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To assess the association of regional socioeconomic deprivation and nicotine use, survey data from 17,877 pupils aged 9–17 years were analysed. Lifetime use of combustible, e-cigarettes, and both products were the outcome variables. The German Index of Socioeconomic Deprivation was the exposure variable. Logistic regression models controlling for age, gender, school type, and sensation seeking were used to examine associations between regional socioeconomic deprivation and nicotine use. Ever use of combustible cigarettes was 17.8%, of e-cigarettes 19.6%, and of both products 13.4%. Compared to the most affluent area, the adjusted odds ratio of combustible cigarette use in the most deprived area was 2.24 (95% CI: 1.67–3.00), of e-cigarette use 1.56 (95% CI: 1.20–2.03), and of poly use 1.91 (95% CI: 1.36–2.69). Nicotine use among young people across ages and especially in socioeconomic-deprived areas was widespread. Nicotine control measures are urgently needed to reduce smoking and vaping in German adolescents. [ABSTRACT FROM AUTHOR]

Background: Simulation models play an increasingly important role in tobacco control. Models examining the impact of nicotine vaping products (NVPs) and smoking tend to be highly specialized and inaccessible. We present the Smoking and Vaping Model (SAVM),a user-friendly cohort-based simulation model, adaptable to any country, that projects the public health impact of smokers switching to NVPs. Methods: SAVM compares two scenarios. The No-NVP scenario projects smoking rates in the absence of NVPs using population projections, deaths rates, life expectancy, and smoking prevalence. The NVP scenario models vaping prevalence and its impact on smoking once NVPs became popular. NVP use impact is estimated as the difference in smoking- and vaping-attributable deaths (SVADs) and life-years lost (LYLs) between the No-NVP and NVP scenarios. We illustrate SAVM's adaptation to the German adult ages 18+ population, the Germany-SAVM by adjusting the model using population, mortality, smoking and NVP use data. Results: Assuming that the excess NVP mortality risk is 5% that of smoking, Germany-SAVM projected 4.7 million LYLs and almost 300,000 SVADs averted associated with NVP use from 2012 to 2060. Increasing the excess NVP mortality risk to 40% with other rates constant resulted in averted 2.8 million LYLs and 200,000 SVADs during the same period. Conclusions: SAVM enables non-modelers, policymakers, and other stakeholders to analyze the potential population health effects of NVP use and public health interventions. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Perspective of experts on the implementation of the planned controlled delivery of recreational cannabis in Germany. Methods : Convenience sample of 1217 experts from addiction aid, prevention and research answered an online questionnaire about selected aspects of the planned implementation of the cannabis legalization. Respondents were on average 40 to 49 years old with more than 10 years of professional experience, and 59 % were female. Results: More than 90 % of experts rated the following measures as important: no delivery to adolescents, expansion of (school) preventive measures, use of tax revenues for the cannabis-related health sector, delivery only by licensed exclusive cannabis shops with trained staff and duty to provide information, age checks when entering the shops, test purchases by adolescents, mandatory labelling of cannabis products, no mixing with alcohol products, no advertising, no cannabis and driving, and the extension of the Non-Smoking Protection Act to cannabis. 65 % called for a minimum age of 21 years, 76 % called for a possession limit of maximum 10 g, 86 % for a limited purchase quantity and 97 % supported a price equal or cheaper compared to illegal markets. Conclusions: Compared to nicotine and alcohol politics, the experts call for a more controlled and restrictive legalization model. [ABSTRACT FROM AUTHOR]

Introduction: In addition to the prevention of tobacco consumption, the establishment and assurance of high-quality treatment for harmful use and dependence on tobacco products remains an important health-related task in Germany. Regular updating of the Association of the Scientific Medical Societies (AWMF) S3 guideline "Smoking and Tobacco Dependence: Screening, Diagnosis, and Treatment" (Tobacco Guideline) offers a sustainable and reputable source of knowledge on smoking cessation. Methods: Under the auspices of the German Society for Psychiatry, Psychotherapy, Psychosomatics, and Neurology (DGPPN) and the German Society for Addiction Research and Addiction Therapy (DG-Sucht), the Tobacco Guideline was revised in 2019–2020 by 63 experts, who were involved in the development process of the text, in 11 working groups. Undue influence of conflicts of interest on the guideline could be minimized through careful conflict of interest management. Delegates from 50 professional societies discussed the 80 guideline recommendations and voted online. Results: In addition to recommendations for screening and diagnostics, the Tobacco Guideline takes a positive stance towards the use of low-threshold counseling and support services. If, due to the severity of the tobacco-related disorder, brief counseling, telephone counseling, or internet- or smartphone-based methods are not sufficiently effective, individual or group behavioral therapy, possibly in combination with medication, is indicated. If nicotine replacement therapy is not effective, varenicline or bupropion should be offered. Alternative strategies with a lower level of recommendation are hypnotherapy, mindfulness-based treatments, or medication with cytisine. In adolescents and pregnant women, the use of medication should be limited to well-specified exceptions and nicotine replacement. The mean agreement with the recommendations reached a value of 98%. A general overview of the treatment recommendations of the Tobacco Guideline is provided by three clinical algorithms. [ABSTRACT FROM AUTHOR]

Rationale: Recently, experimental paradigms have been developed to strengthen automatic avoidance or inhibitory responses for smoking cues. However, these procedures have not yet been directly compared regarding their effectiveness and mechanisms of action. Objective: This study compared the effects of avoidance vs. inhibitory training as an add-on to a brief smoking cessation intervention. The standard Approach-Avoidance-Task (AAT) was adapted for both training types and control conditions. Methods: One hundred twenty-four smokers attended behavioral counseling for smoking cessation and were thereafter randomized to one of four training conditions: avoidance-AAT, sham-avoidance-AAT, inhibition-AAT, sham-inhibition-AAT. During a 2-week training period including five training sessions, smokers in the avoidance-AAT trained to implicitly avoid all smoking-related cues, while smokers in the inhibition-AAT trained to implicitly inhibit behavioral response to smoking cues. During sham training, no such contingencies appeared. Self-report and behavioral data were assessed before and after training. Cigarette smoking and nicotine dependence were also assessed at 4- and 12-week follow-ups. Results: At posttest, avoidance training was more effective in reducing daily smoking than inhibition training. However, this difference was no longer evident in follow-up assessments. All training conditions improved other smoking- and health-related outcomes. Neither training changed smoking-related approach biases or associations, but approach biases for smoking-unrelated pictures increased and Stroop interference decreased in all conditions. Smoking devaluation was also comparable in all groups. Conclusions: Avoidance training might be slightly more effective in reducing smoking than inhibitory training. Overall, however, all four training types yielded equivalent therapy and training effects. Hence, a clear preference for one type of training remains premature. [ABSTRACT FROM AUTHOR]

Background: Background: Smoking has been linked to depression and anxiety problems for a long time, and it is a known health risk. The precise nature of the varied and intricate association between smoking and mental health illnesses is still unknown, though. Three studies have been carried out to look at this intriguing subject. Material and methods: Materials and Method: The first study primarily focused on nicotine dependence in patients already diagnosed with depression or anxiety. It looked into how these people's experiences of sadness and anxiety developed in relation to their smoking and nicotine dependence. The third study looked at the relationship between adolescent depression and smoking initiation, while the second study focused on smoking and depression in particular in teenagers. Results: Results: Patients with anxiety or depression who had previously been treated were monitored over time in the first research. The most severe symptoms and the slowest recovery were seen in smokers who were also nicotine dependent. If nicotine dependency remained, people's symptoms did not always get better even after they stopped smoking. This implies that the intensity and progression of anxiety and depressive disorders may be made worse by nicotine dependency. Teenagers were observed for a full year in the second trial. The results showed that whereas depressed teens were not necessarily more likely to start smoking heavily, smoking adolescents were more likely to experience depression. Additionally, the best indicator of becoming a heavy smoker was trying cigarettes before going through depression. This suggests that depression may not always be the main cause of a teen's decision to start smoking. The idea that smoking may cause depression in teenagers was further supported by the third study, which evaluated previous data. Conclusions: Conclusion: When considered collectively, these studies point to a complicated reciprocal relationship between smoking and anxiety or depression. Depression and anxiety disorders can worsen in intensity and course, even though smoking--especially when it leads to nicotine dependence--may not always precede the onset of depression, especially in teenagers. For those who are battling these disorders, understanding this complex interplay is essential to creating interventions and treatment plans that work. To clarify the underlying mechanisms and guide comprehensive preventative and intervention efforts, more study is necessary. Healthcare professionals can provide their patients with more comprehensive care if they simultaneously address mental health and smoking-related disorders. For those who are battling melancholy or anxiety in addition to smoking, this strategy might provide greater results and enhance general wellbeing. [ABSTRACT FROM AUTHOR]

Passive smoking is a preventable and significant cause of many serious health problems, with children being particularly at risk. In the fifth German Environmental Survey (GerES V), conducted from 2014 to 2017, information reflecting the extent of passive smoke exposure in children and adolescents was collected by interview-based questionnaires and human biomonitoring (HBM) analyses of cotinine in urine from 2260 participants, aged 3–17 years. Based on these population-representative data, we describe current passive smoke exposure stratified by different subgroups and identify specific exposure determinants using multivariate logistic regression. The questionnaire data revealed that 42% of children and adolescents lived with at least one smoker in the household. Quantifiable concentrations of cotinine could be detected in 56% of the participants. The overall median concentration of cotinine was 0.2 μg/L, with children and adolescents of low socioeconomic status found to be a group particularly affected by passive smoke with higher cotinine concentrations (median = 1.2 μg/L). In the multiple analysis, the most significant predictor of cotinine levels derived from the questionnaire was passive smoking at home (odds ratio (OR) 13.07 [95CI: 4.65, 36.70]). However, parental smoking and passive smoking among friends and relatives could also be identified as independent factors influencing elevated cotinine levels. The comparison between the previous cycle GerES IV (2003–2006) on 3–14-year-olds and GerES V shows that tobacco smoke exposure of children decreased significantly. This decrease is likely an effect of extensive non-smoker protection laws being enforced 2007–2008 on federal and state level. This is reflected by a halving of urinary cotinine concentrations. Nevertheless, our results indicate that passive smoke is still a relevant source of harmful pollutants for many children and adolescents in Germany, and thus support the need for further efforts to reduce passive smoke exposure, especially in the private environment. • Quantifiable concentrations of cotinine in more than half of the participants. • Significant reduction in cotinine concentration compared to GerES IV (2003–2006). • Results demonstrate success of non-smoker protection laws. • 42% of participants live with at least one smoker in the household. • Passive smoke at home was the strongest predictor of elevated cotinine levels. [ABSTRACT FROM AUTHOR]