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Background: The tobacco industry uses product descriptors to communicate reduced harm and increase appeal. This cross-sectional study assessed store-level racial, ethnic, and socioeconomic inequities in the distribution of retail tobacco product descriptors in a convenience sample of retailers in Washington, DC. Methods: Young adults (n = 146) who did not currently use tobacco reported real-time store visits over 14 days. Trained data collectors took high-resolution photographs of all tobacco (including e-cigarette) marketing in each store (n = 96) participants visited. We coded text descriptors on tobacco product advertisements and displays into descriptor categories (eg, fruit, sweet, concept). We fit multilevel models to examine relationships between store neighborhood census tract-level racial, ethnic, and socioeconomic characteristics and tobacco product descriptors in stores. As a supplementary analysis, we used geospatial methods to model predicted patterns of descriptors at the census tract level. Results: Stores located in census tracts with the highest versus lowest percentage of Black residents had a greater count of fruit, sweet or dessert, alcohol, and concept descriptors (p < .05), similar to findings from the geospatial approach. Adjusted models also indicated some inequities in stores in census tracts with higher percentages of Hispanic or Latino residents for fruit, alcohol, and concept descriptors; however, tract-level models showed opposite results for concept flavors. Conclusions: In this convenience sample, fruit, alcohol, sweet/dessert, and concept FTP descriptors were prevalent in stores in neighborhoods with more Black residents demonstrated through two analytic approaches. Surveillance using representative samples of tobacco retailers could improve the ability to track the extent of this inequity. Implications: We document inequities in the amount of fruit, sweet or dessert, alcohol, and concept flavor descriptors in stores across neighborhoods in Washington, DC. Federal, state, and local regulatory action is needed to reduce inequities in flavored tobacco product availability and marketing, including for concept flavors. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this research was to identify how young adult sexual gender minority (SGM) women who use cigarillos may respond to cigar flavor restrictions. Aims and Methods: Young adults aged 21-28 years in the United States who currently use cigarillos were recruited between October 2020 and April 2021 to participate in an online survey. Due to high prevalence of cigarillo use among individuals who identify as sexual and/or gender minority (SGM) women, their (n = 192) flavored tobacco-use behaviors and anticipated responses to cigarillo flavor restrictions were compared to cisgender heterosexual (CisHet) women (n = 110). Logistic regression was used to model cigarillo cessation and product-switching behaviors (flavored and unflavored). Results: SGM women were significantly less likely to report the use of flavor at the initiation of cigarillo use (61.7% vs. 86.1%) but were no different in current flavor use compared to CisHet women, with more than 80% of all women using any flavor. SGM women were 2.36 times as likely to say they would discontinue using cigarillos if flavors were unavailable. Among those who would continue using cigarillos, SGM women were 4.53 times as likely to endorse switching to an unflavored tobacco product but had the same likelihood of saying they would switch to flavored product compared to CisHet women. Conclusions: Flavor restriction policies may not reduce the initiation of cigarillos among SGM women and may elicit differential cigarillo use and tobacco product substitution by SGM identity. Flavor restriction policies should be coupled with targeted cessation resources to address potential remaining disparities. Implications: SGM US women have a unique cigarillo-use trajectory. These women are more likely to initiate cigarillos without flavor and then later integrate it into their behavior. National cigar flavor restrictions are expected to have a greater impact decreasing cigarillo initiation among CisHet women and decreasing current cigarillo use among SGM women. However, for those who would continue using unflavored cigarillos, SGM women may remain at risk for nicotine dependence due to increased product substitution. SGM women should be prioritized for cessation resources to reduce tobacco-use disparities leading up to and following the implementation of cigar flavor restrictions. [ABSTRACT FROM AUTHOR]

Introduction: Cigarette smoking accounts for >30% of the socioeconomic gap in life expectancy. Flavored restrictions claim to promote equity; however, no previous studies have compared the effect of cigarette and e-cigarette flavor restrictions among individuals who smoke with lower and higher socioeconomic status (SES). Aims and Methods: In a between-group within-subject design, individuals with lower (n = 155) and higher (n = 125) SES completed hypothetical purchasing trials in the experimental tobacco marketplace (ETM). Conditions were presented in a 2 × 2 factorial design (cigarette flavors restricted or unrestricted and e-cigarette flavors restricted or unrestricted) with increasing cigarette prices across trials. Results: Results show (1) SES differences in cigarette, e-cigarette, and NRT purchases under unrestricted policies, with lower SES showing higher cigarette demand and lower e-cigarette and NRT substitution than higher SES, (2) cigarette restrictions decreased cigarette and increased NRT purchases among lower SES, but no significant changes among higher SES, (3) decreased SES differences in cigarette demand under cigarette restrictions, but persistence under e-cigarette restrictions or their combination, (4) persistence of SES differences in e-cigarette purchases when all restrictions were enforced, and (5) waning of SES differences in NRT purchasing under all restrictions. Conclusions: Flavor restrictions differentially affected individuals based on SES. Within-group comparisons demonstrated restrictions significantly impacted lower SES, but not higher SES. Between-group comparisons showed SES differences in cigarette purchasing decreased under cigarette restrictions, but persisted under e-cigarette-restrictions or their combination. Additionally, SES differences in NRT substitution decreased under flavor restrictions. These findings highlight the utility of the ETM to investigate SES disparities. Implications: With increasing trends of socioeconomic differences in smoking prevalence and cessation rates, smoking-related health disparities are expected to continue to widen. Restricting menthol flavor in cigarettes while enhancing the availability and affordability of NRT have the potential to alleviate SES disparities in tobacco use, therefore, positively impacting health equity. However, this effect may depend on flavor availability in other tobacco products. [ABSTRACT FROM AUTHOR]

Introduction: The Massachusetts legislature passed An Act Modernizing Tobacco Control in November 2019 to restrict retail sales of flavored commercially manufactured tobacco products including menthol products, increase penalties for violating the law's provisions, and provide health insurance coverage for tobacco treatment. Aims and Methods: This study explores key informants' perceptions of intended and unintended impacts of implementation of the 2019 Massachusetts statewide law through a health equity and racial justice lens. We conducted in-depth interviews with 25 key informants from three key informant groups (public health officials and advocates, clinicians, and school staff) between March 2021 and April 2022. Using deductive codes on unintended impacts of the implementation of the law's policies, we conducted a focused analysis to identify impacts that were perceived and observed by informants from different key informant groups. Results: Perceived or observed impacts of the law were identified across multiple levels by key informants and included concerns related to three broad themes: 1) intended impacts on health equity and racial justice, 2) ongoing availability of restricted products undermining the intended impact of the law, and 3) inequitable targeting by the policies and enforcement among communities of color. Conclusions: Future evaluation is needed to assess the intended and unintended impacts of implementation of the Massachusetts law to maximize the potential of the policies to reduce tobacco-related health disparities. We discuss implications and recommendations for achieving a national policy and equitable enforcement of flavored tobacco sales restrictions. Implications: This qualitative study among 25 key informants including public health and tobacco control advocates, clinicians, and school staff obtained perspectives of intended and unintended health equity and racial justice impacts of the 2019 Massachusetts An Act Modernizing Tobacco Control. Findings and recommendations from this study can inform monitoring efforts to assess the law's impacts in Massachusetts and the adoption of similar flavored tobacco sales restrictions and other tobacco control policies in other states to maximize the health equity benefits and minimize unintended impacts. [ABSTRACT FROM AUTHOR]

In response to the problem of moisture absorption or desorption of tobacco core materials during processing and storage, which were easily affected by environmental humidity, this paper summarized the relevant evaluation techniques for the moisture absorption characteristics of tobacco core materials. It was pointed out that the equilibrium moisture content could reflect the water holding capacity of tobacco core materials, and the testing techniques include non-destructive testing (oven method, gas chromatography, Karl Fischer method, difference method) and non-destructive testing (nuclear magnetic method, microwave method, infrared method). The former had high accuracy but took a long time. The latter had the advantage of fast and non-destructive testing, but was easily affected by sample morphology, stacking state, and other factors. Furthermore, the water status could be analyzed by water activity and low field nuclear magnetic resonance. Water activity reflected the availability of water, while low field nuclear magnetic resonance method could monitor and distinguish free water and bound water, but it was subject to interference from other hydrogen-containing components. Adsorption thermodynamics could be explored through isothermal hygroscopicity curves, adsorption models, and adsorption heat, while hygroscopicity kinetics could be explored through hygroscopicity time curves and related models. However, evaluating hygroscopicity characteristics solely from a thermodynamic or kinetic perspective might have limitations in evaluation dimensions and applicability. The future evaluation technology could combine the two to establish a more reasonable and applicable evaluation technique for the moisture absorption characteristics of tobacco core materials, providing reference for the research on the moisture absorption characteristics of tobacco products during processing and storage. [ABSTRACT FROM AUTHOR]

Introduction: Habitual betel quid chewing, a tobacco product, is a leading cause of oral cancer in Asia–Pacific countries where this practice is most prevalent. However, it is not well understood whether betel quid chewing is also a cause of adverse cardiovascular outcomes. To address this gap, we conducted a systematic literature review of peer‐reviewed published studies evaluating the association between habitual betel quid use on the risk of adverse cardiovascular outcomes. Methods: We searched PubMed for studies assessing the correlation between betel quid chewing and cardiovascular health. We included studies if (i) they included human subjects; (ii) were peer‐reviewed articles in indexed journals; and (iii) were in English. We extracted data from eligible studies and stratified them by geographical location, study designs and cardiovascular outcomes. Finally, we did a narrative synthesis of the data to identify adverse cardiovascular outcomes associated with chronic betel quid use. Findings: We reviewed data from 19 studies that met the inclusion criteria. Habitual betel quid chewing was associated with hypertension, atherosclerosis, inflammation and ischaemic heart disease. In addition, betel quid use was a risk factor for arrhythmias. Interestingly, betel quid use was an independent risk factor for cardiovascular disease in women. Long‐term betel quid consumption was associated with higher risks for all‐cause mortality and increased overall cardiovascular risk. Conclusions: Habitual betel quid chewing is an important cardiovascular risk factor in populations where the practice is prevalent. [ABSTRACT FROM AUTHOR]

Background: This multicentre case–control study aimed to identify risk factors associated with non-operative treatment failure for patients with CT scan Hinchey Ib-IIb and WSES Ib-IIa diverticular abscesses. Methods: This study included a cohort of adult patients experiencing their first episode of CT-diagnosed diverticular abscess, all of whom underwent initial non-operative treatment comprising either antibiotics alone or in combination with percutaneous drainage. The cohort was stratified based on the outcome of non-operative treatment, specifically identifying those who required emergency surgical intervention as cases of treatment failure. Multivariable logistic regression analysis to identify independent risk factors associated with the failure of non-operative treatment was employed. Results: Failure of conservative treatment occurred for 116 patients (27.04%). CT scan Hinchey classification IIb (aOR 2.54, 95%CI 1.61;4.01, P < 0.01), tobacco smoking (aOR 2.01, 95%CI 1.24;3.25, P < 0.01), and presence of air bubbles inside the abscess (aOR 1.59, 95%CI 1.00;2.52, P = 0.04) were independent predictors of failure. In the subgroup of patients with abscesses > 5 cm, percutaneous drainage was not associated with the risk of failure or success of the non-operative treatment (aOR 2.78, 95%CI − 0.66;3.70, P = 0.23). Conclusions: Non-operative treatment is generally effective for diverticular abscesses. Tobacco smoking's role as an independent risk factor for treatment failure underscores the need for targeted behavioural interventions in diverticular disease management. IIb Hinchey diverticulitis patients, particularly young smokers, require vigilant monitoring due to increased risks of treatment failure and septic progression. Further research into the efficacy of image-guided percutaneous drainage should involve randomized, multicentre studies focussing on homogeneous patient groups. [ABSTRACT FROM AUTHOR]

INTRODUCTION Previous research indicates that cigarette smokers with a time to first cigarette (TTFC) of less than 30 minutes after waking up had significantly higher levels of carcinogen biomarkers compared to those with a TTFC of more than 30 minutes. The mediation (potential mediator: cigarettes smoked per day) between TTFC and carcinogen biomarkers, remains unclear and has yet to be established. METHODS Multivariable linear regression models were used to estimate adjusted geometric means (GMs) and ratios of GMs for urine biomarkers of VOCs by smokers' TTFC status (≤30 vs >30 min). Further, data from the NHANES 2015-2016 special sample were analyzed to assess the mediation between TTFC (exposure) and carcinogen biomarkers, including urine metabolites of polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), and cadmium. RESULTS Cigarette smokers with a short TTFC (≤30 min) presented significantly higher concentrations in 8 out of 17 urine metabolites of VOCs examined compared to smokers with TTFC >30 min. The association between exposure and carcinogen biomarkers was not mediated by CPD. CONCLUSIONS Cigarette smokers with a short TTFC (<30 min) had significantly higher levels in VOCs, PAHs, and cadmium, but the association was not mediated by cigarettes smoked per day. [ABSTRACT FROM AUTHOR]

Emerging tobacco products such as electronic nicotine delivery systems (ENDS) and heated tobacco products (HTPs) have a dynamic landscape and are becoming widely popular as they claim to offer a low-risk alternative to conventional smoking. Most pre-clinical laboratories currently exploit in vitro, ex vivo, and in vivo experimental models to assess toxicological outcomes as well as to develop risk-estimation models. While most laboratories have produced a wide range of cell culture and mouse model data utilizing current smoke/aerosol generators and standardized puffing profiles, much variation still exists between research studies, hindering the generation of usable data appropriate for the standardization of these tobacco products. In this review, we discuss current state-of-the-art in vitro and in vivo models and their challenges, as well as insights into risk estimation of novel products and recommendations for toxicological parameters for reporting, allowing comparability of the research studies between laboratories, resulting in usable data for regulation of these products before approval by regulatory authorities. [ABSTRACT FROM AUTHOR]

INTRODUCTION Cigarette package inserts that describe quitting benefits and tips may promote cessation; however, research is needed to understand better their effects, including potentially enhancing the effects of pictorial health warning labels (PHWLs). METHODS A randomized trial with a 2x2 factorial design was conducted with adult smokers (n=356) assigned to either small text-only health warning labels (HWLs; control); inserts with cessation messages, and the small text-only HWLs (inserts-only); large PHWLs (PHWLs-only); both inserts and PHWLs (inserts + PHWLs). Participants received a 14-day supply of their preferred cigarettes with packs labeled to reflect their group. Upon finishing the trial, participants reported their past 14-day frequency of noticing, reading, thinking about smoking harms and cessation benefits, talking about labels, and forgoing cigarettes because of the labels. Ordered logistic models regressed these outcomes on labeling groups, and mediation analyses assessed whether attention (i.e. noticing, reading) to labels mediated effects of labeling exposure on other outcomes (i.e. thinking about harms/benefits, talking, forgoing). RESULTS The inserts + PHWLs group reported higher frequencies than the control group for all outcomes. Compared to the control group, both the inserts-only and PHWLs-only groups reported higher frequency of noticing (AOR=3.53 and 2.46, respectively) and reading labels (AOR=2.89 and 1.71), thinking about smoking risks because of the labels (AOR=1.93 and 1.82), and talking about labels (AOR=2.30 and 2.70). Participants in the inserts-only group also reported more frequent thinking about quitting benefits (AOR=1.98). Attention mediated all labeling effects except for the contrast between PHWLs only and control. CONCLUSIONS Compared to text-only HWLS, cigarette labeling that involves inserts, PHWLs, or both appears more effective at drawing attention to warnings, which mediated the effects on cessation-related psychosocial and behavioral outcomes. [ABSTRACT FROM AUTHOR]

Background: Restrictions on televised tobacco ads do not apply to vaping and oral nicotine products. Several campaigns are currently active on U.S. national television. This research examines the extent to which objective ad features are associated with ad, brand, and product appeal and use intentions among 18-24-year-olds. Methods: We identified seven unique campaigns for Vuse, Velo, and JUUL from the Mintel Comperemedia database, coded for youth-appealing content, and then randomly assigned among N = 1450 18-24-year-olds. Following exposure to one 15-second ad, participants completed a survey assessing their subjective responses. Results: Youth-appealing content was prevalent across these ads to varying degrees. Mixed effects regression analyses showed a positive association between features from the Content Appealing to Youth (CAY) index and pro-social brand perceptions, positive attitudes, reactions, and perceived effectiveness of the ad, and positive use perceptions. Moreover, themes related to customization of the device and environmental sustainability were associated with similar positive perceptions, including that using the product would be cool, as well as behavioral intentions to try, use occasionally, and use daily. Conclusions: Regulators need to update tobacco advertising restrictions to accurately reflect the current tobacco product landscape. This study contributes to the research on tobacco promotion strategies by examining the current marketing landscape for newer tobacco products and their appeal to youth. Findings from this study inform comprehensive tobacco marketing regulations, recommending the FDA update its guidelines and apply current marketing restrictions to e-cigarettes and oral nicotine products. [ABSTRACT FROM AUTHOR]

To inform policy and messaging, this study examined characteristics of adolescents' and young adults' (AYAs') exposure to and engagement with nicotine and tobacco product (NTP) social media (SM) content. In this cross-sectional survey study, AYAs aged 13–26 (N=1,163) reported current NTP use, SM use frequency, and exposure to and engagement with SM content promoting and opposing NTP use (i.e. frequency, source[s], format[s], platform[s]). Participants who used NTPs (vs. did not use) were more likely to report having seen NTP content (p-values<.001). Prevalent sources were companies/brands (46.6%) and influencers (44.4%); prevalent formats were video (65.4%) and image (50.7%). Exposure to content promoting NTP use was prevalent on several popular platforms (e.g. TikTok, Instagram, Snapchat); exposure to content opposing NTP use was most prevalent on YouTube (75.8%). Among those reporting content engagement (i.e. liking, commenting on, or sharing NTP content; 34.6%), 57.2% engaged with influencer content. Participants reported engaging with content promoting and opposing NTP use on popular platforms (e.g. TikTok, Instagram, YouTube). Participants with (versus without) current NTP use were significantly more likely to use most SM platforms and to report NTP content exposure and engagement (p-values<.05). Results suggest that NTP education messaging and enforcement of platforms' content restrictions are needed. [ABSTRACT FROM AUTHOR]

To evaluate the incidence of tobacco-related oral mucosal lesions in the adult population visiting ENT-OPD at Shri Maharaja Gulab Singh Hospital, GMC Jammu, India. From December 2021 to November 2022 we attempted to compile the prevalence of tobacco-induced oral mucosal lesions in the adult population visiting ENT-OPD at Shri Maharaja Gulab Singh Hospital Jammu, India. The study included a total of 400 patients of various age groups. The patients were divided as current users with a habit of tobacco consumption for atleast 6 months and ex-users who had used any form of tobacco in their lifetime for a minimum of 6 months but had abstained the use since last 1 year. Age group, gender, employment, type of tobacco use, site of placement of tobacco in the oral cavity, frequency and duration of use, and the types of mucosal lesions were all documented on a standardized interviewer-based questionnaire.The oral mucosal lesions were diagnosed in accordance with international recommendations. Males (55%) had somewhat more oral mucosal lesions than females (45%). Oral submucous fibrosis was found in 110 individuals, followed by leukoplakia in 102, erythroplakia in 14, tobacco pouch keratosis in 81, tobacco induced melanosis in 82 patients and malignancy in 11 patients. 107 conventional smokers (26.75%), 254 patients using smokeless tobacco (63.5%) and 39 patients using combined form of tobacco (9.75%) showed oral mucosal lesions. The most prevalent site of lesions was the labial comissure, which showed 117 lesions (29.25%), followed by 114 lesions on the buccal mucosa (28.5%), and 99 lesions (24.75%) on buccal sulcus. Gingiva showed 41 lesions (10.25%), tongue had 15 entities (3.75%) and palate had 14 (3.5%). The most frequent oral mucosal lesion was shown to be oral submucous fibrosis, followed by leukoplakia. Smokeless tobacco was the most commonly used tobacco product. This study emphasizes the need of routine evaluation of the oral mucosa and the need for patients to be urged to stop this hazardous behavior. [ABSTRACT FROM AUTHOR]

Evidence suggests that cigarette costs significantly impact tobacco use, yet the effect of state-level cost variations on cigarette sales per capita in the US remains uncertain. This study investigates how state-level cigarette costs affect pack sales per capita consumption. This was an observational study of cigarette-pack sales per capita consumption in the United States. We used the tobacco tax burden data (1989–2019) and a two-way fixed-effects model to analyse how cigarette costs affect consumption. Our predictor variables were average cost per pack, state tax per pack, and combined federal and state tax as a percentage of the retail price. Additionally, we compared the percentage change in state cigarette taxes per pack for each state in five-year intervals, adjusting for inflation. Regression analysis revealed that a 10% increase in the average cost per pack was related to a 9.59% decrease in per capita cigarette consumption (β_average cost = −0.959, P < 0.001). Similarly, a rise in state tax per pack and a higher tax as a proportion of the retail price per pack were related to a decline in consumption (β_ state tax = −0.176, P < 0.001), (β_retail price = −0.323, P < 0.001). States that raised cigarette taxes beyond the rate of inflation had a higher reduction in cigarette per capita sales than those maintaining stable tax rates. Some states have not raised their cigarette taxes sufficiently to account for inflation. It appears that cigarette costs have significantly reduced cigarette consumption in the US. [ABSTRACT FROM AUTHOR]

This study investigated the association between lung cancer and waterpipe smoking, which is an emerging global public health concern. Multicentre case-control study. This study included 627 cases and 3477 controls from the Iranian Study of Opium and Cancer (IROPICAN) study, which was conducted between 2017 and 2020. One frequency-matched control for each lung cancer patient was selected by age, gender and residential place; however, this study used controls of four cancer types in the analyses. The multivariable logistic regression model estimated the odds ratio (OR) and 95% confidence intervals (CIs). Additional analyses were performed among 181 lung cancer cases and 2141 controls who were not cigarette smokers or opium or nass/pipe users. The odds of lung cancer were higher among waterpipe smokers than never-smokers (OR = 1.3, 95% CI: 1.0–1.7). Results showed a higher OR of lung cancer for those who smoked the waterpipe daily (OR = 2.1, 95% CI: 1.4–3.0), smoked more than two heads per day (OR = 2.7, 95% CI: 1.8–4.0), had smoked for >20 years (OR = 1.9, 95% CI: 1.3–2.7), smoked more than 20 head-years (OR = 2.8, 95% CI: 1.9–4.1) and initiated smoking before the age of 30 years (OR = 1.7, 95% CI: 1.1–2.5). The association was only statistically significant for squamous cell carcinomas (OR = 1.8, 95% CI 1.2–2.7). Furthermore, this study observed a higher OR of lung cancer among exclusive waterpipe smokers (OR = 2.3, 95% CI: 1.6, 3.5). Waterpipe smoking was associated with an increased risk of lung cancer. The association was stronger with higher frequency, duration and intensity of exposure to waterpipe smoking. The association increases in exclusive waterpipe smokers, which is likely due to controlling for residual confounding by cigarette smoking and opium consumption, and higher exposure levels in this subpopulation. [ABSTRACT FROM AUTHOR]

Unhealthy lifestyle, such as alcohol use, and negative health outcomes have been associated with impairments in psychological well-being. The primary objective of the study was to test the efficacy of an intervention based on Well-Being Therapy to prevent or stem alcohol use, binge drinking and other unhealthy lifestyle among Italian adolescents in school settings. A three-arm cluster randomized controlled trial including three test periods (baseline, post-test, six-month follow-up) was implemented. Seven classes (144 students) were randomly assigned to receive well-being intervention (WBI), lifestyle intervention (LI), or no intervention (NI). Primary outcomes were alcohol use (AUDIT-C), binge drinking and other unhealthy lifestyle behaviors (i.e. unhealthy diet, physical inactivity, tobacco and cannabis smoking, poor sleep and Internet addiction). Linear mixed models and mixed-effects logistic regression were used to test the efficacy of WBI in comparison with LI and NI. At six-month follow-up, AUDIT-C total score increased more in NI in comparison with WBI (p = 0.044) and LI (p = 0.016), whereas the odds of being classified as at-risk drinker were lower in WBI (p = 0.038) and LI (p = 0.002), than NI. Only WBI showed a protective effect for cannabis use at post-test in comparison with NI (p = 0.003) and LI (p = 0.014). Sleep hours at night decreased more in NI than in LI (p = 0.027) at six months. Internet addiction decreased more in WBI (p = 0.002) and LI (p = 0.005) at post-test in comparison with NI. Although both interventions showed a positive impact on adolescent lifestyle, the positive effect of WBI on cannabis use underlines how this approach might be promising to stem adolescents' substance use. [ABSTRACT FROM AUTHOR]

A vape, often known as an electronic cigarette, is a device that mimics tobacco use. The most popular tobacco products used by youth are electronic cigarettes and vape pens, in thisresearch suggested that flavored liquid of electronic cigarettes have a negative effect on teeth and may cause other oral health problems. The e-cigarette has gained popularity all around the world since its release in 2003, most frequently in young individuals (18–25 years old). The term "smoking" gave rise to the term "vaping," which describes breathing an aerosolized "e-liquid" that has been evaporated without burning thanks to a small electronic vaporizer device. The aim of this study is to describe electronic cigarettes and their components, as well as to highlight the hazards of e-cigarette smoking on human health, regarding their safety; their impact on smoking initiation and smoking cessation; and regulatory issues related to their use. The scientific databases Scopus, Google Scholar, PubMed, and Web of Science can be searched using relevant keywords to find relevant papers. In conclusion electronic cigarette have an impact on oral and general health. [ABSTRACT FROM AUTHOR]

BACKGROUND: Adolescents' school engagement, mental health, and substance use have been major concerns during the COVID‐19 pandemic, particularly given disruptions to school instruction. We examined how the instructional setting was associated with academic and health‐related outcomes within an adolescent cohort followed during the pandemic. METHODS: During 3 semi‐annual follow‐up surveys, adolescents (N = 1066 students; 2242 observations) from 8 California high schools responded to items measuring academic self‐efficacy, school connectedness, internalizing and externalizing problems, and use of substances. Separate generalized estimating equation models predicted outcomes based on the instructional setting. RESULTS: Relative to in‐person instruction, students in remote instruction reported lower academic self‐efficacy (Beta: −0.11; 95% confidence interval [CI]: −0.22, −0.01) and school connectedness (Beta: −0.37; 95% CI: −0.48, −0.25), greater odds of past 30‐day internalizing problems (AOR: 1.46; 95% CI: 1.09, 1.95), externalizing problems (AOR: 1.36; 95% CI: 1.02, 1.82), and cigarette, cigar, smokeless tobacco, or hookah use (AOR: 2.50; 95% CI: 1.06, 5.91), but lower odds of past 30‐day e‐cigarette use (AOR: 0.50; 95% CI: 0.30, 0.86). CONCLUSIONS: Multiple adverse outcomes related to school engagement, mental health, and substance use were associated with remote instruction. To reduce such impacts under future emergencies, schools should rely sparingly on remote instruction and provide appropriate supportive resources. [ABSTRACT FROM AUTHOR]

Introduction E-cigarettes and heated tobacco products (HTPs) may serve as potential options for harm reduction for smokers if they possess reward profiles similar to cigarettes. Little is known about the abuse liability of HTPs and e-cigarettes versus cigarettes in racial/ethnic minority smokers. Aims and Methods Twenty-two nicotine-deprived people who smoke (black [ n  = 12] and white [ n  = 10]) completed three visits that included a standardized 10-puff bout followed by a 50-minute ad libitum use assessment with their usual brand cigarette (UBC), an e-cigarette, and HTP. Visits were completed in a randomized crossover design and were separated by a minimum 48-hour washout period. Assessments included plasma nicotine, Cmax, and reductions in craving and withdrawal. Results UBC delivered significantly greater levels of nicotine compared to the e-cigarette (p  < .001) and HTP (p  < .01) during both the standardized and ad libitum sessions. HTP delivered more nicotine than the e-cigarette during the standardized puffing session (p  = .047) but not the ad libitum session. Only craving during the standardized puffing session and not the ad libitum session showed significant differences across products (p  < .001) such that UBC resulted in the greatest reduction followed by HTP and e-cigarette. Conclusions Despite greater nicotine delivery from the UBC compared to e-cigarette and HTP, participants reported reductions in craving and withdrawal across products, particularly following ad libitum use. Implications Use of participant's UBCs (UBC) resulted in greater nicotine delivery compared to both the e-cigarette and HTP. Despite this relative difference in nicotine delivery, participants reported reductions in craving and withdrawal across products, particularly following ad libitum use. These findings suggest that in this sample of black and white people who smoke, HTPs and e-cigarettes provided significant relief from negative symptoms that maintain smoking. [ABSTRACT FROM AUTHOR]

Introduction Twitter data have been used to surveil public sentiment about tobacco products; however, most tobacco-related Twitter research has been conducted with English-language posts. There is a gap in the literature on tobacco-related discussions on Twitter in languages other than English. This study summarized tobacco-related discussions in Spanish on Twitter. Methods A set of Spanish terms reflecting electronic cigarettes (eg, "cigarillos electrónicos"), cigarettes (eg, "pitillo"), and cigars (eg, "cigaro") were identified. A content analysis of tweets (n  = 1352) drawn from 2021 was performed to examine themes and sentiment. An initial codebook was developed in English then translated to Spanish and then translated back to English by a bilingual (Spanish and English) member of the research team. Two bilingual members of the research team coded the tweets into themes and sentiment. Results Themes in the tweets included (1) product promotion (n  = 168, 12.4%), (2) health warnings (n  = 161, 11.9%), (3) tobacco use (n  = 136, 10.1%), (4) health benefits of vaping (n  = 58, 4.3%), (5) cannabis use (n  = 50, 3.7%), (6) cessation (n  = 47, 3.5%), (7) addiction (n  = 33, 2.4%), (8) policy (n  = 27, 2.0%), and (9) polysubstance use (n  = 12, 0.9%). Neutral (n  = 955, 70.6%) was the most common category of sentiment observed in the data. Conclusions Tobacco products are discussed in multiple languages on Twitter and can be summarized by bilingual research teams. Future research should determine if Spanish-speaking individuals are frequently exposed to pro-tobacco content on social media and if such exposure increases susceptibility to use tobacco among never users or sustained use among current users. Implications Spanish-language pro-tobacco content exists on Twitter, which has implications for Spanish-speaking individuals who may be exposed to this content. Spanish-language pro-tobacco-related posts may help normalize tobacco use among Spanish-speaking populations. As a result, anti-tobacco tweets in Spanish may be necessary to counter areas of the online environment that can be considered pro-tobacco. [ABSTRACT FROM AUTHOR]

Oklahoma's medical cannabis is some of the least restrictive in the US. Previous research suggests that American Indian/Alaska Native (AIAN) have higher rates of cannabis use than other racial or ethnic groups. The goals of this paper are, first, to look at cannabis use among high school students living on the Cherokee Nation Reservation before (2017) and after (2019) medical cannabis because legal in Oklahoma (2018) utilizing the Cherokee Nation Youth Risk Behavior Survey (CNYRBS). Second, to describe the socio-demographic characteristics of youth using cannabis in the Cherokee Nation Reservation. Data were retrieved from the 2017 and 2019 CNYRBS. The data for this study included 1,216 high school students who completed the 2017 and 1,476 who completed the 2019 CNYRBS. After removal of incomplete records, there were 2,602 students whose data was analyzed in this study. Data were weighted to be representative of public-school students attending grades 9–12 within Cherokee Nation Reservation. Despite the legalization of medical cannabis in Oklahoma in 2018, there was no change in cannabis use among youth between 2017 and 2019. There were variations in cannabis use based on demographic factors and other substance uses. AIAN individuals had higher odds of current cannabis use compared to non-Hispanic White students, but there were no differences based on ethnicity. Additionally, the use of cigarettes, e-cigarettes, alcohol, and illegal drugs were associated with increased odds of cannabis use among both current and former users compared to those who had never used it. There was no spike in use among youth at least immediately after the legalization of cannabis in the Cherokee Nation Reservation. There were socio-demographic as well as substance use disparities in the use of cannabis. [ABSTRACT FROM AUTHOR]

Background The objective is to estimate the importance of the decrease of smoking habits in Sweden for the occurrence of lung cancer. Methods The change in smoking habits in the general population was retrieved from surveys and on taxation of sale of cigarettes. We used data from the Swedish Cancer Register on incidence of lung cancer between 1970 and 2021, stratified for sex, age and cell type, and compared the occurrence overtime in ages between 40 and 84 years. Results The sale of cigarettes peaked in 1980 to 1800 cigarettes per person and decreased to 600 per person in 2021. The change in incidence rates of squamous cell cancer and other cell types varied over time, sex, and age in a pattern that partly seems to be explained by change in the prevalence of daily smokers. The incidence of adenocarcinoma was similar in men and women 1970–2021 and increased, e.g. for women and men 75–79 years of age from around 20 cases in early 1970s to around 120 cases per 100 000 person-years in the 2020s. Conclusions Our data indicate that the risk of lung cancer several years after smoking cessation is less favourable than previously studies have indicated. There is a similar increase in the incidence of adenocarcinoma in men and women which is hard to explain only with changing smoking habits. The change from non-filter to filter cigarettes in the 1960s–1970s may be a contributing factor. [ABSTRACT FROM AUTHOR]

Cigarette draw resistance and filter pressure drop are both critical physical indicators for the tobacco industry, which use testing equipment to measure the two parameters. Pressure drop standards are used as transfer standards to ensure the accuracy and reliability of the testing equipment. Pressure drop standards are generally cylindrical rods having a certain number of parallel capillaries. To address the issue of how to design and fabricate pressure drop standards quickly and conveniently, this paper proposes a design method for pressure drop standards based on structural parameters. The method uses a mathematical model of the internal airflow of the standard including the entrance effect into a circular capillary and uses an iterative calculation algorithm accordingly. By iterative calculation, the structural parameters of the pressure drop standard, namely, diameter and length of the capillaries, were obtained, along with the relationship between the draw resistance of the standard and the flow rate in each capillary. The accuracy of the mathematical model was validated by comparing and analyzing the experimental and theoretical draw resistance of standards with different structural parameters. The experimental results showed that the relative error between the measured draw resistance and the calculated draw resistance was below 8%, which proves the reliability and validity of the mathematical model, and provides theoretical support for the design and fabrication of pressure drop standards. [ABSTRACT FROM AUTHOR]

Despite the inclusion of both individual interventions and population-based measures in the Aotearoa New Zealand (Aotearoa NZ) Tobacco Control Programme, the gap between Māori, Pacific peoples and European/Asian/Other (EAO) populations in tobacco use has not decreased significantly. Tobacco control interventions that focus on individual behaviour change have produced little impact towards reducing tobacco smoking inequities for Māori and Pacific peoples in Aotearoa NZ. Using data from the New Zealand Health Survey (NZHS), this research investigates the impact of the wider determinants of health and individual-level factors on inequities in tobacco use between Māori, Pacific peoples and EAO. A conceptual framework was developed to support the theoretical positioning of this research and to inform data categorization, framing, discourse, analyses and interpretation. We conducted hierarchical regression to examine the effect of factors from each domain on ethnic inequities in tobacco use. We found that socioeconomic factors accounted for a significant amount of the disparity in adults currently smoking between Māori and Pacific peoples and EAO. Our results suggest that socioeconomic factors may be a more effective target of intervention than individual behaviours for reducing tobacco-related inequities. Addressing the broader determinants of health through comprehensive cross-agency cooperation to reduce ethnic inequities in tobacco use in Aotearoa NZ is likely to be more effective than individual behaviour change approaches. [ABSTRACT FROM AUTHOR]

The relationship between mental health and heated tobacco products' (HTPs) use remains unclear. We obtained data from the Korea National Health and Nutrition Examination Survey (2018–2020) on 18,231 participants aged ≥ 19 years. We examined the association between participants' type of tobacco use (non-tobacco, combustible cigarette (CC) only, or HTP use [with or without CCs]) and their mental health using logistic regression analysis. Among 18,231 participants, 18.41% was current tobacco users and 38.32% was lifetime tobacco users. Approximately 18.38% (18.14%) current (lifetime) tobacco users were current (lifetime) HTP users. Lifetime HTP users had higher odds of reporting perceived stress (adjusted odds ratio: 1.91, 95% confidence interval: [1.61–2.25]), depressive mood (1.79 [1.17–2.73]), suicidal ideation (2.09 [1.08–4.04]), Patient Health Questionnaire-9 (PHQ-9) ≥ 10 (3.68 [2.38–5.71]), and doctor-diagnosed depression (2.52 [1.75–3.62]) than non-tobacco users, and reporting perceived stress (1.18 [1.004–1.38]), depressive mood (1.53 [1.03–2.26], and PHQ-9 ≥ 10 (1.67 [1.12–2.49]) than lifetime CC only users. Finally, lifetime HTP only users had increased odds of doctor-diagnosed depression (4.30 [1.41–13.16]) than lifetime CC only users. Lifetime HTP users are more likely to experience poor mental status than non-tobacco and CC only users. [ABSTRACT FROM AUTHOR]

Substance use disorder (SUD) is a significant health problem, and trauma exposure is a known risk factor for the escalation of substance use. However, the shared neural mechanisms through which trauma is associated with substance use are still unknown. Therefore, we systematically review neuroimaging studies focusing on three domains that may contribute to the overlapping mechanisms of SUD and trauma—reward salience, negative emotionality, and inhibition. Using PRISMA guidelines, we identified 45 studies utilizing tasks measuring these domains in alcohol, tobacco, and cannabis use groups. Greater reward, lesser regulation of inhibitory processes, and mixed findings of negative emotionality processes in individuals who use substances versus controls were found. Specifically, greater orbitofrontal cortex, ventral tegmental area, striatum, amygdala, and hippocampal activation was found in response to reward-related tasks, and reduced activation was found in the inferior frontal gyrus and hippocampus in response to inhibition-related tasks. Importantly, no studies in trauma-exposed individuals met our review criteria. Future studies examining the role of trauma-related factors are needed, and more studies should explore inhibition- and negative-emotionality domains in individuals who use substances to uncover clinically significant alterations in these domains that place an individual at greater risk for developing a SUD. [ABSTRACT FROM AUTHOR]

Objectives: Smoking is a major global health problem with serious systemic and oral consequences. This study aims at assessing the influence of smoking cigarettes and other types of smoked tobacco on oral conditions (OCs) using a representative sample of US adults. Methods: Pre‐pandemic data from the National Health and Nutrition Examination Survey 2017–2020 were utilized, and 7840 adults aged ≥30 years were included in our analyses. Descriptive statistics, logistic, and negative binomial regression models were performed to assess the relationship between tobacco products and OCs including, tooth loss (TL), coronal (CC) and root caries (RC). Results: Overall, 16.29% of our sample were current cigarette smokers (CCS). TL (17.25%) and untreated RC (28.26%) were more evident among CCS. In the adjusted regression models, smoking cigarettes was associated with RC (AOR: 3.20, 95% CI; 2.02, 5.09), untreated CC (IRR: 3.08, 95% CI: 1.50, 6.31), and TL (IRR: 2.18, 95% CI: 1.64, 2.88). Regarding the type of used tobacco product in the past 5 days, cigarettes were the most common type (15.03%). The adjusted model indicated that e‐cigarette smokers had the highest odds of untreated RC (AOR: 5.17, 95% CI: 2.19, 12.23) and the highest rate of TL (IRR: 2.21, 95% CI: 1.45, 3.35). Further, cigar smokers had the highest rate of teeth with untreated CC (IRR: 3.25, 95% CI: 1.46, 7.25). Conclusions: Using tobacco products is associated with poor OCs. Dentists, being the primary oral health care providers, can play a crucial role in counseling and supporting smokers to quit as part of their routine dental examination. [ABSTRACT FROM AUTHOR]

Despite the implementation of significant measures by European countries in recent years, smoking rates in Europe remain persistently high. The European Commission is currently undertaking a comprehensive review of its tobacco regulations. This article aims to address critical inquiries that arise during the amendment of the regulatory framework. We evaluate the effectiveness of existing tobacco control methods and observe a diminishing impact on promoting smoking cessation. Additionally, we explore how individuals of varying genders respond to the regulatory environment. We propose a comprehensive and evidence-based framework for implementing a taxation system in response to the proliferation of emerging products, including e-cigarettes and heated tobacco. This system is designed to align effectively with health policy objectives, providing a strategic approach to curbing tobacco use and promoting public health. [ABSTRACT FROM AUTHOR]

The use of electronic cigarettes, or "e-cigarettes", among youths has sparked worries about the possibility of nicotine dependence as a serious public health issue. Dental practitioners play a critical role in helping their patients quit smoking. Dental schools across the globe have policies encouraging their students to help patients quit smoking. Current research, however, indicates that a significant portion of dental students smoke combustible cigarettes and use e-cigarettes. According to studies, using e-cigarettes has resulted in the subsequent initiation of combustible cigarette smoking among its users. The aim of this study was to determine the association between the use of electronic cigarettes and the subsequent initiation of combustible cigarette smoking among dental students who were not attitudinally susceptible to smoking combustible cigarettes. A longitudinal cohort study was conducted among 121 study participants who were never combustible cigarette users and were attitudinally non-susceptible to smoking at baseline. At baseline, 66 (54.6%) study participants were categorized as e-cigarette users who were attitudinally non-susceptible to combustible cigarette smoking, and 55 (45.4%) study participants were categorized as non-users who were attitudinally non-susceptible to combustible cigarette smoking. The initiation of combustible cigarette smoking was assessed at 6- and 12-month intervals. Binomial regression analysis of the outcome at the end of one-year follow-up, when analyzed with independent variables, revealed a significant influence of e-cigarette use on taking up combustible cigarette smoking [Relative Risk: 9.395; 95% CI: 3.03–29.04]. Chi-squared analysis of independent variables revealed e-cigarette use to be significantly associated with fathers' education level (p = 0.00), parental cigarette smoking status (p = 0.00), cigarette smoking among friends (p = 0.00), and family income (p = 0.00). E-cigarette users are more likely to believe it to be healthier (p = 0.00) than combustible smoking. In the present study, e-cigarette usage demonstrated a significant influence on taking up combustible cigarette smoking among its users. Educational institutions should implement stringent policies and regulations to prevent health professionals from using these products. [ABSTRACT FROM AUTHOR]

Aim: Tobacco use is projected to increase in sub-Saharan Africa (SSA) over the next century, and delineating the patterns of inequality in tobacco use will facilitate its control. This study explored the association between the social determinants of health and tobacco use among SSA adults. Subject and methods: We used nationally representative data from Global Adult Tobacco Surveys (GATS) conducted in seven SSA countries (2012–2018). The surveys provided information on 47,246 adults aged 15 years or older in Cameroon, Ethiopia, Kenya, Nigeria, Senegal, Tanzania, and Uganda. Current tobacco use prevalence was estimated in each country overall and across socioeconomic and demographic factors (sex, age, residence, education, wealth, religion, marital status, and tobacco health knowledge). Multiple logistic regression analysis was used to assess the association of these determinants with current tobacco use in each country and for the combined dataset. The pooled data analysis was further stratified by tobacco product category and sex. Results: We found significant homogenous associations between the social determinants and tobacco use across all countries. For the pooled data, smoking was independently associated with male sex, rural residence, greater age, lower education and health knowledge, and irreligiousness. For smokeless tobacco (SLT) use, the trends were similar and stronger for all determinants except sex. Among women only, the odds of smoking and SLT use respectively increased and decreased with greater wealth. Conclusions: Tobacco use is significantly associated with socioeconomic deprivation in SSA (stronger for SLT use than for smoking). These findings highlight opportunities for targeted interventions within SSA. [ABSTRACT FROM AUTHOR]

INTRODUCTION Prior research has linked media tobacco promotion to increased tobacco use and favorable perceptions of tobacco products. Switzerland's tobacco lobby employs advertisements to sway policy decisions in its favor, yet no recent research has assessed this in detail. Our study aims to provide detailed estimates of tobacco industry (TI) advertisement costs, focusing on Philip Morris International (PMI) in Switzerland, and examine potential chronological links between TI advertisement campaigns and parliamentary discussions on tobacco bills. By spreading knowledge on this issue, we aim to support the development of future tobacco advertisement regulations. METHODS We conducted an expenditure analysis of tobacco-related press advertisements in Swiss print media published between August 2020 and August 2021, accessed through the media intelligence firm Argus Data Insights. Advertisement costs were estimated using publicly available data. We plotted expenditure sums of PMI against key parliamentary session dates featuring discussions on proposed tobacco control measures, such as tighter restrictions on advertising. RESULTS Over 12 months, 501 advertisements with tobacco-specific headlines were published in Swiss press media. Of these, 437 advertisements (87.22%) were linked to PMI. PMI accounted for 88.21% (CHF 6486969) of total advertisement expenditure. Notably, PMI advertisements coincided with key political sessions discussing tobacco legislation in parliament, with a limited presence outside these periods. CONCLUSIONS PMI advertisements were published parallel to key moments of parliamentary discussions, suggesting an attempt by TI to potentially influence discussions. Applying such an advertisement monitoring methodology helps understand the contextual conditions of public health in Switzerland. By analyzing TI advertisements in print media, we sought to highlight regulatory gaps and support the creation of stricter advertising regulations. We recommend continuing such research to strengthen tobacco control policymaking. Key public health efforts should include raising awareness of TI tactics, implementing a comprehensive ban on tobacco advertising, and strategically engaging with the media in tobacco control campaigns. [ABSTRACT FROM AUTHOR]

Heated tobacco products show great market potential because of their advantages in terms of low toxicity, minimal production of second-hand smoke, and a similarity of smoking experience to traditional cigarettes. However, a change in heating method can cause the temperature in the mainstream smoke to be too high. Therefore, the development of cooling filters for heated tobacco products is urgently needed. With cellulose diacetate filter rod as the carrier, and food-grade paraffin wax as the phase change endothermic material, cooling filter rods made of paraffin wax/cellulose diacetate were prepared by the impregnation method, and the developed rods were characterized by TG/DTA, FT-IR, DSC and SEM. The effects of melting point and loading amount of paraffin wax on the temperature in the mainstream smoke of heated tobacco product were investigated. The filter rods are produced by the adsorption of paraffin wax onto the filter rods of cellulose diacetate. Good heat absorption capacity and thermal stability of the system are observed in the smoking process. When the mass fraction of the emulsified 52# paraffin wax is 60%, i.e. the loading amount of paraffin wax is 35 mg, the three-stage cooling filter composed of paraffin wax/cellulose diacetate filter rod show a significant cooling effect on the mainstream smoke, leading to a reduction of temperature from 68 °C to 42 °C. [ABSTRACT FROM AUTHOR]

The aim of this study is to examine the phenomenon of non-consumption and its impact on the tobacco industry. Utilizing industry data, we illustrate the challenges arising from changing market conditions. Non-consumption significantly affects manufacturing companies; a decline in tobacco use reduces their revenue and underutilizes production capacity. In the 21st century, growing environmental and health consciousness among consumers is leading to decreased demand for tobacco products, impacting the industry and its associated companies. This downturn is reshaping the tobacco industry, with production shifting to regions experiencing a rise in tobacco use. Tobacco processing companies face the challenge of adapting to these market changes. Companies focused on mass production, due to their specific production models, struggle more to adapt compared to those already equipped for flexible production. [ABSTRACT FROM AUTHOR]

This study was designed to investigate patterns and risk factors for substance use among obstetrical patients who gave birth during the early period of the pandemic, and their partners. Cross-sectional survey of obstetrical patients between March 17th and June 16th, 2020, at The Ottawa Hospital, Ottawa, Canada. Substance use was a composite measure of any alcohol, tobacco, or cannabis use since COVID-19 began. Four outcomes included: any participant substance use or increase in substance use, any partner substance use or increase in substance use. Adjusted risk ratios (ARR) and 95% confidence intervals (CI) are presented. Of 216 participants, 113 (52.3%) and 15 (6.9%) obstetrical patients reported substance use and increased use, respectively. Those born in Canada (ARR: 2.03; 95% CI: 1.27–3.23) and those with lower household income (ARR: 1.38; 95% CI: 1.04–1.85) had higher risk of substance use. Those with postpartum depression (ARR: 5.78; 95%CI: 2.22–15.05) had the highest risk of increased substance use. Families affected by school/daycare closure reported a higher risk of increased partner substance use (ARR: 2.46; 95% CI:1.38–4.39). This study found that risk factors for substance use included demographics (i.e., being born in Canada, income), mental health (postpartum depression), and school/childcare closures. [ABSTRACT FROM AUTHOR]

Tobacco smoking and substance use is a public health hazard. The investigations studying tobacco smoking, substance use, and their associated factors among Iraqi undergraduates are limited. Our study aimed to examine tobacco smoking, and substance use among medical undergraduates in Najaf, Iraq, and report associated characteristics. A piloted questionnaire was utilized to conduct a descriptive cross-sectional web-based survey. The snowball technique was used for sampling. The subjects' features, perceived risk of harm, location, motivations, and effects of cigarette smoking and substance misuse were used to conduct association testing. Tobacco smoking was reported in 17.3% of the students (at least once in the previous month), and substance use in 3%. Mostly, the age of initiation was <15 years, and psychological stress (50.9%) was the reason for tobacco smoking and substance use. However, the presence of a smoker or user friend or family member was significantly associated (p-value <.05) with tobacco smoking and substance use. The prevalence of tobacco smoking and substance use and several risk factors were identified. In addition to promoting awareness about tobacco smoking and substance use and its potential consequences, the associated characteristics reported in this study are useful when developing effective counteracting policy initiatives. [ABSTRACT FROM AUTHOR]