effectiveness of smoking cessation interventions aimed at pregnant women found that a hypothetical smoking cessation intervention would greatly extend reach, reduce smoking and be cost‐effective. [ABSTRACT FROM AUTHOR]

Background and aim: The prevalence of tobacco smoking has declined in most high‐income countries, while cannabis use has been rising. Moreover, cannabis use has been found to have increased among cigarette smokers in recent years in jurisdictions where it has been either decriminalized or legalized. This study measured trends in cannabis, tobacco and the co‐use of cannabis and tobacco in Australia. Design: Age–period–cohort analysis. Setting and participants: Participants were n = 143 344 individuals aged 18–80 years who participated in Australia's National Drug Strategy Household Surveys (NDSHS) between 2001 and 2019. Measurements Regular (weekly/more frequently): (1) tobacco smoking only, (2) cannabis use only and (3) the co‐use of cannabis and tobacco. Findings Prevalence of only smoking tobacco decreased in all age groups (P < 0.001) and birth cohorts between 2001 and 2019, but the co‐use of cannabis and tobacco did not. Younger cohorts were much less likely to co‐use tobacco and cannabis (P = 0.02). Period trends showed that both cannabis use only and the co‐use of cannabis and tobacco have increased since 2013. Conclusion: There has been a consistent decrease in exclusive tobacco smoking across age, period and birth cohorts between 2001 and 2019 in Australia, although there is a recent increasing period trend in cannabis use with or without tobacco. The non‐decreasing trend of co‐use may reflect the strong tobacco control policies introduced over the period and changing attitudes towards cannabis use in Australia. [ABSTRACT FROM AUTHOR]

The author comments on an article by T. L. Fazzino and colleagues which combined previously secret tobacco industry documents and U.S. Department of Agriculture data sets capturing the food supply to estimate the likelihood that some consumer food brands have reformulated to be hyperpalatable. Topics include finding of a 2019 randomized clinical trial on people on ultraprocessed food diets and a growing need and interest in understanding a commercial determinants of health (CDoH) framework.

Background and Aims: Tobacco consumption and its associated adverse outcomes remain major public health issues, particularly in low‐ and middle‐income countries. This systematic review aimed to identify and critically assess full economic evaluations for tobacco control interventions in low‐ and middle‐income countries. Methods: Electronic databases, including EMBASE, MEDLINE and PsycINFO and the grey literature, were searched using terms such as 'tobacco', 'economic evaluation' and 'smoking' from 1994 to 2020. Study quality was assessed using the Consensus Health Economic Criteria and the Philips checklist. Studies were included which were full economic evaluations of tobacco control interventions in low‐ and middle‐income settings. Reviews, commentaries, conference proceedings and abstracts were excluded. Study selection and quality assessment were conducted by two reviewers independently. A narrative synthesis was conducted to synthesize the findings of the studies. Results: This review identified 20 studies for inclusion. The studies evaluated a wide range of interventions, including tax increase, nicotine replacement therapy (nicotine patch/gum) and financial incentives. Overall, 12 interventions were reported to be cost‐effective, especially tax increases for tobacco consumption and cessation counselling. There were considerable limitations regarding data sources (e.g. using cost data from other countries or assumptions due to the lack of local data) and the model structure; sensitivity analyses were inadequately described in many studies; and there were issues around the transferability of results to other settings. Additionally, the affordability of the interventions was only discussed in two studies. Conclusions: There are few high‐quality studies of the cost‐effectiveness of tobacco use control interventions in low‐ and middle‐income countries. The methodological limitations of the existing literatures could affect the generalizability of the findings. [ABSTRACT FROM AUTHOR]

Background and aims: Previous analyses of the effect of e‐cigarettes on real world smoking cessation success have mainly been based on surveys undertaken in the United States and United Kingdom, where nicotine e‐cigarettes can be readily obtained. In Australia, regulations have made obtaining e‐cigarettes containing nicotine difficult. The effectiveness of e‐cigarette use as a smoking cessation aid in Australia might therefore be lower than survey‐based estimates published to date. This study aimed to estimate the effect of using e‐cigarettes for a smoking cessation attempt on past‐year smoking cessation success in Australia. Design: Multivariable logistic regression models for past‐year smoking cessation success. Setting and participants: Respondents to the 2019 wave of Australia's National Drug Strategy Household Survey who made a smoking cessation attempt in the 12 months leading up to the survey. Measurements Past‐year smoking cessation success was assumed if a smoking cessation attempt resulted in abstinence of more than a month at the time of the survey. Findings In 2019, Australians who attempted to quit smoking using e‐cigarettes achieved greater success than smokers attempting to quit without e‐cigarettes [adjusted odds ratio (aOR) = 1.68; 95% confidence interval (CI) = 1.09–2.60]. If people who only tried e‐cigarettes once or twice are considered not to have used e‐cigarettes, the estimated effect was slightly stronger (aOR = 1.98; 95% CI = 1.27–3.10). Also, the estimated odds ratio was higher among vapers who acquired their e‐cigarettes from overseas websites (aOR = 2.24; 95% CI = 1.02–4.93). Conclusions: Use of e‐cigarettes for a smoking cessation attempt appears to be associated with greater success among Australians who attempted to quit tobacco in 2019 compared with Australians attempting to quit without e‐cigarettes, after adjusting for confounding effects. [ABSTRACT FROM AUTHOR]

Aim: To (i) estimate the prevalence of adolescent vaping in 47 lower‐middle, upper‐middle and high‐income countries, and (ii) test the association between implementation of World Health Organisation (WHO) tobacco control policies and adolescent e‐cigarette use (also known as vaping) in 44 countries where implementation data were available. Design: Cross‐sectional surveys. Settings A total of 47 lower‐middle, upper‐middle and high‐income countries. Participants: A total of 151 960 adolescents (typically ages 13–15) who participated in WHO's Global Youth Tobacco Survey between 2015 and 2018. Measurements Prevalence of past‐30‐day vaping and past 30‐day frequent vaping (≥10 days) were estimated from the surveys. Data on the implementation of six tobacco control measures including monitoring, smoke‐free policies, cessation programs, warning about the dangers of tobacco, advertising bans and taxation were taken from WHO's report on global tobacco epidemic. Findings The overall weighted prevalence of adolescent vaping and frequent vaping in the past 30 days was 8.6% (95% CI, 8.3‐8.9) and 1.7% (95% CI, 1.6‐1.8), respectively. For five of WHO's policies (monitoring, smoking‐free environment, cessation programs, health warning and advertising bans), their association with adolescent vaping was inconclusive because of large variation of their effects across countries. Higher tax on combustible tobacco products was associated with higher adolescent vaping (> = 75% tax vs < 25% tax; odds ratio = 2.58; 95% CI, 1.25‐5.21). Conclusion: In 47 lower‐middle, upper‐middle and high‐income countries from 2015 to 2018, ~1 in 12 (8.6%) adolescents reported vaping in the past 30 days, but prevalence of frequent vaping was low (1 in 60; 1.7%). A higher tobacco tax was associated with higher adolescent vaping. [ABSTRACT FROM AUTHOR]

Background and aims: Smoking is extremely common among adults experiencing homelessness, but there is lack of evidence for treatment efficacy. E‐cigarettes are an effective quitting aid, but they have not been widely tested in smokers with complex health and social needs. Here we build upon our cluster feasibility trial and evaluate the offer of an e‐cigarette or usual care to smokers accessing a homeless centre. Design, Setting and Participants: Multi‐centre two‐arm cluster‐randomized controlled trial with mixed‐method embedded process and economic evaluation in homeless centres in England, Scotland and Wales. Adult smokers (18+ years; n = 480) accessing homeless centres and who are known to centre staff and willing to consent. Intervention and Comparator: Clusters (n = 32) will be randomized to either an e‐cigarette starter pack with weekly allocations of nicotine containing e‐liquid for 4 weeks [choice of flavours (menthol, fruit and tobacco) and strengths 12 mg/ml and 18 mg/ml] or the usual care intervention, which comprises very brief advice and a leaflet signposting to the local stop smoking service. Measurements The primary outcome is 24‐week sustained carbon monoxide‐validated smoking cessation (Russell Standard defined, intention‐to‐treat analysis). Secondary outcomes: (i) 50% smoking reduction (cigarettes per day) from baseline to 24 weeks; (ii) 7‐day point prevalence quit rates at 4‐, 12‐ and 24‐week follow‐up; (iii) changes in risky smoking practices (e.g. sharing cigarettes, smoking discarded cigarettes) from baseline to 4, 12 and 24 weeks; (iv) cost‐effectiveness of the intervention; and (v) fidelity of intervention implementation; mechanisms of change; contextual influences and sustainability. Conclusions: This is the first study, to our knowledge, to randomly assign smokers experiencing homelessness to an e‐cigarette and usual care intervention to measure smoking abstinence with embedded process and economic evaluations. If effective, its results will be used to inform the larger‐scale implementation of offering e‐cigarettes throughout homeless centres to aid smoking cessation. [ABSTRACT FROM AUTHOR]

Aims: To test the hypothesis that exposure to parental substance use disorder is associated with an increased risk of being not in education, employment or training (NEET) in male and female offspring during young adulthood. Design, setting and participants: A register‐based, national cohort study of 797 376 individuals born between 1984 and 1990, residing in Sweden at age 17 years. Participants were followed from age 17 years to maximum age 32 years and assessed annually for being NEET. Measurements The exposure variable was binary, defined as any diagnosis of substance use disorder (alcohol and/or drug use disorder) in one or both parents, measured between offspring's birth and age 17 years. Cox regression analysis was used to obtain hazard ratios (HRs) for being NEET, assessed annually as a binary variable using income and employment data. Findings We found that 4.4% of individuals were exposed to parental substance use disorder. When adjusted for birth year, domicile, origin, psychiatric diagnosis, household income and parental psychiatric diagnosis, HRs for being NEET were HR = 1.13 (95% CI 1.09–1.16) for males, and HR = 1.15 (95% CI 1.12–1.19) for females. When stratified by age, adjusted HRs for experiencing the first episode of NEET peaked at age 17–19 years, HR = 1.37 (95% CI 1.25–1.50) for males, and HR = 1.31 (95% CI 1.18–1.44) for females. Conclusions: In Sweden, exposure to parental substance use disorder before age 17 years is associated with increased risk of being not in education, employment or training during early adulthood. The risks were highest at age 17–19 years for both males and females, decreasing with greater age. [ABSTRACT FROM AUTHOR]

The authors talk about the environmental impact of tobacco products and the need for increase awareness and action. Topics discussed include the negative environmental impact of tobacco products, the theme for World No Tobacco Day 2022 which aims to educate the public about the harms of tobacco and the tactics of the tobacco industry, and significance of public education campaigns about the environmental harms caused by tobacco products.

Aims: To estimate the impact of recreational and medical cannabis laws (RCL, MCL) on the use of cannabis and cigarettes in the United States. Design A difference‐in‐difference approach was applied to data from the 2004–17 National Survey on Drug Use and Health (NSDUH). Setting: United States. Participants: Nationally representative cross‐sectional survey of Americans aged 12 years and older (combined analytical sample for 2004–17, n = 783 663). Measurements Data on past‐month use of (1) cigarettes and (2) cannabis were used to classify respondents into four groups: cigarette and cannabis co‐use, cigarette‐only use, cannabis‐only use or no cigarette or cannabis use. State of residence was measured by self‐report. MCL/RCL status came from state government websites. Findings Difference‐in‐difference analyses suggest that MCL was associated with an increase in cigarette–cannabis co‐use overall [adjusted odds ratio (aOR) = 1.09; 95% confidence interval (CI) = 1.02–1.16], with the greatest increases among those aged 50 years and above (aOR = 1.60; CI = 1.39–1.84), married (aOR = 1.19; CI = 1.07–1.31), non‐Hispanic (NH) black (aOR = 1.14; CI = 1.02–1.07) and with a college degree or above (aOR = 1.15; CI = 1.06–1.24). MCL was associated with increases in cigarette‐only use among those aged 50 years and above (aOR = 1.07; CI = 1.01–1.14) and NH black (aOR = 1.16; CI = 1.06–1.27) and increases in cannabis‐only use among those aged 50 years and above (aOR = 1.24; CI = 1.07–1.44) and widowed/divorced/separated (aOR = 1.18; CI = 1.01–1.37). RCL was associated with an increase in cannabis‐only use overall (aOR = 1.21; 95% CI = 1.09–1.34), a decline in cigarette‐only use overall (aOR = 0.89; 95% CI = 0.81–0.97) and increases in co‐use among those who were married (aOR = 1.24; CI = 1.02–1.50) and aged 50 years and above (aOR = 1.37; CI = 1.03–1.84). Conclusions: Recreational and medical cannabis legalization have had a varying impact on the use, and co‐use, of cannabis and cigarettes in the United States. [ABSTRACT FROM AUTHOR]

The use of tobacco during pregnancy is the leading preventable cause of pregnancy complications and adverse birth outcomes. In high‐income countries, around one in 10 pregnant women smokes tobacco, while smokeless tobacco is the primary form of tobacco used in many low‐ and middle‐income countries. Although the risk of tobacco‐related harms can be reduced substantially if mothers cease smoking in the first trimester of pregnancy, the proportion of women who successfully quit smoking during pregnancy remains modest. Psychosocial interventions are first‐line treatment, with some high‐quality evidence showing that counselling is effective in promoting smoking cessation among pregnant women. There is insufficient evidence regarding the efficacy and safety of smoking cessation pharmacotherapies when used during pregnancy, although in some countries nicotine replacement therapy is recommended for pregnant women who have been unable to quit without pharmacological assistance. E‐cigarettes are increasingly being used as a smoking cessation aid in the general population of smokers, but more research is needed to determine if e‐cigarettes are a safe and effective treatment option for pregnant women. [ABSTRACT FROM AUTHOR]

Aims: To measure how cigarette packaging (standardised packaging and branded packaging) and health warning size affect visual attention and pack preferences among Colombian smokers and non‐smokers. Design To explore visual attention, we used an eye‐tracking experiment where non‐smokers, weekly smokers and daily smokers were shown cigarette packs varying in warning size (30%‐pictorial on top of the text, 30%‐pictorial and text side‐by‐side, 50%, 70%) and packaging (standardised packaging, branded packaging). We used a discrete choice experiment (DCE) to examine the impact of warning size, packaging and brand name on preferences to try, taste perceptions and perceptions of harm. Setting: Eye‐tracking laboratory, Universidad Nacional de Colombia, Bogotá, Colombia. Participants: Participants (n = 175) were 18 to 40 years old. Measurements For the eye‐tracking experiment, our primary outcome measure was the number of fixations toward the health warning compared with the branding. For the DCE, outcome measures were preferences to try, taste perceptions and harm perceptions. Findings We observed greater visual attention to warning labels on standardised versus branded packages (F[3,167] = 22.87, P < 0.001) and when warnings were larger (F[9,161] = 147.17, P < 0.001); as warning size increased, the difference in visual attention to warnings between standardised and branded packaging decreased (F[9,161] = 4.44, P < 0.001). Non‐smokers visually attended toward the warnings more than smokers, but as warning size increased these differences decreased (F[6,334] = 2.92, P = 0.009). For the DCE, conditional trials showed that increasing the warning size from 30% to 70% reduced preferences to try (odds ratio [OR] = 0.48, 95% CI = [0.42,0.54], P < 0.001), taste perceptions (OR = 0.61, 95% CI = [0.54,0.68], P < 0.001); and increased harm perceptions (OR = 0.78, 95% CI = [0.76,0.80], P < 0.001). Compared with branded packaging, standardised packaging reduced our DCE outcome measures with ORs ranging from OR = 0.25 (95% CI = [0.17,0.38], P < 0.001) to OR = 0.79 (95% CI = [0.67,0.93], P < 0.001) across two brands. These effects were more pronounced among non‐smokers, males and younger participants. Unconditional trials showed similar results. Conclusions: Standardised cigarette packaging and larger health warnings appear to decrease positive pack perceptions and have the potential to reduce the demand for cigarette products in Colombia. [ABSTRACT FROM AUTHOR]

Aims: To summarize evidence on tobacco addiction interventions published by the Cochrane Tobacco Addiction Group (CTAG) from 2019 to 2020. Methods: Narrative summary of all new and updated Cochrane Reviews published by CTAG in 2019 and 2020, outlining key results and promising avenues for future research. Results: CTAG published six new reviews and updated 15 reviews. There is high‐certainty evidence that combining fast‐acting nicotine replacement therapy (NRT) with transdermal patches helped more people to quit than single‐form NRT [risk ratio (RR) = 1.25, 95% confidence interval (CI) = 1.15–1.36, 14 studies, n = 11 356; I2 = 4%] and moderate‐certainty evidence that using NRT before quitting can increase quit rates more than using NRT from quit day onwards (RR = 1.25, 95% CI = 1.08–1.44, nine studies, n = 4395; I2 = 0%). Reducing smoking in order to quit completely results in similar quit rates to abrupt quitting (RR = 1.01, 95% CI= 0.87–1.17; I2 = 29%; 22 studies, n = 9219; moderate‐certainty). Electronic cigarettes may help more people quit than NRT (RR = 1.53, 95% CI = 1.21–1.93; I2 = 0%; four studies, n = 1924; moderate certainty), nicotine‐free electronic cigarettes (RR = 1.94, 95% CI = 1.21–3.13; I2 = 0%; five studies, n = 1447; moderate‐certainty) and behavioural/no support (RR = 2.61, 95% CI = 1.44–4.74; I2 = 0%; six studies, n = 2886; very low‐certainty). Varenicline may help prevent relapse in abstainers (RR = 1.23, 95% CI = 1.08–1.41; I2 = 82%; 11 studies, n = 1297; moderate‐certainty), but behavioural support did not prevent relapse (RR = 0.98, 95% CI = 0.87–1.11; I2 = 52%; 11 studies, n = 5523; moderate‐certainty). Financial incentives increased quit rates in the general population (RR = 1.49, 95% CI = 1.28–1.73; I2 = 33%; 30 studies, adjusted n = 20 097; high‐certainty) and during pregnancy (RR = 2.38, 95% CI = 1.54–3.69; I2 = 41%; nine studies, n = 2273; moderate‐certainty). This overview also provides detail on a wider range of interventions. Conclusions: There is high certainty that using nicotine replacement therapy from quit day increases smoking abstinence and no further research is required. Evidence is less certain that nicotine replacement increases abstinence when used in higher doses tailored to particular groups of smokers or use prior to quit day, and further research would be helpful. There is moderate‐certainty evidence to support the use of e‐cigarettes as cessation aids, but research on their role in preventing relapse would be particularly helpful. [ABSTRACT FROM AUTHOR]

Aims: To measure the prospective relationship between smoking trajectories from adolescence to young adulthood and mental health in later adulthood and test whether this relationship was mediated by concurrent co‐use of alcohol and marijuana. Design Longitudinal study using data drawn from rounds 1 to 18 of the National Longitudinal Survey of Youth 1997 (NLSY97), a nationally representative cohort study spanning 21 years. Setting: United States. Participants: The analytical sample included those who completed survey items about smoking behaviors on at least half the data collection opportunities in adolescence and young adulthood (n = 8570, 48.9% female, 66.2% white). Measurements Mental health in adulthood was measured using the five‐item Mental Health Inventory (MHI‐5; range = 0–100) at round 18. Seven trajectories of smoking from adolescence to young adulthood were identified by group‐based multi‐trajectory modeling, using data over 11 years from rounds 1 to 11. Findings Late‐onset moderate smokers [β = −1.95, 95% confidence interval (CI) = −3.61 to −0.29], late‐onset accelerated smokers (β = −2.53, 95% CI = −4.28 to −0.78), early‐onset heavy smokers (β = −3.72, 95% CI = −5.59 to −1.85) and early‐onset moderate smokers (β = −2.66, 95% CI = −4.48 to −0.84) showed poorer regression‐adjusted mean MHI‐5 scores in later adulthood than stable abstainers, even after controlling for baseline mental health and covariates. Whether or not a difference in MHI‐5 scores was present between quitters and stable abstainers was inconclusive. The concurrent co‐use of alcohol and marijuana in young adulthood significantly mediated the relationship between smoking trajectory and mental health. Conclusions: Continued smoking, especially early‐onset and heavy smoking from adolescence to young adulthood, appears to increase the risk of poor mental health later in mid‐adulthood, and quitting smoking in young adulthood may mitigate such risk even among early‐onset smokers. Mediation analyses underscore the role of using multiple substances in this pathway. [ABSTRACT FROM AUTHOR]