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An essay is presented on the subject of cigarette smoking among U.S. laborers in factories, corporate spying on workers, and the social culture of shopfloors in the U.S. during the 20th century. It examines the records of Erie, Pennsylvania, paper manufacturer Hammermill Paper Company concerning employee cigarette consumption, how employees attempted to evade corporate surveillance of their smoking, and labor relations in the U.S.

This study compares estimates of self-reported substance use and psychological well-being obtained in computer-assisted and paper-and-pencil self-administered surveys. We examine the extent to which mode effects on survey responses are moderated by respondent characteristics and respondent attitudes, including attitudes toward computers, attitudes about confidentiality and privacy, and their general mistrust of others. Respondents age 12-34 were selected through a multistage area probability sample of urban and suburban areas nationally and were randomly assigned to interview mode. There were few main effects of mode on self-reported substance use and well-being. Significant mode-by-age interaction terms revealed that adolescents were more sensitive to mode of administration than older respondents. Adolescents reported significantly higher levels of alcohol use, illicit drug use, and psychological distress in the computer mode than on paper self-administered questionnaires. Significant mode-by-mistrust interactions were also found. Respondents with higher levels of mistrust in others were less likely to report substance use in the computer mode than in the paper-and-pencil format. [ABSTRACT FROM AUTHOR]

Objective To assess the evidence for a reduced risk of acute coronary events following comprehensive smoke-free legislation. Methods Two independent systematic reviews were undertaken using PubMed, Embase and Science Direct with no date restrictions imposed. Meta-analysis was undertaken using a random effects model to obtain a pooled estimate of the relative risk. Linear regression was used to examine possible bias and meta-regression was used to investigate possible causes of heterogeneity. Main outcome measure Acute coronary events. Results The 17 eligible studies (10 from North America, 6 from Europe and 1 from Australasia) provided 35 estimates of effect size. Apart from five subgroup analyses, all of the published results suggested a reduction in the incidence of acute coronary events following the introduction of smoke-free legislation. Meta-analysis produced a pooled estimate of the relative risk of 0.90 (95% CI 0.86 to 0.94). There was significant heterogeneity (overall I=95.1%, p<0.001) but there was no evidence of small study bias (p=0.714). On univariate random effects meta-regression analysis, studies with longer data collection following legislation produced greater estimates of risk reduction and remained significant after adjustment for other study characteristics (adjusted coefficient −0.005, 95% CI −0.007 to −0.002, multiplicity adjusted p=0.006). Conclusions There is now a large body of evidence supporting a reduction in acute coronary events following the implementation of comprehensive smoke-free legislation, with the effect increasing over time from implementation. Countries that have not yet adopted smoke-free legislation should be encouraged to do so. [ABSTRACT FROM PUBLISHER]

Menthol is the only tobacco additive promoted and advertised by the tobacco industry. Although a considerable body of research has examined the effects of menthol when it is administered alone and unburned, the effects of menthol when burned in cigarette smoke are more complex because it is administered in a matrix of more than 4,000 substances. Therefore, it is difficult to isolate potential pharmacological and toxic effects of menthol when it is administered in a smoke mixture. Menthol properties include cooling and local anesthesia, as well as effects on drug absorption and metabolism, bronchodilation and respiration changes, and electrophysiology. Subjective effects of smoothness and less harshness have been identified as reasons for menthol cigarette smoking, but findings have been inconclusive regarding the effect of menthol on carbon monoxide exposure and smoking topography parameters. Gaps in the research literature and future research areas include the following: (a) What is the role of menthol in tobacco reinforcement and addiction? (b) In the absence of nicotine, is menthol reinforcing? (c) Are the pharmacological and physiological effects of menthol mediated by a menthol-specific receptor or some other central nervous system-mediated action? (d) What are the influences of menthol and menthol metabolism on the metabolic activation and detoxification of carcinogens in tobacco smoke? and (e) Do differences exist in cigarette smoking topography in relation to the interaction of ethnicity, gender, and menthol cigarette preference? Answers to these questions will help to elucidate the function of menthol in cigarettes and its impact on smoking behavior. [ABSTRACT FROM AUTHOR]

Background High-risk human papillomavirus (HR-HPV) is a known cause of cervical cancer (CC). Latvia has a high incidence of CC compared with the average incidence in the European Union. This study aims to fill the data gap on the HR-HPV burden in Latvia, providing information on its prevalence and associated factors. Methods The cross-sectional study was conducted from February 2021 to April 2022. Participants 25–70 years old visiting a general practitioner (general population) or those referred to a colposcopy clinic with changes in their cervical cytology (colposcopy population) collected vaginal self-sample and completed a paper-based questionnaire. Samples were analyzed with Cobas 6800 System (Roche) for HPV16, HPV18 and other HR-HPV (HPV31/33/35/39/45/51/52/56/58/59/66/68). Descriptive statistics for categorical variables were performed. The Chi-square test was used to determine for the statistical significance of differences in the proportions of the dependent variable between subgroups of the independent variable. Univariate and multivariate binary logistic regression were used to identify factors associated with positive HR-HPV status. Results were considered statistically significant at P  < 0.05. Results A total of 1274 participants provided a valid sample. The prevalence of any HR-HPV infection was 66.8% in the colposcopy group and 11.0% in the general population. Factors associated with positive HR-HPV status were marital status single/divorced/widowed (vs. married/cohabiting) [adjusted OR (aOR) 2.6; P  = 0.003], higher number of lifetime sex partners [aOR 5.1 (P  < 0.001) and 4.0 (P  = 0.001)] for six or more and three to five partners in the general population; in the colposcopy group, the statistical significance remained only for Latvian ethnicity (vs. other) (aOR 1.8; P  = 0.008) and current smoking (vs. never) (aOR 1.9; P  = 0.01). Conclusion We documented a comparison to European Union HR-HPV infection burden in Latvia. Any HR-HPV positivity was significantly associated with sexual and other health behavior. [ABSTRACT FROM AUTHOR]

Conceptualizing tobacco dependence as a chronic relapsing condition suggests the need to use analytic strategies that reflect that premise. However, clinical trials for smoking cessation typically define the primary endpoint as a measure of abstinence at a single timepoint distal to the intervention, typically 3–12 months. This reinforces the concept of tobacco outcomes as a dichotomous state—one is, or is not, abstinent. Fortunately, there are several approaches available to handle longitudinal data that reflect the relapsing and remitting nature of tobacco use during treatment studies. In this paper, sponsored by the Society for Research on Nicotine and Tobacco's Treatment Research Network, we present an introductory overview of these techniques and their application in smoking cessation clinical trials. Topics discussed include models to examine abstinence outcomes (eg, trajectory models of abstinence, models for transitions in smoking behavior, models for time to event), models that examine reductions in tobacco use, and models to examine joint outcomes (eg, examining changes in the use of more than one tobacco product). Finally, we discuss three additional relevant topics (ie, heterogeneity of effects, handling missing data, and power and sample size) and provide summary information about the type of model that can be used based on the type of data collected and the focus of the study. We encourage investigators to familiarize themselves with these techniques and use them in the analysis of data from clinical trials of smoking cessation treatment. Implications Clinical trials of tobacco dependence treatment typically measure abstinence 3–12 months after participant enrollment. However, because smoking is a chronic relapsing condition, these measures of intervention success may not accurately reflect the common trajectories of tobacco abstinence and relapse. Several analytical techniques facilitate this type of outcome modeling. This paper is meant to be an introduction to these concepts and techniques to the global nicotine and tobacco research community including which techniques can be used for different research questions with visual summaries of which types of models can be used for different types of data and research questions. [ABSTRACT FROM AUTHOR]

The author comments on "Smoking and lung cancer: Recent evidence and a discussion of some principles," by J. Cornfield, W. Haenszel and colleagues, published in the 1959 issue and reprinted in the 2009 issue. He discusses the significance of the study for those interested in the history of a major issue in non-infectious disease epidemiology. He also notes the potential causal interpretation of the researchers' data and the introduction of statistical models to represent causal processes.

Comments on the progress in nicotine research. Development of experimental models for the study of the various component processes of nicotine dependence; Difficulties in sustaining treatment gains for drug dependence in general; Usefulness of biological and behavioral studies in understanding the acquisition of tobacco-use behavior.

Background: Retirement is a life-course transition in late adult life that is marked by major changes that may affect healthy lifestyles. Our aim is to give an overview of the current knowledge on changes in smoking, alcohol consumption, physical activity and dietary habits during the transition to retirement. This may provide clues to a better targeting and timing of preventive activities at older age. Methods: Literature search in Medline, Scopus, Embase, PsycInfo, Social SciSearch and SciSearch limited to English-language papers published between 2001 and May 2013. Results of 20 original papers are summarized in a narrative review. Results: Some studies report an increase in alcohol consumption after retirement, whereas others found a decrease or no change at all. Those who retired involuntarily tended to increase their alcohol consumption, whereas retirees who quit voluntarily did not change their alcohol consumption. Leisure-time physical activity seems to increase slightly after retirement, especially moderately intensive physical activity. This increase does not compensate the loss of work-related physical activity such as the work itself or work-related transportation. The studies on changes in smoking and dietary habits were too limited to draw conclusions. Conclusions: The transition to retirement is accompanied with both favourable and unfavourable lifestyle changes, depending on the type of lifestyle, lifestyle indicator and the personal situation of the retiree. The (pre-)retirement period may well offer a suitable opportunity for preventive action, for example in pre-retirement programmes, planning or other retirement-related support. [ABSTRACT FROM AUTHOR]

Introduction: The review had the aim of investigating factors enabling or discouraging the uptake of smoking cessation services by pregnant women smokers. Methods: The literature was searched for papers relating to the delivery of services to pregnant or recently pregnant women who smoke. No restrictions were placed on study design. A qualitative synthesis strategy was adopted to analyze the included papers. Results: Analysis and synthesis of the 23 included papers suggested 10 aspects of service delivery that may have an influence on the uptake of interventions. These were whether or not the subject of smoking is broached by a health professional, the content of advice and information provided, the manner of communication, having service protocols, follow-up discussion, staff confidence in their skills, the impact of time and resource constraints, staff perceptions of ineffectiveness, differences between professionals, and obstacles to accessing interventions. Discussion: The findings suggest variation in practice between services and different professional groups, in particular regarding the recommendation of quitting smoking versus cutting down but also in regard to procedural aspects, such as recording status and repeat advice giving. These differences offer the potential for a pregnant woman to receive contradicting advice. The review suggests a need for greater training in this area and the greater use of protocols, with evidence of a perception of ineffectiveness/pessimism toward intervention among some service providers. [ABSTRACT FROM PUBLISHER]

The author comments on "Smoking and lung cancer: Recent evidence and a discussion of some principles," by J. Cornfield, W. Haenszel and colleagues, published in the 1959 issue and reprinted in the 2009 issue. He cites the ideas present in the paper which include the basic concepts about confounding, genetic influences, selection and other biases, and the nature of observational evidence. He also elucidates key aspects of the paper and discusses how they still lead to debate in the 21st century.

Introduction The prevalence of smoking is unequally distributed across certain groups. One significant dimension is education inequality, where higher smoking prevalence is generally observed in lower-educated groups. However, studies investigating educational inequality are mostly associative. Meanwhile, studies carrying out a causal investigation focus typically on developed countries. In this study, we consider a panel of low-and-middle-income countries (LMICs) to investigate the causal link between education and smoking behavior. Aims and Methods We use detailed micro-level household surveys for 12 LMICs where the duration of compulsory schooling has been extended. By identifying the individuals subject to higher compulsory schooling and using the exogenous variation in education caused by the increase in the duration of compulsory schooling, we estimate the causal impact of education on tobacco consumption. We rely on regression analysis to estimate the effect. Results Our results reveal that those subject to higher years of compulsory schooling have lower smoking-related outcomes, suggesting that higher education significantly lowers tobacco consumption in LMICs. The effect is primarily observed for women, where, for instance, higher compulsory schooling reduces the probability of smoking by 23% and the number of cigarettes smoked by 27%. Conclusions The study's results establish the causal link between education and smoking behavior in LMICs. This significant impact suggests that education policy is still an important tool to help reduce tobacco consumption, especially in settings where the average level of education is not high initially. Moreover, discouraging men from smoking requires other measures to complement education policy. Implications Education might help reduce tobacco consumption. However, studies—primarily for developed countries—find mixed results. This paper investigates the causal role of education on smoking in LMICs. Education reduces tobacco consumption, especially for women. Thus, education policy can be effective in low-education settings. Nonetheless, education policy should be accompanied by other policies to discourage men from smoking. [ABSTRACT FROM AUTHOR]

Services offering on-demand delivery of unhealthy commodities, such as fast food, alcohol and smoking/vaping products have proliferated in recent years. It is well known that the built environment can be health promoting or harmful to health, but there has been less consideration of the digital environment. Increased availability and accessibility of these commodities may be associated with increased consumption, with harmful public health implications. Policy regulating the supply of these commodities was developed before the introduction of on-demand services and has not kept pace with the digital environment. This paper reports on semi-structured interviews with health policy experts on the health harms of the uptake in on-demand delivery of food, alcohol and smoking/vaping products, along with their views on policies that might mitigate these harms. We interviewed 14 policy experts from central and local government agencies and ministries, health authorities, non-Government Organisations (NGOs) and university research positions in Aotearoa New Zealand using a purposive sampling strategy. Participants concerns over the health harms from on-demand services encompassed three broad themes—the expansion of access to and availability of unhealthy commodities, the inadequacy of existing restrictions and regulations in the digital environment and the expansion of personalized marketing and promotional platforms for unhealthy commodities. Health policy experts' proposals to mitigate harms included: limiting access and availability, updating regulations and boosting enforcement and limiting promotion and marketing. Collectively, these findings and proposals can inform future research and public health policy decisions to address harms posed by on-demand delivery of unhealthy commodities. [ABSTRACT FROM AUTHOR]

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). [ABSTRACT FROM AUTHOR]

Introduction Subjective experience of e-cigarettes may be an important factor in helping people who use combustible cigarettes switch completely to e-cigarettes to reduce harm from smoking. This paper describes a novel two-stage analysis using pleasure and satisfaction responses from ecological momentary assessments (EMA) of both cigarette and e-cigarette use to predict future cigarette and e-cigarette tobacco use. Aims and Methods This observational study included adult users of cigarettes and e-cigarettes who provided 7 days of EMA, capturing cigarette and e-cigarette use, followed by biweekly reports of cigarette and e-cigarette use over 1 year. Participants were 279 adults who provided both cigarette and e-cigarette responses during the EMA. We employed a two-stage analytic approach in which EMA data were used to predict subsequent levels of cigarette and e-cigarette use. In the first stage, EMA responses to cigarette and e-cigarette events were modeled via a mixed-effects location scale model to yield summaries of participants' means and variability on event-related ratings of pleasure and satisfaction. These EMA summaries served as predictors in the second stage analysis of the biweekly post-EMA longitudinal cigarette and e-cigarette use data. Results EMA pleasure and satisfaction ratings were similar for both products and predicted both longitudinal cigarette and e-cigarette use, even after controlling for baseline cigarette and e-cigarette dependence. Relatively higher levels of satisfaction with e-cigarettes were associated with greater decreases in cigarette use over time. Conclusions Pleasure and satisfaction are important predictors of subsequent cigarette and e-cigarette use. Implications Experienced subjective pleasure and satisfaction from e-cigarettes relative to cigarettes may be an important factor in helping individuals who smoke to switch completely to e-cigarettes as a harm reduction approach. In order to help sustain complete product switching and reduce dual use or relapse to smoking, e-cigarettes may need to deliver more satisfaction to the user compared to that experienced from cigarettes. [ABSTRACT FROM AUTHOR]

Introduction: The PROMIS Smoking Initiative has developed six item banks for assessment related to cigarette smoking among adult smokers (Nicotine Dependence, Coping Expectancies, Emotional and Sensory Expectancies, Health Expectancies, Psychosocial Expectancies, and Social Motivations). This article evaluates the psychometric performance of the banks when administered via short form (SF), computer adaptive test (CAT), and by mode of administration (computer vs. paper-and-pencil).Methods: Data are from two sources: an internet sample (N = 491) of daily and nondaily smokers who completed both SFs and CATs via the web and a community sample (N = 369) that completed either paper-and-pencil or computer administration of the SFs at two time points. First a CAT version of the PROMIS Smoking Assessment Toolkit was evaluated by comparing item administration rates and scores to the SF administration. Next, we considered the effect of computer versus paper-and-pencil administration on scoring and test-retest reliability.Results: Across the domains approximately 5.4 to 10.3 items were administered on average for the CAT. SF and CAT item response theory-scores were correlated from 0.82 to 0.92 across the domains. Cronbach's alpha for the four- to eight-item SFs among daily smokers ranged from .80 to .91 and .82 to .91 for paper-and-pencil and computer administrations, respectively. Test-retest reliability of the SFs ranged from 0.79 to 0.89 across mode of administration.Conclusions: Results indicate that the SF and CAT and computer and paper-and-pencil administrations provide highly comparable scores for daily and nondaily smokers, but preference for SF or CAT administration may vary by smoking domain. [ABSTRACT FROM AUTHOR]

Introduction Cigarette smoke contains highly reactive free radicals thought to play an important role in tobacco smoke-induced harm. Previously, large variations in free radical and toxicant output have been observed in commercial cigarettes. These variations are likely because of cigarette design features (paper, filter, and additives), tobacco variety (burley, bright, oriental, etc.), and tobacco curing methods (air, sun, flue, and fire). Previous reports show that tobacco varieties and curing methods influence the production of tobacco smoke constituents like the tobacco-specific carcinogen nicotine-derived nitrosamine ketone (NNK). Aims and Methods We evaluated free radical, nicotine, and NNK production in cigarette smoke from cigarettes produced with 15 different types of tobacco. Gas-phase free radicals were captured by spin trapping with N- tert -butyl-α-phenylnitrone and particulate-phase radicals were captured on a Cambridge Filter pad (CFP). Both types of radicals were analyzed using electron paramagnetic resonance spectroscopy. Nicotine and NNK were extracted from the CFP and analyzed by gas chromatography flame ionization detection and liquid chromatography-mass spectrometry, respectively. Results Gas-phase radicals varied nearly 8-fold among tobacco types with Saint James Perique tobacco producing the highest levels (42 ± 7 nmol/g) and Canadian Virginia tobacco-producing the lowest levels (5 ± 2 nmol/g). Nicotine and NNK levels in smoke varied 14-fold and 192-fold, respectively, by type. Gas-phase free radicals were highly correlated with NNK levels (r  = 0.92, p  < .0001) and appeared to be most impacted by tobacco curing method. Conclusions Altogether, these data suggest that tobacco types used in cigarette production may serve as a target for regulation to reduce harm from cigarette smoking. Implications Variations in cigarette free radical and NNK levels vary based on the tobacco variety and curing method. Reducing the ratio of high-producing free radical and NNK tobacco types offer a potential tool for regulators and producers looking to reduce toxicant output from cigarettes. [ABSTRACT FROM AUTHOR]

Background Chronic disease is a significant burden on the global population. The Helping Everyone Achieve Long Term Health (HEALTH) Passport is a paper-based approach previously utilized to help adults modify clinical risk factors through lifestyle, which may be effective in improving the long-term health of school-age children. This study investigates the feasibility of in-school use by engaging trainee teachers in primary and secondary education. Methods Two hundred and fifty six unique responses were collated to evaluate current teaching of the main health risk factors and HEALTH Passports specifically adapted for schools. Trainees attended workshops with pre- and post-questionnaires used to measure training efficacy and evaluate the Passports' suitability for in-school use. Narrative analysis of feedback was performed. Results Feedback received for both Passports was positive overall. Trainees highlighted the need for the Passports to be further age differentiated. Significantly increased confidence (P  < 0.01) in knowledge of exercise, type 2 diabetes, weight and blood pressure was shown. Confidence in smoking, drugs and alcohol knowledge was reduced highlighting the requirement for further teacher training. Conclusions The HEALTH Passport has potential as an intervention to improve health literacy in school-age children. Age adaptation is needed with references to weight measures removed. Emotional well-being should be focused on, and data management stringently assessed for child protection. [ABSTRACT FROM AUTHOR]

Introduction: Changing patterns of cannabis consumption related to the liberalization of cannabis policies may have a countervailing effect on tobacco use. We analyzed whether cannabis policies have tempered the effects of tobacco control policies as well as the extent to which they were associated with young adult cigarette smoking.Aims and Methods: Combining data on tobacco and cannabis policies at the state, county, and city levels with the nationally-representative geocoded National Longitudinal Survey of Youth 1997 and Census data, we use multilevel regression and fixed effect analyses to examine the impact of cannabis policies on any past 30-day cigarette smoking, frequency of smoking, and past 30-day near-daily smoking among young adults while accounting for community and individual covariates.Results: Tobacco control policies, including significant effects of comprehensive smoking bans, total vending machine restrictions, single cigarette sale restrictions, and advertising restrictions, remain robust in reducing young adult smoking, net of cannabis policy liberalization, including the legal status of possession, penalties for sale, and medical cannabis. Cannabis policies do not directly affect young adult smoking patterns in an adverse way.Conclusions: This paper provides evidence that the liberalization of cannabis laws has not adversely affected the efficacy of tobacco control efforts.Implications: While the effects of tobacco control policies on smoking are well-established, little research has considered how the liberalization of cannabis policies may affect these relationships, which is important given the co-use of these substances. This paper provides evidence that the liberalization of cannabis laws has not adversely affected tobacco control efforts. [ABSTRACT FROM AUTHOR]

We based our analysis on the data in Table 2 of Kim et al. 3 which, as Yue et al. correctly note, implicitly assumes that the one patient without data on smoking was a nonsmoker. 2 They note that the paper by Kim et al. 3 only reported smoking status for 27 of the 28 hospitalized COVID-19 patients they studied, but did not report which patient did not have data on smoking status. [Extracted from the article]

Introduction: The cigarette stick is an important communications tool as well as the object of consumption. We explored young adults' responses to cigarettes designed to be dissuasive.Methods: Data come from a cross-sectional online survey, conducted in September 2015, with 16- to 24-year-old smokers and nonsmokers (N = 997) in the United Kingdom. Participants were shown images of a standard cigarette (white cigarette paper with imitation cork filter), a standard cigarette displaying the warning "Smoking kills" on the cigarette paper, and an unattractively colored cigarette (green cigarette paper and filter). They were asked to rate each of the three cigarettes, shown individually, on eight perception items, and to rate the three cigarettes, shown together, on how likely they would be to try them. Ordering of the cigarettes and questions, with the exception of the question on trial, was randomized.Results: The eight perception items were combined to form a composite measure of cigarette perceptions. For smokers and nonsmokers, the two dissuasive cigarettes (cigarette with warning, green cigarette) were rated significantly less favorably than the standard cigarette, and less likely to encourage trial. For cigarette perceptions, no significant interaction was detected between cigarette style and smoking status or susceptibility to smoke among never smokers. A significant interaction was found for likelihood of trying the cigarettes, with dissuasive cigarettes having a greater impact with smokers than nonsmokers.Conclusions: This study suggests that dissuasive cigarettes may help to reduce the desirability of cigarettes.Implications: The cigarette stick is the object of tobacco consumption, which is seen every time a cigarette is smoked. It is also an increasingly important promotional tool for tobacco companies. In this study, young adults rated two dissuasive cigarettes (a green colored cigarette and a cigarette displaying a health warning) more negatively than a standard cigarette, and considered them less likely to encourage product trial. Our findings suggest that it may be possible to reduce the desirability of cigarette sticks by altering their design, for example, with the addition of a warning or use of an unattractive color. [ABSTRACT FROM AUTHOR]

Background Smoking rates in Greece are the highest recorded among OECD countries, but the historical and life-course evolution of smoking patterns is largely unknown. The present paper addresses this gap. Methods We produce nationally representative life-course trajectories of smoking and related mortality of eight generations of Greek men and women. We estimate the smoking–mortality correlation conditional on several confounders and project the estimates forward. Results We show that smoking prevalence among Greek men has plateaued at >60% for all but the youngest generation. For women, smoking prevalence is relatively lower, lags by several generations and follows a hump-shaped pattern. Smoking-attributable mortality is currently peaking for men (nearing 40% of total deaths) and is rising for women. We estimate that it takes ~20 years of smoking to maximize the smoking–mortality correlation (at 0.48 for men and 0.32 for women). Based on this estimation, we forecast that mortality rates will begin falling within the current decade. Conclusions The breadth of the Greek smoking epidemic has been high by international standards, reflecting the ineffective tobacco control efforts in the country. While smoking popularity fell during the Great Recession, policy vigilance is necessary to prevent a relapse once the economy recovers. [ABSTRACT FROM AUTHOR]

Tobacco is already the world’s leading cause of preventable death, claiming over 5 million lives annually, and this toll is rising. Even though effective tobacco control policies are well researched and widely disseminated, they remain largely unimplemented in most low- and middle-income countries (LMICs). For the most part, control attempts by advocates and government regulators have been frustrated by transnational tobacco companies (TTCs) and their supporters. One reason tobacco is so difficult to control is that its political economy has yet to be adequately understood and addressed. We conducted a review of the literature on tobacco control in LMICs using the databases PubMed, EconLit, PsychInfo and AGRICOLA. Among the over 2500 papers and reports we identified, very few explicitly applied political economy analysis to tobacco control in an LMIC setting. The vast majority of papers characterized important aspects of the tobacco epidemic, including who smokes, the effects of smoking on health, the effectiveness of advertising bans, and the activities of TTCs and their allies. But the political and economic dynamics of policy adoption and implementation were not discussed in any but a handful of papers. To help control advocates better understand and manage the process of policy implementation, we identify how political economy analysis would differ from the traditional public health approaches that dominate the literature. We focus on five important problem areas: information problems and the risks of smoking; the roles of domestic producers; multinational corporations and trade disputes in consumption; smuggling; the barriers to raising taxes and establishing spatial restrictions on smoking; and incentive conflicts between government branches. We conclude by discussing the political economy of tobacco and its implications for control strategies. [ABSTRACT FROM PUBLISHER]

Background During the coronavirus disease 2019 (COVID-19) pandemic, all European countries were hit, but mortality rates were heterogenous. The aim of the current paper was to identify factors responsible for this heterogeneity. Methods Data concerning 40 countries were gathered, concerning demographics, vulnerability factors and characteristics of the national response. These variables were tested against the rate of deaths per million in each country. The statistical analysis included Person correlation coefficient and Forward Stepwise Linear Regression Analysis (FSLRA). Results The FSLRA results suggested that 'days since first national death for the implementation of ban of all public events' was the only variable significantly contributing to the final model, explaining 44% of observed variability. Discussion The current study suggests that the crucial factor for the different death rates because of COVID-19 outbreak was the fast implementation of public events ban. This does not necessarily mean that the other measures were useless, especially since most countries implemented all of them as a 'package'. However, it does imply that this is a possibility and focused research is needed to clarify it, and is in accord with a model of spreading where only a few superspreaders infect large numbers through prolonged exposure. [ABSTRACT FROM AUTHOR]

Background The aim of this study is to determine the feasibility of implementing and evaluating the World Health Organization Package of Essential Non-communicable Disease Interventions (WHO PEN) approach in primary healthcare in the Republic of Moldova. Methods According to our published a priori methods, 20 primary care clinics were randomized to 10 intervention and 10 control clinics. The intervention consisted of implementation of adapted WHO PEN guidelines and structured training for health workers; the control clinics continued with usual care. Data were gathered from paper-based patient records in July 2017 and August 2018 resulting in a total of 1174 and 995 patients in intervention and control clinics at baseline and 1329 and 1256 at follow-up. Pre-defined indicators describing assessment of risk factors and total cardiovascular risk, prescribing medications and treatment outcomes were calculated. Differences between baseline and follow-up as well as between intervention and control clinics were calculated using logistic and linear regression models and by assessing interaction effects. Results Improvements were seen in recording smoking status, activity to measure HbA1c among diabetes patients and achieving control in hypertension treatment. Improvement was also seen in identification of patients with hypertension or diabetes. Less improvement or even deterioration was seen in assessing total risk or prescribing statins for high-risk patients. Conclusions It is feasible to evaluate the quality and management of patients with non-communicable diseases in low-resource settings from routine data. Modest improvements in risk factor identification and management can be achieved in a relatively short period of time. [ABSTRACT FROM AUTHOR]

Introduction: Smoking prevalence among Indigenous Australians nationally (45%) is more than double that of other Australians but ranges up to 82% in remote communities, causing significant health disparities. This paper examines trends in peer-reviewed research outputs related to Indigenous Australian tobacco control over the past decade and describes their research translation potential and alignment with national and jurisdictional policy priorities. Methods: Systematic searches of electronic databases were conducted: Medline, CINAHL, Cochrane Systematic Reviews, PsychInfo, and Australian HealthInfoNET for English-language peer-reviewed publications (2004-2013) primarily focusing on Indigenous Australian tobacco use. Publications were categorized by types, topics, and geographic location. Following established procedures, "reviews" and "commentaries" were distinguished from "original research," the latter further classified as "measurement," "descriptive," or "intervention" studies. Research translation categories used were: "synthesis," "dissemination," "exchange," and "application." Results: The majority of 78 publications meeting selection criteria focused on cessation treatment (28%), monitoring and prevalence (24%) and passive smoking (13%). "Original research" was mostly "descriptive/epidemiologic" (81%) with few "intervention" studies (9%). Many studies were in remote communities. Components of research translation were identified in 50% of the publications with little evidence of dissemination strategies. Conclusion: Remote community populations are an area of great need. However, generally it is disappointing that since 2004, few intervention studies are available to guide efforts to reduce tobacco-related health disparities. Stronger and more immediate alignment of policy with research that contributes to the evidence-base is required together with more systematic use of research dissemination translation strategies to better match evidence with priorities which may develop rapidly over time. [ABSTRACT FROM AUTHOR]

The article focuses on the epidemiological fundamentals discussed in the 1956 paper "Smoking and lung cancer: Recent evidence and a discussion of some questions," by Jerome Cornfield and colleagues. It notes the paper's account of how causal interference could be applied to observational data on smoking and lung cancer. The paper's meta-analysis of 14 case-control studies of smoking and lung cancer and its inclusion of the case-control study done by Schairer and Schöniger in Germany in the early 1940s are also cited.

Background Exposure to cold is known to be associated with severe health impacts. The primary epidemiological evidence for this is the seasonal variation in mortality. However, there is a paucity of directly measured data for personal cold temperature exposure. This paper develops the concept of experienced temperature, and reports how it varies with season, demographics and housing factors. Methods This study uses data from 77 743 UK Biobank participants. A novel method to directly measure participant's exposure to low temperatures using a thermistor in a wrist-worn activity monitor is described. These readings are combined with demographic and housing factor variables in a multiple regression model to understand underlying relationships. Results The study reveals a significant difference in experienced temperature of ~1.8°C between the periods of coldest and hottest external temperature. A number of demographic differences were also observed—such as people of Chinese ethnic background experiencing 0.65°C lower temperatures than other groups. Conclusions This paper presents primary evidence for a seasonal variation in experienced temperature. This variation likely contributes to cold related mortality and morbidity. It is hypothesized that this relationship would be less strong in countries which suffer fewer impacts of cold winter temperatures. [ABSTRACT FROM AUTHOR]

In the one analysis that did follow NASEM guidelines, their findings are consistent with the other PATH Study paper that was co-authored by the senior authors of this paper - it found no association between e-cigarette use and smoking cessation. Of interest, the two senior authors were also co-authors on another recent publication 2 reporting on e-cigarette use and cigarette abstinence that came to a strikingly different conclusion, despite using the same data set from the Population Assessment of Tobacco and Health (PATH) cohort study. Patterns of e-cigarette use and subsequent cigarette smoking cessation over two years (2013/2014 to 2015/2016) in the Population Assessment of Tobacco and Health (PATH) Study [published online ahead of print, September 17, 2020]. [Extracted from the article]

Diverse manifestations of biological aging often reflect disparities in socioeconomic status (SES). In this paper, we examine associations between indicators of SES and an mRNA-based aging signature during young adulthood, before clinical indications of aging are common. We use data from wave V (2016–2018) of the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of adults aged 33–43 years, with transcriptomic data from a subset of 2,491 participants. Biological aging is measured using 1) a composite transcriptomic aging signature previously identified by Peters et al.'s out-of-sample meta-analysis (Nat Commun. 2015;6:8570) and 2) 9 subsets that represent functional pathways of coexpressed genes. SES refers to income, education, occupation, subjective social status, and a composite measure combining these 4 dimensions. We examine hypothesized mechanisms through which SES could affect aging: body mass index, smoking, health insurance status, difficulty paying bills, and psychosocial stress. We find that SES—especially the composite measure and income—is associated with transcriptomic aging and immune, mitochondrial, ribosomal, lysosomal, and proteomal pathways. Counterfactual mediational models suggest that the mediators partially account for these associations. The results thus reveal that numerous biological pathways associated with aging are already linked to SES in young adulthood. [ABSTRACT FROM AUTHOR]

Objectives Previous research in the United States suggests contextual income mobility may play a role in explaining the disparities between life expectancy in the United States and peer countries. This article aims to extend previous research by estimating the consequences of average individual exposure to mobility regimes during childhood and adolescence on adult health. Methods This study draws its data from two longitudinal datasets that track the county of residence of respondents during childhood and adolescence, the Panel Study of Income Dynamics and the National Longitudinal Survey of Youth 1997. We implement marginal structural models to assess the association of the average exposure to county income mobility on five health outcomes and behaviors. Results The results are only partially consistent with a systematic association between exposure to income mobility and health outcomes. Evidence obtained from the National Longitudinal Survey of Youth suggests less income mobility might increase the probability of smoking by age 30. Discussion The paper provides a precise assessment of the hypothesis that childhood exposure to income mobility regimes may influence health status through behavior later in life and contribute to longevity gaps. Only partial evidence on smoking suggests an association between income mobility and health, so we discuss potential reasons for the disparities in results with previous research. [ABSTRACT FROM AUTHOR]

Background: This paper explores whether plans to quit, wanting to quit, and quit efficacy add predictive value over measures of habit strength and dependence in making quit attempts and/or attaining smoking abstinence.Aims and Methods: We used three waves of the International Tobacco Control (ITC) Four Country Smoking and Vaping Survey conducted in 2016, 2018, and 2020. Baseline daily smokers (N = 6710) who provided data for at least one wave-to-wave transition (W1 to W2, N = 3511 or W2 to W3, N = 3199) and provided outcome data at the next wave (follow-up) formed the analytic sample. Generalized estimating equations (GEE) logistic regression analyses examined predictors of quit attempts and abstinence at follow-up (1- and 6-month sustained abstinence).Results: Wanting and planning to quit were significantly positively associated with making quit attempts, but negatively associated with smoking abstinence. A significant interaction between the Heaviness of Smoking Index and age warranted an age-stratified analysis for both abstinence outcomes. Lower HSI predicted abstinence in only the younger smokers Motivation and plans to quit were positively associated with abstinence in younger smokers, but surprisingly were negatively associated with abstinence in older smokers. Quit efficacy was associated with abstinence in the older, but not the younger smokers.Conclusions: Models of smoking abstinence are significantly improved by including motivational predictors of smoking. Age was an important moderator of the association between abstinence for both dependence and motivational variables.Implications: The findings from this large cohort study indicate there are age-related differences in predictors of smoking abstinence but not quit attempts. These associations may reflect differential experiences of older and younger cohorts of smokers, which may have implications for interventions to motivate and assist smokers in quitting. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that cross-national variation in educational inequalities in health outcomes (e.g. NCDs) is due to cross-national variation in risky health behaviour. In this paper we aim to use highly recent data (2014) to examine educational inequalities in risky health behaviour in 21 European countries from all regions of the continent to map cross-national variation in the extent to which educational level is associated with risky health behaviour. We focus on four dimensions of risky health behaviour: smoking, alcohol use, lack of physical activity and lack of fruit and vegetable consumption. Methods: We make use of recent data from the 7th wave of the European Social Survey (2014), which contains a special rotating module on the social determinants of health. We performed logistic regression analyses to examine the associations between educational level and the risky health behaviour indicators. Educational level was measured through a three-category version of the harmonized International Standard Classification of Education (ISCED). Results: Our findings show substantial and mostly significant inequalities in risky health behaviour between educational groups in most of the 21 European countries examined in this paper. The risk of being a daily smoker is higher as respondents' level of education is lower (Low education (L): OR = 4.24 (95% CI: 3.83^.68); Middle education (M): OR = 2.91 (95% CI: 2.65-3.19)). Respondents have a lower risk of consuming alcohol frequently if they have a low level of education (L: OR = 0.59 (95% CI: 0.54-0.64); M: OR = 0.70 (95% CI: 0.65-0.76)), but a higher risk of binge drinking frequently (L: OR = 1.29 (95% CI: 1.16-1.44); M: OR = 1.15 (95% CI: 1.04-1.27)). People are more likely to be physically active at least 3 days in the past week when they have a higher level of education (M: OR = 1.42 (95% CI: 1.34-1.50); H: OR = 1.67 (95% CI: 1.55-1.80)). Finally, people are more likely to consume fruit and vegetables at least daily if they have a higher level of education (fruit: M: OR = 1.09 (95% CI: 1.03-1.16); H: OR = 1.77 (95% CI: 1.63-1.92); vegetables: M: OR = 1.34 (95% CI: 1.26-1.42); H: OR = 2.35 (95% CI: 2.16-2.55)). However, we also found considerable cross-national variation in the associations between education and risky health behaviour. Conclusions: Our results yield a complex picture: the lowest educational groups are more likely to smoke and less likely to engage in physical activity and to eat fruit and vegetables, but the highest educational groups are at greater risk of frequent alcohol consumption. Additionally, inequalities in risky health behaviour do not appear to be systematically weakest in the South or strongest in the North and West of Europe. [ABSTRACT FROM AUTHOR]

Background To address social inequalities in adolescent substance use and consequent disparities in health, it is important to identify the mechanisms of the association between substance use and academic performance. We study the role of health literacy (HL) in the association between academic performance and weekly smoking, monthly alcohol use and cannabis ever-use among adolescents in Europe. Methods SILNE-R school survey data, which was collected in 2016–17 with paper-and-pencil-method from Hanover (GE), Amersfoort (NL) and Tampere (FI), were used (N  = 5088, age 13–19). Health Literacy for School-aged Children instrument was used to assess students' HL. Logistic regression analyzed the association of substance use with academic performance and HL, separately and in the same model. Linear and multinomial logistic regression analyzed the association between academic performance and HL. Results Poor academic performance compared with high was associated with smoking [odds ratio (OR) 3.94, 95% confidence interval (CI) 2.83–5.49], alcohol use (OR: 2.94, 95% CI: 2.34–3.68) and cannabis use (OR: 2.56, 95% CI: 1.89–3.48). Poor HL was also associated with each substance use (with ORs of 2.32, 1.85 and 1.29). HL was positively associated with academic performance (β = 1.04, 95% CI: 0.89–1.20). The associations between academic performance and substance use were only slightly attenuated after controlling for HL. Conclusions Academic performance and HL were both determinants of substance use, confirming their role in tackling the disparities in substance use. However, HL did not demonstrably mediate the association between academic performance and substance use. A wider set of factors needs to be tackled to address emerging social inequalities in adolescent substance use. [ABSTRACT FROM AUTHOR]

Introduction: Over the past 20 years, there has been a tripling in the consumption of small cigars and cigarillos, with further increases expected because cigar products are not subject to Food and Drug Administration regulations. Acute toxin exposure from cigar smoking is difficult to assess because unlike cigarettes, cigars vary widely in size, design, composition, and in the smoking behavior of their consumers. For example, a recent practice among urban youth is to remove the paper liner (i.e., “freaking”) of a small cigar in the belief that it is this paper liner that leads to addiction and cancer. Methods: We examined acute exposure (CO and nicotine boosts) and puffing behavior in 12 participants (10 men) who smoked (ad lib) their usual conventional cigarette, a Black & Mild cigar (B&M) and a B&M without the paper liner (i.e., “freaked” [B&Mf]). Results: All products (cigarettes, B&M, and B&Mf) significantly increased heart rate and CO with a trend for plasma nicotine. Nicotine boost was significantly higher after cigarette smoking than both B&M and B&Mf, while CO boost was significantly greater after B&M and B&Mf than cigarettes. The CO boost after B&M was larger than after B&Mf. Conclusions: These findings suggest that small cigar smoking is associated with smoke inhalation that leads to significant exposure to nicotine, CO, and presumably other components of tobacco smoke and that removing the inner liner does not substantially reduce toxin exposure. [ABSTRACT FROM PUBLISHER]

This paper explores prisoner and staff views of the current smoking policy in English and Welsh prisons (a partial ban permitting smoking in prison cells) and gauges perceptions of the implications of the forthcoming policy change which will see a total smoking ban within all parts of the institution. Five focus group discussions in one medium security male prison in England were undertaken. Three focus groups were undertaken with prisoners (both smokers and non-smokers) and two focus groups with staff. The findings suggest that smoking is embedded in the fabric of prison life and serves several functions, including alleviating anxiety in prisoners. The current smoking policy was perceived as being a fair policy that both supported smoking and non-smoking prisoners. There were concerns, however, that a total smoking ban would have adverse outcomes for prisoners and staff, including deleterious effects on mental health and the potential for violence. The paper concludes by suggesting that the incoming policy, which sees a total smoking ban in prisons, is laudable, but this research suggests that without careful implementation there may be adverse health and organisational outcomes. [ABSTRACT FROM AUTHOR]

Background While tobacco smoking has declined among UK youth in recent decades, cannabis use has begun to show some growth. Given their interrelationship, growth in cannabis use may act as a barrier to continued reduction in youth smoking. This paper assesses recent tobacco and cannabis use trends in Wales, and their association, to explore whether change in cannabis use might have impacted youth tobacco smoking prevalence. Methods Repeat cross-sectional data on tobacco and cannabis use were obtained from biennial Welsh Student Health and Wellbeing surveys between 2013 and 2019. Data were pooled and analysed using logistic regression with adjustment for school-level clustering. Results No change in regular youth tobacco smoking was observed between 2013 and 2019. In contrast, current cannabis use increased during this time, and cannabis users had significantly greater odds of regular tobacco smoking. After adjusting for change in cannabis use, a significant decline in youth tobacco smoking was observed (OR 0.95; 95% confidence intervals: 0.92, 0.97). Conclusion Recent growth in cannabis use among young people in Wales may have offset prospective declines in regular tobacco smoking. Further reductions in youth smoking may require more integrated policy approaches to address the co-use of tobacco and cannabis among adolescents. [ABSTRACT FROM AUTHOR]

The concept of the Health Promoting School (HPS) encourages a holistic approach to promoting health in schools, instead of a more traditional education on health. The aim of this paper was to determine the association between studying in a HPS and smoking and alcohol consumption among adolescents. A cross-sectional study of 3574 adolescents from 44 HPS and 66 non-HPSs was conducted. The association between studying in a HPS and smoking and alcohol consumption among adolescents was analysed using logistic regression models. Pearson's χ 2 test was used to determine the differences between HPS and non-HPS students' sociodemographic characteristics, and the difference in distribution of students who smoked and consumed alcohol at various rates across different groups. Studying in a HPS setting was not significantly associated with adolescent smoking or attempts to smoke. Compared to HPS students, non-HPS students had a significantly higher chance of attempting to consume alcohol and consumed alcohol once a month or more frequently. In comparing the distribution of HPS and non-HPS students according to the frequency of smoking and alcohol consumption across various groups of respondents, it was determined that some factors were associated with frequency of smoking and alcohol consumption among adolescents. The results of the study showed that studying in a HPS was associated with a reduction in both smoking and alcohol consumption, and therefore it is advisable to further develop the HPS network. However, both the individual and educational characteristics of adolescents must be taken into account when planning prevention measures. [ABSTRACT FROM AUTHOR]

Objectives: The US Food and Drug Administration has expressed interest in using mathematical models to evaluate potential tobacco policies. The goal of this systematic review was to synthesize data from tobacco control studies that employ mathematical models.Methods: We searched five electronic databases on July 1, 2013 to identify published studies that used a mathematical model to project a tobacco-related outcome and developed a data extraction form based on the ISPOR-SMDM Modeling Good Research Practices. We developed an organizational framework to categorize these studies and identify models employed across multiple papers. We synthesized results qualitatively, providing a descriptive synthesis of included studies.Results: The 263 studies in this review were heterogeneous with regard to their methodologies and aims. We used the organizational framework to categorize each study according to its objective and map the objective to a model outcome. We identified two types of study objectives (trend and policy/intervention) and three types of model outcomes (change in tobacco use behavior, change in tobacco-related morbidity or mortality, and economic impact). Eighteen models were used across 118 studies.Conclusions: This paper extends conventional systematic review methods to characterize a body of literature on mathematical modeling in tobacco control. The findings of this synthesis can inform the development of new models and the improvement of existing models, strengthening the ability of researchers to accurately project future tobacco-related trends and evaluate potential tobacco control policies and interventions. These findings can also help decision-makers to identify and become oriented with models relevant to their work. [ABSTRACT FROM AUTHOR]

Introduction: To review the geographic exposure measures used to characterize the tobacco environment in terms of density of tobacco outlets and proximity to tobacco outlets, and its association with smoking-related outcomes.Methods: We used PubMed and Google Scholar to find articles published until December 2019. The search was restricted to studies that (1) measured the density of and/or proximity to tobacco outlets and (2) included associations with smoking outcomes. The extraction was coordinated by several observers. We gathered data on the place of exposure, methodological approaches, and smoking outcomes.Results: Forty articles were eligible out of 3002 screened papers. Different density and proximity measures were described. 47.4% density calculations were based on simple counts (number of outlets within an area). Kernel density estimations and other measures weighted by the size of the area (outlets per square kilometer), population, and road length were identified. 81.3% of the articles which assessed proximity to tobacco outlets used length distances estimated through the street network. Higher density values were mostly associated with higher smoking prevalence (76.2%), greater tobacco use and smoking initiation (64.3%), and lower cessation outcomes (84.6%). Proximity measures were not associated with any smoking outcome except with cessation (62.5%).Conclusion: Associations between the density of tobacco outlets and smoking outcomes were found regardless of the exposure measure applied. Further research is warranted to better understand how proximity to tobacco outlets may influence the smoking outcomes. This systematic review discusses methodological gaps in the literature and provides insights for future studies exploring the tobacco environment.Implications: Our findings pose some methodological lessons to improve the exposure measures on the tobacco outlet environment. Solving these methodological gaps is crucial to understand the influence of the tobacco environment on the smoking outcomes. Activity spaces should be considered in further analyses because individuals are exposed to tobacco beyond their residence or school neighborhood. Further studies in this research area demand density estimations weighted by the size of the area, population, or road length, or measured using Kernel density estimations. Proximity calculations should be measured through the street network and should consider travel times apart from the length distance. [ABSTRACT FROM AUTHOR]

Principled methods with which to appropriately analyze missing data have long existed; however, broad implementation of these methods remains challenging. In this and 2 companion papers (Am J Epidemiol. 2018;187(3):576-584 and Am J Epidemiol. 2018;187(3):585-591), we discuss issues pertaining to missing data in the epidemiologic literature. We provide details regarding missing-data mechanisms and nomenclature and encourage the conduct of principled analyses through a detailed comparison of multiple imputation and inverse probability weighting. Data from the Collaborative Perinatal Project, a multisite US study conducted from 1959 to 1974, are used to create a masked data-analytical challenge with missing data induced by known mechanisms. We illustrate the deleterious effects of missing data with naive methods and show how principled methods can sometimes mitigate such effects. For example, when data were missing at random, naive methods showed a spurious protective effect of smoking on the risk of spontaneous abortion (odds ratio (OR) = 0.43, 95% confidence interval (CI): 0.19, 0.93),while implementation of principled methods multiple imputation (OR = 1.30, 95% CI: 0.95, 1.77) or augmented inverse probability weighting (OR = 1.40, 95% CI: 1.00, 1.97) provided estimates closer to the "true" full-data effect (OR = 1.31, 95% CI: 1.05, 1.64). We call for greater acknowledgement of and attention to missing data and for the broad use of principled missing-data methods in epidemiologic research. [ABSTRACT FROM AUTHOR]

Background: Consistent evidence shows the importance of preventing smoking at young ages, when health behaviours are formed, with long-term consequences on health and survival. Although tobacco control policies and programmes targeting adolescents are widely promoted, the cost-effectiveness of such interventions has not been systematically documented. We performed a systematic review on the cost-effectiveness of policies and programmes preventing tobacco consumption targeting adolescents. Methods: We systematically reviewed literature on the (i) cost and effectiveness of (ii) prevention policies targeting (iii) smoking by (iv) adolescents. PubMed, Web of Science, Cochrane, CEA-TUFTS, Health Economic Evaluations, Wiley Online Library, Centre for Reviews and Dissemination Database, the National Institute for Health and Care Excellence and Google Scholar databases were used, and Google search engine was used for other grey literature review. Results: We obtained 793 full-text papers and 19 grey literature documents, from which 16 studies fulfilled the inclusion criteria. Of these, only one was published in the last 5 years, and 15 were performed in high-income countries. Eight analyzed the cost-effectiveness of school-based programmes, five focused on media campaigns and three on legal bans. Policies and programmes were found to be cost-effective in all studies, and both effective and cost-saving in about half of the studies. Conclusions: Evidence is scarce and relatively obsolete, and rarely focused on the evaluation of legal bans. Moreover, no comparisons have been made between different interventions or across different contexts and implementation levels. However, all studies conclude that smoking prevention policies and programmes amongst adolescents are greatly worth their costs. [ABSTRACT FROM AUTHOR]

Introduction: Young adult cigarette smoking behaviors are complex and dynamic. Emerging research suggests a growing rate of switching from non-menthol to menthol cigarettes. Transitions across cigarette smoking states are not well understood. This research longitudinally explores transitions in cigarette smoking behaviors among 18-29 year olds.Methods: We applied a Markov model to data collected biannually for 1542 initially 18-29 year old young adults (mean age: 20.9 years; SD = 2.6) in Texas, who provided 7021 total observations from Fall 2014 to Spring 2017. All participants were past 30 day menthol or non-menthol cigarette smokers at first observation. We examined transitions across three states of cigarette smoking (menthol, non-menthol, and nonsmoking) and compared predictors of each transition, during young adulthood.Results: Descriptively, 22.2% of menthol and 14.3% of non-menthol smokers switched products while 25.6% of menthol and 26.0% of non-menthol smokers quit smoking. Among quitters, 20.0% relapsed via menthol and 28.2% relapsed via non-menthol cigarettes. Results from Markov model indicated that Hispanic/Latinos (Hazard Ratio [HR]: 3.69) and Asians (HR: 2.85) were significantly more likely to switch from non-menthol to menthol cigarettes, relative to non-Hispanic whites. Among recent quitters, the use of non-cigarette products was associated with increased risk of relapse via menthol (HR: 1.54) and non-menthol (HR: 1.85) cigarettes.Conclusion: A substantial proportion of young adult cigarette smokers transitioned across cigarette smoking states over the course of 2.5 years. Other tobacco use and nicotine dependence were impediments to becoming and remaining a non-smoker. Hispanic/Latinos and Asians, relative to non-Hispanic whites, had greater odds of transitioning from non-menthol smoking to both non-smoking and to menthol smoking. Findings suggest racial/ethnic differences in cigarette smoking transitions during young adulthood.Implications: This paper examined multidirectional transitions across cigarette smoking, including switching between menthol and non-menthol cigarettes, among young adults. Results indicate that Hispanic/Latino and Asian young adults are at increased risk of transition to menthol cigarette smoking compared with non-Hispanic white young adults. Findings highlight need for further study of Hispanic/Latino and Asian young adult smoking behaviors. [ABSTRACT FROM AUTHOR]

Introduction Smoking commercial tobacco products is highly prevalent in American Indian and Alaska Native (Indigenous) pregnancies. This disparity directly contributes to maternal and fetal mortality. Our objective was to describe cigarette smoking prevalence, cessation intervention uptake, and cessation behaviors of pregnant Indigenous people compared to sex and age-matched regional cohort. Aims and Methods Pregnancies from an Indigenous cohort in Olmsted County, Minnesota, identified in the Rochester Epidemiology Project, were compared to pregnancies identified in a sex and age-matched non-Indigenous cohort from 2006 to 2019. Smoking status was defined as current, former, or never. All pregnancies were reviewed to identify cessation interventions and cessation events. The primary outcome was smoking prevalence during pregnancy, with secondary outcomes measuring uptake of smoking cessation interventions and cessation. Results The Indigenous cohort included 57 people with 81 pregnancies, compared to 226 non-Indigenous people with 358 pregnancies. Smoking was identified during 45.7% of Indigenous pregnancies versus 11.2% of non-Indigenous pregnancies (RR: 3.25, 95% CI = 1.98–5.31, p ≤.0001). Although there was no difference in uptake of cessation interventions between cohorts, smoking cessation was significantly less likely during Indigenous pregnancies compared to non-Indigenous pregnancies (OR: 0.23, 95% CI = 0.07–0.72, p  = .012). Conclusions Indigenous pregnant people in Olmsted County, Minnesota were more than three times as likely to smoke cigarettes during pregnancy compared to the non-indigenous cohort. Despite equivalent uptake of cessation interventions, Indigenous people were less likely to quit than non-Indigenous people. Understanding why conventional smoking cessation interventions were ineffective at promoting cessation during pregnancy among Indigenous women warrants further study. Implications Indigenous pregnant people in Olmsted County, Minnesota, were greater than three times more likely to smoke during pregnancy compared to a regional age matched non-Indigenous cohort. Although Indigenous and non-Indigenous pregnant people had equivalent uptake of cessation interventions offered during pregnancy, Indigenous people were significantly less likely to quit smoking before fetal delivery. This disparity in the effectiveness of standard of care interventions highlights the need for further study to understand barriers to cessation in pregnant Indigenous people. [ABSTRACT FROM AUTHOR]

Introduction: Various approaches have been used to estimate the population health impact of introducing a Modified Risk Tobacco Product (MRTP).Aims and Methods: We aimed to compare and contrast aspects of models considering effects on mortality that were known to experts attending a meeting on models in 2018.Results: Thirteen models are described, some focussing on e-cigarettes, others more general. Most models are cohort-based, comparing results with or without MRTP introduction. They typically start with a population with known smoking habits and then use transition probabilities either to update smoking habits in the "null scenario" or joint smoking and MRTP habits in an "alternative scenario". The models vary in the tobacco groups and transition probabilities considered. Based on aspects of the tobacco history developed, the models compare mortality risks, and sometimes life-years lost and health costs, between scenarios. Estimating effects on population health depends on frequency of use of the MRTP and smoking, and the extent to which the products expose users to harmful constituents. Strengths and weaknesses of the approaches are summarized.Conclusions: Despite methodological differences, most modellers have assumed the increase in risk of mortality from MRTP use, relative to that from cigarette smoking, to be very low and have concluded that MRTP introduction is likely to have a beneficial impact. Further model development, supplemented by preliminary results from well-designed epidemiological studies, should enable more precise prediction of the anticipated effects of MRTP introduction.Implications: There is a need to estimate the population health impact of introducing modified risk nicotine-containing products for smokers unwilling or unable to quit. This paper reviews a variety of modeling methodologies proposed to do this, and discusses the implications of the different approaches. It should assist modelers in refining and improving their models, and help toward providing authorities with more reliable estimates. [ABSTRACT FROM AUTHOR]

Background This paper studies the evolution of transitions from first cigarette use to daily use by socioeconomic status (SES) among French adolescents over the course of 17 years, in a context of decreasing prevalence of tobacco use. Methods A total of 182 266 adolescents participated in the nationally representative ESCAPAD survey at nine different time points between 2000 and 2017. Discrete time-event analysis was used to model the transition to daily cigarette use as a function of SES, gender, age at onset and the use of other psychoactive substances. Results Although lifetime cigarette smoking and daily cigarette smoking decreased significantly over the studied time span, suggesting a positive impact of prevention policies, disadvantaged adolescents were consistently more prone to engage in daily cigarette smoking, more so in 2017 than 15 years earlier. In the same time span, transitions from initiation to daily cigarette smoking have shortened, with an accelerated pace among underprivileged adolescents. Conclusions Accelerated transitions from initiation to daily cigarette use are a prevalent trend among disadvantaged adolescents in France. Efforts to mitigate the impact of marketing strategies and to promote health literacy should be pursued to reduce social inequalities in health. [ABSTRACT FROM AUTHOR]

Background: This paper examines whether participating in Mahatma Gandhi National Rural Employment Guarantee Program (NREGA) is associated with the likelihood of smoking among program participants in India.Methods: We use two-stage residual inclusion (2SRI) estimation method and two waves of India Human Development Surveys completed before (2005) and after (2012) NREGA implementation.Results: The likelihood of smoking increased with NREGA participation. For every 10% increase in NREGA income, the likelihood of smoking bidis (but not cigarettes) increased by 0.88 percentage point. A bidi, a stick of unprocessed tobacco wrapped in temburini leaves, is a significantly cheaper alternative to cigarettes. Nonparticipants who had a comparable increase in income between the two India Human Development Survey waves did not show an increase in likelihood of smoking. The heterogeneity in NREGA treatment effect shows that smoking tendency is not influenced by caste/religion or literacy.Conclusions: NREGA, as the largest workfare program, most certainly has had a significantly positive influence on the rural poor in India. The findings highlight its small but meaningful influence of a negative health behavior, greater likelihood of uptake of smoking bidis/hookah among program participants.Implications: Existing studies have found mixed evidence of an exogenous increase in income among low-income adults and its impact on smoking. No studies to date have tested the influence of workfare programs in rural areas of developing countries, where unemployment rates are higher and a substantial share of population in those areas is poor. Based on participation in employment guarantee programs as a proxy for exogenous increase in guaranteed income among rural population in India, we find that participants in the program were more likely to smoke bidis/hookah but not cigarettes. [ABSTRACT FROM AUTHOR]

Background Cardiovascular toxicity as a consequence of nicotine from conventional tobacco cigarette smoking is well documented. However, little is known about the cardiovascular consequences of nicotine e-vaping. We review the literature and report a case series of three cases of major adverse cardiovascular clinical effects post nicotine e-vaping. Case summary Three patients with known peripheral arterial disease who switched from heavy cigarette smoking consumption to a high-intensity dose of nicotine e-vaping all developed further arterial complications within 6–30 months. Discussion With the recent epidemic of e-vaping in young individuals and the national outbreak of e-vaping use-associated lung injury (EVALI), the dangers of e-vaping are now coming to light. The pulmonary effects are now well described, and this paper highlights three new cases of cardiovascular toxicity associated with e-vaping. The potential role of nicotine e-vaping and the risk of coronavirus disease-2019 (COVID-19) will also be discussed. [ABSTRACT FROM AUTHOR]