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Introduction Addressing cigarette and e-cigarette use in China is key to reducing the global tobacco epidemic. Marketing exposure is one causal factor for adolescent smoking and e-cigarette use. Currently, China restricts cigarette and e-cigarette ads in public places and online; however, there may not be full policy compliance. We collected real-time data in the natural environment to estimate how much and where Chinese adolescents—a group susceptible to smoking and e-cigarette use—are exposed to cigarette and e-cigarette marketing to inform policy responses. Aims and Methods In June 2022, we conducted a 7-day ecological momentary assessment (EMA) study with 15–16-year-olds (n  = 96) across eight Chinese cities. Participants completed up to 42 EMA surveys (six per day), sent at random intervals outside of school hours. In each survey, participants reported whether they saw (1) displays and (2) ads in the past hour (none, cigarette, e-cigarette, both) in the past hour. We also captured the source of cigarette/e-cigarette ad exposure. Results Most participants were exposed to cigarette and/or e-cigarette displays (89.6%) or ads (79.2%) more than 7 days. On average, participants reported past-hour exposure to displays 12.7 times and past-hour exposure to ads 10.8 times over the week. The most common sources of cigarette ads were public places (eg, kiosks, supermarkets); the most common sources of e-cigarette ad exposure were social media/internet or e-cigarette stores. Conclusions Findings highlight the need to enhance enforcement of restrictions on cigarette and e-cigarette ads in public places and online in China and extend restrictions to ban displays. Implications Marketing exposure is a causal factor in youth smoking and e-cigarette use. We used EMA to estimate cigarette and e-cigarette display and ad exposure among Chinese adolescents. On average, participants reported past-hour exposure to cigarette and/or e-cigarette displays 13 times and past-hour exposure to cigarette and/or e-cigarette ads 11 times more than 1 week. Most saw ads in public places and online. Results suggest strengthening implementation of China's ban on cigarette and e-cigarette ads in public places and online and banning product displays. These are policy responses that can contribute to reducing adolescent cigarette and e-cigarette uptake in China. [ABSTRACT FROM AUTHOR]

The Report on Chinese Adolescent Tobacco Use 2023 announces a year-on-year decline in the prevalence of smoking in Chinese teenagers. Nevertheless, the hazards of tobacco products to the physical and mental health of this population remain a concerning issue. This study is an encapsulation of factors influencing the smoking behavior of Chinese adolescents based on a review of relevant literature. Personal characteristics such as gender, age, psychological traits, lifestyle, and perceptions of tobacco use, along with environmental factors like the family environment, circle of friends, and school climate, can all potentially influence a teenager's smoking behavior. A thorough examination of these factors can provide implications for advancing the regulation of teenager tobacco use and improving the work on adolescent health protection. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionsNeighborhood disadvantage is associated with a higher concentration of tobacco, cannabis and alcohol retailers and greater risk of certain substance use behaviors among youth. Less is known about the impact of subjective neighborhood disorder, which captures distinct exposures that may be relevant to substance use outcomes, including neighborhood social processes, safety, physical characteristics, and neighborhood drug use.Data are from two waves (Feb-Dec 2022) of a prospective cohort of Southern California high school students (n = 2,139; mean[SD] age = 15.7.[0.6]). We examined associations of perceived neighborhood disorder at baseline with (a) perceived ease of purchase (continuous scale 0-100) for alcohol, cannabis, e-cigarettes, cigarettes, hookah, cigars/cigarillos, and oral nicotine at baseline and follow-up, and (b) repeated measures of past 6-month and past-30-day alcohol, vaped cannabis, smoked cannabis, cannabis edibles, e-cigarette, cigarette, cigarillo, hookah, and oral nicotine use.E-cigarettes were perceived to be the easiest product to purchase. Participants in the highest (vs. lowest) quartile of neighborhood disorder reported greater mean ease of purchasing scores for all products (mean difference range = 5.43 [95%CI: 1.64-9.21] for mint/menthol oral nicotine products to 9.40 [95%CI: 6.16-12.64] for hookah) and greater odds of e-cigarette, smoked cannabis, edibles, vaped THC, and alcohol use (odds ratio range = 1.52 [95%CI: 1.05 to 2.18] for past 6-month alcohol to 5.40 [95% CI: 3.46 to 8.42] for 30-day smoked cannabis).Interventions that shape youth perceptions of their neighborhood and reduce youth retail access in disadvantaged neighborhoods are needed and may help to prevent youth substance use. [ABSTRACT FROM AUTHOR]

Background: Tobacco use is a global public health threat and a leading preventable cause of death in the world. While cigarette use among youth has been decreasing in high-income countries, low- and middle-income countries have contrastingly high rates of adolescent smoking. In Ghana, smoking prevalence is lower than in other parts of the African continent and more common among men than women; however the gender gap in tobacco use among adolescents has narrowed, with shisha use among girls recently surpassing boys. These trends toward increased relative use among adolescent girls are a cause for concern and highlight the need for interventions to prevent and/or reduce tobacco use in this population. Methods: We conducted in-depth interviews with girls aged 13–20 (n = 148) and their parents (n = 7) in Ghana's largest two cities – Accra and Kumasi, to explore the physical, social, and psychological context underlying smoking perceptions and behavior. Results: We identified 11 key insights into influences on smoking behavior, organized into the broader themes of perceptions of smoking, environmental factors, and internal factors. Findings underscore that perceptions around smoking are very much driven by girls' social world, which is generally small and parent-centric for non-smokers at younger ages but can start to expand as girls get farther along in school or leave school entirely. After what may have been a sheltered adolescence, many older girls in Ghana look for ways to express their independence in decision-making and a few may use their developing agency to rationalize limited or infrequent tobacco use if they perceive the benefits to them outweigh the potential consequences. Conclusions: Our findings highlight strong social influences on girls' perceptions, exposure to opportunities, and decision-making in ways that can often be protective against smoking, particularly at younger ages, but may also leave girls unprepared to manage challenging situations later in life. Understanding this context in Ghana will be important for any future programming aiming to prevent smoking initiation among adolescents. [ABSTRACT FROM AUTHOR]

Absolute prevalence of tobacco smoking has fallen in recent decades but inequalities by socioeconomic position (SEP) persist. Adolescence is a critical period for smoking initiation and habits formed during this period likely continue into adulthood. Explanations for inequalities in adolescent smoking have tended to focus on individualistic theories based on differentials in knowledge and psychology. These have been criticised for their blindness to processes of social stratification and social context that influence smoking behaviours. Based on previous social theories, we put forward, and test empirically, two potential structural explanations for inequalities in smoking, using nationally representative longitudinal cohort data on 6039 Irish young people aged 9–18 years. Descriptive analyses confirmed the adverse SEP gradient in smoking prevalence as well as SEP gradients in variables representing individual‐level characteristics and structural‐level explanations. Despite lower self‐esteem being associated with a higher likelihood of smoking, there was no significant indirect pathway between SEP and smoking via self‐esteem. Path analyses found that differentials in exposure to parental smoking and levels of oppositional values mediate the relationship between SEP and smoking. Our results favour structural and group‐based explanations for inequalities, that is, the ‘smoking exposure’ and ‘social resistance’ models, over explanations based on individual psychology. [ABSTRACT FROM AUTHOR]

Introduction: Risky behaviours, including tobacco use, are highly prevalent among adolescents worldwide. Although these behaviours are largely influenced by various sociodemographic factors, including sex, there is a paucity of regionally representative literature on the sex-related inequalities in cigarette smoking among adolescents in Africa. This study examined the sex-based disparities in current cigarette smoking among adolescents aged 13–15 years in Africa. Methods: The present study employed a secondary analysis of nationally representative data on 45 African countries obtained from the Global Youth Tobacco Survey, accessible through the World Health Organization (WHO) Global Health Observatory. We used the online version of the WHO Health Equity Assessment Toolkit (HEAT) to generate the results. Results: The prevalence of current cigarette smoking among the adolescents surveyed ranged from 1.6% in Eritrea to 10.4% in Mali among the low-income countries, from 1.3% in Tanzania to 13.1% in Mauritania among the lower-middle-income countries, from 5.2% in Gabon to 15.3% in Mauritius among the upper-middle-income countries, and 14.7% in Seychelles, the only high-income country in the study. The absolute summary measure (D) showed diverse sex-related disparities in the burden of current cigarette smoking among adolescents across the sub-regions. In all countries surveyed, the prevalence of cigarette smoking was higher among male adolescents compared to females, except in Liberia and Mozambique, where female adolescents bore a more significant burden than their male counterparts. Furthermore, male adolescents were more burdened with high cigarette smoking prevalence than females in low-income countries such as Mali, Madagascar, Guinea, Burkina Faso, and The Gambia, where such disparities were most pronounced. Meanwhile, we found less disparity in the burden of cigarette smoking between male and female adolescents in most of the lower and upper-middle-income countries surveyed. Conclusion: This study sheds light on the sex-based inequalities in the prevalence of current cigarette smoking among adolescents in Africa. In contrast to female adolescents, male adolescents bear a greater burden of current cigarette smoking. The burden of cigarette smoking is most pronounced in low-income countries such as Mali, Madagascar, Guinea, Burkina Faso, and The Gambia. Conversely, in most of the lower and upper-middle-income countries surveyed, the burdens of current cigarette smoking among male and female adolescents were found to be less disparate. Consequently, cigarette smoking prevention programmes and strategies must be implemented in all African nations. There is also the need to intensify interventions aimed at altering the smoking behaviour of male adolescents. Policymakers can develop and implement evidence-based interventions to address the burden of cigarette smoking among the adolescents. Finally, existing policies and programmes addressing adolescents' cigarette smoking should be re-assessed and strengthened to achieve their objectives. [ABSTRACT FROM AUTHOR]

Objective: The present study sought to assess the prevalence and determinants of tobacco use (cigarette smoking and shisha use) and khat chewing among Yemeni adolescents, and to evaluate their knowledge and attitudes toward these habits. Methods: This school-based cross-sectional study was conducted among 13 to 19-year-old students attending middle/high schools (both private and public) across five main cities in Yemen. Data were collected using self-administered questionnaires comprising questions/items related to sociodemographic data, cigarette smoking, shisha use, khat chewing, and knowledge on and attitudes toward these habits. Bivariate and multivariate analyses were used to explore the most determinant factors. Results: A total of 7505 students were recruited from 42 schools across five major cities in Yemen. The prevalence rates of khat chewing, cigarette smoking, and shisha use were 42.4%, 6.8%, and 19.3%, respectively. Compared to females, male subjects reported significantly higher prevalence of khat chewing (51.4% vs. 23.5%, p < 0.001), shisha use (20.3% vs. 17.2%, p < 0.01), and cigarette smoking (8.8% vs. 2.6%, p < 0.001). Male gender, older age, poor knowledge, khat chewing, parents' low education level, and parents' and peers' smoking habits were significant determinants of adolescents' cigarette smoking status. Private education, male gender, older age, poor knowledge, parents' low education level, and parents' and peers' khat chewing habits were significant determinants of adolescents' khat chewing status. The participant's knowledge of and attitudes toward tobacco use and khat chewing were inadequate. Conclusion: The prevalence of khat chewing, shisha use, and to lesser extent cigarette smoking among Yemeni adolescents is high that needs immediate intervention. The results highlight the urgent need to implement prevention strategies to tackle these habits among the youth in Yemen. [ABSTRACT FROM AUTHOR]

Background: The world's population in 2020, 22.3% consumed tobacco: 36.7% of males and 7.8% of women. 15.9% of those 15 years of age and above daily smoked tobacco throughout Organization for Economic Cooperation and Development (OECD) nations in 2021. Methods: A descriptive correlation conducted from 10th November 2023 to 20th June 2024, study aimed to identify if participants' age, family's socioeconomic status, and knowledge about smoking consequences can predict their Self-Efficacy for smoking cessation. The study included a convenience sample of 400 high school students. The study instrument is composed of students' sociodemographic sheet, Family's Socioeconomic Status Scale, The Smoking: Self-Efficacy/Temptation Scale, and The Knowledge about the Consequences of Smoking Scale. Data were collected using a self-reported instrument for the period from February 15th, 2024, to March 4th, 2024. Results: The study results revealed that family's socioeconomic status positively predicts students' Self-Efficacy for smoking cessation. On the other hand, knowledge about the consequences of smoking negatively predicts students' Self-Efficacy for smoking cessation. There is a statistically significant difference in Self-Efficacy for smoking cessation among family's socioeconomic status groups. Conclusion: The student researcher concluded that the better the socioeconomic status the family has, the greater the Self-Efficacy students enjoy. The broader the knowledge the students have, the greater the Self-Efficacy for smoking cessation they enjoy. [ABSTRACT FROM AUTHOR]

Exposure to secondhand smoke is one of the leading causes of death for non-smokers worldwide. The prevalence of exposure to secondhand smoke is higher among adolescents. Research on predictors of secondhand smoke exposure in adolescents is still rarely conducted in Indonesia. This study aimed to analyze the predictors of exposure to secondhand smoke among non-smoking adolescents in Indonesia. This study used data from the Global Youth Tobacco Survey (GYTS) Indonesia 2019 with a cross-sectional design. A total of 7,594 adolescents aged 13 to 15 were selected using purposive sampling. The dependent variables were exposure to secondhand smoke at home and in public. The independent variables included age, gender, smoking parents, smoking friends, and knowledge of the dangers of secondhand smoke. Data were analyzed using STATA with inferential tests, namely chi-square and logistic regression. The prevalence of adolescents exposed to secondhand smoke at home and in public was 49.57% and 71.86%, respectively. At-home exposure was significantly associated with smoking parents [AOR=3.50, 95% CI=2.97 to 4.12], smoking friends [AOR=1.50, 95% CI=1.30 to 1.73], and knowledge of the dangers of secondhand smoke [AOR=2.11, 95% CI=1.52 to 2.93]. Public exposure was associated with ages 13-15 [AOR=1.32, 95% CI=1.10 to 1.58] and older than 15 [AOR=1.77, 95% CI=1.39 to 2.25], male gender [AOR=1.31, 95% CI=1.11 to 1.53], smoking parents [AOR=1.58, 95% CI=1.36 to 1.84], smoking friends [AOR=2.16, 95% CI=1.85 to 2.53], and knowledge of secondhand smoke dangers [AOR=2.84, 95% CI=2.15 to 3.75]. Adolescents' exposure to secondhand smoke in public spaces is higher in prevalence and has more associated factors compared to exposure at home. Exposure reductions require comprehensive actions from authorities by strictly implementing and expanding non-smoking areas covered by existing regulations. Also, family and school management should be involved in prevention efforts. [ABSTRACT FROM AUTHOR]

In recent years, the prevalence of tobacco and electronic cigarette (e-cigarette) use among adolescents has raised significant public health concerns worldwide. This study aimed to investigate respiratory symptoms among Polish adolescents. We conducted an online survey among Polish school students from all provinces, collecting data over two months in spring 2021. Students voluntarily complete the anonymous survey, answering questions about respiratory symptoms, smoking habits (both traditional and electronic cigarettes), and demographic information. The analysis focused on four subgroups, namely non-tobacco users, traditional cigarette smokers, e-cigarette users, and dual users, totaling 10,388 pupils aged 12–18 years, predominantly attending secondary technical and comprehensive schools. A total of 10,388 pupils participated in the study, 55.6% (5778) of whom were girls and 44.4% (4610) boys. Adolescents who admitted using both e-cigarettes and traditional cigarettes experienced more frequent episodes of cough during the day (39.70%) and at night (18.40%) compared to their peers in other groups. Chest discomfort, including pain and pressure, was also reported more often by adolescents who used e-cigarettes and traditional cigarettes concurrently (27.60%) compared to their peers in other groups. Chest pressure was experienced less commonly by non-smoking adolescents (14.40%) than by smokers (18.90%). Higher severity of cough during the day and at night was observed in the group of adolescents using traditional cigarettes and e-cigarettes concurrently compared to the other groups. The adolescents in the dual-user group experienced more severe dyspnea and wheezing compared to the other groups included in the comparison. The results of this study confirm the correlation between the occurrence of respiratory symptoms in adolescents who smoke cigarettes, adolescents who use e-cigarettes, and adolescents who are dual users. The respiratory symptoms occur most frequently and are the most severe in the group of adolescents who use e-cigarettes and traditional cigarettes [ABSTRACT FROM AUTHOR]

Aim: This study classified 99 countries into four income groups and then analysed the impact of secondhand smoke (SHS) exposure at home, in public places and at school, on current cigarette smoking prevalence. Methods: We utilised data from the WHO Global Youth Tobacco Survey and a meta‐analysis was conducted to evaluate the prevalence and weighted odds ratios (wORs) of adolescent smoking behaviour and SHS exposure locations. Results: Both smoking behaviours increased with higher national income levels. Smoking behaviours in high and upper‐middle‐income countries (HICs and UMICs) exhibited an association with SHS exposure in public places (HIC: wOR, 3.50 [95% CI, 2.85–4.31]; UMIC: wOR, 2.90 [2.60–3.23]) compared to home. Low‐ and lower‐middle‐income countries (LICs and LMICs) showed an association with SHS exposure in the home (LIC: wOR, 5.33 [3.59–7.93]; LMIC: wOR, 2.71 [2.33–3.17]) than public places. The association between current cigarette smoking and SHS exposure at home increased with lower income levels, while anticipated future use of any form of tobacco with SHS exposure in public places rose in lower income countries. Conclusions: Targeted interventions based on income levels are essential, emphasising home strategies in lower income countries and public place efforts in higher income countries. [ABSTRACT FROM AUTHOR]

Background and Objectives: In 2022, the Centers for Disease Control and Prevention (CDC) discovered that 2.55 million middle and high school students were using electronic cigarettes (e-cigarettes) in the US alone. E-cigarettes allow people to inhale a nicotine solution (e-liquid) into their bodies. While e-cigarettes are often advertised as a way to help people quit traditional tobacco products, the World Health Organization (WHO) has stated that there is no proof of e-cigarettes being effective at reducing an individual's tobacco use. The objective of this study is to determine why adolescents start smoking e-cigarettes. Materials and Methods: For the following study, the National Youth Tobacco Survey (NYTS) 2021 was used. This is a nationally representative cross-sectional survey that includes middle and high school students. The data were analyzed using SAS v.9.4. The odds ratio for smoking e-cigarettes was evaluated for both sex and race via a logistic regression. Results: It was discovered that the percentage of only e-cigarette smokers (12.10%) was 5.5 times the percentage of only traditional smokers (2.19%). Additionally, the median age at which adolescents started smoking e-cigarettes was fifteen years with an IQR (Inter Quartile Range) of two. We used a logistic regression to show that biological sex and race were significant predictors of e-cigarette usage. Conclusions: In general, we saw that adolescents were mostly starting to smoke e-cigarettes because their friends were doing it, out of curiosity, they were depressed or anxious, and/or to get a "high", implying that adolescents mostly started smoking in order to fit in and/or to numb themselves. Interestingly, reasons like cost, using them to quit smoking, seeing them in the media, and ease of attainment were ranked the lowest when it came to smoking e-cigarettes. However, their lower costs naturally lead to increased accessibility compared to traditional cigarettes, making them easier to reach the hands of teenagers. Overall, in this paper, we aim to identify if adolescents are choosing e-cigarettes as their first foray into tobacco products and why. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to examine the prevalence of unhealthy lifestyle behaviors, overweight, and obesity in Dutch childhood cancer survivors (CCSs) compared with sibling controls and the Dutch general population. Other aims were to assess associated factors of unhealthy lifestyle behaviors, overweight, and obesity and to identify subgroups of CCSs at risk for these unhealthy statuses. Methods: The authors included 2253 CCSs and 906 siblings from the Dutch Childhood Cancer Survivor Study‐Late Effects After Childhood Cancer cohort, part 1, and added data from the Dutch general population. Questionnaire data were collected on overweight and obesity (body mass index >25.0 kg/m2), meeting physical activity guidelines (>150 minutes per week of moderate or vigorous exercises), excessive alcohol consumption (>14 and >21 alcoholic consumptions per week for women and men, respectively), daily smoking, and monthly drug use. Multivariable logistic regression analyses and two‐step cluster analyses were performed to examine sociodemographic‐related, health‐related, cancer‐related, and treatment‐related associated factors of unhealthy lifestyle behaviors and to identify subgroups of CCSs at risk for multiple unhealthy behaviors. Results: CCSs more often did not meet physical activity guidelines than their siblings (30.0% vs. 19.3%; p <.001). Married as marital status, lower education level, nonstudent status, and comorbidities were common associated factors for a body mass index ≥25.0 kg/m2 and insufficient physical activity, whereas male sex and lower education were shared associated factors for excessive alcohol consumption, daily smoking, and monthly drug use. A subgroup of CCSs was identified as excessive alcohol consumers, daily smokers, and monthly drug users. Conclusions: The current results emphasize the factors associated with unhealthy behaviors and the potential identification of CCSs who exhibit multiple unhealthy lifestyle behaviors. The results of this study indicate a higher prevalence of physical inactivity in childhood cancer survivors compared with sibling controls and the Dutch population, emphasizing the necessity for personalized health behavior interventions in childhood cancer survivors. These findings can be used in clinical practice to create awareness and to identify subgroups of childhood cancer survivors who need special attention regarding health behaviors. [ABSTRACT FROM AUTHOR]

Introduction: Smoking behavior among adolescents is a public health problem. The use of e-cigarettes is desirable to teenagers in Indonesia, with as many users aged 10-19 years. To change behavior, health education is needed. One of the strategies is online health education. This research aims to determine the effectiveness of web-based education on e-smoking behavior. Materials and methods: Research using the Mix Method. The research was carried out experimentally and then qualitatively using a case study approach. In experimental research, samples were taken using simple random sampling with a total of 310, divided into 2, namely experimental and control groups. Providing webbased education is carried out for one month. Qualitative research with a case study approach conducted in-depth interviews with 12 students who use electronic cigarettes. Qualitative analysis by creating codes, Simplification, and presentation of data, and Clarification of data Conclusion. Results: The results of this study are that the average age of respondents is 19 years, and 7.7% of students smoke conventional types of cigarettes, electric and use both, smoking more than 100 days. After being given web-based education, with a statistically exact p-value=1 (>0.05) test score; there was no difference in pre- and post-treatment smoke behavior. The results of in-depth interviews showed that students’ knowledge about dangerous e-cigarettes can interfere with health and cause addiction. Conclusion: Web-based education carried out for one month did not influence smoking behavior, but that the perception of e-cigarettes was that e-cigarettes contain tar and are harmful to health. [ABSTRACT FROM AUTHOR]

Preventing young people's cigarette smoking is a major public health priority, and smoking is especially prevalent in vocational schools. Well-enforced comprehensive school tobacco policies accompanied by preventive efforts show potential to reduce smoking, but the implementation process is crucial to achieve the intended effect. We investigate whether and how implementation fidelity of a multi-component smoking prevention intervention impacted student smoking outcomes after 4–5 months among students in Danish vocational education and training (national age range 15–65 years, mean 25.6) and preparatory basic education (national age range 15–25 years, mean 17.6) institutions using questionnaire data from a cluster-RCT. The intervention included a smoke-free school hours policy, educational curriculum, and class competition. We calculated an overall implementation fidelity measure combining staff-reported school-level delivery (fidelity) and student-reported receipt (participation, responsiveness), and used multilevel regression models to analyze associations with smoking outcomes (smoking daily, regularly, and during school hours). We supplemented the analysis with restricted cubic spline regression. Additionally, we stratified the analyses by school types and analyzed associations between implementation fidelity of the separate intervention components and smoking outcomes. High implementation was associated with lower odds of regular smoking (OR: 0.37, 95% CI: 0.18–0.78) and smoking during school hours, but not daily smoking, and these associations varied between the school settings. When analyzed separately, implementation fidelity of the components did not affect the outcomes significantly. Our findings underline the need to support the implementation process of school tobacco policy interventions to ensure the intended effects of reducing students' smoking. [ABSTRACT FROM AUTHOR]

Introduction: With the premise that the demanding educational process and associated factors could influence the work‐related quality of life (WRQoL) of dental students, this study aimed to investigate the influence of diverse sociodemographic and health‐related factors, clinical education status, and sleep quality on the WRQoL of dental students. Materials and Methods: A three‐part questionnaire was administered to a group of preclinical and clinical dental students studying in different classes. The first part of the questionnaire included various sociodemographic and health‐related questions. In the second part, the multidimensional 23‐item WRQoL scale, with established validity and reliability, was applied to evaluate the WRQoL of the students. The last part of the questionnaire included the Pittsburgh Sleep Quality Index, comprising 19 items. General linear models were created to predict subscale scores using sociodemographic and health‐related characteristics, as well as univariate significant independent variables. Results: It was observed that the majority of the participants (78.2%) had poor sleep quality. Being clinical dental students had a significant and positive effect on the stress at work domain of WRQoL (p =.006), while it had a significant and negative effect on the home‐work interface domain (p <.001). The decrease in sleep quality had a significant and negative effect on all domains of WRQoL (p <.05) except for the stress at work domain. Conclusions: Clinical education status, regular smoking, and sleep quality significantly affect different domains of dental students' WRQoL. Changes in these factors should be considered in approaches to increasing students' WRQoL. [ABSTRACT FROM AUTHOR]

Claiming causal inferences in network settings necessitates careful consideration of the often complex dependency between outcomes for actors. Of particular importance are treatment spillover or outcome interference effects. We consider causal inference when the actors are connected via an underlying network structure. Our key contribution is a model for causality when the underlying network is endogenous; where the ties between actors and the actor covariates are statistically dependent. We develop a joint model for the relational and covariate generating process that avoids restrictive separability and fixed network assumptions, as these rarely hold in realistic social settings. While our framework can be used with general models, we develop the highly expressive class of Exponential-family Random Network models (ERNM) of which Markov random fields and Exponential-family Random Graph models are special cases. We present potential outcome-based inference within a Bayesian framework and propose a modification to the exchange algorithm to allow for sampling from ERNM posteriors. We present results of a simulation study demonstrating the validity of the approach. Finally, we demonstrate the value of the framework in a case study of smoking in the context of adolescent friendship networks. [ABSTRACT FROM AUTHOR]

Introduction: The consumption of alcohol, tobacco, and cannabis is a public health problem that impacts the cognitive, social, and emotional development of adolescents. Prevention strategies such as the "Unplugged" program are effective in delaying the progression of daily smoking and episodes of drunkenness among adolescents. "Yo Se Lo Que Quiero" (YSLQQ) corresponds to the adaptation of this program to the Chilean context. This study assesses the acceptability and feasibility of implementing this program to the local reality. Material and methods: This was a cluster-randomized controlled pilot study conducted on six public schools. All consented students attending 6th, 7th, and 8th grades (n = 1,180) participated in the study. The schools were randomly assigned to one of two conditions in a 1:1 ratio: (1) the "YSLQQ" intervention group (n = 526), and (2) the Control group (n = 654). The program consisted of a 12-hour class-based curriculum based on a comprehensive social-influence approach delivered by a trained facilitator. The acceptability and feasibility were assessed in the intervention group at the end of the intervention using questionnaires answered by students and facilitators. The quality and fidelity of the program were evaluated during the implementation using self-ported surveys answered by the facilitators and the assessment of video-recorded sessions rated by external observers. Finally, a pre-test and a post-test survey assessing past and current substance use and risk and protective factors were conducted before and immediately after the program's implementation. Results: A high proportion of students (49.6%) liked the sessions. 79.2% reported that the YSLQQ helped them learn about the dangers of substances, while 65.8% reported having more skills to avoid substance use in the future. Regarding students' satisfaction with YSLQQ, 62.9% reported being happy or very happy with the program. Facilitators reported implementing the intervention according to the manual in 73.9% of sessions. Regarding substance use, students who participated in the intervention groups reported a significant reduction in drunkenness in the last year and last 30-day prevalence and also a significant reduction in a lifetime and 30-day prevalence of cannabis use when compared with those students in the control group. Conclusions: Our results suggest that YSLQQ has adequate acceptability and feasibility to be implemented in the Chilean context, and there were promising results in reducing drunkenness and cannabis use. Future research should confirm these results in a larger RCT study. Trial registration: The trial was registered in ClinicalTrials.gov, NCT04566627; registration date: 01/03/2019 [ABSTRACT FROM AUTHOR]

Background and Aims Design Setting Participants Measurements Findings Conclusions Disposable e‐cigarette use has increased among United States (US) high school students in recent years. However, there is limited research on the profile of these users, how often they use these products, and whether they displace cigarette smoking. This study aimed to measure how disposable e‐cigarette use among US youth varies according to demographic characteristics and whether there is any association between e‐cigarette use and reduced use of traditional cigarettes.We used cross‐sectional data from the 2022 National Youth Tobacco Survey and conducted a multinomial logistic regression to examine factors associated with the types of e‐cigarette devices used in the prior 30 days, adjusting for sex, sexual identity, grade level and race/ethnicity. We also used a finite mixture model to account for unobserved differences among users and identify e‐cigarette use patterns in different subgroups of users.United States.High school students in grades 9–12 (n = 14 389).Survey participants self‐reported the type of e‐cigarette device used, the frequency of e‐cigarettes used and cigarettes smoked over the past 30 days.Disposable e‐cigarettes were the most popular e‐cigarette type. Sex, sexual orientation, grade level and race/ethnicity were associated with disposable e‐cigarette use. The odds of disposable e‐cigarette use were lower in male students than in female students (odds ratio [OR] = 0.78, 95% confidence interval [CI] = [0.64–0.96]), and higher in students who identified as gay or lesbian (OR = 1.70, 95% CI = [1.11–2.61]) or bisexual (OR = 1.52, 95% CI = [1.16–1.99]) than in heterosexual students. The odds of disposable use were higher among students in higher grades (10th, 11th and 12th) than in 9th graders (OR = 1.71, 2.24 and 2.52, respectively). Disposable e‐cigarette users had a lower frequency of traditional cigarette use than other e‐cigarette users, both in the low‐frequency class (incidence rate ratio [IRR] = 0.33, 95% CI = [0.12–0.92]) and the high‐frequency class (IRR = 0.27, 95% CI = [0.08–0.92]).Disposable e‐cigarette use appears to be higher among United States high school students who are female, older and/or identify as gay, lesbian or bisexual. Disposable e‐cigarettes appear to be associated with reduced traditional cigarette use. [ABSTRACT FROM AUTHOR]

Gastro-oesophageal reflux disease (GORD) is recognized by symptoms of heartburn and acid regurgitation. These gastro-oesophageal reflux symptoms (GORS) are common in adults, but data from adolescents are sparse. This study aimed to assess the prevalence and risk factors of GORS among adolescents in a large and unselected population. This study was based on the Trøndelag Health Study (HUNT), a longitudinal series of population-based health surveys conducted in Nord-Trøndelag County, Norway. This study included data from Young-HUNT4 performed in 2017–2019, where all inhabitants aged 13–19 years were invited and 8066 (76.0%) participated. The presence of GORS (any or frequent) during the past 12 months and tobacco smoking status were reported through self-administrated questionnaires, whereas body mass index (BMI) was objectively measured. Among 7620 participating adolescents reporting on the presence of GORS, the prevalence of any GORS and frequent GORS was 33.2% (95% confidence interval [CI] 32.2 − 34.3%) and 3.6% (95% CI 3.2 − 4.0%), respectively. The risk of frequent GORS was lower among boys compared to girls (OR 0.61; 95% CI 0.46 − 0.79), higher in current smokers compared to never smokers (OR 1.80; 95% CI 1.10 − 2.93) and higher among obese compared to underweight/normal weight adolescents (OR 2.50; 95% CI 1.70 − 3.66). A considerable proportion of adolescents had GORS in this population-based study, particularly girls, tobacco smokers, and individuals with obesity, but frequent GORS was relatively uncommon. Measures to avoid tobacco smoking and obesity in adolescents may prevent GORS. [ABSTRACT FROM AUTHOR]

Introduction: Tobacco smoking is one of the 10th leading health indicators proposed by the World Health Organisation (WHO) Healthy People 2020, with major concerns regarding increased mortality rates. Tobacco smoke contains 2.94 mg of nicotine, 802 mg of tar, 145 mg of carbon monoxide, and greater quantities of chrysene. Hookah tobacco poses a serious health threat because of the commonly held belief among college students that this tobacco product is not addictive. Assessing practices represents an important starting point in curbing the spread of tobacco use. It is crucial to understand the use, patterns, and dependence on tobacco to develop appropriate prevention and cessation strategies. Aim: To assess tobacco smoking-related knowledge, attitudes, and practices among students of dental Institutions in Lucknow city, Uttar Pradesh, India. Materials and Methods: A descriptive cross-sectional study was conducted among five dental colleges in Lucknow city from July 2023 to November 2023. A total of 1050 undergraduate dental students were included in the study, and a self-structured, close-ended questionnaire was used to collect information on the knowledge, attitudes, and practices of hookah tobacco. The reliability of the questionnaire was evaluated using Cronbach’s coefficient alpha to measure internal consistency, which was found to be 0.9. Discrete (categorical) data were summarised in numbers (n) and percentages (%). Categorical groups were compared by Chi-square (χ2 ) test. Results: Out of the total 1050 students, 392 (37.3%) were aged between 18-21 years, 630 (60.0%) were aged between 22-25 years, and 28 (2.7%) were aged between 26-30 years. Furthermore, among the students, 355 (33.8%) were females and 695 (66.2%) were males. Among the total of 1050 dental students, the prevalence of hookah smoking was 59.1%. The presence or prevalence of hookah smoking was higher in males (29.4%) at 480 (45.7%) than in females 141 (13.4%), and the difference was statistically significant (χ2 =83.75, p<0.001). Conclusion: The study found that the frequency of hookah smoking continues to increase with the increasing age of the participants. The study also revealed the alarming situation of a high prevalence of hookah smoking among dental college students. [ABSTRACT FROM AUTHOR]

Introduction We quantified the linear trend in combustible tobacco smoking among adolescents in the United States from 2014 to 2020, and then compared these trends across racial and ethnic categories. We also tested the effect of e-cigarette use on these trends for all-youth and across racial and ethnic categories. Aims and Methods We pooled and analyzed seven years of National Youth Tobacco Survey data for n  = 124 151 middle and high school students from 2014 to 2020. Weighted logistic regression analyses calculated the annual change in combustible tobacco smoking (ie cigarettes, cigars, and hookah) from 2014 to 2020. Stratified analyses examined linear trends for non-Hispanic White (NHW), NH-Black (NHB), Hispanic/Latino, and NH-Other (NHO) youth. All-models controlled for sex, grade level, and past 30-day e-cigarette use. Results Combustible tobacco smoking from 2014 to 2020 dropped by more than 50% for NHW youth, more than 40% for Latino and NHO youth, compared to just 16% among NHB youth. From 2014 to 2020, the odds of combustible tobacco smoking declined by 21.5% per year for NHWs, which was significantly greater than Hispanic/Latinos (17% per year; p  = .025), NHOs (15.4% per year; p  = .01), and NHBs (5.1% per year; p  < .001), adjusting for sex, grade, and e-cigarette use. Trends and disparities in trends by race and ethnicity were observed independent of e-cigarette use. Conclusions Combustible tobacco smoking declined for all-youth but at significantly different rates across races and ethnicities. Notably, declines in combustible tobacco smoking are lagging among NHB youth. Interventions are critically needed to address this disparity. Implications A direct, evidence-based intervention to reduce combustible tobacco smoking among NHB youth is critically needed. Such tobacco control initiatives should follow the Best Practices for Comprehensive Tobacco Control Framework, incorporating sustainable funding for school-based intervention, public health education, and adult cessation. [ABSTRACT FROM AUTHOR]

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• This is one of the first studies examined differential pattern and risk factors of NSSI behavior of youth at different developmental stages during the COVID-19 pandemic in China. • The late-adolescent group (age ≥15 - <18) had the highest rate reporting NSSI behavior, while the young-adult group had the lowest rate during the COVID-19 pandemic. • Early-adolescents (age ≥12 - <15) with a poorer help-seeking pattern, lower paternal education level and being female had significantly higher rate of NSSI behavior. • Young adults (age ≥18 - ≤25) with increased smoking, higher maternal education level and lower education level had increased NSSI behaviors. • It is crucial to develop the targeted and personalized intervention strategies on reducing NSSI behavior for youth. [ABSTRACT FROM AUTHOR]

AbstractThailand removed kratom from the list of prohibited substances in 2021, possession and consumption of Kratom is now legal. It is prohibited from selling Kratom to anyone under the age of 18 and/or who is pregnant or breastfeeding. While there are benefits from kratom use with few reported adverse effects, escalating dose and increased use frequency raise the risk for toxic events in the setting of polysubstance use or development of a use disorder. We utilized data from the Behavior Surveillance Survey in Bangkok (n = 5,740) to examine the use of kratom with other substances use in the 12 months before the survey. The prevalence of past-year kratom use among students was 9.3% (95%CI = 8.7–9.9), with higher proportions of males (12.4 versus 6.1%, p < 0.001). The factors associated with past 12-month kratom use were academic performance (Medium GPA; AOR = 2.41, 95% CI = 1.76–3.29; Low GPA; AOR = 4.15, 95% CI = 2.94–5.87), close friend use substance (AOR = 1.94, 95% CI = 1.44–2.59), cannabis use (AOR = 6.84, 95% CI = 4.61–10.15), consumed alcohol (AOR = 2.32, 95% CI = 1.77–3.02), smoked conventional cigarettes (AOR = 4.20, 95% CI = 3.16–5.58), used e-cigarettes (AOR = 4.37, 95% CI = 3.30-5.79) used illicit opioids (AOR = 8.13, 95% CI = 4.35–15.18), and other illicit drug use (AOR = 9.15, 95% CI = 3.78–22.14). These findings may be useful for the initial targeting of efforts to reduce adolescent consumption of kratom. Future studies should examine the effect of regulatory policies or other Thai FDA-related policies use of illicit drugs and e-cigarettes on kratom use. [ABSTRACT FROM AUTHOR]

Introduction: Ferritin has been implicated in body physiology and pathology. Smoking cigarettes (Cg) alters ferritin metabolism. Waterpipe (Wp) smoking has recently reemerged as a global epidemic and is linked to the most devastating diseases. However, the effect of smoking Wp on ferritin is not known. Therefore, the current study compared plasma ferritin in adolescents smoking Cg, Wp, both (CgWp) versus never smoked. Material and methods: Self-reported smoking status and plasma ferritin levels were obtained from 849 boys (n = 470) and girls (n = 379) in the 7th-10th grade (age range = 13-17 years). Results: The ANCOVA revealed a main effect for gender (p < 0.000) and smoking status (p < 0.02) without an interaction effect (p > 0.9). Post-hoc analysis showed greater plasma ferritin in the adolescents smoking Wp (p < 0.03) and CgWp (p < 0.004) versus never smoked. Gender-stratified ANCOVA showed a main effect for smoking status in the boys (p < 0.02) and girls (p < 0.03). Additional comparisons among the boys showed greater plasma ferritin in the Wp (p < 0.006) and CgWp (p < 0.008) smoking groups versus never smoking, without differences (p > 0.5) between Wp and CgWp smoking. Another subgroup comparison showed greater plasma ferritin in the girls smoking Cg (p < 0.02) and CgWp (p < 0.02) versus never smoking, without a difference (p > 0.3) between Cg and CgWp smoking. Conclusions: The results indicate that ferritin is elevated in adolescent smokers, particularly the boys smoking Wp and CgWp and in the girls smoking Cg and CgWp. [ABSTRACT FROM AUTHOR]

This study investigated the relationship between active smoking and nutritional status among male adolescents aged 14-16 years in Kertagena Tengah Village, Kadur District, Pamekasan, Indonesia. A cross-sectional study design was employed, and a total of 55 adolescents were included using a total sampling technique. Smoking status was assessed using standardized questionnaires, while nutritional status was determined using anthropometric measurements, including body mass index (BMI). The study found that 76% of the adolescents were active smokers, with 69% of them being classified as undernourished. A significant relationship was observed between active smoking and poor nutritional status (p=0.018). The main contributing factors to poor nutritional status included an unbalanced diet, lack of access to nutritious food, and high smoking rates among adolescents. Smoking was found to reduce appetite and interfere with nutrient absorption, exacerbating nutritional deficiencies. The study highlights the urgent need for comprehensive public health interventions, including health education, stricter regulation of cigarette sales to minors, and community support to create a smoke-free environment. Future research should include longitudinal studies to clarify the causal link between smoking and nutritional status, broaden demographic coverage, and incorporate qualitative methods to explore the social and cultural influences on adolescent smoking.

AbstractEach year, the average age of new smokers decreases in Indonesia, and at least one student in the classroom is a smoker. However, previous literature on adolescent smoking that focused on emotion and peer relationship remains largely underexplored. This study aimed to examine the effects of the antecedent and moderator variables of empathic concern on altruistic motivation in context of adolescent smoking prevention. We designed a school-based smoking cessation program as a social marketing intervention tool to influence high-school student behavior using a testimonial video. A simulation with a hypothetical scenario was conducted to observe students’ reactions to the stimulus. Participants were exposed to a testimonial video of a young person who has suffered because of smoking, and were asked to imagine such consequences happening to their own peers. The program development started in June 2022, and was implemented in August-September 2022. A total 78 students from two experimental studies was participated. We use ANOVA to test the effect of stimuli on empathic concern and regression analysis to test the effect of empathic concern on altruistic motivation. This study found that salience of the need (light vs. severe condition) and attachment style (secure vs. Insecure) significantly affect student empathic concern. Simultaneously, empathic concern also significantly affected altruistic motivation, and no significant interaction effect was reported. In addition, the result also suggest that the affective approach is more effective in affecting empathic concern and altruistic motivation than the cognitive approach. The implications of this research suggest that schools, as organizations, can utilize a multimedia approach (e.g., video testimonials) to design comprehensive social marketing programs focused on peer relationships.

There is a lack of robust research investigating the association between neurocognitive impairments and chronic tobacco smoking in adolescents/young adults. Therefore, a systematic review and meta-analysis were conducted to examine this association by pooling cross-sectional studies published from 1980 to 2023. The systematic review assessed the neurocognitive performances between chronic tobacco smokers and nonsmokers in each study. The meta-analysis included six studies that compared chronic tobacco smokers against non-smokers using neuropsychological tests covering three neurocognitive domains. The results showed a cross-sectional association between impairpments in motor impulsivity across two aspects: reaction delay and incongruent errors, with the effect size being (SDM = 0.615, p = 0.000) and (SDM = 0.593, p = 0.000) respectively. However, no significant associations were found for intelligence (SDM = 0.221, p = 0.425) or working memory (SDM = 0.150, p = 0.581). This study highlights the need for further research to explore a greater number of neurocognitive domains in the context of chronic smoking in adolescents/young adults, particularly motor impulsivity, intelligence and working memory, as well as the socioeconomic factors involved. There is also a need to further study the effects of emerging alternative nicotine administration methods in this age group. [ABSTRACT FROM AUTHOR]

Background: Past year, month, and lifetime adolescent e-cigarette use rates remain persistently high, despite falling cigarette use rates. Previous investigations have noted a strong relationship between an individual's positive and negative cognitions related to a behavior, and subsequent initiation of that behavior. Objective: This investigation was conducted to determine the impact positive and negative explicit and implicit cigarette-related cognitions may have on the use of cigarettes and e-cigarettes among at-risk, cigarette-naive adolescents. Methods: A three-year longitudinal investigation evaluated the relationship between cigarette-related cognitions and subsequent cigarette and e-cigarette use among 586 alternative high school students (female: 50.8%; mean age: 17.4 years; Hispanic/Latino: 75.0%) who had never smoked cigarettes at the baseline assessment. Multilevel logistic regression models were used to generate demographics-adjusted odds ratios (OR) and 95% confidence intervals (95% CI). Results: Students with higher positive explicit cigarette cognitions at the baseline had greater odds of subsequent cigarette use (OR = 1.72, 95% CI 1.11–2.68). If students also reported an increase over time in positive (OR = 3.45, 95% CI 2.10–5.68) or negative (OR = 1.93, 95% CI 1.03–3.61) explicit cigarette cognitions, the odds of cigarette use increased. The odds of dual use of cigarettes and e-cigarettes were greater among students who had higher negative implicit cigarette cognitions at the baseline (OR = 2.07, 95% CI 1.03–4.17) compared to those with lower levels of negative implicit cognitions. Conclusion: Prevention programming that focuses on decreasing positive cognitions related to nicotine and tobacco use may have greater overall effect on decreasing use compared to programs that only focus on increasing negative cognitions individuals form surrounding cigarette or e-cigarettes. [ABSTRACT FROM AUTHOR]

The article discusses the role of dental professionals in tobacco intervention and the importance of providing tobacco cessation counseling to patients. It highlights the harmful effects of tobacco use on oral health, including oral cancer, periodontal diseases, and birth defects. The article emphasizes the need for dentists to play a role in tobacco control initiatives and raise awareness about the risks of tobacco use. It also mentions the efforts of the Indian Dental Association in setting up Tobacco Control & Cessation Centers and providing training to dentists in tobacco cessation. [Extracted from the article]

Aims: The Coronavirus Disease of 2019 pandemic has negatively affected human life all over the world. The current study aims to evaluate the perceptions and attitudes of medical students regarding the pandemic while raising awareness about the pandemic's social, economic, psychological, and academic reflections. Methods: The research data were obtained through a questionnaire administered to 371 medical students and literature reviews. The questionnaire was administered through Google Forms. While preparing the questionnaire, the Scale of Evaluation of Perceptions and Attitudes towards the Coronavirus Disease of 2019 outbreak was used. Results: It was found that male students and smokers viewed the disease as more dangerous, while female students presented avoidance behaviors more commonly. Students in the pre-clinical years tended to attribute the pandemic to conspiratorial and environmental reasons more than students in the clinical years. Second- and fourth-year students had higher avoidance behaviors than first-year students. Students who experienced the disease had higher scores in perception sub-dimensions, while students whose relatives had Coronavirus Disease of 2019 were more prone to avoidance behaviors. Conclusion: It was determined that the Coronavirus Disease of 2019 pandemic affected students' mental well-being negatively and that the students' perception of disease, cause, control, and avoidance behaviors differed according to factors such as gender, smoking status, grade, and experiencing the disease. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effectiveness of a school‐based multiple health behaviour change e‐health intervention for modifying risk factors for chronic disease (secondary outcomes). Study design: Cluster randomised controlled trial. Setting, participants: Students (at baseline [2019]: year 7, 11–14 years old) at 71 Australian public, independent, and Catholic schools. Intervention: Health4Life: an e‐health school‐based multiple health behaviour change intervention for reducing increases in the six major behavioural risk factors for chronic disease: physical inactivity, poor diet, excessive recreational screen time, poor sleep, and use of alcohol and tobacco. It comprises six online video modules during health education class and a smartphone app. Main outcome measures: Comparison of Health4Life and usual health education with respect to their impact on changes in twelve secondary outcomes related to the six behavioural risk factors, assessed in surveys at baseline, immediately after the intervention, and 12 and 24 months after the intervention: binge drinking, discretionary food consumption risk, inadequate fruit and vegetable intake, difficulty falling asleep, and light physical activity frequency (categorical); tobacco smoking frequency, alcohol drinking frequency, alcohol‐related harm, daytime sleepiness, and time spent watching television and using electronic devices (continuous). Results: A total of 6640 year 7 students completed the baseline survey (Health4Life: 3610; control: 3030); 6454 (97.2%) completed at least one follow‐up survey, 5698 (85.8%) two or more follow‐up surveys. Health4Life was not statistically more effective than usual school health education for influencing changes in any of the twelve outcomes over 24 months; for example: fruit intake inadequate: odds ratio [OR], 1.08 (95% confidence interval [CI], 0.57–2.05); vegetable intake inadequate: OR, 0.97 (95% CI, 0.64–1.47); increased light physical activity: OR, 1.00 (95% CI, 0.72–1.38); tobacco use frequency: relative difference, 0.03 (95% CI, –0.58 to 0.64) days per 30 days; alcohol use frequency: relative difference, –0.34 (95% CI, –1.16 to 0.49) days per 30 days; device use time: relative difference, –0.07 (95% CI, –0.29 to 0.16) hours per day. Conclusions: Health4Life was not more effective than usual school year 7 health education for modifying adolescent risk factors for chronic disease. Future e‐health multiple health behaviour change intervention research should examine the timing and length of the intervention, as well as increasing the number of engagement strategies (eg, goal setting) during the intervention. Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12619000431123 (prospective). [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the prevalence rate and assess knowledge and attitudes among secondary students in Sulaimani city. Methods: A cross-sectional study was conducted among school students, from eight randomly selected secondary schools in Sulaimani city, Iraq. 1200 students participated in this study during six months from October 2022 to April 2023. The respondents were explained about each section of the questionnaire form. It describes behaviors, knowledge, beliefs, opinions, and other variables related to tobacco use. Results: The prevalence rate of current tobacco use (all types) is 21.8%, from this rate; 13.2% were cigarette smoking, 11.9% waterpipe, 24.7% used electronic smoke such as vape and pods and 50.2% of students used all types of tobacco product. The prevalence rates of tobacco use in males (31.3%) and females (12.1%). The rates were higher among students whose mother and father, schoolmates, relatives, and friends were smokers than those whose parents, schoolmates, relatives, and friends were non-smokers. A higher rate of smokers have not thought about the harmful of other people's cigarettes on them, 16.7%, 25%, 9.9%, and 4.8% of smokers have not thought definitely, probably not, probably yes, and definitely yes. Regarding the attitude of the smokers, it showed statistically that there were significant associations for example only 6.6% of smokers were with the banning of smoking in public places while 21.7% of them were with not banning smoking in public places. Conclusions: Despite the prevalence rate of smoking in Sulaimani City being relatively lower than in other cities in Iraq the rate is still high. The rate was higher in males than females. In addition, there were factors connected with smoking initiation which are parents, schoolmates, relatives, and friends smoking. A higher rate of smokers did not think about the harmful of other people's cigarettes to them and a lower rate of smokers were with the banning smoking in public places. [ABSTRACT FROM AUTHOR]

The study aimed to explore prevalence, risk factors, and intervention approaches related to adolescent smoking in Pakistan. Databases included PubMed, Scopus, Embase, Google Scholar, and ProQuest. Studies were selected on Pakistani adolescents aged 10-21 years, original or secondary articles published in English, and the use of qualitative and quantitative methods. Out of 1300 articles, 300 duplicates were removed. After reviewing titles and abstracts, 980 records were excluded. The full text of the 18 remaining studies was reviewed based on inclusion criteria, with 13 eligible studies included. Data extraction included author, age, setting, design, sample, theory, prevalence, risk factors, findings, and appraisal. Ten eligible studies reported varying prevalence rates of adolescent smoking in Pakistan, ranging from 09% to 61.14%. Individual risk factors associated with smoking included disposition, mood, and substance abuse. Social risk factors included family and peer influences, including father's smoking status, family members' tobacco use, and peer pressure. Environmental risk factors, including attendance at a public school, school-related pressure, exposure to tobacco use on social media, and lower socioeconomic status, significantly increased the likelihood of smoking among adolescents. Three studies evaluating prevention and intervention approaches demonstrated positive outcomes, including increased awareness of smoking harms, attitude shifts, and increased intention to quit smoking. This scoping review identified the influence of individual, social, and environmental risk factors on adolescent smoking. Educational interventions showed positive results on knowledge and attitude; however, none specifically focused on smoking cessation. Future research should focus on addressing these risk factors and implementing theory-guided interventions. [ABSTRACT FROM AUTHOR]

Background: The positive association of health with education level and socioeconomic status (SES) is well-established. Two theoretical frameworks have been delineated to understand main mechanisms leading to socioeconomic health inequalities: social causation and health selection but how these work in adolescence is poorly known. We studied if adolescent health and health behaviours predict higher education and higher SES in adulthood and if family background and school performance in adolescence explain these associations. Methods: Surveys on health and health behaviours were sent to representative samples of 12–18-year-old Finns in 1981–1997 every second year (response rate 77.8%, N = 55,682). The survey data were linked with the respondents' and their parents' socioeconomic data from the Finnish national registries. Both latent variables, namely, health (perceived health, health complaints, chronic disease), health-compromising behaviours (smoking status, drunkenness frequency), and family background (parents' occupation-based SES, education, family type) and variables directly measuring health-enhancing behaviours (toothbrushing, physical activity) and school performance were used to predict higher education and higher occupation-based SES at age 34. Logistic regression analysis and structural equation models (SEM) were used. Results: In logistic regression analyses, good health, health-enhancing behaviours, and lack of health-compromising behaviours were related to higher education and SES, also after controlling for family background and school performance. In the SEM analyses, good health, health-enhancing behaviours, and lack of health-compromising behaviours directly predicted higher SES and higher education, although the standardised coefficients were low (from 0.034 to 0.12). In all models, health, lack of health-compromising behaviours, and health-enhancing behaviours predicted school performance, which in turn, predicted the outcomes, suggesting indirect routes to these. Good socioeconomic prospects in terms of family background predicted good health, healthy behaviours, and good school performance in adolescence and higher SES and higher education in adulthood. Conclusion: Health and health behaviours in adolescence predicted education and SES in adulthood. Even though the relationships were modest, they support the health selection hypotheses and emphasise the importance of adolescence for health inequalities during the life-course. Health and health behaviours were strongly associated with school performance and family background which together modified the paths from health and health behaviours to the outcomes. [ABSTRACT FROM AUTHOR]

Background: Despite the widespread prevalence of adolescent smoking in Gambia, a West African country, there is limited research exploring the relationships between exposure to pro-tobacco and anti-tobacco media messages and events and smoking behaviour among young people. This study investigates the interplay of these exposures and smoking behaviour among 11-17-year-old adolescents in Gambia. Methods: Secondary data analysis was conducted using the 2017 Gambia Global Youth and Tobacco Survey (GYTS), which included a total of 9,127 respondents. Descriptive and inferential analyses, including proportions, Pearson's chi-squared tests, and multivariable logistic regression models, were employed to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results: The final model revealed significant associations between exposure to anti-tobacco media messages and events and smoking behaviour. Adolescents exposed to anti-tobacco media messages had a 29% increased odds of smoking (aOR 1.29,CI = 1.08,1.53) compared to those unexposed, while exposure to anti-tobacco media events showed a 31% increased odds (aOR 1.31,CI = 1.09,1.59) compared to those unexposed. Exposure to pro-tobacco messages, such as witnessing tobacco use on TV (aOR 1.41, CI = 1.17,1.69) and owning objects with tobacco brand logos (aOR 1.49,CI = 1.19,1.86), was associated with higher odds of smoking. Covariates, including sex, age, and exposure to smoking behaviour by significant others, also demonstrated associations with smoking behaviour. Notably, male respondents showed significantly higher odds of smoking (aOR = 4.01,CI = 3.28,4.89) compared to females. Respondents aged 15 years and older had increased odds of smoking (aOR = 1.47,CI = 1.22,1.76) compared to those below 15 years old. Those whose fathers smoke displayed higher odds of smoking (aOR = 1.35, CI = 1.04,1.76) compared to individuals with non-smoking parents. Additionally, those whose closest friends smoke showed remarkably higher odds of smoking (aOR = 2.87,CI = 2.37, 3.48) compared to those without such influence. Conclusion: This study underscores the significant impact of exposure to both anti-tobacco and pro-tobacco media messages and events on smoking behaviour among adolescents in Gambia. However, pro-tobacco messages had a greater influence on smoking prevalence than anti-tobacco messages and events. Understanding these associations is crucial for devising effective public health interventions aimed at reducing tobacco use in this population. [ABSTRACT FROM AUTHOR]

This study aimed to assess the level of knowledge among students regarding the smoke-free campus concept at a university in Izmir and evaluate their perspectives on its implementation. A cross-sectional study was conducted during the 2022-2023 academic year, involving 486 students at a university in Izmir. Participants completed an online questionnaire, which gathered data on their sociodemographic characteristics, smoking status, and their attitudes toward the smoke-free campus initiative. Among the participants, 50.6% were female, and the median age was 20 years. Approximately 35% of students were smokers. Notably, 55.1% of participants had never heard of the smoke-free campus concept. Non-smokers were significantly more likely to report being "exposed to passive smoking," feeling "disturbed by it," and acknowledging the health risks associated with passive smoking. Students who smoked exhibited lower support for switching to a smokefree campus," perceiving it as "discriminatory practice." Approximately 54.9% of students believed that "student participation in creating a smoke-free campus would impact its success," and 91.8% agreed that "student opinions should be considered when determining smoke-free campus policies." The study reveals an inadequate level of knowledge among students regarding the smoke-free campus concept, with a considerable portion being unaware of its existence. [ABSTRACT FROM AUTHOR]

Prior research has predominantly focused on the overall effects of the tobacco tax increase and the COVID-19 pandemic on adolescent smoking behavior. However, there is a need to examine both the immediate and sustained associations of these two factors on subgroups of adolescents, employing an interrupted time-series model. We aimed to investigate the immediate and sustained association of tobacco tax increase and the COVID-19 pandemic on adolescent smoking prevalence. This study utilized data from the Korea Youth Risk Behavior Web-Based Survey to analyze the prevalence of current smoking among all participants (CSP) and the prevalence of daily smoking among current smokers (DSP) of Korean adolescents (n = 1,159,995; mean, age 14.99; male 51.5%) over 18 years from 2005 to 2022. The study examined 18-year trends in CSP and DSP among Korean adolescents, emphasizing the influences of the 2015 tobacco tax increase and the COVID-19 pandemic, using β coefficients and their differences (βdiff) from an interrupted time-series ARIMA model. While CSP exhibited a decreasing trend, DSP exhibited an increasing trend. Tobacco tax increase was associated with both the short and long terms in smoking prevalence, however, the short-term association on prevalence (CSP, − 3.076 [95% CI, − 3.707 to − 2.445]; DSP, − 4.112 [95% CI, − 6.488 to − 1.735]) was stronger. The pandemic was associated with an immediate increase in DSP (9.345 [95% CI, 5.285–13.406]). These effects were strongest among adolescents from low economic status and those exposed to familial secondhand smoking. Supportive programs for adolescents in low-income families will help overcome the effects associated with the pandemic. As a tobacco tax increase was associated with a reduction in smoking prevalence, this could be one method to overcome the effects of the pandemic. [ABSTRACT FROM AUTHOR]

Background and Aims: The present study was conducted with the aim of investigating the relationship between health‐promoting lifestyle profile (HPLP) among medical students and contextual factors such as gender, age, field of study, academic level, marital status, history of physical and mental illnesses, and smoking. Methods: The present research was conducted in a cross‐sectional method in 2021 on 500 students of Shiraz University of Medical Students. An e‐questionnaire link was sent to them via email. The research tool was the HPLP questionnaire consisting of 52 questions in six domains in a 4‐point Likert scale. Data were analyzed using SPSS software version 24 with one‐sample t‐test, independent t‐test, analysis of variance, and Tukey's post hoc test. Results: A total of 500 students fully answered the questions completely. All components of a healthy lifestyle—except for exercise—obtained a score higher than the cut‐off point. The component of Self‐Actualization (spiritual growth) (3.035 ± 0.68) had the highest score, while the lowest score was related to exercise and physical activity (2.126 ± 0.60). Married individuals had a better average health score compared to singles (p = 0.047). The average health score did not have a significant relationship with gender, but significantly related to age, field of study (p < 0.001), history of mental illnesses (p < 0.001) and Smoking (p < 0.001). Conclusion: It seems that university officials should pay more attention to the health domain of students' lifestyles, such as nutrition, the development of exercise and physical activities, and the management of stress and mental health. Additionally, providing necessary awareness and considering training courses, as well as developing sports and recreational facilities, can be effective in creating a better environment for the growth and development of students and ensuring their well‐being. [ABSTRACT FROM AUTHOR]

Background: Smoking remains a major risk factor for the development and progression of chronic obstructive pulmonary disease (COPD). Due to the adolescent smoking associated with worse health state, the age, at which an individual started smoking, might play a key role in shaping the trajectory of COPD development and the severity. Methods: We conducted an observational study from September 2016 through January 2023 of eligible patients hospitalized with COPD. Patients who started smoking during the alveolar development stage (ADS, smoking initiation ≤ 24 years old) were defined as early smoking patients, and patients who started smoking after ADS (smoking initiation > 24 years old) were defined as late smoking patients. We collected demographic and clinical data characterizing the patients and documented their condition from hospital discharge to follow-up. The primary endpoints were short-term (within one year), 3-year, and long-term (beyond 3 years) all-cause mortality after discharge. Results: Among 697 COPD patients, early smoking patients had a lower smoking cessation rate (P < 0.001) and a higher smoking index (P < 0.001) than late smoking patients. Although adjusted smoking index, early smoking patients still had poorer lung function (P = 0.023), thicker left ventricular diameters (P = 0.003), higher frequency of triple therapy use during stable stage (P = 0.049), and more acute exacerbations in the past year before enrollment (P < 0.05). Survival analysis showed that they had a higher risk of death after discharge within three years (P = 0.004) and beyond three years (P < 0.001). Furthermore, even in early smoking COPD patients who quit smoking after adjusting the smoking index had poorer lung function (P < 0.05) and thicker left ventricular diameters (P = 0.003), and survival analysis also showed that they had a higher long-term mortality rate (P = 0.010) and shorter survival time (P = 0.0128). Conclusion: Early smoking COPD patients exhibited multiple adverse clinical outcomes, including heavy cigarette addiction, compromised pulmonary function, augmented left ventricular diameter, and elevated mortality risk. Additional, smoking cessation could not bring enough improvement of health state in early smoking COPD patients as late smoking COPD patients. Consequently, early intervention and specialized cessation approaches for younger smokers are of paramount importance in this context. [ABSTRACT FROM AUTHOR]

Introduction: This study elucidates the complex journey of adolescents toward smoking cessation, investigating the association of relevant demographic factors, advertising, promotion, anti-cigarette messages, and individual knowledge and attitudes with being in different smoking cessation stages. Methods: Utilizing data from the 2019 Indonesia Global Youth Tobacco Survey, this secondary analysis included adolescents who reported ever smoking. The Transtheoretical Model (TTM) guided the categorization of the outcome variable into three smoking cessation stages based on the responses to two questions related to the intention and timing of the smoking cessation. This included contemplation, action, and maintenance stages. Multinomial logistic regression analyzed the associations between each independent variable and being in each stage of smoking cessation. The study comprised 3596 Indonesian adolescents from grades 7-12, of which 2484 responded to two questions related to intention and timing of smoking cessation and were included in regression analysis. Results: Findings indicate that males and those aged ≥16 were predominantly in contemplation phase. Early smoking initiation, usage of other tobacco products, and exposure to various forms of smoke increased the likelihood of being in contemplation and action phases. Parental smoking, school smoking exposure, and second-hand smoke were significant contemplation phase predictors. Exposure to tobacco advertising was linked to an increased likelihood of being in contemplation and action phases, whereas anti-cigarette messages showed no significant impact. Awareness of cigarette and second-hand smoke harms reduced the odds of being in the contemplation phase, while enjoying smoking and willingness to accept cigarettes from friends increased the odds of being in contemplation and action phases rather than in maintenance phase. Conclusion: Addressing age, gender, cultural influences, environmental factors, and attitudes towards smoking through tailored interventions is vital for aiding smoking cessation in Indonesian adolescents. Strengthened tobacco control in schools and public places is recommended to bolster these efforts. Longitudinal studies are required to explore the evolving patterns of smoking cessation behaviors over time, enhancing our understanding of the factors influencing sustained cessation. [ABSTRACT FROM AUTHOR]

The issue of smoking is becoming progressively genuine, both for dynamic smokers and individuals around them who don’t smoke (detached smokers). The cause of smoking among youngsters is expanding, due to the expanding concentration of publicizing, particularly portraying smoking as cool, and cheap cost of cigarettes. Cross-sector participation in dealing with KTR in schools is vital since execution is way better with cross-sector commitment and participation. The resultant information is considered to be exceptionally compelling and critical in changing students’ states of mind and practices regarding the threats of smoking, that is to say that, there is a relationship between information and early adolescents’ activities concerning KTR approaches in junior high schools. The method used in the study is in-depth interviews. Results show that companions have the most significant influence on pre-adult smoking behavior compared to mass media and peers. A few of the deterrents that exist within the bureaucratic structure, division of specialists, and extraordinary controls in a few schools in Bener Meriah have not been completely shaped, agreeing to Qanun number 1 of 2018 with respect to non-smoking zones in schools that still need to be moved forward. The study recommends more studies to be conducted on high-school students or young people who don’t go to school since their level of autonomy and social designs are distinctive from those that are in universities and colleges. [ABSTRACT FROM AUTHOR]

Cigarette smoking, as a significant public health problem worldwide, deserves more attention. This research intended to assess the prevalence rate of smoking among college students self-identified as lesbian or gay, examine whether depression mediated the association between social support and smoking, and explore whether disclosure moderated the indirect effect of the mediation model. All data were collected by online questionnaires, yielding a total of 1,109 homosexual college students involved in the analysis. A moderated mediation analysis was adopted to uncover the connection between social support, depression, and cigarette smoking, with disclosure as the moderator. The prevalence of smoking was 7.4%, and lesbian females (12.5%) were more likely to report smoking than gay males (5.2%). Depression fully mediated the effects of social support on cigarette smoking (coefficient ab = −0.0097, 95% Boot CI: −0.0174 to −0.0029), accounting for 97.0% of the total effect. Further moderated mediation analyses revealed the indirect effect of depression was statistically significant in both disclosed (effect = 0.0737, 95% Boot CI: 0.0005 to 0.1502) and non-disclosed groups (effect = −0.0109, 95% Boot CI: −0.0183 to −0.0039). The prevalence of smoking among homosexual college students in China should not be neglected, especially among lesbian students. Interventions, such as encouraging greater disclosure and expanding social support, may help break the link between depression and smoking. [ABSTRACT FROM AUTHOR]

Methods: Data from two surveys (2019, n=2096, and 2020, n=1606) of a student cohort in private high schools in Guatemala City was used. Logistic models for past 30-day cigarette, e-cigarette, marijuana, and alcohol (including binge drinking) were used, regressing these on survey wave, while adjusting for sex, scholastic performance, high school year of student, parental education, substance use, and household member tobacco use. Results: Prevalence declined for smoking (10% to 3%, p<0.001), e-cigarette (31% to 14%, p<0.001), marijuana (4.3% to 1.9%, p<0.001), and alcohol use (47% to 38.5%, p<0.001), and binge drinking (24% to 13%, p<0.001). Adjusted models showed wave 2 associated with lower odds of using cigarettes (AOR=0.44, 95% CI=0.32-0.62), e-cigarettes (AOR=0.41, 95% CI=0.35-0.49, p<0.001), and binge drinking (AOR=0.73, 95%CI=0.59-0.89; p=0.002) Conclusion: Among Guatemalan adolescents, COVID-19 restrictions were associated with a significant decrease in smoking, e-cigarette use, and binge drinking. [ABSTRACT FROM AUTHOR]

Background: Most adult smokers started smoking in their teenage years, which increases the risk of nicotine dependence. In Denmark, there is a high prevalence of youth smoking among students in Vocational Education and Training (VET). However, reducing and preventing smoking in this group is a major challenge. This article presents a needs assessment aimed to explore factors sustaining legitimacy of smoking in VET schools and consider the measures needed to prepare VET schools' implementation of smoking reduction and prevention interventions. Methods: Participant observations were conducted in four VET classes representing three VET schools in Denmark with a duration of four days each. Individual, semi-structured interviews were conducted with teachers, managers, and a student advisor, as well as four focus groups with a total of 20 students. Interviews were audio-taped, transcribed, and the data material was analyzed following Malterud's systematic text condensation. Findings: Factors that helped sustain legitimacy of smoking in VET schools included a positive and normalized attitude towards smoking at home and among friends, an understanding of smoking as an integral and expected practice in VET professions and schools, a perceived reliance on smoking as an icebreaker in new social relations and as a pedagogical tool, and smoking as a habit and a means to deal with boredom and stress relief. Conclusions: The factors sustaining legitimacy of smoking in VET schools are reciprocal and call for smoking reduction and prevention intervention efforts which consider and address social influence, habitual behavior, and psychological needs, as well as changes at the policy level. [ABSTRACT FROM AUTHOR]

Background: The present research aimed to determine the effect of an educational intervention based on the extended theory of planned behavior (ETPB) on waterpipe (WT) smoking cessation in women. Methods: The present quasi-experimental had a pre-test, post-test design with 3, 6 and 12 months follow-ups was conducted in Bandar Abbas city, south of Iran in December 2021-March 2023. A total of 448 women over the age of 15 (224 in the intervention group (IG), 224 in the control group (CG)), using a two-stage cluster sampling method participated. The educational intervention focused on WT smoking cessation implemented in 14 sessions. The educational methods in the training sessions were lectures, collaborative discussions, Q&As, brainstorming, role plays, and peer education. The main outcome was WT cessation behavior. Repeated measures ANOVA tests and post hoc were run to compare the IG and CG at baseline in terms of demographic variables, t-test and chi square test, and in the four points of time of data collection. The data were analyzed in Stata14. A p-value < 0.05 was considered as statistically significant. Results: The mean and standard deviation of WT cessation behavior and all ETPB constructs in the IG was significantly higher than the CG. After the educational intervention, in the IG, the perceived behavioral control, attitude, subjective norm, intention and knowledge increased, and the weekly smoking and WT smoking habit decreased (P < 0.001). The CG did not have any significant change in other variables except for the increased knowledge score. During the 12-month follow-up, the cessation rate was 43.81% (P = 0.645) in the IG and 7.45% in the CG (P = 0.081). Conclusions: The educational intervention positively affected WT smoking reduction and cessation in women through influencing the ETPB constructs. It is strongly recommended to design theory-based interventions beyond the individual level with an emphasis on interpersonal relationships to facilitate WT cessation as far as possible. [ABSTRACT FROM AUTHOR]

Psychedelics can profoundly alter cognition and consciousness. Their use in Middle Eastern countries, including Iraq, is ambiguous. We aim to investigate psychedelic awareness and use among Iraqi and Polish medical students. We surveyed 739 university students from Poland (315) and Iraq (424) using 31 adapted questions from the European School Survey Project on Alcohol and Other Drugs (ESPAD). We conducted multivariable analyses based on binary logistic regression to identify the factors associated with psychedelic awareness and use. Most of the respondents were females (65.6%) and senior medical students (69.6%). Notably, the Polish students displayed a higher prevalence of psychedelic use (21.6% compared to 1.2%, p < 0.001), while the Iraqi participants exhibited a lower familiarity with psychedelics (p < 0.001). The multivariable model demonstrated a commendable level of statistical accuracy and satisfactorily conformed to the Hosmer–Lemeshow goodness-of-fit test (statistical accuracy = 91.61%, Nagelkerke R2 = 0.488, p-value = 0.848). Several factors emerged as correlates of increased psychedelic use, including lacking an intact religious belief system or commitment to its practice (OR = 7.26, 95% CI [2.33, 22.60]). Additionally, those who perceived a low risk associated with sporadic psychedelic use (3.03, [1.44, 6.36]) were likelier to engage in such behavior. Other factors included residing in Poland (2.82, [0.83, 9.55]), maintaining positive attitudes toward psychedelics (2.49, [1.20, 5.14]), frequent social nightlife activities (2.41, [1.26, 4.61]), male gender (2.05, [1.10, 3.85]), and cigarette or tobacco smoking (2.03, [1.06, 3.86]). Significant disparities exist between Poles and Iraqis, influenced by religiosity, perceptions of the usage risks, geographical location, gender, attitudes toward psychedelics, parental leniency, and social freedom, especially concerning nightlife activities. Addressing the factors influencing psychedelic usage is paramount to responsible psychedelic engagement and culturally sensitive interventions to prevent misuse. [ABSTRACT FROM AUTHOR]

Objectives: To explore the relationship between cumulative ecological risk and individual risky behavior and multiple forms of aggregated behaviors among adolescents, and examine the gender differences. Methods: A large-scale, nationally representative, and students-based investigation was conducted in rural and urban areas of eight provinces in China from October to December 2021. A total of 22 868 adolescents with an average age of 14.64 years completely standardized questionnaire in which the sociodemographic characteristics, socio-ecological risk factors and risky behaviors were used to analyze. Results: Of included students, 48.4% encountered the high level of social-ecological risk. The prevalence of breakfast intake not daily, alcohol use (AU), smoking, physical inactivity, prolonged screen time (ST) on weekdays and weekends, suicidal ideation, suicidal plan, suicidal attempt, and non-suicidal self-injury (NSSI) was 41.0%, 11.9%, 3.4%, 61.9%, 15.1%, 51.1%, 27.7%, 13.9%, 6.5% and 27.0% respectively. 22.2% of participants engaged in high-risk behaviors. All were significantly influences of increased cumulative ecological risk on individual behavior and low-risk clustering behaviors separately. The odds ratio of breakfast intake not daily, AU, smoking, physical inactivity, prolonged ST in weekday and weekend, suicidal ideation, suicidal plan, suicidal attempt, and NSSI for the adjusted model in low versus high level of cumulative ecological risk was respectively significant in both boy and girls, and the ratio of odds ratios (ROR) was separately 0.95 (p = 0.228), 0.67 (p < 0.001), 0.44 (p < 0.001), 0.60 (p < 0.001), 0.78 (p = 0.001), 0.83 (p = 0.001), 0.80 (p = 0.001), 0.83 (p = 0.022), 0.71 (p = 0.005), 0.75 (p = 0.001). Girls encountering a high level of cumulative ecological risk were more likely to engage in multiple forms of clustering risky behaviors than boys (RORs: 0.77, p = 0.001). Conclusions: Research and effective inventions at the social-ecological environment, based on the view of cumulative risk, are needed to promote the healthy development of behaviors in adolescence, and pay more attention to decreasing the occurrence of risky behaviours in girls than boys. [ABSTRACT FROM AUTHOR]

Background: Substance abuse remains a challenging public health issue, especially among young people. It has been shown that poor sleep and substance abuse may have mutual intensifying effects. This study aimed to evaluate the rates of substance abuse, cigarette smoking, and alcohol consumption and their association with sleep disturbances among university students in 2021. Methods: The participants were the students of the Faculty of Sciences, University of Guilan, Iran in 2021. Data were collected through a researcher-made demographic questionnaire, the first two questions of the translated version of the World Health Organization (WHO) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and the Pittsburgh Sleep Quality Index (PSQI). Findings: A total of 222 students entered the study from March to August 2021. The rates of substance abuse in the past three months and lifetime were 35.6% and 45.5%, respectively. The most common type of substance abuse was related to the 'other substances' category. Substance abuse was significantly higher in students living in dormitories and those with a family history of substance abuse. Poor sleep was found in 34.2% of the students, and substance abuse and alcohol consumption both in the past three months and lifetime were significantly associated with lower sleep quality. Conclusion: This study showed that substance abuse was significantly associated with sleep disturbances. The study results also illustrated an upward trend of substance abuse in recent years among students in Rasht, which may be related to economic issues in the country and/or the effects of the COVID-19 pandemic. Considering the rising prevalence of substance abuse and its impacts on society, policymakers are highly recommended to pay special attention to its risk factors. [ABSTRACT FROM AUTHOR]