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Introduction: In 2021, among French women who smoked when they knew they were pregnant, 59% still smoked at the end of pregnancy. Support for pregnant women to stop smoking must include a structured organisational perspective. The main objective of the study is to evaluate the effectiveness of the 5A-QUIT-N organisational intervention on smoking cessation at delivery among pregnant women who smoke during pregnancy., Methods and Analysis: The overarching goal of the 5A-QUIT-N intervention, which aims to organise the healthcare professionals monitoring pregnancy, specialists in addiction and tobacco use, and clinical and training tools, using the 5As method. The 5A-QUIT-N intervention will be evaluated in a pragmatic stepped-wedge cluster randomised trial. Within each cluster, during the 6 months before (control) and after (intervention) the intervention, women who smoke tobacco during pregnancy will be enrolled during their maternity stay after delivery. A transition period is planned between the control and intervention periods to deploy the intervention. All participating women will be interviewed using a heteroquestionnaire to assess smoking cessation, tobacco use monitoring by healthcare professionals and individual factors associated with tobacco use during pregnancy. The primary outcome was the point prevalence of abstinence at delivery, which is the proportion of women reporting abstinence from smoking for at least 7 days at delivery. 4200 women who smoked tobacco during pregnancy will be recruited over the entire study period (33 months) to evaluate the effectiveness. An estimated 4585 participants will be included for all aims., Ethics and Dissemination: The study will be implemented in accordance with French regulations. The study including the consent process has been independently reviewed and approved by the French ethical board 'CPP Ile de France I' on 10 February 2022 (No CPPIDF1-2022-DI08-cat.2). The results will be disseminated on various academic and non-academic platforms. The results will be reported in international peer-reviewed journals and presented at international and national conferences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Many people quit smoking during pregnancy, but postpartum smoking relapse is common. Maintaining smoking abstinence achieved during pregnancy is key to improving maternal and child health. There are no evidence-based interventions for preventing postpartum smoking relapse. This trial aims to determine whether an intervention to prevent postpartum relapse is effective and cost-effective., Methods and Analysis: A randomised controlled trial of a complex intervention to prevent postpartum smoking relapse (BabyBreathe), with internal pilot, economic and process evaluations. Participants are adults who are pregnant and who report having quit smoking in the 12 months before, or during pregnancy. Participants are eligible if they read and understand English, and provide informed consent. Following consent and biochemical validation of smoking abstinence, participants are randomised to intervention or usual care/control (no specific relapse prevention support). The BabyBreathe intervention consists of manualised advice from a trained member of the health visiting service, health information leaflets for participants and partners, access to the BabyBreathe website and app. At the time of birth, participants are posted the BabyBreathe box and support is provided by text message for up to 12 months postpartum. Target sample size is 880, recruiting across midwifery services at four hubs in England and Scotland and through remote advertising in England, Scotland, Wales and Northern Ireland. Outcomes are collected at 6 and 12 months. The primary outcome is self-reported sustained smoking abstinence at 12 months, carbon monoxide verified. Secondary outcomes include self-reported abstinence, time to relapse, partner smoking status and quality of life., Ethics and Dissemination: The trial was approved by the North West Preston Research Ethics committee (21/NW/0017). Dissemination will include publication in peer-reviewed journals, presentation at academic and public conferences including patient and public involvement and to policymakers and practitioners., Trial Registration Number: ISRCTN70307341., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Background: Despite the commendable progress made globally in tobacco control, the world is falling short of achieving a 30% relative reduction in current tobacco use by 2025. The African region remains the least in the efforts in fighting the tobacco epidemic and is most exploited by the tobacco industry. Schools have been continuously used for over three decades as a setting for delivering youth smoking prevention programmes; however, the evidence of the effectiveness of those school-based interventions provides varying outcomes. Also, interventions that proved to be effective, in high-income countries (HICs), may not necessarily be effective in the African region as a result of cultural differences and other contrasting factors. An existing systematic review that explored school-based tobacco prevention programmes among the youth in African countries from 2000 to 2016 showed partial effectiveness. This review will address the gap by updating the 2016 review to examine studies in LMICs to generate findings to help target resources which have the potential to save lives by preventing smoking initiation among young people., Methods: The JBI methodology for systematic reviews of effectiveness will guide the conduct of this review. A comprehensive strategic search will be developed to retrieve both published and unpublished studies that evaluate school-based interventions to prevent tobacco smoking initiation among in-school young people in LMICs compared to non-intervention programmes. Published studies would be from databases such as MEDLINE via Ovid, CINAHL via EBSCO, Embase, PsycINFO, PsycEXTRA, and the Cochrane Central Register of Controlled Trials. Sources of grey literature would be ProQuest Dissertations and Theses, MedNar, EBSCO Open Dissertations, Open Access Theses and Dissertations, and Trove. The databases will be searched for published studies in the English language. The processes of study selection, critical appraisal, data extraction, and data synthesis will be in accordance with the JBI approach for reviews of effectiveness with a minimum of two reviewers at each stage. The primary outcome of the review will be the non-initiation of tobacco smoking by the youth., Discussion: The review will provide synthesized evidence on the effectiveness of school-based smoking initiation prevention among young people in LMICs. The findings of the review would support policymakers and programme implementers to develop targeted interventions for effective tobacco control initiatives., Systematic Review Registration: PROSPERO CRD42021246206., (© 2022. The Author(s).)

Background: Tobacco smoking is a leading preventable cause of death and increases perioperative risk. Determinants of smoking abstinence after noncardiac surgery and the association between smoking and 1-yr vascular outcomes are not fully elucidated., Methods: We did a prospective cohort study of 40 004 patients, aged ≥45 yr, enrolled between August 2007 and November 2013, and followed for 1 yr after surgery. Patients were categorised as never smokers, ex-smokers (quit >4 weeks preoperatively), and current smokers (smoking ≤4 weeks preoperatively). Primary outcome was abstinence at 1 yr. Secondary outcome was a composite of all-cause death, non-fatal myocardial infarction, and non-fatal stroke at 1 yr., Results: Of 4658 current smokers, 1838 (39.5%) were abstinent 1 yr after surgery. Median (inter-quartile range) time to resumption was 7 (3-23) days post-surgery. Perioperatively, 7.2% of current smokers obtained smoking cessation pharmacotherapy. Older age (adjusted risk ratio [aRR] 1.21; 95% confidence interval [CI]: 1.12-1.32); having recent coronary artery disease (aRR 1.41; 95% CI: 1.29-1.55); cancer (aRR 1.37; 95% CI: 1.18-1.59); and undergoing major vascular (aRR 1.20; 95% CI: 1.02-1.41), urgent/emergent (aRR 1.14; 95% CI: 1.05-1.23), or thoracic (aRR 1.41; 95% CI: 1.26-1.56) surgeries increased abstinence. One-year abstinence was less likely when patients stopped smoking 0-1 day (aRR 0.53; 95% CI: 0.43-0.66) and 2-14 days (aRR 0.76; 95% CI: 0.71-0.82) before surgery compared with >14 days before surgery. Current smokers (adjusted hazard ratio [aHR] 1.14; 95% CI: 1.01-1.29) and ex-smokers (aHR 1.11; 95% CI: 1.03-1.21) had higher risk of the 1-yr vascular outcome compared with never smokers., Conclusions: Long-term tobacco abstinence is more likely after major surgery in those with serious medical comorbidities. Interventions to prevent smoking resumption after surgery remain a priority. Clinical trial registration NCT00512109., (Copyright © 2022 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Setting: The Indigenous Tobacco Program (ITP) operated by the Indigenous Cancer Care Unit at Cancer Care Ontario provides customized tobacco prevention workshops to First Nations youth across Ontario, in partnership with First Nations communities and partner organizations., Intervention: First Nations youth in Canada are more likely than non-Indigenous youth to be smokers. The ITP aims to address the negative health impacts of commercial tobacco, using culturally relevant approaches, tools and resources while remaining respectful to the significance of sacred tobacco. This paper aims to determine whether a culturally tailored tobacco prevention workshop increases tobacco-related knowledge among First Nations youth in Ontario., Outcomes: The workshops exhibited promise in impacting First Nations youth knowledge on the harms of commercial tobacco, as after the workshop intervention, all indicators showed improved knowledge. Building strong and ongoing relationships with communities and partner organizations is vital to the success of the program., Implications: Culturally tailored workshops grounded in traditional knowledge and values provide an opportunity to increase the knowledge of the harms of commercial tobacco among First Nations youth in Ontario. With commercial tobacco use and exposure having tremendous health consequences, such interventions are essential.

Background and Objective: Low motivation to quit smoking affects individual smoking behavior. Health education using audiovisual media can increase smokers' motivation to quit smoking. The objective of this study was to determine the effectiveness of health education using audiovisuals on the Santri smokers' motivation to stop smoking., Methods: This quasi-experimental study was carried out using a pretest-posttest design. The sample in this study included Santri smokers studying at the Traditional Islamic Boarding School in Aceh Besar . This study consisted of 4 groups. Three groups were given intervention (audiovisual health education with different themes) and one group received just health education. Groups were compered in terms of difference in the mean smokers' motivation to quit smoking. The data analysis was done by running paired t-test and one-way ANOVA., Results: The results of statistical tests showed that there was a difference in the mean motivation to quit smoking before and after the intervention in each group (mean ± SD for group 1 to 4 was 11.52 ± 4.76, 15.39 ± 6.06, 22.57 ± 6.23, and 9.84 ± 6.42, respectively). The highest increase in the mean motivation to quit smoking was allocated to group 3 who received audiovisual health education with the theme of risk of developing cancer due to smoking., Conclusion: Health education using audiovisuals could increase the motivation of students to quit smoking, especially interventions on the risk of developing cancer due to smoking. Therefore, health workers are suggested to use audiovisuals to implement various intervention in order to change smoking behavior in students.

Cigarette smoking among postpartum women remains a significant public health problem despite known health risks to women and their newborns. It is estimated that over 50% of women quit smoking during pregnancy but 90% relapse by one year. Safe and effective postpartum relapse prevention strategies are urgently needed. In an attempt to address this deficit, we will investigate the efficacy of bupropion vs. placebo as a smoking relapse prevention aid in postpartum women. The objective of this paper is to detail an approach to investigate bupropion's efficacy for preventing postpartum smoking relapse among women who quit smoking during pregnancy. Specifically, we designed a two-arm, double-blind, placebo-controlled randomized trial testing the efficacy of bupropion vs. placebo as a relapse prevention tool. Mothers of healthy infants who quit smoking while pregnant will be stratified based on current or past history of major depressive disorder or persistent depressive disorder and randomized to receive either active (bupropion XL 300 mg/day) or placebo medication for 12 weeks. To respond to safety concerns associated with participant and staff exposure to COVID-19, we revised our original protocol and present procedures which allow our trial to be conducted entirely remotely. Primary and secondary outcomes will be assessed at weeks 12, 24, 36 and 52 post-randomization. The primary outcome is 7-day point prevalence abstinence at 24 weeks. Results of this work have the potential to positively impact women and their children by promoting lifelong cessation, eliminating secondhand smoke exposure, and modelling of abstinence to children., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Cue exposure for extinguishing conditioned urges to smoking cues has been promising in the laboratory, but difficult to implement in natural environments. The recent availability of augmented reality (AR) via smartphone provides an opportunity to overcome this limitation. Testing the ability of AR to elicit cue-provoked urges to smoke (ie, cue reactivity [CR]) is the first step to systemically testing the efficacy of AR for cue exposure therapy., Objectives: To test CR to smoking-related AR cues compared to neutral AR cues, and compared to in vivo cues., Methods: A 2 × 2 within-subject design comparing cue content (smoking vs. neutral) and presentation modality (AR vs. in vivo) on urge response. Seventeen smokers viewed six smoking-related and six neutral cues via AR smartphone app and also six smoking and six neutral in vivo cues. Participants rated their urge to smoke and reality/co-existence of the cue., Results: Average urge to smoke was higher following smoking-related AR images (Median = 7.50) than neutral images (Median = 3.33) (Z = -3.44; p = .001; d = 1.37). Similarly, average urge ratings for in vivo smoking-related cues (Median = 8.12) were higher than for neutral cues (Median = 2.12) (Z = -3.44; p = .001; d = 1.64). Also, greater CR was observed for in vivo cues than for AR cues (Z = -2.67, p = .008; d = .36). AR cues were generally perceived as being realistic and well-integrated., Conclusions: CR was demonstrated with very large effect sizes in response to AR smoking cues, although slightly smaller than with in vivo smoking cues. This satisfies the first criterion for the potential use of AR for exposure therapy., Implications: This study introduces AR as a novel modality for presenting smoking-related stimuli to provoke cue reactivity, and ultimately to conduct extinction-based therapy. AR cues presented via a smartphone have the advantage over other modes of cue presentation (pictures, virtual reality, in vivo, etc.) of being easily transportable, affordable, and realistic, and they can be inserted in a smokers' natural environment rather than being limited to laboratory and clinic settings. These AR features may overcome the generalizability barriers of other methods, thus increasing clinical utility for cue exposure therapies., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The vast majority of smokers become dependent on nicotine in youth. Preventing dependence has therefore been crucial to the recent decline in youth smoking. The advent of vaping creates an opportunity for harm reduction to existing smokers (mostly adults) but simultaneously also undermines prevention efforts by becoming a new vehicle for young people to become dependent on nicotine, creating an ethical dilemma. Restrictions to access to some vaping products enacted in response to the increase in vaping among youth observed in the United States since 2018 have arguably prioritized prevention of new cases of dependence-protecting the young-over harm reduction to already dependent adults. Can this prioritization of the young be justified? This article surveys the main bioethical arguments for prioritizing giving health benefits to the young and finds that none can justify prioritizing dependence prevention over harm reduction: any reasons for prioritizing the current cohort of young people at risk from vaping will equally apply to current adult smokers, who are overwhelmingly likely to have become nicotine-dependent in their own youth. Public health authorities' current tendency to prioritize the young, therefore, does not seem to be ethically justified., Implications: This article argues that commonsense reasons for prioritizing the young do not apply to the ethical dilemma surrounding restricting access to vaping products., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Since its introduction, the e-cigarette has become a commonly used consumer product. In this study, we investigate whether regulatory changes had an impact on the quality of refill liquids (e-liquids) available on the Belgian market through analysis of their chemical composition. Hence, the nicotine concentration accuracy was investigated in samples before, during and after the implementation of the revised Tobacco Product Directive (TPD) as an indicator of good manufacturing practices. This is, however, not enough to assure the quality. Therefore, extra criteria were also assessed based on TPD requirements., Methods: By using in-house validated methods, a total of 246 e-liquids purchased prior (2013-2015), during (2016) and after (2017-2018) the implementation of the TPD revisions, were analyzed for the presence of nicotine, nicotine-related impurities, volatile organic compounds (VOCs), caffeine and taurine, and the flavors diacetyl and acetylpropionyl., Results: Although not all manufacturers managed to produce and label their products accurately, nicotine labeling discrepancies have decreased over time. Moreover, also the number of e-liquids, containing high-risk VOCs (10% in 2016 vs. none of the samples in 2017-2018), caffeine (16% in 2017 vs. 5% in 2018), and diacetyl and acetylpropionyl (50% in 2017 vs. 27% in 2018 of sweet-flavored samples) diminished over time., Conclusion: Our results demonstrate that the overall quality of the e-liquids has improved after the implementation of the revised TPD. However, the results also show that periodic quality control might be required to ensure further compliance to the TPD., Implications: This study clearly demonstrates that the implementation of the revised TPD has improved the quality of the e-liquids on the Belgian market. However, there are still e-liquids that are not in agreement with the TPD due to nicotine concentration label discrepancies, presence of e-liquid impurities and controversial flavors diacetyl and acetylpropionyl or the additive caffeine., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Disease burden due to tobacco smoking in Latin America remains very high. The objective of this study was to evaluate the potential impact of implementing smoke-free air interventions on health and cost outcomes in Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru, using a mathematical model., Aims and Methods: We built a probabilistic Monte Carlo microsimulation model, considering natural history, direct health system costs, and quality of life impairment associated with main tobacco-related diseases. We followed individuals in hypothetical cohorts and calculated health outcomes on an annual basis to obtain aggregated 10-year population health outcomes (deaths and events) and costs. To populate the model, we completed an overview and systematic review of the literature. Also, we calibrated the model comparing the predicted disease-specific mortality rates with those coming from local national statistics., Results: With current policies, for the next 10 years, a total of 137 121 deaths and 917 210 events could be averted, adding 3.84 million years of healthy life and saving USD 9.2 billion in these seven countries. If countries fully implemented smoke-free air strategies, it would be possible to avert nearly 180 000 premature deaths and 1.2 million events, adding 5 million healthy years of life and saving USD 13.1 billion in direct healthcare., Conclusions: Implementing the smoke-free air strategy would substantially reduce deaths, diseases, and health care costs attributed to smoking. Latin American countries should not delay the full implementation of this strategy., Implications: Tobacco smoking is the single most preventable and premature mortality cause in the world. The Framework Convention on Tobacco Control, supported by the World Health Organization, introduced a package of evidence-based measures for tobacco control. This study adds quality evidence on the potential health effects and savings of implementing smoke-free air policies in countries representing almost 80% of the Latin America and the Caribbean population., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.)

Background: Quitting smoking is the most effective way of reducing the risk of cancer among smokers. One way of helping people stop smoking is to provide them with free Nicotine Replacement Therapy (NRT), such as when NRT is sent to people by postal mail as part of a mass distribution initiative. Our previous research indicated that there may be a substantial impact on increasing quit rates of a mailed NRT intervention in rural areas. The current research seeks to confirm this finding and to understand the social determinants of health driving these anticipated large effects., Methods/design: Telephone numbers will be randomly selected from across rural regions of Canada in order to recruit adult smokers interested in completing a smoking survey and willing to be interviewed again in 6 months. The survey will ask participants about their smoking history, demographic characteristics, and a hypothetical question: would they be interested in receiving nicotine patches if they were provided to them free of charge? Half of the smokers interested in receiving nicotine patches will be selected by chance and offered the NRT package. The other half of smokers will not be offered the nicotine patches. In addition, the municipality where each participant lives will be identified and, once the relevant general population data becomes available, attempts will be made to link participant data to relevant municipal characteristics (e.g., smoking rates, availability of health services). Characteristics of the participants and the municipalities in which they live will be used to explain why the nicotine patch intervention may have a larger impact in some rural regions compared to others., Discussion: The findings from the proposed RCT are timely and of high relevance as the distribution of nicotine patches has substantial potential to combat the public health problem of cigarette related cancer, other diseases, and premature death from tobacco use. Targeting such tobacco cessation initiatives to rural regions may substantially increase the impact of this intervention, helping to optimize the use of limited prevention resources while aiming to save the maximum number of lives., Clinical Trials Registration: ClinicalTrials.gov NCT04606797 , October, 27, 2020.

This study aimed to assess the prevalence and patterns of tobacco and alcohol use and the associations with socio-demographic variables among presumptive TB patients. A cross-sectional study was conducted among 397 presumptive TB patients in a tertiary hospital in Myanmar. Global Adult Tobacco Survey (GATS) questionnaire and AUDIT-C were used to measure daily tobacco use (single, any or dual use of smoked and smokeless tobacco) and harmful alcohol use, respectively. Multiple and multinomial logistic regression were used to examine the associations with socio-demographic factors. The prevalence of daily use of dual tobacco and any tobacco was 28.2% and 65.7%, respectively. Harmful alcohol use was also high (44.8%). While single use of daily tobacco and harmful alcohol was 28.2% and 7.3%, respectively, concurrent tobacco and alcohol use was 37.5%. While being male and having low education were associated with tobacco use, concurrent tobacco and harmful alcohol use were associated with male gender, low education, and occupation with the government or a company. Due to the high prevalence of tobacco and alcohol misuse, identifying those at risk of tobacco and alcohol misuse and providing integrated care services in a health facility should be considered as a joint activity in national TB and tobacco control programmes., Competing Interests: None of the authors has any conflicts of interest to declare in relation to this work.

Background: General practitioners (GP) are key players in screening and counselling for smokers and alcohol drinkers exceeding French guidelines for low-risk consumption thresholds. Tackling the subject from the patients' perspective, the authors aim at estimating the proportion of the population having discussed their smoking and alcohol consumption with their GPs, and to pinpoint the factors associated with their having done so., Methods: The data (n=6346) are derived from nationwide representative phone survey in mainland France conducted by the French public health monitoring center Baromètre de Santé publique France., Results: Among the persons aged 18-75 having consulted a GP over the last 12 months (82.5%), 36.7% stated that smoking had been discussed in consultation while 16.8% had talked about alcohol use. For both substances, being a man, a smoker, an excessive alcohol user and having a chronic illness were not only independently associated with being questioned by one's doctor, but also with more frequent patient initiative. About 87% considered it normal to be asked by their GP about their alcohol intake, this proportion being higher among men and people with high incomes., Conclusion: Even though a large portion of the population would deem it normal to discuss smoking and alcohol intake in consultation with a GP, the subjects are rarely broached. Our results underline the need to bolster efforts at systematic screening for substance use by GPs., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Introduction: In 2019, nearly 30% of US high-school students reported current (past 30 day) e-cigarette use. Adolescents with disabilities are consistently more likely to smoke cigarettes compared with their nondisabled peers, yet little is known about their use of other forms of tobacco, including e-cigarettes. We compared the prevalence of tobacco use (e-cigarettes, cigarettes, little cigars, large cigars, hookahs, and smokeless tobacco) among high school students with at least 1 disability to those without disability., Methods: Data were from the 2015 and 2017 Oregon Healthy Teens survey, a statewide representative sample of 11th-grade students. We estimated the prevalence of current (past 30 day) tobacco use by product type and disability status (yes or no). We used multivariable Poisson regression to estimate prevalence ratios measuring the association between disability status and current tobacco use, by product: 1) combustible products only, 2) e-cigarettes only, and 3) dual use of combustibles and e-cigarettes., Results: Students with disabilities were more likely to use a variety of tobacco products compared with their nondisabled peers, including cigarettes (12.3% vs 5.4%), little cigars (7.0% vs 5.4%), hookahs (6.2% vs 3.8%), and e-cigarettes (18.3% vs 12.3%). In adjusted models, students with a disability were more likely to report using combustibles only (adjusted prevalence ratio [aPR], 1.55; 95% CI, 1.31-1.84), e-cigarettes only (aPR, 1.36; 95% CI, 1.16-1.59), or dual use (aPR, 1.52; 95% CI, 1.29-1.80) compared with nondisabled students., Conclusion: Effective tobacco control programs should target populations with the greatest burden of tobacco use. Results suggest that tobacco prevention and reduction efforts should explicitly include adolescents with disabilities and employ accommodations that support their participation in program activities.

Background: E-cigarettes are the most popular aid to smoking cessation attempts in England and the USA. This research examined associations between e-cigarette device characteristics and patterns of use, tobacco-smoking relapse, and smoking abstinence., Methods: A convenience sample of 371 participants with experience of vaping, and tobacco-smoking abstinence and/or relapse completed an online cross-sectional survey about e-cigarettes. Factors associated with smoking relapse were examined using multiple linear and logistic regression models., Results: Most participants were self-reported long-term abstinent smokers (86.3%) intending to continue vaping. Most initiated e-cigarette use with a vape pen (45.8%) or cig-a-like (38.7%) before moving onto a tank device (89%). Due to missing data, managed through pairwise deletion, only around 70 participants were included in some of the main analyses. Those using a tank or vape pen appeared less likely to relapse than those using a cig-a-like (tank vs. cig-a-like OR = 0.06, 95% CI 0.01-0.64, p = 0.019). There was an inverse association between starting self-reported e-cigarette liquid nicotine concentration and relapse, interacting with device type (OR = 0.79, 95% CI 0.63-0.99, p = 0.047), suggesting that risk of relapse may have been greater if starting with a low e-cigarette liquid nicotine concentration and/or cig-a-like device. Participants reported moving from tobacco-flavored cig-a-likes to fruit/sweet/food flavors with tank devices., Conclusions: Knowledge of how people have successfully maintained tobacco-smoking abstinence using vaping could help other tobacco smokers wishing to quit tobacco smoking through vaping.

Tobacco use has unique, adverse health consequences for reproductive-aged women, particularly should these women become pregnant. Thus, successful efforts to reduce tobacco use among this population have strong potential to improve public health and reduce health disparities. The present review examines contributions to reducing tobacco use among women of childbearing age spanning the domains of tobacco regulatory science and tobacco control from the passage of the Family Smoking Prevention and Tobacco Control Act in 2009 through September 2019. In the domain of tobacco regulatory science, such efforts include research conducted by various National Institutes of Health/Food and Drug Administration (FDA)-supported Tobacco Centers of Regulatory Science, epidemiological surveillance studies, as well as studies examining the potential impact of tobacco regulatory policies currently under consideration by the FDA (e.g., reduced nicotine content cigarettes, health warning labels). Tobacco control efforts within this same 10-year timeframe include developments in pharmacological and psychosocial approaches to promoting tobacco cessation, mHealth interventions, and tobacco control policy. Emerging issues pertinent to ongoing efforts to reduce tobacco use within the domains of both tobacco regulatory science and tobacco control are also reviewed, including e-cigarettes, comorbid health conditions, course of tobacco and other drugs of abuse, and obstacles to the dissemination and implementation of evidence-based treatment and policy. Although the past decade has seen numerous important contributions to reducing tobacco use among reproductive-aged women within both domains, existing obstacles must be surmounted to continue reducing tobacco use and protecting health among this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective: Both alcohol drinking and second-hand smoke (SHS) exposure have shown a strong association with smoking behaviour. This study uses mediation analysis to clarify the process underlying the relationship between smoking prevalence and SHS exposure and the extent to which this relationship is mediated by alcohol use in the workplace., Method: A total of 14,195 employees from 81 companies in China participated in this survey. Mediation analysis was used to establish the mediation effect of alcohol drinking. Structural equation modelling (SEM) was used to evaluate the role of alcohol drinking when a smoke-free (SF) workplace policy was imposed., Results: For males, approximately 6.3% of the effects on SHS exposure were mediated through the channel of alcohol use. For females, this channel mediated 14.1% of the total effects. SF policy was negatively associated with smoking prevalence and SHS exposure. The indirect effect of the SF policy on reducing SHS exposure by controlling smoking behaviour was significant. For smokers, worksite smoking bans were negatively associated with the smoking amount and drinking behaviour, and the indirect effect of this policy on promoting smokers' intention to quit by reducing the smoking amount and controlling drinking behaviour was significant., Conclusion: This study confirmed that alcohol drinking is among the channels that mediate the association between smoking prevalence and SHS exposure in workplaces. Our results also find a spillover effect of SF workplace policy and call for effective interventions for alcohol use, which may influence the outcomes of SF policy implementation.

Introduction: Posttreatment relapse is a major roadblock to stemming the global epidemic of tobacco-related illness. This article presents results from a pilot trial evaluating the feasibility and initial efficacy of Mindfulness-Based Relapse Prevention (MBRP) as an adjunct to standard relapse prevention treatment (ST) for smoking cessation., Aims and Methods: Smokers (n = 86) in the maintenance phase of treatment were randomized to receive either ST plus MBRP (MBRP) (n = 44) or ST alone (ST) (n = 42). Data were collected at baseline and at 4-, 12-, and 24-week follow-up points. We evaluated the feasibility of the protocol with frequency analysis, and the efficacy with both intention to treat and complete case analyses of the effects of MBRP on abstinence. Secondary outcomes included mindfulness, craving, depression, anxiety, and positive/negative affect., Results: High adherence suggested MBRP is acceptable and feasible. Participants in the MBRP group reported increases in mindfulness (M = -7.833, p = .016), and reductions in craving (M = 17.583, p = .01) compared with the ST group. Intention to treat analysis found that, compared with MBRP (36.4%), ST (57.1%) showed trend-level superiority in abstinence at Week 4 (Prevalence Ratio = 0.63, p = .06); however at Week 24, the ST group (14.3%) demonstrated a twofold greater decrease in abstinence, compared with the MBRP group (20.1%) (Prevalence Ratio = 2.25, p = .08). Therefore, the MBRP group maintained a higher abstinence rate for longer. Reported effects were greater in the complete case analysis., Conclusions: MBRP holds promise for preventing relapse after aided tobacco quit attempts., Implications: Findings suggest that MBRP is acceptable, feasible, and valued by participants. At 24-week follow-up, there was a large effect size and a statistical trend toward fewer MBRP patients relapsing compared with ST patients. MBRP conferred ancillary benefits including reductions in craving and increases in levels of mindfulness. MBRP for tobacco cessation is highly promising and merits further research., Trial Registration: clinicaltrials.gov., Identifier: NCT02327104., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: To analyze the determinants of tobacco smoking addiction in rural areas., Methods: A cross-sectional study was conducted on February 2020. The self-administered questionnaire ( α  = 0.908) and Perceived Stress Scale-10 were used as tobacco smoking determinants and the WHO ASSIST questionnaire V3.0 to determine its addiction risk. Their correlations were analyzed by Spearman's rank-order approach using the SPSS version 23.0., Results: Among 75 male respondents that participated in this study, those on low, moderate, and high addiction risk were 45 (60.00%), 23 (30.67%), and 7 (9.33%), respectively, and significantly correlated with the research questionnaire that consisted three parts: 1. awareness toward the health risk; 2. social control; 3. mass media role in tobacco smoking ( p =0.014, 0.004, and 0.009 respectively), but there was no significant correlation with the stress level ( p =0.287)., Conclusion: Increased awareness toward the health risk, good social control, and mass media reporting the danger of tobacco smoking is significantly in correlation with the decreased addiction in rural areas. However, the high perceived stress has no correlation with its increase., Competing Interests: The authors of this article declared no potential conflicts of interest., (Copyright © 2020 Jovian Philip Swatan et al.)

Annually, the National Association of School Nurses (NASN) sets advocacy goals. The goals include legislative and policy priorities. This article sets forth current NASN legislative priorities and results of advocacy that benefit students. The NASN Board of Directors are instrumental in moving policy priorities forward. In addition, this article shares NASN advocacy during the COVID-19 pandemic.

Objectives: The primary objective of the present study was to compare the prevalence and patterns of second-hand smoke (SHS) exposure in the home, workplace, public places, and at all three places amongst the non-smoker respondents between the two rounds of Global Adult Tobacco Survey (GATS) in India. The secondary objectives were to assess the differences in various factors associated with SHS exposure among non-smokers., Study Design: This secondary data analysis incorporated data generated from the previous two rounds of the cross-sectional, nationally representative GATS India, which covered 69,296 and 74,037 individuals aged 15 years and above. Exposure to the SHS at home, workplace, and public places amongst the non-smokers were the primary outcome variables. Standard definitions of the surveys were used., Results: The overall weighted prevalence of exposure to SHS amongst the non-smokers inside the home and public places reduced. In contrast, the prevalence in the workplace increased marginally in round II compared to I. The proportion of adults who were exposed to SHS at all three places did not change much in two rounds of surveys. A decrease in the knowledge of the respondents exposed to SHS at home and public places was observed about the harmful effects of smoking in round II. Age, gender, occupation, place, and region of respondents were found to be significant determinants of SHS exposure at all the three places on multinomial logistic regression analysis., Conclusions: The study calls for focused interventions in India and stringent implementation of anti-tobacco legislation, especially in the workplaces for reducing the exposure to SHS amongst the non-smokers and to produce encouraging and motivating results by next round of the survey., Competing Interests: The authors have declared that no competing interests exist.

This special issue on substance use issues comes at a critical time for Canadian health policy makers and researchers. Most attention is currently focussed on the opioid crisis and the potential impacts of cannabis legalization. However, our most widely used and harmful substances continue to be alcohol and nicotine. Our policies to reduce harms from these substances are failing. While alcohol control policies are being gradually abandoned, opportunities to maximize the harm reduction potential of new, alternative and safer nicotine delivery devices are not being grasped. More generally, a greater focus is needed on harm reduction strategies that are informed by the experience of marginalized people with severe substance use-related problems so as to not exacerbate health inequities. In order to better inform policy responses, we recommend innovative approaches to monitoring and surveillance that maximize the use of multiple data sources, such as those used in the Canadian Substance Use Costs and Harms (CSUCH) project. Greater attention to precision in defining patterns of risky use and harms is also needed to support policies that more accurately reflect and respond to actual levels of substance use-related harm in Canadian society., Competing Interests: None.

Introduction: To implement and evaluate a blended online and in-person training to help mentors of early-career researchers appreciate the complexities of Tobacco Regulatory Science (TRS), refine TRS mentoring skills, and become acquainted with resources for providing effective guidance to TRS mentees., Methods: TRS mentors engaged in a two-part pilot test of the training program. Authors evaluated both the online and in-person training using retrospective pre-post evaluations, which measure learning at the conclusion of a training program, and post-program focus groups. Twenty learners completed the online training, and 16 learners attended the in-person training module. Nine participants completed evaluations for the online module, and 12 participants completed evaluations for the in-person module., Results: Program assessments revealed that participants found that the training achieved its overall goals. The majority of respondents (87.5%) rated the online portion of the training as valuable. For the in-person training, participants reported statistically significant improvements regarding confidence in: helping mentees to identify skills and training to effectively pursue TRS, assisting mentees in weighing career trajectories, and guiding mentees in conducting research responsive to TRS regulatory priorities., Conclusions: The novel mentoring program was well received by faculty seeking to strengthen skills for mentoring early-career TRS researchers to navigate the complex landscape of TRS, explore diverse funding opportunities, and discern potential career trajectories. It provided unique content to address issues outside the traditional tobacco research training curriculum and offered specific information on regulatory policies, priorities, and opportunities., Implications: This research documents the deployment and evaluation of a blended online and in-person training program for investigators mentoring early-career researchers working in TRS. Our assessment discovered that participants found the training to be valuable to their overall mentoring objectives. The training comprises a novel curriculum for investigators engaged in mentoring early-career researchers in a unique field, thus filling a deficit in the published literature by presenting a curriculum that has been customized to the unique needs of TRS mentors., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.)

In this brief article, we review the evidence on whether easier access to vaping could help lower smoking rates in Australia. To make a convincing case for vaping the following conditions need to be met: that vaping assists in smoking cessation; that the prevalence of vaping is high enough to produce measurable effects at a population level; and that the decline in smoking prevalence is slower in countries where vaping is less common. The evidence suggests that these criteria are satisfied., (© 2020 Australasian Professional Society on Alcohol and other Drugs.)

Introduction: In line with the European Union's Tobacco Products Directive (TPD), new regulations for electronic cigarettes implemented in the United Kingdom between May 2016 and May 2017 included limiting refills to 10 mL, tank and cartridge sizes to 2 mL, and nicotine concentrations to 20 mg/mL., Aims: To investigate the (1) awareness of new regulations, (2) product use before and after implementation, and (3) association between use of compliant products and subsequent smoking., Methods: A UK online longitudinal survey of smokers, ex-smokers, and vapers was conducted between May and June 2016 (wave 4) and September 2017 (wave 5).The following methods were used: (1) to assess awareness of changes, proportions were calculated by smoking and vaping status (n = 1606). (2) Comparison of refill volume, tank and cartridge volumes, nicotine concentration at waves 4 and 5 (n = 199-388) was conducted. (3) Association was studied between number of TPD-compliant products used at wave 4 and smoking at wave 5, adjusted for wave 4 vaping status, age, gender, income, urges to smoke, and device type (n = 480)., Results: Awareness of regulations was highest for refill volume (10.1%; 37.4% among exclusive vapers) and nicotine concentration (9.5%; 27.3%). Higher proportions used TPD-compliant refill volumes (60.0%-73.7%, χ2(1) = 10.9, p = .001) and nicotine concentrations (89.2%-93.9%, χ2(1) = 7.41, p = .007) in wave 5 than wave 4, with little change for tank or cartridge volumes (77.1-75.5%, χ2(1) = 0.38, p = .540). The likelihood of smoking was similar for those using no or one TPD-compliant products as it was for those using two (OR = 1.10, 95% CI = 0.47-2.59) or three (OR = 1.56, 95% CI = 0.69-3.55)., Conclusion: Several months after full implementation, awareness of new regulations was low and most vapers used TPD-compliant products. Use of compliant products was not associated with subsequent smoking., Implications: Using a longitudinal survey at the beginning and a few months after the end of the transition period for implementation of new regulation on electronic cigarettes, this is the first study to assess awareness of regulation and use of compliant products. After full implementation, awareness of changes was low overall (smokers, ex-smokers, and vapers combined) although higher among those who vaped. Nevertheless, most vapers (74%-94%) used products that were compliant with the new regulations and the use of products compliant with incoming regulations did not predict whether they were smoking cigarettes after implementation., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.)

Background: Interventions that reduce morbidity, in addition to mortality, warrant prioritisation. It is important to understand the magnitude of potential morbidity and health gains from changing risk factor distributions. We quantified the impact of tobacco compared with overweight/obesity eradication on future morbidity and health-adjusted life expectancy (HALE) for the New Zealand population alive in 2011., Methods: Business-as-usual (BAU) future smoking rates were set based on past falling rates, but we assumed no future change in Body Mass Index (BMI) distribution, given historic trends. Population impact fractions and the percentage reduction in incidence rates for 16 tobacco-related and 14 overweight/obesity-related diseases (allowing for time lags) were calculated using the difference between BAU and eradication risk factor scenarios combined with tobacco and BMI incidence rate ratios. We used two multistate lifetable models to estimate HALE changes over the remaining lifespan and morbidity rate changes 30 years hence., Results: HALE gains always exceeded life expectancy (LE) gains for overweight/obesity eradication (ie, absolute compression of morbidity), but for eradication of tobacco, the pattern was mixed. For example, among 32-year-olds in 2011, overweight/obesity eradication increased HALE by 2.06 years and LE by 1.21 years, compared with 0.54 and 0.50 years for tobacco eradication.Morbidity rate reductions 30 years into the future were considerably greater for overweight/obesity eradication (eg, a 15.8% reduction for 72-year-olds in 2041, or the cohort that was aged 42 years in 2011) than for tobacco eradication (2.7%). The same rate of morbidity experienced at age 65 years under BAU was deferred by 5 years with overweight/obesity eradication., Conclusions: Preventive programmes that reduce overweight and obesity have strong potential to reduce or compress morbidity, improving the average health status of ageing populations. This paper simulated eradication of tobacco and overweight/obesity; actual interventions will have lesser health impacts, but the relativities of morbidity to mortality gains should be similar., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

The majority of premature deaths related to tobacco cigarettes (TCs) are attributable to cardiovascular disease, so it is fitting and timely to review the overall cardiovascular impact of electronic cigarettes (ECs), which have recently exploded onto the tobacco product market. Longitudinal studies of EC users are necessary, but not yet available, to answer the question whether cardiovascular disease is lower in chronic EC users compared to TC smokers, so we must rely on biomarker studies. Several biomarkers that portend increased cardiovascular risk, including markers of increased sympathetic nerve activity, oxidative stress and inflammation, vascular dysfunction, and thrombosis, have been reported to be abnormal after EC use, although often not to the degree found in TC smokers. We conclude that if all FDA-certified strategies for TC smoking cessation have been tried without success, then ECs may be a reasonable strategy for TC smoking cessation, but the message to non-TC smokers must be clear and unwavering: non TC-smokers should not use ECs - they are not harmless., (Copyright © 2019 The Author. Published by Elsevier Inc. All rights reserved.)

Introduction: Tobacco control programs and policies reduce tobacco use and prevent health and economic harms. The majority of tobacco control programs and policies in the United States are implemented at local and state levels. Yet the literature on state-level initiatives reports a limited set of outcomes. To facilitate decision-making that is increasingly focused on costs, we provide estimates of a broader set of measures of the impact of tobacco control policy, including smoking prevalence, disease events, deaths, medical costs, productivity and tobacco tax revenues, using the experience of Minnesota as an example., Methods: Using the HealthPartners Institute's ModelHealth™: Tobacco MN microsimulation, we assessed the impact of the stream of tobacco control expenditures and cigarette price increases from 1998 to 2017. We simulated 1.3 million individuals representative of the Minnesota population., Results: The simulation estimated that increased expenditures on tobacco control above 1997 levels prevented 38,400 cancer, cardiovascular, diabetes and respiratory disease events and 4,100 deaths over 20 years. Increased prices prevented 14,600 additional events and 1,700 additional deaths. Both the net increase in tax revenues and the reduction in medical costs were greater than the additional investments in tobacco control., Conclusion: Combined, the policies address both short-term and long-term goals to reduce the harms of tobacco by helping adults who wish to quit smoking and deterring youth from starting to smoke. States can pay for initial investments in tobacco control through tax increases and recoup those investments through reduced expenditures on medical care., Competing Interests: AL, MM and ZX have received salary support through their employer for research projects with aspects of tobacco control funded by the U.S. Centers for Disease Control and Prevention, ClearWay Minnesota℠, and the Robert Wood Johnson Foundation. All authors are employed by organizations whose missions include reducing the population harms of tobacco. All authors (ClearWay Minnesota, HealthPartners, and Truth Initiative) contributed to the study design. HealthPartners collected and analyzed the data, and led the interpretation of findings. All authors contributed to the writing of this report and decided to submit the article for publication.

A previous analysis of the Alpha-Tocopherol Beta-Carotene (ATBC) Study on male smokers found that β-carotene supplementation increased the risk of pneumonia 4-fold in those who started smoking at the age of ≥21 years and smoked ≥21 cigarettes/d (a subgroup of 7 % of the study population). The present study hypothesised that β-carotene increases mortality in the same subgroup. The ATBC Study (1985-1993) recruited 29 133 Finnish male smokers (≥5 cigarettes/d) aged 50-69 years. Cox regression models were constructed to estimate the effect of β-carotene supplementation in subgroups. β-Carotene increased mortality (risk ratio 1·56; 95 % CI 1·06, 2·3) in those who started to smoke at ≥21 years and smoked ≥21 cigarettes/d. Within this subgroup, there was strong evidence of further heterogeneity. The effect of β-carotene supplementation was further modified by dietary vitamin C intake, fruit and vegetable intake ( P = 0·0004), and by vitamin E supplementation ( P = 0·011). Thus, harm from β-carotene was not uniform within the study population. Interactions between β-carotene and vitamins C and E were seen only within a subgroup of 7 % of the ATBC participants, and therefore should not be extrapolated to the general population. Heterogeneity of the β-carotene effect on mortality challenges the validity of previous meta-analyses that have pooled many diverse antioxidants for one single estimate of effect using the assumption that a single estimate equally applies to all antioxidants and all people. Trial registration: ClinicalTrials.gov NCT00342992., (© The Author(s) 2020.)

Introduction: This study examined the associations of micro-level factors with current alcohol use and binge drinking among a large sample of Canadian youth., Methods: This descriptive-analytical study was conducted among high school students enrolled in the COMPASS study between 2012/13 and 2017/18. We used generalized estimating equations modelling to determine associations between micro-level factors and likelihood of current versus non-current alcohol use and binge drinking among respondents., Results: Students reporting current cannabis use were more likely to report current alcohol use over never use (odds ratio [OR] = 4.46, 95% confidence interval [CI]: 4.33-4.60) compared to students reporting non-current cannabis use. Students reporting current smoking of tobacco products were more likely to report current binge drinking over never binge drinking (OR = 2.52, 95% CI: 2.45-2.58), compared to non-smoking students. Students reporting weekly disposable incomes of more than $100 were more likely to report current over never binge drinking (OR = 2.14, 95% CI: 2.09-2.19), compared to students reporting no weekly disposable income., Conclusion: Higher disposable incomes, smoking of tobacco products and use of cannabis were associated with current alcohol use and binge drinking among youth. Findings may inform design of polysubstance use prevention efforts in high schools., Competing Interests: The authors have no conflicts of interest to report.

Background: Previous secondhand smoke (SHS) reduction interventions have provided only delayed feedback on reported smoking behaviour, such as coaching, or presenting results from child cotinine assays or air particle counters., Design: This SHS reduction trial assigned families at random to brief coaching and continuous real-time feedback (intervention) or measurement-only (control) groups., Participants: We enrolled 298 families with a resident tobacco smoker and a child under age 14., Intervention: We installed air particle monitors in all homes. For the intervention homes, immediate light and sound feedback was contingent on elevated indoor particle levels, and up to four coaching sessions used prompts and praise contingent on smoking outdoors. Mean intervention duration was 64 days., Measures: The primary outcome was 'particle events' (PEs) which were patterns of air particle concentrations indicative of the occurrence of particle-generating behaviours such as smoking cigarettes or burning candles. Other measures included indoor air nicotine concentrations and participant reports of particle-generating behaviour., Results: PEs were significantly correlated with air nicotine levels (r=0.60) and reported indoor cigarette smoking (r=0.51). Interrupted time-series analyses showed an immediate intervention effect, with reduced PEs the day following intervention initiation. The trajectory of daily PEs over the intervention period declined significantly faster in intervention homes than in control homes. Pretest to post-test, air nicotine levels, cigarette smoking and e-cigarette use decreased more in intervention homes than in control homes., Conclusions: Results suggest that real-time particle feedback and coaching contingencies reduced PEs generated by cigarette smoking and other sources., Trial Registration Number: NCT01634334; Post-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The English National Health Service NHS Stop Smoking Services (SSS), established in 2001, were the first such services in the world. An appropriate evaluation of the SSS has national and international significance. This modelling study sought to evaluate the impact of the SSS on changes in smoking prevalence in England., Methods: A discrete time state-transition model was developed to simulate changes in smoking status among the adult population in England during 2001-2016. Input parameters were based on data from national statistics, population representative surveys and published literature. The main outcome was the percentage point reduction in smoking prevalence attributable to the SSS., Results: Smoking prevalence was reduced by 10.8 % in absolute terms during 2001-2016 in England, and 15.3 % of the reduction could be attributable to the SSS. The percentage point reduction in smoking prevalence each year was on average 0.72%, and 0.11 % could be attributable to the SSS. The proportion of SSS supported quit attempts increased from 5.5 % in 2001, to as high as 18.9 % in 2011, and then reduced to 8.2 % in 2016. Quit attempts with SSS support had a higher success rate than those without SSS support (15.1% vs 11.3%). Smoking prevalence in England continued to decline after the SSS was much reduced from 2013 onwards., Conclusions: Approximately 15% of the percentage point reduction in smoking prevalence during 2001-2016 in England may be attributable to the NHS SSS, although uncertainty remains regarding the actual impact of the formal smoking cessation services., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Since the WHO released the M onitoring tobacco use and tobacco control policies; P rotecting from the dangers of tobacco smoke; O ffering help to quit tobacco; W arning the public about the dangers; E nforcing bans on advertising, promotion and sponsorship; and R aising tobacco taxes (MPOWER) policy package to assist nations with implementing the Framework Convention on Tobacco Control (FCTC), 88 countries have adopted at least one MPOWER policy at the highest level as of 2014. Building on previous evaluations, we estimated the reduction in smoking-attributable deaths (SADs) from all policies newly adopted at the highest level between 2014 and 2016., Methods: For each nation that implemented highest level policies, t he difference in policy effect sizes from previously validated SimSmoke models for the policies in effect in 2014 and 2016 were multiplied by the number of smokers in that nation to derive the reduction in the number of smokers. Based on research that half of all smokers die from smoking, we derived SADs averted., Findings: In total, 43 nations adopted at least one highest-level MPOWER policy between 2014 and 2016, resulting in 14.6 million fewer SADs. The largest number of SADs averted were due to stronger health warnings (13.3 million), followed by raising taxes (0.6 million), increased marketing bans (0.4 million), smoke-free air laws (0.3 million) and cessation interventions (2500)., Conclusion: These findings demonstrate the continuing public health impact of tobacco control policies adopted globally since the FCTC, and highlight the importance of more countries adopting MPOWER policies at the highest level to reduce the global burden of tobacco use., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Smoking education and prevention campaigns have had marked success in reducing rates of tobacco use among adolescents, however, disparities in use continue to exist. It is critical to assess if adolescents at risk for tobacco use are being exposed to antitobacco campaigns. We used data from Wave 2 of the Population Assessment of Tobacco and Health Study to assess the relationship between exposure to three antitobacco campaigns and key characteristics related to higher risk of cigarette use using full-sample weights and Poisson regression models with robust variance. Adjusted models identified that exposure to antitobacco campaigns was more common among racial and sexual minority adolescents and adolescents who: reported exposure to tobacco marketing, spent more time using media and had household income greater than $25 000. While some high-risk youth are more likely to report exposure to campaigns, there are some priority groups that are not being reached by current efforts compared with non-priority groups, including youth living in households with income below the poverty line and adolescents who are susceptible to cigarette smoking. Future campaigns should consider targeting these groups specifically in order to reduce tobacco use disparities., (� The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

School tobacco policies (STPs) are a crucial strategy to reduce adolescents smoking. Existing studies have investigated STPs predominantly from a school-related 'insider' view. Yet, little is known about barriers that are not identified from the 'schools' perspective', such as perceptions of local stakeholders. Forty-six expert interviews from seven European cities with stakeholders at the local level (e.g. representatives of regional health departments, youth protection and the field of addiction prevention) were included. The analysis of the expert interviews revealed different barriers that should be considered during the implementation of STPs. These barriers can be subsumed under the following: (i) Barriers regarding STP legislature (e.g. inconsistencies, partial bans), (ii) collaboration and cooperation problems between institutions and schools, (iii) low priority of smoking prevention and school smoking bans, (iv) insufficient human resources and (v) resistance among smoking students and students from disadvantaged backgrounds. Our findings on the expert's perspective indicate a need to enhance and implement comprehensive school smoking bans. Furthermore, collaboration and cooperation between schools and external institutions should be fostered and strengthened, and adequate human resources should be provided., (� The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: Most people who stop smoking gain weight. Dietary modification may seem an obvious solution, but food restriction may increase cigarette craving and smoking relapse., Trial Design: An unblinded parallel randomised controlled trial., Methods: Participants were adult smokers with a body mass index greater or equal to 23 kg/m 2 . Setting was National Health Service commissioned Stop Smoking Services, interventions were referral to a commercial weight management programme, plus stop smoking support (treatment group), compared with stop smoking support alone (control group). Objective was to compare weight change between interventions in smoking abstainers and not abstinent rates in all. Primary outcome was change in weight (kg) at 12 weeks. Randomisation sequence was computer generated and concealed until allocation., Results: Seventy-six participants were recruited, 37 were randomised to the treatment group and 39 to the control group. Change in weight was analysed in long-term abstainers (13 treatment, 14 control) only because the aim was to prevent weight gain associated with smoking cessation. Abstinence was analysed on an intention-to-treat basis (37 treatment, 39 control). At 12 weeks weight gain was less in the treatment than the control group with an adjusted mean difference of -2.3 kg 95% CI (-4.4 to -0.1). Craving scores were lower (Mood and Physical Symptoms Scale craving domain -1.6 (-2.7 to -0.5)) and quit rates were higher in the treatment than the control group (32% vs 21%), although the trial was not powered to superiority in cravings and quit rates. No adverse events or side effects were reported., Conclusion: In people who are obese and want to quit smoking, these data provide modest encouragement that providing weight management at the time of quitting may be helpful. Those who are not obese, but who are informed about potential weight gain during their quit attempt, were uninterested in a weight management programme., Trial Registration Number: ISRCTN65705512., Competing Interests: Competing interests: DL has received hospitability from manufacturers of smoking cessation products, Pfizer, Tadworth, UK. DL’s institution during the active phase of the trial has received smoking cessation products for use in a clinical trial from Johnson & Johnson, New Brunswick, New Jersey, USA. DL has received Slimming World membership vouchers for use in this trial. DL has received expenses and consultancy fees from the NHS and Universities for teaching about cessation-related weight gain. DL has received grant funding from UKCTCS and the NIHR-SPCR for research relating to cessation-related weight gain. PA is an NIHR senior investigator and is funded by NIHR Biomedical Research Centre and the CLAHRC, Oxford. AF is an NIHR Senior Investigator and receives funding from NIHR Oxford Biomedical Research Centre. AL has received hospitality from Weight Watchers. In the last 5 years, MM has received grant funding from Pfizer and varenicline, for research purposes., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

EVICT project has noted the increase in cannabis use in the Spanish youth population, and has studied its association with tobacco, concluding that: It has an influence in the learning to smoke process: The beginning can be combined and with bi-directional influence. It has an influence on dependence the development of dependence Their interaction is relevant in the development of dependence. It has an influence on toxicity: Smoking tobacco and cannabis generates greater problems than smoking tobacco alone. And, therefore, the EVICT team issues some considerations: Prevention considerations. Differentiate between therapeutic and recreational use. Smoking cannabis is not therapeutic nor innocuous, and can affect the development of nicotine dependence, or, less frequently, cannabis dependence. Approach and treatment considerations. In A first option of cessation of both must be proposed in people who consume tobacco and cannabis Harm Reduction. To those that only consume tobacco/cannabis: Harm Reduction programs should be more applicable to those in whom consumption is considered more problematic., (Copyright © 2018 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: This study sought to empirically evaluate whether the Medicaid expansion under the Affordable Care Act increased smoking cessation among low-income childless adult smokers., Methods: The effects of the Medicaid expansion on smoking quit attempts and the probability of 30- and 90-day smoking cessation were evaluated using logistic regression and data from the 2010-2011 and 2014-2015 waves of the Tobacco Use Supplement to the Current Population Survey. Using boosted logistic regression, the Tobacco Use Supplement was restricted to an analytic sample composed of childless adults with high probability of being <138% of the federal poverty level. Propensity score weighting was used to compare changes in smoking cessation among a sample of current and past smokers in states that expanded Medicaid with a control sample of current and past smokers in states that did not expand Medicaid with similar sociodemographic characteristics and smoking histories. This study additionally controlled for state socioeconomic trends, welfare policies, and tobacco control policies. Analysis was conducted between January 2018 and June 2019., Results: After weighting by propensity score and adjusting for state socioeconomic trends, welfare policies, and tobacco control policies, the Medicaid expansion was not associated with increases in smoking quit attempts or smoking cessation., Conclusions: The Medicaid expansion did not appear to improve smoking cessation, despite extending health insurance eligibility to 2.3 million low-income smokers. Greater commitments to reducing barriers to cessation benefits and increasing smoking cessation in state Medicaid programs are needed to reduce smoking in low-income populations., (Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Although we know much about demographic patterns of smoking, we know less about people's explanations for when, how and why they avoid, develop, or alter smoking habits and how these explanations are linked to social connections across the life course. We analyze data from in-depth interviews with 60 adults aged 25-89 from a large southwestern U.S. city to consider how social connections shape smoking behavior across the life course. Respondents provided explanations for how and why they avoided, initiated, continued, and/or quit smoking. At various times, social connections were viewed as having both positive and negative influences on smoking behavior. Both people who never smoked and continuous smokers pointed to the importance of early life social connections in shaping decisions to smoke or not smoke, and viewed later connections (e.g., marriage, coworkers) as less important. People who quit smoking or relapsed tended to attribute their smoking behavior to social connections in adulthood rather than early life. People who changed their smoking behavior highlighted the importance of transitions as related to social connections, with more instability in social connections often discussed by relapsed smokers as a reason for instability in smoking status. A qualitative approach together with a life course perspective highlights the pivotal role of social connections in shaping trajectories of smoking behavior throughout the life course., Competing Interests: The authors declare no competing interests.

Objective: This narrative review aimed to identify and categorize the barriers and facilitators to the provision of brief intervention and behavioral change programs that target several risk behaviors among the Indigenous populations of Australia, Canada, and New Zealand., Methods: A systematic database search was conducted of six databases including PubMeD, Embase, CINAHL, HealthStar, PsycINFO, and Web of Science. Thematic analysis was utilized to analyze qualitative data extracted from the included studies, and a narrative approach was employed to synthesize the common themes that emerged. The quality of studies was assessed in accordance with the Joanna Briggs Institute's guidelines and using the software SUMARI - The System for the Unified Management, Assessment and Review of Information., Results: Nine studies were included. The studies were classified at three intervention levels: (1) individual-based brief interventions, (2) family-based interventions, and (3) community-based-interventions. Across the studies, selection of the intervention level was associated with Indigenous priorities and preferences, and approaches with Indigenous collaboration were supported. Barriers and facilitators were grouped under four major categories representing the common themes: (1) characteristics of design, development, and delivery, (2) patient/provider relationship, (3) environmental factors, and (4) organizational capacity and workplace-related factors. Several sub-themes also emerged under the above-mentioned categories including level of intervention, Indigenous leadership and participation, cultural appropriateness, social and economic barriers, and design elements., Conclusion: To improve the effectiveness of multiple health behavior change interventions among Indigenous populations, collaborative approaches that target different intervention levels are beneficial. Further research to bridge the knowledge gap in this topic will help to improve the quality of preventive health strategies to achieve better outcomes at all levels, and will improve intervention implementation from development and delivery fidelity, to acceptability and sustainability.