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Introduction This study examines whether smoke-free laws are differentially associated with youth smoking outcomes by parental education, race/ethnicity, sex, and college plans in a U.S. sample. Methods This study assessed the relationships between smoke-free laws in workplaces and hospitality venues (restaurants/bars) and past 30-day smoking participation, first cigarette initiation, and daily smoking initiation within a repeated cross-sectional sample of 8th, 10th, and 12th graders from the Monitoring the Future study. Data were collected between 2001 and 2018 and were analyzed in 2020–2021. Grade-stratified Poisson models were used to calculate prevalence ratios and average marginal effects, incorporating interaction terms to examine differential associations across groups. Results Hospitality smoke-free laws were significantly associated with lower probabilities of smoking participation in all grades as well as with first cigarette and daily smoking initiation in 8th and 10th grade. Workplace smoke-free laws were associated with lower probabilities of smoking participation among 10th and 12th graders as well as with first cigarette and daily smoking initiation among 10th graders. Average marginal effects ranged from −0.4 percentage points (hospitality laws and daily smoking initiation in 8th and 10th grades) to −2.2 percentage points (workplace laws and smoking participation in 10th grade). Associations between smoke-free laws and a lower probability of smoking participation were most pronounced among students who definitely planned to attend college. Other instances of effect modification suggested more pronounced associations for students who were female and from high-SES households; however, relationships varied by grade. Conclusions Smoke-free laws were associated with reduced smoking among youth; however, associations varied by grade, sex, parental education, and college plans.

Objective: This study aimed to explore the individual, familial, and social factors associated with different smoking status in Thai adolescents from the 2017 Cigarette Smoking and Alcohol Drinking Behavior Survey (CSAD) Methods: The nationally representative sample of 6046 adolescents aged 15-19 years who took part in the 2017 CSAD in Thailand. Multinomial logistic regression analysis was conducted to explore the associations between the individual, familial, and social factors and different smoking status. Results: The daily smoking and occasional smoking was 6.4% and 3.3%, respectively. Gender, alcohol use, substance use, attitudes toward smoking, exposure to secondhand smoke at home, anti-smoking social media campaign, and graphic warning labels were related to both daily and occasional smoking. Daily smoking was associated with exposure to secondhand smoke at school, restaurant, and public transport, and exposure to tobacco advertising. Conclusion: These findings suggest that smoking prevention intervention should particularly focus on these factors and also need to develop the anti-smoking policies for smoking prevention among adolescents.

Introduction Standardised packaging on tobacco products was required in Norway July 1, 2018. We report pre-registered analyses of the potential impact on daily smoking and on daily snus use among women and men. Methods Interrupted time series (segmented regression) on repeated cross-sectional surveys (2012–2019) from two sources: probability samples (Registry Sample, N = 46,957) and market research samples (Market Research Sample, N = 64,465) of Norwegian adults aged 16–79. Self-reported daily smoking and snus use were regressed on a step change impact variable, controlled for trend and demographics (sex, age, region, and education based on national registers in the Registry Sample, and self-reported in the Market Research Sample). Results There were tendencies of a decline in smoking (Odds Ratio [OR] = 0.94; 95% confidence interval [CI] = 0.87, 1.02; lower-tail p-value [Plower] = 0.07), and women’s snus use (OR = 0.89; CI = 0.77, 1.03; Plower = 0.06), but not men’s snus use (OR = 1.01; CI = 0.92, 1.11; Plower = 0.59). Analyses using only the Registry Sample did not detect declines in smoking (OR = 0.99; CI = 0.88, 1.11; Plower = 0.43) or women’s snus use (OR = 0.99; CI = 0.80, 1.24]; Plower = 0.48), and indicated no decline in men’s snus use (OR = 1.18; CI = 1.03, 1.35; Plower = 0.99). Exploratory analyses suggested potential acceleration of the declining trend in smoking (change in trends, OR = 0.97) and of the increasing trend in men’s snus use (OR = 1.03). Conclusions The analyses indicate that standardised packaging in Norway did not produce a decline in men’s snus use. Results are inconclusive regarding smoking and women’s snus use. Exploratory analyses indicated a decrease in smoking and an increase in men’s snus use. Implications We could not confirm or disconfirm whether standardised packaging is an effective tobacco control measure in a Norwegian context. According to our analyses, standardized packaging may have effects on smoking prevalence and women’s snus use, but is unlikely to reduce men’s snus use. The present results may reflect higher effectiveness of standardised packaging for products with stronger health warnings. As the results varied according to samples and outcomes, the study underlines the importance of pre-registering future analyses on this topic. Future confirmatory research should test models of gradual impact of standardised packaging.

Background The prevalence of atopic dermatitis (AD) has increased, but studies in adult or elderly populations are sparse. Methods We investigated 12-month and lifetime prevalences of AD in the Finnish adult population ≥30 years of age and analyzed living environment factors, socioeconomic factors, lifestyle-related factors, and serum vitamin D levels for their associations with AD in a national health examination survey. Results The lifetime prevalence was 21.9% and 12-month prevalence 10.1%. The highest prevalence (lifetime 28.6%, 12-month 15.4%) was seen in subjects 30-39 years of age. Prevalence decreased with age. Subjects with highly educated parents were more likely to have active AD, though there was no effect of higher education in subjects themselves. Younger age and being an ex-smoker were associated with active AD. Female sex and daily smoking increased the risk in subjects 30-49 years of age. There was no dose– response relationship to serum vitamin D levels and no association with the living environment. Conclusions Our data show that the number of adult patients with atopic dermatitis has grown and prevalence numbers of AD in Finnish adults are among the highest reported. Together with the aging of the society, the burden of AD is not limited to childhood.

Introduction Greater availability of tobacco product retailers in an area may be associated with smoking behaviors, and the majority of people who smoke purchase their cigarettes at gas stations and convenience stores. This cross-sectional study investigates the associations of overall tobacco retailer density and gas/convenience density with adult smoking behaviors. Methods This study built a list of tobacco retailers in 2014 and calculated the county-level number of retailers per 1,000 people. Individual-level smoking behavior data were drawn from the 2014–2015 Tobacco Use Supplement for a sample of adults (n=88,850) residing in metropolitan counties across the U.S. General estimating equation models were fit to investigate the associations between retailer density and cigarette smoking behaviors (smoking status, quit attempt, quit length). Analyses were conducted in 2020. Results A greater number of tobacco retailers (AOR=1.63, 95% CI=1.35, 1.96) and gas stations and convenience stores (AOR=3.29, 95% CI=2.39, 4.52) per 1,000 people were each associated with a higher odds of a respondent smoking every day than the odds of a respondent not smoking. In addition, both measures were associated with a higher odds of a respondent being an every-day than being a some-day smoker. Associations for gas/convenience density were similar in models that additionally controlled for other tobacco retailers (excluding gas/convenience). Study results did not support associations between retailer density and cessation. Conclusions Tobacco retailer density, especially gas/convenience density, is correlated with daily smoking, the most harmful tobacco use behavior. Calculating tobacco retailer density using gas/convenience stores may be a feasible proxy for overall tobacco retailer density.

Background This study investigates the socio-demographic factors associated with smoking status in five Southeast Asian countries: Malaysia, Thailand, Indonesia, Vietnam, and Philippines. Methods This cross-sectional study utilizes data of adults ≥15 years who completed the Global Adult Tobacco Surveys. Ordered probit analysis is used to account for the smoking statuses of non-smokers, occasional smokers, and daily smokers. Results Malaysian and Vietnamese households with more family members face lower smoking likelihoods than otherwise. Urbanites in Philippines and rural residents in Thailand and Indonesia are more likely to smoke on occasional and daily basis than others. Males are consistently more likely to smoke occasionally or daily and less likely to be non-smokers than females across all countries. Younger middle-age (retiree) individuals aged 30-35 (≥60) years in Malaysia and Thailand exhibit higher (lower) likelihoods to smoke occasionally or daily than their younger cohorts aged 15-29 years. Individuals aged 30 years and above in Indonesia, Vietnam, and Philippines display higher daily smoking propensities than others. Higher education levels dampens smoking likelihoods and increases non-smoking propensities in all countries. Non-government or self-employed workers in all countries are more likely to smoke occasionally or daily than unemployed persons. Being married is associated with higher non-smoking likelihoods in Thailand although this association is not evident in Malaysia. Conclusion These findings suggest that a portfolio of targeted interventions is necessary to meet the needs of specific subpopulations within the various countries. .

Objective: To test whether smoking-specific risk factors in early adulthood mediate prediction to daily smoking from childhood ADHD. Methods: Participants were 237 with and 164 without childhood ADHD. A smoking risk profile score comprising smoking-specific factors measured between ages 18 to 25 (e.g., craving severity) and age of initiation was tested as mediator of the association between childhood ADHD and age 29 daily smoking. Results: Childhood ADHD predicted age 29 smoking (β = −.15, p = .019), 35% of ADHD versus 17% of nonADHD, and the profile score (β = −.07, p = .004), which in turn mediated prediction to age 29 daily smoking (β = −.03; p = .007). When tested individually, three profile variables (# cigarettes/day, difficulty concentrating during abstinence, and nicotine dependence) were significant mediators ( ps = 0.005–0.038), above and beyond early adult smoking, ADHD persistence, and delinquency. Conclusions: These behavioral smoking characteristics help explain later daily cigarette smoking for adults with ADHD histories and may need to be targeted in intervention.

Mekuriaw Wuhib Shumye,1 Belachew Tegegne,1 Sewunet Ademe,1 Moges Workneh,1 Million Abera,2 Gugsa Nemera,2 Fikadu Balcha2 1School of Nursing and Midwifery, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia; 2School of Nursing, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, EthiopiaCorrespondence: Mekuriaw Wuhib Shumye Tel +251 92 126 8193Email eyasuwuhib@gmail.comBackground: Hypertension and diabetes mellitus are the most common comorbid non-communicable chronic diseases that threaten human beings worldwide. Hypertension is associated with an increased risk of diabetes mellitus and vis-a-vis. However, there is limited information on the magnitude of diabetes mellitus in hypertensive patients in sub-Saharan countries. Hence, this study assessed the magnitude of diabetes mellitus and its associated factors among adult hypertensive patients attending a hypertension clinic in Northeast Ethiopia.Methods: Institution-based cross-sectional study conducted on 407 participants from April to June 2019. The participants were included in the study using systematic random sampling. Data were collected using the WHO STEPwise method. We run descriptive statistics to determine the magnitude of diabetes mellitus in hypertensive patients and logistic regression to identify factors associated with diabetes, and statistically significant associations were declared at a P-value of less than 0.05.Results: The magnitude of diabetes mellitus among hypertensive patients was 29.1%, of whom 24% were newly diagnosed. Respondents with a family history of diabetes mellitus (AOR: 4.6, CI: 2.2, 9.48), increased waist-to-height ratio (AOR: 21.5, CI: 5.62,43.67), increased waist circumference (AOR: 3.2, CI: 1.58, 6.53) and primary school educational status (AOR: 3.2, CI: 1.41, 7.25) were more likely to have diabetes. Similarly, respondents with longer hypertension duration (AOR: 4.09, CI: 1.22, 13.64), past daily smoking history (AOR: 10.46, CI: 1.59,6.8), increased diastolic blood pressure (AOR: 4.15, CI: 1.51, 11.37), and increased waist circumference (AOR: 7.5, CI: 4.47,14.95) were more likely to be diagnosed newly for diabetes.Conclusion: Our study indicated around one-third of hypertensive patients had diabetes. Family history of diabetes mellitus, primary educational status and increased waist-to-height ratio and waist circumference were significant predictors of diabetes among hypertensive patients. The finding suggests the need for regular diabetic screening among hypertensive patients.Keywords: magnitude, hypertension, diabetes mellitus, Ethiopia

Occasional smoking is defined as any smoking occurring on a less than daily basis. Social smoking, i.e. smoking primarily in social contexts, is a sub-group of occasional smoking. Data on occasional cigarette smoking and the subset of social smoking among third level students are limited. (1) To determine prevalence of occasional/social smoking among third level students in an Irish university; (2) to evaluate students’ attitudes to occasional/social smoking, including perceived benefits and harm; (3) to explore when students commenced occasional/social smoking, their reasons and continued smoking habits; and (4) to determine any influence of other factors, e.g. alcohol consumption, on occasional/social smoking. An anonymous online survey was distributed to undergraduates and postgraduates, using SurveyMonkey. Data were analysed in Microsoft Excel. Of 18,407 students surveyed, 1310 (7.1%) responded;1267 (96.7%) provided adequate data for analysis. Of the 1267 students, 423 (33.4%) self-reported as current smokers of whom 106/1267 (8.4%) self-classified as daily smokers and 317/1267 (25%) as occasional smokers. The 25% of occasional smokers comprised 266/1267 (21%) social smokers and 51/1267 (4%) non-social smokers. Occasional smokers tended to start smoking earlier and think less about quitting than daily smokers. Of 423 current smokers, 386 (97.2%) reported that alcohol increased their smoking habits. Prevalence of self-reported occasional smoking among university students was higher than daily smoking. Most occasional smokers primarily smoked in social contexts. All current smokers reported that alcohol increased cigarette intake. Effective intervention campaigns tailored to determinants of occasional/social smoking are needed as part of induction to third level.

The purpose of the research is to study smoking behavior in Chuvashia (one of the regions of Russia) in dynamics from 2014 to 2019. Material and methods. 2513 residents of the Chuvash Republic (1165 men and 1348 women) aged 15 to 92 years (average age - 43.0 ± 16.9 years) were interviewed anonymously. The questionnaire was used for the Global Adult Tobacco Survey (GATS), which is the standard for monitoring global tobacco use. Results. In 2019, 19.9% of the respondents (36.7% among men and 5.4% among women) regularly used tobacco products. On average, they smoked more than 14 cigarettes a day, the average age at starting daily smoking was 17.8 years. 53.8% of smokers have sought medical help in the last year and 76.2% of them received advice from a health worker to quit smoking. In 2019, compared to 2014, the number of intermittent smokers and former daily smokers significantly decreased. The average age of starting smoking increased from 16.5 to 17,8 years (for women it decreased from 18 to 17.7 years). Men began to try to quit smoking more often, while women did it less often. Both received the advice of a health worker to quit smoking more often. The respondents were less likely to pay attention to information on cigarette packs about the dangers of smoking, especially women, and, as a result, fewer smokers of both sexes thought about quitting smoking. The positive tendencies include a significant decrease in secondhand smoke at home (14,8%) and work (10%), including secondhand smoke among pregnant and lactating women. Conclusion. Over the past five years, the number of smokers in the Chuvash Republic has remained stable, which is associated with the state policy to combat tobacco consumption in Russia. However, a decrease in the proportion of the respondents who pay attention to information about the dangers of tobacco and who are less likely to think about abandoning tobacco smoking requires the search for new forms of prevention of smoking behavior among the residents of Chuvashia.

Patients with schizophrenia display characteristic smoking-related behaviors and genetic correlations between smoking behaviors and schizophrenia have been identified in European individuals. However, the genetic etiology of the association remains to be clarified. The present study investigated transethnic genetic overlaps between European-based smoking behaviors and the risk of Japanese schizophrenia by conducting polygenic risk score (PRS) analyses. Large-scale European genome-wide association study (GWAS) datasets (n = 24,114–74,035) related to four smoking-related intermediate phenotypes [(i) smoking initiation, (ii) age at smoking initiation, (iii) smoking quantity, and (iv) smoking cessation] were utilized as discovery samples. PRSs derived from these discovery GWASs were calculated for 332 Japanese subjects [schizophrenia patients, their unaffected first-degree relatives (FRs), and healthy controls (HCs)] as a target sample. Based on GWASs of European smoking phenotypes, we investigated the effects of PRSs on smoking phenotypes and the risk of schizophrenia in the Japanese population. Of the four smoking-related behaviors, the PRSs for age at smoking initiation in Europeans significantly predicted the age at smoking initiation (R2 = 0.049, p = 0.026) and the PRSs for smoking cessation significantly predicted the smoking cessation (R2 = 0.092, p = 0.027) in Japanese ever-smokers. Furthermore, the PRSs related to age at smoking initiation in Europeans were higher in Japanese schizophrenia patients than in the HCs and those of the FRs were intermediate between those of patients with schizophrenia and those of the HCs (R2 = 0.015, p = 0.015). In our target subjects, patients with schizophrenia had a higher mean age at smoking initiation (p = 0.018) and rate of daily smoking initiation after age 20 years (p = 0.023) compared with the HCs. A total of 60.6% of the patients started to smoke before the onset of schizophrenia. These findings suggest that genetic factors affecting late smoking initiation are associated with the risk of schizophrenia.

Blood pressure is one of the critical indicators of a person's physiological state. This indicator and the pulse reflect the state of the cardiovascular system. Their values can directly or indirectly determine the presence of diseases of the heart and blood vessels, and other organs. Therefore, determination of blood pressure among people of different levels of health is an urgent task of modern medicine. The aim of the work: hygienic assessment and monitoring of blood pressure in medical students smoking e-cigarettes. Materials and methods: Quantitative and qualitative analysis of the level of systolic, diastolic pressure, mean arterial and pulse pressure in medical students aged 18-23 years, before and after smoking e-cigarettes was carried out. Results: The findings of the study fully reflect the importance of tonometry. Thus, the level of systolic blood pressure increased after 10 minutes by an average of 7.7%, but after 50 minutes returned to optimal value. The level of diastolic blood pressure increased after 10 minutes by an average of 8.8%, but after 50 minutes – an increase of 4%. Conclusions: This type of changes in the short period are not critical, as the body’ compensatory mechanisms stabilize hemodynamic parameters, but daily smoking can lead to the development of COPD, as well as pathology of the cardiovascular system, including myocardial ischemia or heart failure. Therefore, smoking e-cigarettes cannot be attributed to a harmless type of habit.

IntroductionA household-level constant visual deterrent advocacy campaign to reduce tobacco intake was conducted in rural Bangladesh.AimsTo evaluate smoking tobacco expenditure by campaign components.MethodsWe conducted a single-blind clustered randomized controlled trial on 630 adult male household heads from 16 chars (riverine islands) in rural northern Bangladesh, between November 2018 and January 2019. Intervention allotment was randomized at the char level to minimize spillovers, with 8 chars in treatment and control groups each. The intervention provided households in treatment chars (n = 323) with two visual warning posters, detailing the health effects of tobacco on oneself and external actors, to be hung inside the household for 4 weeks. Households in control chars (n = 307) received nothing. Reported daily smoking (log) tobacco expenditure values were the primary outcome of interest.ResultsFinal analysis was conducted using 251 and 210 smokers in treatment and control chars respectively. The intervention reduced relative smoking tobacco expenditure by 12.8% (95% CI −31.45 to 5.81) but was not statistically significant (P-value = 0.163). Weak to moderate emotional reactions to the posters was identified as a reason for the statistical insignificance.ConclusionFor a visual anti-tobacco intervention to have a substantial impact, it must induce strong emotional responses.

ObjectiveThis study examines the extent to which cigarette taxes affect smoking behaviour and disparities in smoking among adolescents by gender, socioeconomic status (SES) and race/ethnicity.MethodsWe used US nationally representative, repeated cross-sectional data from the 2005 to 2016 Monitoring the Future study to evaluate the relationship between state cigarette taxes and past 30-day current smoking, smoking intensity, and first cigarette and daily smoking initiation using modified Poisson and linear regression models, stratified by grade. We tested for interactions between tax and gender, SES and race/ethnicity on the additive scale using average marginal effects.ResultsWe found that higher taxes were associated with lower smoking outcomes, with variation by grade. Across nearly all of our specifications, there were no statistically significant interactions between tax and gender, SES or race/ethnicity for any grades/outcomes. One exception is that among 12th graders, there was a statistically significant interaction between tax and college plans, with taxes being associated with a lower probability of 30-day smoking among students who definitely planned to attend college compared with those who did not.ConclusionWe conclude that higher taxes were associated with reduced smoking among adolescents, with little difference by gender, SES and racial/ethnicity groups. While effective at reducing adolescent smoking, taxes appear unlikely to reduce smoking disparities among youth.

Aims: At a time of declining smoking prevalence in England, it is useful to document any changes in the characteristics of smokers. This has implications for targeting tobacco control policies and interventions. This study compared the characteristics of smokers from 2008 to 2017 to assess changes in smoking and quitting patterns and socio‐demographic profile. Design and setting: Analysis of annual trends in results from repeated cross‐sectional surveys of representative samples of the population in England from 2008 to 2017. Participants: The study included 208 813 adults aged 16+. Measurements: Information was gathered on age, sex, social grade and region, cigarette consumption, cigarette dependence as measured by time to first cigarette of the day, daily smoking, smoking roll‐your‐own cigarettes, attempts to cut down, use of an e‐cigarette or nicotine replacement therapy, attempts to cut down or quit, use of support in quit attempts and whether the quit attempt was abrupt. Findings: During the period, mean daily cigarette consumption [B = –0.30, 95% confidence interval (CI) = –0.33 to −0.27] and the time to first cigarette score decreased (B = –0.03, 95% CI = –0.03 to −0.02). The proportion of smokers attempting to cut down or quit decreased (odds ratio (OR) range = 0.96–0.97, 95% CI range = 0.95–0.97). Use of behavioural support [odds ratio (OR) = 0.89, 95% CI = 0.86–0.92] or no support decreased (OR = 0.98, 95% CI = 0.96–0.99), while use of pharmacological support, including e‐cigarettes, increased (OR = 1.04, 95% CI = 1.02–1.05). There was no significant change in the difference in social grade between smokers and non‐smokers comparing 2008 with 2017. Changes in smoking and quitting behaviour were independent of changes in socio‐demographic characteristics. Conclusions: Between 2008 and 2017 in England, smokers appear to have become less dependent on cigarettes but less likely to try to quit or cut down. Of those who tried to quit, fewer used behavioural support and more used pharmacological support. The proportion from more disadvantaged backgrounds did not change significantly.

Tobacco, alcohol and cannabis use are important health problems that contribute greatly to causes of death in worldwide. Early onset of substance use increases rapidly during adolescence and it has been associated with a wide range of adverse events. Because substance use is associated with dramatic consequences, delaying the initiation of substance use among adolescents remains a major public priority. This study examined the effectiveness of a school-based intervention program based on the application of the Reasoning and Rehabilitation V2 (R&amp, R2) program for preventing substance use among adolescents at risk of academic failure. A sample of 142 participants (aged 13–17 years old) who were studying alternative education provision in Spain were randomly allocated to two conditions (68 experimental group, 74 control group). A pre-test survey assessing past and current substance use was conducted prior the implementation of the program, while a post-test survey was conducted about 12 months after the pre-test. The results showed a significant effect of the R&amp, R program in the reduction of cigarette smoking, episodes of drunkenness, alcohol consumption and cannabis use. However, for daily smoking and episodes of drunkenness such benefits showed a reduction over time. These findings offer additional evidence of the effectiveness of the Reasoning and Rehabilitation V2 program in Spanish adolescent students who are exposed to substance use and suggest areas of future research.

The aim of the current study was to assess the perceived treatment effectiveness and beliefs with respect to the best advisor who could conduct smoking cessation treatment or counseling among socially disadvantaged light and heavy smokers. This could be crucial for implementation of a successful smoking cessation intervention among this vulnerable population.The current assessments were based on the data collected during the second wave of a cross-sectional study performed in the Piotrkowski District among 1668 adults aged 18-59, entitled to social aid from welfare institutions. Face-to-face interviews were conducted to collect the relevant data.The current daily smoking status was declared by 31% of the participants. About 23% of the study sample (74% of daily smokers) admitted to being heavy smokers with a meaningful difference between men and women (p0.05). About 29% of the daily smokers indicated that medications/pharmacotherapy could be a good method for giving up the habit. Fifteen percent of the participants shared the opinion that a smoking cessation specialist is the best advisor for counseling, and only about 7% would choose a general practitioner or pharmacist, and even fewer a nurse, as a person who could provide help to smokers. There were no statistically significant differences in any of the evaluated perceptions between the light and heavy smokers (p0.05).A high share of heavy smokers among socially disadvantaged people, and their perception that medications/pharmacotherapy would be a good solution to quit smoking, underline the need for stronger support for this method, including relevant financing resources and training. However, this method should be applied along with behavioral counseling. Int J Occup Med Environ Health. 2019;32(4):527-36.

Objectives: Alternative tobacco product (ATP) use is popular among adolescents in Western countries, however, little is known about factors influencing ATP experimentation in Europe. The aim of this study was to explore factors associated with ATP experimentation, and to identify patterns of ATP experimentation among Hungarian adolescents who had ever tried manufactured cigarette smoking. Methods: Logistic regression analyses were applied to estimate the relationship between individual cigarette smoking experiences, social smoking influences, demographics, and ATP experimentation (roll-your-own (RYO) cigarettes, cigars/cigarillos, waterpipe, traditional pipe and flavoured cigarettes) in a cross-sectional sample of 8th and 11th grade students (N = 1,067, 56.0% of girls) who had ever tried manufactured cigarette smoking in six metropolitan cities of Hungary. Latent class analysis (LCA) was performed to identify patterns of different ATP use. Results: Almost 90% of the sample had ever tried ATPs and significantly more commonly older (91.8%) versus younger (79.8%) students. Waterpipe was the most popular product to try followed by flavoured cigarettes, cigars/cigarillos, RYO cigarettes, and pipe. Boys were more likely to report ATP experimentation compared to girls. Younger age of cigarette smoking experimentation, greater frequency of past month cigarette smoking and history of ever daily smoking for 30 days showed strong association with ATP experimentation. Students with one or more smoking friends were more vulnerable to experiment with ATPs. Weekly allowance, school academic achievement and household smoking exposure showed no effect on the experimentation. LCA identified four subgroups of ATP experimenters comprising intense polytobacco experimenters (38.4%), mainly waterpipe experimenters (34.2%), moderate polytobacco experimenters (14.9%), and less interested experimenters (12.5%). Conclusion: Tobacco prevention programmes targeting adolescents should emphasize the risks of using ATPs in addition to manufactured cigarettes. Accessibility of ATPs should be better regulated and restrictions should be strongly enforced in order to prevent potential harmful consequences of adolescent polytobacco use.

Poor academic performance is a known risk factor for adolescent smoking, yet the association remains unclear, as the role of social ties has been rarely examined. Our study aims to investigate the role of friendship ties in this association. In a sample of 11,015 adolescents, aged 14 to17, in 50 schools within six European cities (SILNE-survey, 2013), we used multilevel models to analyse the mediating effect of the composition of friendship ties and school types on the association between academic performance and smoking. Results show smoking was more prevalent in adolescents with lower academic performance than with higher. This association was stronger in non-vocational schools than in vocational. Adolescents tended to have friendship ties with someone sharing the same smoking status and academic performance. Finally, friendship networks are patterned both on smoking and academic performance. This suggests the educational environment contributes to future socio-economic inequalities in smoking among young people.

Background Our objective in this study was to find determinants of high-school dropout in a deprived area of Japan using longitudinal data, including socio-demographic and junior high school-period information. Methods We followed 695 students who graduated the junior high school located in a deprived area of Japan between 2002 and 2010 for 3 years after graduation (614 students: follow-up rate, 88.3%). Multivariable log-binomial regression models were used to calculate the prevalence ratios (PRs) for high-school dropout, using multiple imputation (MI) to account for non-response at follow-up. Results The MI model estimated that 18.7% of students dropped out of high school in approximately 3 years. In the covariates-adjusted model, three factors were significantly associated with high-school dropout: ≥10 days of tardy arrival in junior high school (PR 6.44; 95% confidence interval [CI], 1.69-24.6 for "10-29 days of tardy arrival" and PR 8.01; 95% CI, 2.05-31.3 for "≥30 days of tardy arrival" compared with "0 day of tardy arrival"), daily smoking (PR 2.01; 95% CI, 1.41-2.86) and severe problems, such as abuse and neglect (PR 1.66; 95% CI, 1.16-2.39). Among students with ≥30 days of tardy arrival in addition to daily smoking or experience of severe problems, ≥50% high-school dropout rates were observed. Conclusions Three determinants of high-school dropout were found: smoking, tardy arrival, and experience of severe problems. These factors were correlated and should be treated as warning signs of complex behavioral and academic problems. Parents, educators, and policy makers should work together to implement effective strategies to prevent school dropout.

Existing studies in the literature indicate an association between the use of dating apps and substance-related behaviours (i.e., alcohol consumption, drug consumption). However, to date, no studies investigated the relation between dating app use and smoking. This study aims to explore this association. A total of 1278 respondents completed an online ad hoc questionnaire assessing demographics, smoking habits, dating app use, motivations for using dating apps. Multiple logistic regression analyses were run to investigate the relation between demographics and dating apps use on tobacco consumption. Being active user was significantly associated with being smoker, light daily and moderate-to-heavy smoker. Among users, using apps with the motive of searching for friends accounted for lower odds of smoking, light daily smoking and moderate-to-heavy smoking. However, heavy dating app users were less likely to smoke, to be light daily smokers and to be moderate-to-heavy smokers. The study indicates an association between using the apps and smoking, suggesting that motives for using the apps and intensity of use may moderate this association.

Zhuo Zhang,1 Lu Ma,2 Hui Geng,3 Ying Bian1 1State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, People’s Republic of China; 2Xi’an Shiyou University, Xi’an, Shaanxi, People’s Republic of China; 3Physical Examination Center, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of ChinaCorrespondence: Ying BianInstitute of Chinese Medical Sciences, University of Macau, Avenida Da Universidade, Room 2055, N22 Building, Taipa, Macau SAR, People’s Republic of ChinaTel + 86853-66548926Email bianyingum@163.comPurpose: Although drinking and smoking have been associated with gamma-glutamyl transferase (GGT) levels, studies on the effects of smoking and drinking on GGT levels are scarce. The objective of this study was to assess the individual and combined effects of smoking, drinking on GGT levels in the Shaanxi province of Northwest China.Participants and Methods: A questionnaire survey was conducted in a population that underwent health examination at the First Affiliated Hospital of Xi’an Jiaotong University and included employees of enterprises or public institutions. The survey was used to collect the baseline characteristics, smoking status, and drinking status of the participants. This information was collected from January 2019 to December 2019. Data related to the physical examinations were exported using the hospital information system (HIS). A linear regression model was employed to explore the effects of smoking and drinking on GGT levels. The restricted cubic spline model was applied to assess the dose–response relationship between amount of smoking, alcohol consumption and GGT levels.Results: A total of 10,177 participants were included in the study. Linear regression indicated that smoking (β=3.37, 95% CI: 2.57– 4.17) and drinking (β=5.55 L, 95% CI: 4.40– 6.71) individually, and collectively (β=9.30, 95% CI: 7.83– 10.76) had a positive effect on GGT levels. The restricted cubic spline presented a linear dose–response relationship between the amount of daily smoking and GGT levels (P for non-linearity=0.148, P for overall association < 0.001, OR=2.49, 95% CI: 1.27– 4.90), and that between weekly alcohol consumption and GGT levels (P for non-linearity=0.231, P for overall association < 0.001, OR=4.79, 95% CI: 1.72– 13.32). In case of females, stratified analysis showed that in comparison to the reference group, only current drinkers had a significant effect on GGT levels (OR=3.37, 95% CI: 0.19– 6.55).Conclusion: Smoking and drinking have a dose-dependent and a synergistic effect on GGT levels. They should be controlled concurrently, especially among males.Keywords: gamma-glutamyl transferase, smoking, drinking, restricted cubic spline

Background Individuals with epilepsy are up to twice as likely to be current cigarette smokers compared to those without. Moreover, one study showed current smoking is associated with an increased likelihood of seizures. However, outside of this one study, there is limited data on the presentation of specific smoking-related behaviors and cognitions in people with epilepsy, inhibiting our understanding of the severity of this behavior and our ability to formulate effective treatments for this population. Purpose The current study examined smoking-related behaviors and cognitions among smokers with epilepsy compared to smokers without epilepsy. Methods Participants were 43 smokers with (Mage = 43.4, SD = 11.6) and 43 smokers without (Mage = 45.5, SD = 8.8) epilepsy recruited from an urban, academic setting within the U.S. Separate Analyses of Covariance (ANCOVAs) were conducted to evaluate differences between smokers with and without epilepsy in terms of smoking behavior (i.e., daily smoking rate, nicotine dependence, number of quit attempts, smoking duration, age of smoking onset) and smoking-related cognitive processes (i.e., smoking motives, perceived barriers to smoking cessation, cessation motives) after controlling for race and problematic alcohol use. Results Smokers with epilepsy did not differ from smokers without epilepsy in terms of smoking rate (p = .51, ηp2 = .01), nicotine dependence (p = .12, ηp2 = .03), age of smoking onset (p = .42, ηp2 = .01), number of quit attempts (p = .43, ηp2 = .01), barriers to cessation (p = .30 to .80, ηp2 = .00 to .01), or cessation motives (p = .28 to .60, ηp2 = .00 to .02). Smokers without epilepsy reported higher levels of smoking for sensorimotor manipulation reasons (p = .03, ηp2 = .06) and longer smoking duration (p = .03, ηp2 = .06) than smokers with epilepsy. Conclusions Smokers with epilepsy do not appear to differ significantly from smokers without epilepsy in terms of smoking-related behaviors and cognitions, and may therefore benefit from current evidence-based treatments for smoking cessation that are not contraindicated for epilepsy (i.e., bupropion, varenicline).

Increasing sugar-sweetened beverages (SSB) consumption and associated health impacts warrant health-policy action. We assessed associations of socioeconomic and lifestyle variables with adolescents’ consumption of regular soda (RSD), sport (SD), and energy (ED) drinks. Cross-sectional study of 3930 Spanish adolescents (2089 girls, 1841 boys) aged 13–18 years). We compared frequency of consuming each SSB type (European Food Safety Authority questionnaire) with sociodemographic and lifestyle variables (standardized questions). RSD, SD, and ED were consumed at least weekly by 72.7%, 32.3%, and 12.3% of participants, respectively, and more frequently (p &lt, 0.001) by boys, compared to girls. Multivariate ordinal logistic regression showed inverse association between RSD, SD, and ED consumption and parental occupation-based socioeconomic status (p &lt, 0.01). Daily smoking was associated (p &lt, 0.001) with higher ED (OR 3.64, 95% CI 2.39–5.55) and RSD (OR 2.15, 95% CI 1.56–2.97) consumptions. SD intake was associated inversely with smoking (OR 0.60, 95% CI 0.40–0.89, p = 0.012) and directly with physical activity (OR 2.93, 95% CI 2.18–3.95, p &lt, 0.001). School performance was lower among ED (OR 2.14, 95% CI, 1.37–3.35, p = 0.001) and RSD (OR 1.81, 95% CI 1.24–2.64, p = 0.002) consumers, compared to SD. Maleness and low socioeconomic status predicted SSB consumption. Smoking and low school performance were associated with higher ED and RSD intakes.

Key Points Question How have trends in cigarette and smokeless tobacco use among adolescents changed in recent years as e-cigarette use increased? Findings In this cross-sectional study of 1 297 362 US adolescents surveyed between 2011 and 2019, past 30-day and daily use of cigarettes and smokeless tobacco decreased more rapidly since 2012 as e-cigarette use began to increase. Smoking and smokeless tobacco use reached historically low levels among adolescents in the US. Meaning Despite its recent increase in popularity, e-cigarette use does not seem to be counteracting the decreases in other tobacco use prevalence., Importance Use of e-cigarettes increased among adolescents between 2011 and 2019. However, whether these changes are affecting patterns of use of other tobacco products, especially cigarettes, remains unclear. Objective To examine the long-term and recent trends in cigarette smoking and smokeless tobacco product use among US adolescents by grade (8th, 10th, and 12th), sex (male and female), and race (White and Black). Design, Setting, and Participants In this cross-sectional study, joinpoint regression analyses were performed to characterize trends in tobacco product use for key sociodemographic groups, identifying change of trend years (joinpoints). Students in the 8th, 10th, and 12th grades at US secondary schools and high schools who participated in the nationally representative Monitoring the Future survey from January 7, 1991, to June 3, 2019, were evaluated. Exposures Cigarette smoking and smokeless tobacco product use during the past 30 days. Main Outcomes and Measures Past 30-day and daily prevalence of cigarette smoking and smokeless tobacco product use by year, grade, sex, and race. The prevalence trend segments, change of trend years (joinpoints), and annual percentage change (APC) in prevalence within each trend segment were estimated using joinpoint regression. Results Since 1991, 487 335 8th-grade, 447 310 10th-grade, and 424 236 12th-grade students have completed the Monitoring the Future survey (including 663 663 girls and 632 698 boys [those who did not respond to the sex question in the survey were excluded from the sex analyses]). Past 30-day and daily smoking prevalence increased in all groups analyzed from 1991 until 1996 and 1997 and has been decreasing ever since, with more rapid reductions in recent years. For example, daily smoking among 12th-grade boys increased at an APC of 4.9% (95% CI, 3.5%-6.3%) from 1991 to 1998, decreased at an APC of −8.0% (95% CI, –9.3% to –6.7%) from 1998 to 2006, decreased at an APC of −1.6% (95% CI, –4.6% to 1.5%) from 2006 to 2012, and decreased at an APC of −17.4% (95% CI, –19.4% to –15.4%) from 2012 to 2019. Similar results were observed for boys in the 8th grade (5.0% [95% CI, 0.1%-10.2%] for 1991-1996, –8.8% [95% CI, –10.0% to –7.6%] for 1996-2011, and –17.3% [95% CI, –22.2% to –12.0%] for 2011-2019) and 10th grade (7.1% [95% CI, 3.7%-10.7%] for 1991-1997, –11.1% [95% CI, –13.9% to –8.2%] for 1997-2005,–0.7% [95% CI, –5.9% to 4.9%] for 2005-2011, and −17.9 [95%, –21.7% to –13.9%] for 2011-2019), for girls in 8th grade (10.9% [95% CI, 5.0%-17.2%] for 1991-1996 and –10.8% [95% CI, –11.7% to –10.0% for 1996-2019), 10th grade (7.2% [95% CI, 3.9%-10.7%] for 1991-1997, –9.5% [95% CI, –10.5% to –8.6%] for 1997-2012, and –16.3% [95% CI, –21.8% to –10.4%] for 2012-2019), and 12th grade (6.5% [95% CI, 3.6%-9.5%] for 1991-1997, –7.2% [95% CI, –8.1% to –6.3%] for 1997-2012, and –17.5% [95% CI, –21.2% to –13.6%] for 2012-2019). Results were similar, too, for Black adolescents (2015-2019 average annual percentage change: –8.6% [95% CI, –10.3% to –6.8%] for 8th graders; –17.7% [95% CI, –26.3% to –8.2%] for 10th graders; and –18.3% [95% CI, –23.9% to –12.2%] for 12th graders) and White adolescents (2015-2019 average annual percentage change: –17.3% [95% CI, –20.6% to –13.7%] for 8th graders; –16.9% [95% CI, –20.5% to –13.2%] for 10th graders; and –17.0% [95% CI, –20.5% to –13.2%] for 12th graders). Smokeless tobacco was used more variably through 2012, followed by consistent decreases in the past 5 years. For instance, smokeless tobacco use in the past 30 days in 10th-grade boys decreased at an APC of –6.5% (95% CI, –7.5% to –5.4%) from 1991 to 2004, increased at an APC of 3.1% (95% CI, –0.8% to 7.1%) from 2004 to 2012, and decreased at an APC of –11.6% (95% CI, –15.7% to –7.4%) from 2012 to 2019. Similarly, daily smokeless tobacco use in 12th-grade boys decreased at an APC of –3.8% (95% CI, –5.4% to –2.1%) from 1992 to 2005, increased at an APC of 3.1% (95% CI, –0.2% to 6.5%) from 2005 to 2015, and decreased at an APC of –23.0% (95% CI, –33.3% to –11.0%) from 2015 to 2019. Conclusions and Relevance This cross-sectional study suggests that, despite the increase in the prevalence of e-cigarette use among adolescents between 2011 and 2019, the prevalence of cigarette and smokeless tobacco use has decreased more rapidly during the same period compared with earlier years., This cross-sectional study examines how trends in cigarette and smokeless tobacco use among adolescents by grade, sex, and race have changed in recent years as e-cigarette use has increased.

The current study employed socio-demographic, health and lifestyle, and academic variables to assess the prevalence and independent predictors of daily smoking, attempts to quit smoking, and agreement with total smoking ban at university.Students at the University of Turku (1,177) completed an online questionnaire that assessed socio-demographic, health and lifestyle, and academic characteristics, and three smoking variables (smoking, attempts to quit, agreement with total smoking ban at university). Bivariate relationships and multiple logistic regression assessed relationships between student characteristics and the three smoking variables before and after controlling for all other variables.Slightly80% of students never smoked, 16% were occasional, and about 6% were daily smokers, and about 40% had attempted to quit. Nearly half the sample agreed to total smoking ban at university. Physical activity, consuming alcohol, illicit drug/s use and daily smoking were significant independent predictors across1 of the three smoking variables. Age, health awareness, importance of achieving good grades, academic performance compared to peers, study burden, and mother's educational level were significant independent predictors of one of the three variables examined.Universities need to assess smoking, with specific focus on the modifiable independent predictors that were associated with1 the variables examined, to encourage physical activity and pay attention to reduce alcohol consumption and illicit drug/s and daily smoking, whilst targeting at-risk students. University strategies should be part of the wider country-wide effective tobacco control policies.

INTRODUCTION Prevalence of light daily smoking, 10 CPD) and frequency (non-daily vs daily). Combinations of T0 and T1 smoking behaviors resulted in 15 smoking trajectories ending in light/non-daily smoking and a 16th category of heavy daily smokers at T1. Differences in demographics, tobacco use, and smoking cessation behaviors were assessed by using weighted multivariable regression models. RESULTS Overall, 46.1% of US smokers were heavy smokers, 24.6% remained light daily smokers and 12.5% remained light non-daily smokers between T0 and T1. Current cigar, smokeless tobacco, and pipe use differed by smoking trajectories (p

Introduction Very light daily smoking is increasingly common among young adults. Evidence suggests that levels of nicotine dependence vary significantly among young adults who engage in very light daily smoking. However, the links between dependence and clinically relevant outcomes (eg, lapse) in this population remain unclear. The goal of this study was to address this gap by evaluating how well different nicotine dependence scales predict lapse behavior among very light daily smoking young adults. Aims and Methods Very light daily smokers (1–5 cigarettes/day) aged 18–25 participated in an initial laboratory session, during which nicotine dependence was assessed using four commonly used measures: the Fagerstrӧm Test for Cigarette Dependence (FTCD), the Hooked On Nicotine Checklist (HONC), the Transdisciplinary Tobacco Use Research Centers (TTURC) Nicotine Dependence Inventory, and the Wisconsin Inventory of Smoking Dependence Motives (WISDM). After a baseline period, eligible participants (n = 40) completed a 10-day abstinence incentive period in which they attempted to refrain from smoking to earn monetary rewards. Cox proportional hazards models were used to test whether dependence predicted days to first lapse. Results FTCD scores significantly predicted days to lapse, as did scores on the FTCD item assessing time to first cigarette of the day (TTFC). No other dependence measures predicted time to lapse. Both the FTCD and TTFC continued to independently predict time to lapse after controlling for smoking frequency and duration. Conclusions The FTCD may be a particularly useful tool for capturing clinically meaningful variability in nicotine dependence among young adults who engage in very light daily smoking. Implications This is the first study to directly link self-reported nicotine dependence with the ability to achieve and maintain abstinence among very light daily smoking young adults. The results may aid clinicians in selecting among variable measures of nicotine dependence when assessing and treating this population.

Background Tobacco control measures carried out in the countries can affect social inequalities in the smoking habit. This study aimed to examine the 20-year trends in social patterning of daily smoking in Lithuania. Methods The data were obtained from 11 biannual cross-sectional postal surveys of Lithuanian Health Behaviour Monitoring, beginning in 1994. Each survey used a randomly selected nationally representative independent sample of 3000-4000 inhabitants aged 20-64 drawn from the population register. In total, 8738 men and 11822 women participated in the surveys. The analysis of daily smoking involved the respondents who had smoked daily for at least one year. Results The prevalence of daily smoking was increasing up to the year 2000, especially among women, while a decreasing trend in men and levelling off a trend in women was observed afterwards. In the last survey, 33.3% of men and 12.5% of women were daily smokers. The proportion of daily smokers was higher among younger than older participants; however, the age difference in smoking decreased over time. The highly educated men and women smoked less than those with low education. The odds ratio (OR) of smoking in men with university versus lower education was 0.42 (95% CI 0.37-0.47) and in women - 0.68 (95% CI 0.60-0.78). The proportion of smoking men decreased in all educational groups; however, the differences in the smoking prevalence remained. Since 2000, the educational gradient in smoking among women was increasing due to a decline in smoking prevalence among women with university education. More women living in big cities than in non-urban areas were daily smokers (OR 1.29; 95% CI 1.15-1.44). Over 20 years, no consistent difference in the smoking trends by place of residence was found in both genders. Conclusions The 20-year trends in social patterning of daily smoking differed between men and women. Inequalities in daily smoking by age and education remained in both genders. Key messages In Lithuania, the trends and social differences in daily smoking were related to gender. Comprehensive tobacco control measures targeting young and lower educated groups should be implemented aiming to reduce social inequalities in smoking.

Aim: To examine trends in socioeconomic differences in daily smoking among 15-year-old Danes between 1991–2014, using occupational social class as indicator of socioeconomic status. Methods: The study included 15-year-olds participating in seven Danish Health Behaviour in School-aged Children studies between 1991–2014, n = 8,641. The analyses focused on absolute socioeconomic differences (prevalence difference between low and high occupational social class) and relative socioeconomic differences communicated by odds ratio for daily smoking. Results: The prevalence of daily smoking declined from 18.6% in 1991 to 4.5% in 2014. Across all surveys, the prevalence was 8.9% in high, 12.8% in middle and 16.5% in low occupational social classes ( p < 0.0001). The absolute socioeconomic differences increased from 1991 to 2006 and declined thereafter. Across all survey years, the odds ratio (95% confidence interval) for daily smoking was 1.40 (1.19–1.65) in middle and 1.90 (1.56-2.32) in low versus high occupational social classes. The statistical interaction between occupational social class and survey year was significant ( p = 0.0404), suggesting increasing relative socioeconomic differences from 1991 to 2014. Conclusions: There was a substantial decline in daily smoking among 15-year-olds between 1991–2014 in all occupational social class groups. The prevalence of daily smoking was highest in the low occupational social class during the entire period. The absolute socioeconomic differences in daily smoking increased between 1991–2006 and declined thereafter. The relative socioeconomic differences increased over 1991–2014. Studies of change in socioeconomic differences over time should address both absolute and relative socioeconomic differences as they may result in different conclusions and because important improvement in prevalence patterns may be disguised by exclusive focus on changes in relative socioeconomic differences.

Aims: Swedish smokeless tobacco (snus) is a lower-risk tobacco product than cigarette smoking for individuals. However, the public health impact of snus use is less well studied. Critically, it is uncertain whether use of snus leads to the onset of smoking. This study aimed to investigate prospectively the association between snus experimentation in late adolescence and daily cigarette smoking in early adulthood among Finnish young men. Methods: Data were obtained from 1090 young men within the population-based FinnTwin12 cohort. At baseline (mean age 17 years), we assessed lifetime use of cigarettes and snus, plus other potential predictors of cigarette smoking. At follow-up (mean age 24 years), participants were categorized according to their current smoking status. The final analyses were conducted among 375 young men who were never smokers at baseline with adequate data on follow-up smoking status and other potential predictors of cigarette smoking. Results: Age-adjusted logistic regressions showed an increased risk of becoming a daily smoker at follow-up among those participants who had at least tried snus but had never smoked cigarettes at baseline (odds ratio (OR) 6.48, 95% confidence interval (CI) 2.02–20.7), compared with those who had never used snus. When additionally adjusted for monthly alcohol intoxication, maternal smoking, and peer drug use, the association between snus experimentation and later daily cigarette smoking was attenuated, but remained significant (OR 3.94, 95% CI 1.22–12.7). Conclusions: Our data support the proposition that snus experimentation during late adolescence is longitudinally associated with daily cigarette smoking in early adulthood. Although a causal association cannot be inferred with certainty, snus experimentation might constitute an indicator of the propensity to proceed to regular snus use and initiation of use of other tobacco or nicotine products.

Background and aims The associations between traumatic events, substance use and perceived discrimination have been rarely studied among migrants in host countries. We examined whether pre-migration potentially traumatic experiences (PTEs) or perceived discrimination (PD) are associated with substance use among migrants with voluntary (Russians) and forced (Kurds) migration backgrounds. Design Cross-sectional interview and health examination data from the Finnish Migrant Health and Wellbeing Study were used. The target sample (n = 1000 for each group) was drawn from the national population register using stratified random sampling by participants' country of birth and native language. Setting Population-based data were collected from six cities in Finland during 2010-12. Participants The participation rates were 68% (Russians) and 59% (Kurds). The analytical sample size varied (Russians n = 442-687, Kurds n = 459-613), as some participants completed only interview, health examination or short interview. The majority of Kurds had a refugee background (75%) while Russians had mainly migrated for other reasons (99%). Measurements The three main outcomes were self-reported binge drinking, daily smoking and life-time cannabis use. PTEs and PD were self-reported in the interview. Socio-demographic background, migration-related factors and current affective symptoms were adjusted for. Findings Among Kurds, PTEs were associated with binge drinking [adjusted odds ratio (aOR) = 2.65, 95% confidence interval (CI) = 1.30-5.42] and PD was associated with life-time cannabis use (aOR = 3.89, 95% CI = 1.38-10.97) after adjusting for contextual factors. Among Russians, PTEs were associated with life-time cannabis use adjusting for contextual factors (aOR = 2.17, 95% CI = 1.12-4.18). Conclusions In Finland, pre-migration traumatic experiences appear to be associated with life-time cannabis use among the Russian migrant population (voluntary migration) and binge drinking among the Kurdish migrant population (forced migration). Perceived discrimination in Finland appears to be associated with life-time cannabis use among Kurdish migrants.

We analyze risk factors correlated with the initial transmission growth rate of the recent COVID-19 pandemic in different countries. The number of cases follows in its early stages an almost exponential expansion; we chose as a starting point in each country the first day $d_i$ with 30 cases and we fitted for 12 days, capturing thus the early exponential growth. We looked then for linear correlations of the exponents $\alpha$ with other variables, for a sample of 126 countries. We find a positive correlation, {\it i.e. faster spread of COVID-19}, with high confidence level with the following variables, with respective $p$-value: low Temperature ($4\cdot10^{-7}$), high ratio of old vs.~working-age people ($3\cdot10^{-6}$), life expectancy ($8\cdot10^{-6}$), number of international tourists ($1\cdot10^{-5}$), earlier epidemic starting date $d_i$ ($2\cdot10^{-5}$), high level of physical contact in greeting habits ($6 \cdot 10^{-5}$), lung cancer prevalence ($6 \cdot 10^{-5}$), obesity in males ($1 \cdot 10^{-4}$), share of population in urban areas ($2\cdot10^{-4}$), cancer prevalence ($3 \cdot 10^{-4}$), alcohol consumption ($0.0019$), daily smoking prevalence ($0.0036$), UV index ($0.004$, 73 countries). We also find a correlation with low Vitamin D levels ($0.002-0.006$, smaller sample, $\sim 50$ countries, to be confirmed on a larger sample). There is highly significant correlation also with blood types: positive correlation with types RH- ($3\cdot10^{-5}$) and A+ ($3\cdot10^{-3}$), negative correlation with B+ ($2\cdot10^{-4}$). Several of the above variables are intercorrelated and likely to have common interpretations. We performed a Principal Component Analysis, in order to find their significant independent linear combinations. We also analyzed a possible bias: countries with low GDP-per capita might have less testing and we discuss correlation with the above variables., Comment: 42 pages, 31 figures, 32 tables. Principal Component Analysis added in v2

(1) Background: Many studies have shown that increasing taxation on cigarettes does play a role in tobacco control, but few studies have focused on whether increasing cigarette excise taxes significantly affects alcohol consumption. In this article, we aim to examine the effects of China&rsquo, s 2015 increase in the cigarette excise tax on residents&rsquo, regular drinking behavior. (2) Methods: Using survey data from China Family Panel Studies (CFPS), we performed a panel logit regression analysis to model the relationship between the cigarette excise tax and regular drinking behavior. The Propensity Score Matching with Difference-in-Differences (PSM-DID) approach was adopted to determine the extent to which the cigarette excise tax affected residents&rsquo, drinking behavior. To test whether the cigarette excise tax could change regular drinking behavior by decreasing daily smoking quantity, we used an interaction term model. (3) Results: China&rsquo, s 2015 increase in the cigarette excise tax had a significant negative effect on the probability of regular alcohol consumption among smokers, and the cigarette excise tax worked by reducing the average daily smoking of smokers. We also found that the regular drinking behavior of male smokers was more deeply affected by the increased cigarette excise tax than females. (4) Conclusions: Our research results not only give a deeper understanding of the impact of the cigarette excise tax, but also provide an important reference with which to guide future decisions concerning excise taxes imposed on cigarettes.

Between 2005 and 2007, important reinforcements of the tobacco legislation have been implemented in Portugal, which may have affected smoking patterns. The aim of this study was to measure the change in prevalence of first- and second-hand smoking (SHS) among adults, and its socio-demographic patterning in Portugal from 2005 to 2014. Data from the last two Portuguese National Health Interview Surveys (2005 and 2014) were used. The changes in daily smoking and SHS were measured using Poisson regressions, stratifying by sex and survey year. The inequalities were measured using relative inequality indexes (RII). From 2005 to 2014, there was a reduction in SHS (75%&ndash, 54% among men, and 52%&ndash, 38% among women), and a reduction in smoking among men (27%&ndash, 26%), and an increase among women (9%&ndash, 12%). SHS reduction was more marked among less privileged people. Among Portuguese men, inequalities in daily smoking have increased slightly, while among women the gap favoring low-educated reduced. Between 2005 and 2014, SHS decreased, but not daily smoking, particularly among women. Additionally, socioeconomic inequalities in smoking increased. Future policies should simultaneously tackle smoking and SHS prevalence, and their socioeconomic patterning. More comprehensive policies such as comprehensive national (non-partial) bans, combined with price increases could be more effective.

Importance: As the pandemic of COVID-19 is still under progression, identification of prognostic factors is a global challenge. Among epidemiological risk factors, the role of smoking, to date, is unclear. Objective: To accurately evaluate a possible correlation of daily smoking with an increased susceptibility to SARS-CoV-2 infection. Participants: We estimated the rates of daily current smokers in COVID-19-infected patients in a large French university hospital between February 28th 2020 and March 30th 2020 for outpatients and from March 23rd till April 9th 2020 for inpatients. Design: The rates from both groups were compared to those of daily current smokers in the 2018 French general population, established in 2018, after standardization of the data for sex and age. Results: The inpatient group was composed of 343 patients, median age 65 yr: 206 men (60.1%, median age 66 yr) and 137 women (39.9%, median age 65 yr) with a rate of daily smokers of 4.4% (5.4% of men and 2.9% of women).The outpatient group was composed of 139 patients, median age 44 yr: 62 men (44.6 %, median age 43 yr, and 77 women (55.4 %, median age 44). The daily smokers rate was 5.3% (5.1% of men and 5.5 % of women). In the French population, the daily smokers rate is 25.4% (28.2% of men and 22.9% of women). The rate of current daily smokers was significantly lower in COVID-19 outpatients and inpatients (80.3% and 75.4%, respectively), as compared to that in the French general population with standardized incidence ratios according to sex and age of 0.197 [0.094 - 0.41] and 0.246 [0.148 - 0.408]. These ratios did not significantly differ between the two groups (P=0.63). Conclusions and relevance: Our study highlights for the first time a dramatic decreased prevalence of daily current smokers both in COVID-19 outpatients and inpatients as compared to the general population.

Background Despite declining US adolescent smoking prevalence from 40% among 12th graders in 1995 to around 10% in 2018, adolescent smoking is still a significant problem. Using the International Childhood Cardiovascular Cohort (i3C) Consortium, which includes 7 international cohorts recruited in childhood and followed into adulthood, the present study was designed to confirm the important relation between adolescent smoking and daily adult smoking and present new data on adult smoking into the forties and comparison of smoking in the United States, Finland, and Australia. Methods and Results Childhood smoking experience during ages 6 to 19 in the 1970s and 1980s was classifiable in 6687 i3C participants who also provided smoking status in their twenties and forties through 2011–2018. Prevalence of daily smoking in their twenties was directly related to degree of smoking during adolescence and inversely related to the age at which that smoking experience occurred ( P trend, P trend, US , Finnish, and Australian participants. Conclusions These long‐term follow‐up data show that smoking intensity increased throughout adolescence. Prevalence of adult smoking and cessation by the forties were both correlated with levels of childhood smoking intensity. These data lend support to preventive strategies designed to reduce, delay, or eliminate any youth access to cigarettes.

Comorbidity of substance use with affective symptoms and suicidality has been well documented in the general population. However, population-based migrant studies about this association are scarce. We examined the association of affective symptoms and suicidal ideation with binge drinking, daily smoking, and lifetime cannabis use among Russian, Somali, and Kurdish migrants in comparison with the Finnish general population. Cross-sectional data from the Finnish Migrant Health and Wellbeing Study (Maamu, n = 1307) and comparison group data of the general Finnish population ( n = 860) from the Health 2011 Survey were used. Substance use included self-reported current binge drinking, daily smoking, and lifetime cannabis use. Affective symptoms and suicidal ideation were measured using the Hopkins Symptom Checklist-25 (HSCL-25). We performed multivariate logistic regression analyses, including age, gender, and additional socio-demographic and migration-related factors. Suicidal ideation (OR 2.4 95% CI 1.3–4.3) was associated with binge drinking among Kurds and lifetime cannabis use among Russians (OR 5.6, 95% CI 1.9–17.0) and Kurds (OR 5.5, 95% CI 1.9–15.6). Affective symptoms were associated with daily smoking (OR 1.6, 95% CI 1.02–2.6) and lifetime cannabis use (OR 6.1, 95% CI 2.6–14.5) among Kurdish migrants. Our results draw attention to the co-occurrence of suicidal ideation, affective symptoms, and substance use, especially among Kurdish migrants. These results highlight the variation of comorbidity of substance use and affective symptoms between the different populations. This implies that screening for substance use in mental healthcare cannot be neglected based on presumed habits of substance use.

BackgroundWe revisited the association between progress in MPOWER implementation from 2008 to 2016 and smoking prevalence from 2009 to 2017 and offered an in-depth understanding of differential outcomes for various country groups.MethodsWe used data from six rounds of the WHO Reports on the Global Tobacco Epidemic and calculated a composite MPOWER Score for each country in each period. We categorised the countries in four initial conditions based on their tobacco control preparedness measured by MPOWER score in 2008 and smoking burden measured by age-adjusted adult daily smoking prevalence in 2006: (1) High MPOWER – high prevalence (HM-HP). (2) High MPOWER – low prevalence (HM-LP). (3) Low MPOWER – high prevalence (LM-HP). (4) Low MPOWER – low prevalence (LM-LP). We estimated the association of age-adjusted adult daily smoking prevalence with MPOWER Score and cigarette tax rates using two-way fixed-effects panel regression models including both year and country fixed effects.ResultsA unit increase of the MPOWER Score was associated with 0.39 and 0.50 percentage points decrease in adult daily smoking prevalence for HM-HP and HM-LP countries, respectively. When tax rate was controlled for separately from MPOWE, an increase in tax rate showed a negative association with daily smoking prevalence for HM-HP and LM-LP countries, while the MPOWE Score showed a negative association for all initial condition country groups except for LM-LP countries.ConclusionA decade after the introduction of the WHO MPOWER package, we observed that the countries with higher initial tobacco control preparedness and higher smoking burden were able to reduce the adult daily smoking prevalence significantly.

BackgroundSimilar to the debate around e-cigarettes, an increase in snus use among Norwegian adolescents has prompted debate on whether flavour options in snus should be limited. To this end, we compared use of flavoured snus among snus users with different smoking status.MethodsQuestions about flavoured snus use were included in an online omnibus study conducted from 2015 to 2019 (N = 65,445) that included 16,295 ever snus users (aged 15+). Current snus users (N = 9783) were asked “Do you usually use snus that has a flavouring (liquorice, mint, wintergreen, etc.)? Adjusted predicted probabilities and 95% confidence intervals (CI) were calculated from a logistic regression model.ResultsLess than 25% of the snus users reported never having smoked. The overall probability of using flavoured snus was .45 (95% CI .44–.46), highest among daily (.51, 95% CI .47–.54) and former daily smokers (.50, 95% CI .48–.52), and lowest among never (.41, 95% CI .39–.43) and occasional smokers without any prior history of daily smoking (.41, 95% CI .38–.44). Use of flavoured products was higher among female snus users (p = .67, 95% CI .65–.69) compared to males (p = .35, 95% CI .34–.36), highest among the youngest age group, 15–24 years (p = .58, 95% CI .56–.60) and decreased with increasing age.ConclusionRegulation that would ban or limit flavoured snus use may affect smokers—an at risk population—more than never smokers. The health authorities should be mindful of the real-world complexity governing potential harms and benefits of flavour restrictions on snus. A further assessment of flavour limitations should acknowledge that flavoured snus products also function as alternatives to cigarettes.

International audience; Introduction: According to multiple studies, e-cigarette use among adolescents is associated with subsequent smoking initiation. However, little is known about its effect on the transition from smoking initiation to daily smoking. Methods: Using retrospective data from a French national representative survey collected in 2017 (n = 39,115), we analyzed the role of ever using e-cigarettes on daily cigarette smoking status at 17 among ever smokers (n = 21,401). Risk-ratios (RR) were computed through modified Poisson regressions with an inverse probability of treatment weighting (IPTW) approach. Results: Among French adolescents aged 17, 16.8 % declared current e-cigarette use (1.9 % reported daily use) and 34.1 % cigarette smoking (25.1 % reported daily smoking). Among ever-smokers, adolescents who declared having ever used e-cigarettes were less likely than those who did not to transition to daily smoking at 17: RR = 0.62 95 %CI [0.60 – 0.64]. We found similar results for those who experimented with e-cigarettes before initiating smoking, RR = 0.76 95 %CI [0.66 – 0.89]. Conclusions: Our results found no evidence of an increased risk of transitioning to daily smoking at 17 among ever-smokers who also experimented with e-cigarettes. Further studies should investigate the longer-term role of vaping on future smoking habits with the use of causal inference methods.

Aims With the Sustainable Development Goals 2016-2030 increased attention is given to adolescents’ health and well-being, and the multiple challenges they face related to their health and wellbeing with trajectories of importance for their later adult health. A recent trend within childhood and youth studies acknowledges commonalities of lived experiences of young people in middle- and low-income countries, where the majority of them lives, vis-a-vis high-income countries. In sub-Saharan Africa adolescents comprise 23% of the population compared to 12% in high-income countries. Here we describe and analyse the prevalence of smoking and use of alcohol by Bissau-Guinean adolescents aged 15-16 and compare to peers European cities. Methods Survey with locally adapted and pilot tested Planet Youth questionnaire was conducted in June 2017 in 16 secondary schools in the capital Bissau, Guinea-Bissau. It targeted adolescents aged 15-16 years in randomly selected classes with information that is comparable with data from eight European cities in 2015-2016. Results In Bissau, 871 adolescents aged 15-16 participated (52% girls and 46% boys) compared to 6,534 peers in eight European cities (49% girls and 51% boys). In total, 2.2% of the Bissau-Guineans reported daily smoking (boys=3.9%; girls=0.7%) compared to 11.3% of their European peers (boys=13.2%; girls=9,4%). About 1/3 of the Bissau Guineans had life-time experience of drinking alcohol compared to about 2/3 of the European ones, with no difference among boys and girls; 10,6% of Bissau-Guineans reported having been drunk during the last 30 days compared to 14% of the Europeans, the prevalence being slightly higher among boys compared to girls. Conclusions Bissau-Guinean adolescents aged 15-16 report less smoking and drinking than European peers. Against a background of intensive marketing of alcohol and tobacco in Guinea-Bissau, it is urgent to initiate health promotional activities in secondary schools in Bissau to inform and educate adolescents and teachers on the detrimental effect of such behaviours on their long-term health and wellbeing.

Background Electronic cigarette may help adults quit smoking. For adolescents, the concern is whether e-cigarette initiation is a gateway to subsequent smoking. Our objectives were to describe the sequence of conventional cigarette and e-cigarette initiations among adolescents who had already used both products, and to analyse the current smoking behaviour according to the first experienced product. Methods Analyses were based on a two-stage random sample of 9,937 12-20-year-old adolescents included in the French-speaking Belgian 2018 Health Behaviour in School-aged Children cross-sectional survey. Cigarette and e-cigarette initiations and its sequence, current daily smoking and other characteristics were collected through a self-administered questionnaire. Associations, adjusted for demographic data, were estimated using logistic regression and weighted. Sampling design was considered in analyses. Results In 2018, 66.0% of adolescents reported never having tried a cigarette and e-cigarette, 8.1% having experimented cigarettes only, 9.2% e-cigarette only and 16.6% having experimented both. Among adolescents who tried both products, eight out of ten smoked cigarettes before trying the e-cigarette (78.2%). In the whole sample, 6.8% of adolescents were smoking every day. Daily smoking was observed in 19.8% of adolescents who initiated e-cigarette and cigarettes and in 6.4% of those who initiated cigarettes only. Adolescents who first smoked cigarettes were more likely to further smoke daily (aOR: 2.48 [1.69-3.64]) than those who first used e-cigarette. The risk of daily smoking was not different between adolescents who first used e-cigarette compared with those who tried cigarettes only (aOR: 1.23 [0.76-2.00]). Conclusions In French-speaking Belgium, conventional cigarette was the first step in the initiation and continuation of tobacco smoking. These findings help understand smoking patterns among adolescents and will support the development of smoking prevention strategies. Key messages Our findings suggest that health promotion interventions should remain focused on conventional cigarette. Based on a cross-sectional study, they should however be confirmed by prospective studies.

This study was conducted to investigate the effect of human development index (HDI) on tobacco smoking prevalence in men and women of countries which their data about tobacco smoking were available for 2015. Pearson's correlation coefficient and linear regression were used to investigate the association between HDI and all types of smoking, particularly cigarette. Daily smoking and current smoking were used as tobacco smoking indices. The information about prevalence of tobacco smoking and HDI was obtained from the World Health Organization (WHO) website and United Nations Development Programme (UNDP), respectively. The results showed that there is no statistically significant relationship between HDI and current tobacco smoking in men (B = −0.45_CI 95%: −29.97, 29.06). However, the same association was significant for women (B = 43.87, CI 95%: 24.97–62.78). The results indicated that women in developed countries are more at risk of health effects attributed to tobacco smoking. Countries should focus on socioeconomic factors to prevent the spread of risk factors for non-communicable diseases. Keywords: Tobacco, Cigarette smoking, Human development index

INTRODUCTION: Ethnic differences in smoking patterns and dependence have been observed between Caucasian and African American smokers: African Americans who smoke are more likely to be intermittent smokers (ITS), and among daily smokers (DS) consume fewer cigarettes, yet report more dependence. METHODS: Participants’ (N=482, 67% Caucasian, 54% ITS) dependence was assessed by Primary and Secondary Dependence subscales of the Wisconsin Inventory of Smoking Dependence Motives, the Nicotine Dependence Syndrome Scale, the Hooked on Nicotine Checklist, the Fagerstrom Test of Nicotine Dependence, and time to first cigarette after waking. We tested associations with dependence for ethnicity, smoker type, and an ethnicity by smoker type interaction, using multivariable linear regression, with adjustment for age, sex and education. Additional models adjusted for cigarettes per day and history of daily smoking. RESULTS: There was a significant interaction between ethnicity and smoker type for five of six measures of dependence (each scale assessed separately), such that African American ITS reported more dependence than Caucasian ITS, whereas dependence did not differ by ethnicity among DS. African American ITS smoked more cigarettes per day and were more likely to have a history of daily smoking than Caucasian ITS; after further adjustments for these differences, there were no significant interactions of ethnicity and smoker type for any measure. CONCLUSIONS: Among DS, dependence did not differ by race. African American ITS were more dependent than Caucasian ITS; this difference was explained by higher cigarette consumption and a higher proportion converted from DS to ITS among African Americans vs. Caucasians.