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Background: Vaccine hesitancy is increasingly recognized as a health challenge affecting populations worldwide. Given the biological vulnerabilities and structural barriers people who use substances and/or have behavioral addictions face, this systematic review aims to evaluate whether this subpopulation is less prone to adhere to vaccination recommendations., Methods: Electronic searches of published original research were conducted in PubMed, EMBASE, Scopus, and PsycINFO from database inception to December 2022. Our strategy encompassed retrievals regardless of languages and date of publication. Animal studies, abstracts without a full manuscript, and studies which were considered to have lower robustness of scientific evidence were excluded. Outcomes measured were vaccine acceptance, uptake, and adherence. Results were interpreted through a narrative synthesis., Results: The search yielded 103 retrievals encompassing data collected on 5 576 374 persons who were predominantly residents of Europe (n = 39) and North America (n = 27). Tobacco use, the substance for which many studies were found (n = 91), was significantly associated with poorer vaccine acceptance, uptake and adherence for influenza, COVID-19, human papillomavirus (HPV), and maternal and childhood vaccines. Peri-natal and parental substance use was identified as a risk factor for suboptimal vaccine-related outcomes concerning maternal COVID-19 and childhood vaccines. Finally, people identified as 'using', 'abusing', or 'misusing' drugs or substances may be at decreased odds of all outcomes in various vaccines., Conclusions: Collectively, the studies identified several groups with statistically significant greater vaccine hesitancy and decreased engagement among whom targeted measures could be beneficial. Timely evidence, especially on behavioral addictions and substances besides tobacco, is lacking, and warrants urgent attention., (Published by Oxford University Press on behalf of Medical Council on Alcohol 2024.)

The COVID-19 pandemic produced stress for people around the world. The perception that tobacco can be a coping tool for stress relief suggests that the conditions during the COVID-19 pandemic can provide insight into the relationship between stress and tobacco use patterns, particularly among those most at risk for severe COVID-19 disease. The goal was to identify the impacts of the COVID-19 pandemic on tobacco use and preparedness for smoking cessation among individuals who smoke and are older and medically underserved. We conducted in-depth interviews with 39 patients to learn about individuals' smoking behavior during the COVID-19 pandemic. We used a modified grounded theory approach to code and analyze all qualitative data. We conducted thematic analysis to identify key factors associated with smoking behaviors during COVID-19. Our results indicated that increases in perceived stress and social isolation may have been associated with increased tobacco use during the COVID-19 pandemic. Pandemic-related social isolation contributed to increases in smoking, despite respondents being concerned about the severity of COVID-19. While many respondents felt that smoking relieved their stress from the pandemic, they appeared unaware of the stress-inducing properties of tobacco use. Our findings indicate that pandemic-related stress impacted smoking behavior among older, medically underserved smokers. Results may assist clinicians in addressing the role of tobacco use in response to highly stressful events. Smoking cessation strategies should consider the implications of stress on smoking behavior, including smoking relapse in response to highly stressful events-particularly for medically underserved populations., Competing Interests: No authors have competing interests., (Copyright: © 2024 Klaiman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Tobacco use during pregnancy is the main avoidable cause of morbidity and mortality both for pregnant women and their offspring. Between 12 and 22% of pregnant women in industrialized countries smoke during pregnancy, and 13% are unable to stop smoking. Pregnancy is considered an ideal opportunity to intervene and control tobacco use among smokers and their families. However, pregnant women experience barriers to quitting smoking, including social stigma and fear of being judged. Thus, it is necessary to develop interventions for smoking cessation adapted for pregnant women. This paper presents a qualitative study protocol to assess the barriers and facilitators of smoking cessation during pregnancy that female smokers encounter or perceive. It consists of a series of focus groups and individual interviews with female smokers who have been pregnant within the last five years. Participants will be recruited from the Sexual and Reproductive Health Care Services of the Camp de Tarragona. A group of 5-10 women who have been pregnant and tried to quit smoking over the last 5 years will be selected. The data will be collected by means of semistructured interviews. All interviews will be transcribed verbatim, coded and synthesized into categories and main themes. Thematic analysis will be conducted employing an iterative and reflexive approach. The results of this study will offer new perspectives on smoking interventions for pregnant women and enhance our comprehension of the main barriers to and facilitators of smoking cessation during pregnancy. This will contribute to the adaptation of the Tobbstop app, originally designed for the general public, to suit the needs of pregnant women. Consequently, the creation of targeted interventions will positively influence the health outcomes of both pregnant women and newborns. Trial registration: Clinicaltrials.gov ID: NCT05222958. The trial was registered 3 February 2022, at https://clinicaltrials.gov/ct2/show/NCT05222958., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Agràs-Guàrdia et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To examine associations between serious psychological distress (SPD) and tobacco and cannabis use among college students in the United States., Methods: This cross-sectional study included 257,626 college students from the 2019-2022 National College Health Assessment survey. SPD was defined as having symptoms in the past month. Current tobacco (i.e., cigarettes, e-cigarettes) and cannabis use was defined as past month use. Multiple product use was categorized for single, dual, or triple products. Adjusted logistic regression models were used to examine associations between SPD, tobacco, cannabis, and multiple product use., Results: SPD increased over time (18.4% to 23.8%) among students and nearly 30% of tobacco or cannabis users reported SPD. Cigarette, e-cigarette, or cannabis use was associated with about a 50-60% increased likelihood of reporting SPD than non-current use of each product, with the highest associations in Fall 2020. Triple product users had double the likelihood of reporting SPD, followed by dual users at 70% and single users at 47%, relative to non-current users. Daily users also had nearly twice the likelihood of reporting SPD, followed by non-daily users at 13-35%, relative to non-current users., Conclusions: College students have an increasing burden of SPD which is significantly associated with tobacco and cannabis use. There is a dose-response relationship between the number of tobacco and cannabis products used, as well as the frequency of use, and SPD among U.S. college students. Colleges addressing student mental health should prioritize the implementation of screening and treatment support for tobacco, cannabis, and multiple product use., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Anger is elevated in substance use disorders (SUDs) and related to problematic use. However, it is unclear whether anger is elevated in individuals who use substances, is only heightened among those with SUDs, and whether anger is more strongly tied to use of certain substances or SUDs. Objectives: We examine the association between anger, general substance use and SUDs. Methods: Data is N  = 28,753 (55% female) respondents from the NESARC-III. Participants endorsing anger and indicating negative functional impact were deemed to have experienced significant anger. Results: Logistic regression examining the relative strength of associations between anger, substance use and SUDs (alcohol, opioid, stimulant, tobacco and cannabis) indicated that having a SUD was associated with anger beyond use alone. Alcohol (adjusted odds ratio [AOR] = 1.45; 95% CI 1.32-1.6) and tobacco (AOR = 1.38; 95% CI 1.27-1.51) use displayed the strongest odds of experiencing anger above and beyond other substances in the model. Similarly, alcohol (AOR = 1.45; 95% CI 1.31-1.62) and tobacco (AOR = 1.46; 95% CI 1.3-1.64]) use disorders had the greatest odds of anger relative to other SUDs. These results were significant after controlling for mood, anxiety disorders, and PTSD and no sex differences were observed. Conclusion: These results indicate that SUDs, particularly alcohol and tobacco use and disorders, are positively associated with experiencing anger beyond just substance use. Research must identify the mechanism driving this association to enhance treatments that target anger.

Introduction: Although sexual minority (SM; vs heterosexual) individuals display higher rates of tobacco and cannabis use, limited research has examined sociodemographic and psychosocial correlates of single and co-use among this population., Methods: Participants were SM-identifying female (N = 2419; M age  = 27.80; 50.0% racial/ethnic minority) and male (N = 1142; M age  = 30.34; 46.1% racial/ethnic minority) adults from Wave 5 of the Population Assessment of Tobacco and Health study. Multinomial logistic regressions examined sociodemographic (ie, sexual identity, age, race/ethnicity, education, income) and psychosocial (ie, alcohol use, mental health, substance use) correlates of single and co-use (ie, no use [referent], tobacco-only, cannabis-only, co-use), controlling for state cannabis legalization, among SM females and males, separately., Results: The proportions of SM females reporting no use, tobacco-only, cannabis-only, and co-use were 37.9%, 24.0%, 10.5%, and 27.6%, respectively. Among males, 40.6%, 27.8%, 10.1%, and 21.5% reported no use, tobacco-only, cannabis-only, and co-use, respectively. Among females and males, substance use problems were associated with all 3 use groups (vs no use); past-month alcohol use was associated with cannabis-only and co-use; and mental health symptoms were associated with co-use (and cannabis-only in males). Sociodemographic correlates among females were: tobacco-only-identifying as bisexual (vs lesbian), White (vs Black), older, lower education, and lower income; cannabis-only-bisexual, other race (vs White); and co-use-White (vs Hispanic), lower education, and lower income. Among males, sociodemographic correlates were: tobacco-only-older, lower education, and lower income; cannabis-only-Black (vs White) and higher income., Conclusions: Public health efforts to reduce tobacco and cannabis use among SM adults should target single versus co-use patterns and their corresponding sociodemographic, mental health, and substance use profiles., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Understanding factors influencing the transition from non-use to tobacco and nicotine product initiation among adolescents is crucial for designing and implementing effective preventive strategies. This study explores transition patterns among 13-15-year-old adolescents in lower secondary school, focusing on the transition from non-use to tobacco and nicotine product initiation and the influence of individual, social, risk behavioral, and mental health factors on this transition., Methods: Based on data from a Danish smoking prevention trial between 2017 and 2019, this study employed questionnaire surveys at three time points: baseline (start of seventh grade, n = 1,990, response rate = 86.3%), eight-month follow-up (end of seventh grade, n = 1,666, response rate = 74,8%), and 20-month follow-up (end of eighth grade, n = 1,149, response rate = 70,6%). Tobacco and nicotine use indicators included current and lifetime use of cigarettes and lifetime use of e-cigarettes, smokeless tobacco, and hookah. A latent transition analysis was applied to identify longitudinal transition patterns across waves and to explore predictors of these patterns., Results: Three user classes emerged across all waves: none-use, lifetime e-cigarette and cigarette use, and poly-tobacco use. While the most prevalent class was the non-user class (71%-86%), the proportion of the lifetime e-cigarette and cigarette class increased over time (from 12% to 17%). Similarly, the poly-tobacco user class increased from 2% to 12%. The probability of transitioning from non-use to lifetime e-cigarette and cigarette use increased from 0.5% at baseline to 12% by the second follow-up, while the probability of transitioning from lifetime e-cigarette and cigarette use remained stable over time (12%-15%). Across all waves, elevated risk behavior predicted this transition. For instance, binge-drinking (OR = 3.76, 95% CI: 1.51-9.34), susceptibility to smoking (OR = 7.63, 95% CI: 3.68-16.83), and truancy (OR = 7.00, 95% CI: 1.98-24.59) influenced the transition from non-use at baseline to lifetime e-cigarette and cigarette use at first follow-up. Additionally, boys, adolescents with low socioeconomic status, low life satisfaction, and those with smoking friends or parents were more likely to transition from non-use to lifetime e-cigarette and cigarette use., Conclusion: This study demonstrates that sociodemographic, social risk, behavioral, and mental health factors impact the transition from non-use to lifetime e-cigarette and cigarette use. The findings provide valuable insights for developing targeted preventive strategies focusing on these influencing factors., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: The present study utilized an intersectional framework to examine if two forms of gendered racism, psychological emasculation and messages about Asian American men being undesirable partners, were associated with Asian American men's nicotine use. We also examined the potential mediating roles of two racial identity statuses, racial conformity and racial immersion., Methods: A sample of 356 Asian American men living in the United States of America (USA) completed a cross-sectional survey via Qualtrics containing measures assessing the aforementioned constructs of interest. The primary analysis examined separate parallel mediation models, situating psychological emasculation and undesirable partner as separate independent variables, racial conformity and racial immersion as parallel mediators, nicotine use as the outcome, and age and employment as covariates., Results: In separate parallel mediation models, the links between psychological emasculation and undesirable partner on one hand, and nicotine use on the other, were completely mediated only by racial conformity, and not significantly mediated by racial immersion. Specifically, greater endorsement of gendered racism was associated with greater conformity with (and internalization of) these gendered racist beliefs, which in turn were associated with greater nicotine use., Conclusion: Researchers and practitioners may consider racial conformity as an interventional target to ameliorate Asian American men's nicotine use. Future studies should continue to examine other culturally relevant and/or potentially protective constructs (e.g., on the basis of gender, race, and its intersection) that may mitigate Asian American men's nicotine use., (© 2024 Wiley Periodicals LLC.)

Background: Tobacco has been among the most important causes of morbidity and mortality worldwide. In reducing tobacco consumption, media campaigns are crucial in raising awareness and encouraging individuals to quit. The present study aimed to profile participants of GATS-2, including tobacco usage patterns and media exposure, and explore the factors associated with quitting in the presence of media exposure., Methods: Secondary data analysis of Global Adult Tobacco Survey-India (2016-17) data was done among current daily cigarette smokers and smokeless tobacco users. The primary independent variable was an intention to quit, while media exposure was the primary independent variable. Respondents were profiled as per various socio-demographic variables, and exposure to media advertisements and intention to quit were assessed using weighted bivariate analysis and multivariate log regression analysis., Results: Males, and respondents aged 15 to 45, had more exposure to media and advertisements than female respondents. Cigarette smokers with moderate consumption, better awareness, those who had made any quit attempts in the last 12 months, and moderate to high media exposure depicted better intention to quit. In SLT users, intention to quit depicted significant odds per education level quit attempts and exposure to media and advertisements., Conclusion: We report a high intention to quit among those exposed to advertisements. Media campaigns play an important role in promoting tobacco control. There is a need to assess the impact of such advertisements on behavioral aspects. At the same time, comprehensive tobacco control policies should go hand in hand in reducing smoking rates.

Objective: This study aimed to assess a bidirectional relationship between tobacco consumption and quality of life among Chilean teachers., Participants and Methods: A total sample of 647 Chilean teachers was included in a cross-sectional study (71.8% female). Teachers completed a socio-demographic questionnaire, tobacco consumption habits, and the SF-36 questionnaire to assess quality of life. Logistic regression models were employed for statistical analysis of quality of life (physical component summary; mental component summary), and tobacco consumption habits, adjusted for socio-demographic characteristics., Results: A total of 34.2% of teachers were smokers, with the majority (68.7%) being under 45 years old. Smoking teachers demonstrated lower quality of life scores, particularly mental health and emotional problems dimensions, and mental component summary ( p  < 0.05) versus nonsmoking teachers. Teachers with tobacco consumption had a higher risk of low mental component summary (OR: 1.74; p  < 0.001), and those with low mental component summary were more likely to be smokers (OR: 1.77; p  < 0.002)., Conclusion: These findings indicate that tobacco consumption adversely affects the quality of life of Chilean teachers, especially their mental health. Psychological support should be provided to help teachers cope with work stress and tobacco consumption., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lizana, Vilches-Gómez, Barra and Lera.)

Social media posts represent a major route by which youth share their substance use cognitions and experiences with others. Extant research has primarily examined relations between alcohol-related posts and posters' own alcohol use, yet little is known about the role of social media in the use of less socially accepted substances, namely tobacco and marijuana. Our study represents the first to examine the relative strength of this relation across alcohol, tobacco, and marijuana. The current research used a one-month time lag to tease apart the temporal ordering of substance-use-posting and participants' own substance use. A sample of 282 15-20-year-olds (Mage = 18.4, SD = 1.3, 52.9% female) in the United States completed two self-report surveys, one month apart. Results of a cross-lagged panel model revealed significant effects of alcohol and marijuana consumption on subsequent alcohol- and marijuana-related posting, respectively (i.e., selection effects). However, reverse relations (i.e., self-effects) were not significant. Further, we found no differences in the strength of selection effects across substances, suggesting they are similar for both more (alcohol) and less (marijuana and tobacco) socially acceptable substances. Results point to the importance of using young people's social media posts as a way to help identify individuals at risk for heightened substance use and social media as a mechanism for targeted prevention programming.

This study aimed at exploring the association of nomophobia with alcohol, tobacco, and/or cannabis consumption among high school students. We carried out a cross-sectional study among high school and vocational training students in Galicia, Northwest Spain ( N  = 3,100). Collected data included nomophobia, sociodemographic variables, and alcohol, tobacco, and cannabis consumption. Nomophobia was measured using the validated Nomophobia Questionnaire. Adjusted odds ratios (ORs) and their 95 percent confidence intervals (CIs) were estimated using generalized linear mixed models. More than a quarter of the adolescents (27.7 percent) had nomophobia. We found an association between nomophobia and a high level of tobacco smoking in the last month in boys (OR = 2.16; 95 percent CI: 1.55-3.03). Nomophobia was also associated with higher odds of binge drinking in both genders (girls: OR = 1.86; 95 percent CI: 1.61-3.52; boys: OR = 2.29; 95 percent CI: 1.68-3.13) and with cannabis consumption in boys (OR = 1.74; 95 percent CI: 1.07-2.81). Our findings highlight the importance of a comprehensive investigation of the factors underlying alcohol, tobacco, and cannabis consumption in the adolescent population.

Objective: India has the highest number of smokeless tobacco (SLT) products available in different forms, consumed in various ways. The current study aimed to understand the pattern of daily SLT use according to different product categories and whether Quit intention and Quit attempts vary by SLT type and exposure to media messages., Methods: Data from Global Adult Tobacco Surveys (GATS), 2016-17, was used to find access to media messages and warning labels by SLT type. Quit attempt and Quit intention were calculated for each of the SLT types. Logistic regression analyses were employed to identify whether access to media messages, warning labels influenced, quit intention and attempts vary by SLT type., Results: Khaini or tobacco lime mixture was the most common SLT type consumed by 37% of SLT users, whereas SLT users consuming more than one product accounted for 23% of SLT users. Exposure to media messages and warning labels was high among Gutkha/ paan masala tobacco users (74.7% and 81.2%) and low among oral tobacco (Mishri, Gul, Gudakhu) users (56.1% and 60.0%). Quit attempts and quit intention were high among Gutkha/ paan masala tobacco users (38.3% and 22.3%) and low among oral tobacco (Mishri, Gul, Gudakhu) users (25.3% and 13.6%). Users of Oral tobacco and khaini or tobacco-lime mixture were significantly less likely to attempt quitting (AOR 0.806(95%CI: 0.676-0.962), 0.839(95%CI: 0.736-0.956), and have quit intention (AOR 0.681(95%CI: 0.702-0.976), 0.733(95%CI: 0.627-0.857) compared to Gutkha/ paan masala with tobacco users., Conclusion: The reach of media messages and warning labels varies by SLT type. Quit intention and attempts vary by SLT type and access to media messages and warning labels. There is a need to re-strategise the tobacco control Information, Education and Communication (IEC) to reach out with effective messaging to the most unreached.

Background: Multiple tobacco and e-cigarette product (MTEP) use, the concurrent use of two or more different types of tobacco and/or e-cigarettes products, is common among young people in the US. Changes in patterns of MTEP use among US youth between 2014 and 2020 were identified and the determinants of MTEP use were examined., Methods: Four years of repeated cross-sectional data from the US National Youth Tobacco Survey of middle and high school students from grade 6 to 12 (N total =77 402). Multigroup latent class analysis (LCA) was applied to the data series to allow for simultaneous identification of MTEP use patterns between 2014 and 2020. Logistic regression was used to predict class membership on demographic and tobacco-related variables., Findings: Over the 7-year period, LCA identified three patterns: minimal/non-users (MNU: ~89.8%), mostly occasional e-cigarette and cigarette users (MOEC: ~9%) and polytobacco users (POLY: ~1.2%). From 2014 to 2020, MNU increased from 86.4% to 92% (p<0.05), while MOEC and POLY decreased from 11.2% to 7.9% and from 2.4% to 0.1%, respectively. The probability of regular e-cigarette use increased from 0 to 2.3% among MNU, 6% to 31.9% among MOEC and 29.6% to 67.6% among POLY (p<0.05). In binomial logistic regression, being male, in high school, non-heterosexual, living with someone who uses tobacco at home, having cognitive difficulties, having lower perceptions of tobacco's danger and exposure to tobacco marketing were associated with greater odds of MOEC and POLY than MNU., Conclusions: There was an increase in regular e-cigarette use in all three classes, but a corresponding decrease in the proportion of MTEP use. Public health interventions to discourage uptake of e-cigarettes, such as tighter restrictions on marketing to minors, are warranted and there is a need to consider disparities in the determinants of MTEP use., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: To trigger quit intention and practice of preventive measures for COVID-19 among tobacco users; it is imperative for them to be well aware of the fact that they are at higher risk of COVID-19 infection and should be at higher efficacy to practice preventive measures for the disease as compared to nonusers of tobacco., Objectives: This community-based cross-sectional analytical study was conducted from April 2020 to May 2020 among 1203 adult participants to compare the threat and efficacy perception among users and nonusers of tobacco., Materials and Methods: Perception of threat was assessed using three questions on perceived threat and one question on perceived susceptibility; whereas perception of efficacy was assessed using four questions each on self-efficacy and response efficacy through telephonic interview., Results: There was no significant difference in the overall threat perception among users and nonusers of tobacco. However, state-wise analysis showed that tobacco users had higher perception of threat for SARS-CoV-2 infection in all the states except Telangana. The overall perception of efficacy among tobacco users was significantly higher as compared to nonusers of tobacco., Conclusion: The study calls for active collaboration between tobacco control enthusiasts and the Government to promote awareness of a higher risk of COVID-19 disease among tobacco users. In essence, the study's implications extend beyond COVID-19 and can guide targeted efforts to promote awareness, behavior change, and collaboration in the context of other infectious diseases among tobacco users., (Copyright © 2023 Copyright: © 2023 Indian Journal of Public Health.)

Background and Objectives: Limited research has examined mechanisms, including parenting behaviors, contributing to tobacco use disparities among sexual minority young adults (SMYAs)., Methods: Participants were 644 young adult (ages 18-29; 36.5% racial/ethnic minority) women (N = 416; 44.7% bisexual, 7.2% lesbian, 48.1% heterosexual) and men (N = 288; 11.0% bisexual, 13.2% gay, 75.9% heterosexual). Bivariate analyses examined differences among sex-by-sexual identity subgroups in perceived parenting (psychological control, behavioral control, knowledge, autonomy support, warmth, communication), past 30-day cigarette, e-cigarette, and cigar use, and likelihood of future use. Multivariable regression examined associations of sexual identity subgroup and parenting behaviors to tobacco use outcomes among women and men., Results: Bisexual (vs. heterosexual) women reported greater parental psychological control and less autonomy support, warmth, and communication. Bisexual (vs. heterosexual) women had greater odds of past 30-day cigarette and cigar use and greater likelihood of future cigarette and e-cigarette use, and parenting behaviors were associated with past 30-day cigarette (knowledge, warmth), e-cigarette (psychological control, autonomy support, warmth), and cigar use (behavioral control, warmth) and likelihood of future cigarette (psychological control, warmth) and e-cigarette use (autonomy support, communication). Gay (vs. heterosexual) men reported greater parental behavioral control, less knowledge, autonomy support, warmth, and communication. Sexual identity and parenting behaviors were largely not associated with tobacco use among men., Discussion and Conclusions: Findings highlight the role of parenting behaviors as potential mechanisms contributing to tobacco use disparities among SMYA women., Scientific Significance: Tobacco prevention/cessation programs should be tailored toward specific SMYA subgroups, combinations of parenting behaviors, and patterns of tobacco use., (© 2023 The American Academy of Addiction Psychiatry (AAAP).)

We aimed to examine how bidirectional relationships between mental health problems and tobacco use are formed over time by types of tobacco use in recent samples of U.S. youth. Data were drawn from Waves 1-4 of the Population Assessment of Tobacco and Health Study (N = 10,082) and analyzed using cross-lagged panel models. A high level of internalizing problems at Wave 1 predicted conventional cigarette smoking (adjusted odds ratio [AOR] = 1.19, 95% CI = 1.06-1.34) and e-cigarette use (AOR = 1.25, 95% CI = 1.09-1.43) at Wave 2, but not vice versa. Both cigarette smoking and e-cigarette use at Wave 2 tended to persist into Wave 3, which, in turn, increased the risk of subsequent internalizing problems in late adolescence or young adulthood (Wave 4). The bidirectional relationship between tobacco use and internalizing problems seems to begin as a procession from internalizing problems to tobacco use, and then from persistent tobacco use to exacerbated internalizing problems over time., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: This study examined the association of four domains of human capital development (cognitive development, social and emotional development, physical health, and mental health) and exclusive and concurrent tobacco and cannabis use (TCU) among black youth., Aims and Methods: Nationally representative annual cross-sectional data for black adolescents (12-17 years; N = 9017) in the National Survey on Drug Use and Health 2015-2019 were analyzed. Analyses examined the influence of human capital factors (cognitive development, social and emotional development, physical health, and mental health) on exclusive and concurrent TCU., Results: In total, 50.4% were males; prevalence of 12-month tobacco use fluctuated insignificantly between 5.6% and 7.6% across survey years. Similarly, prevalence of 12-month cannabis use remained relatively stable around 13%, with no significant linear change. Prevalence of concurrent TCU also fluctuated insignificantly between 3.5% and 5.3%. Investment in cognitive development decreased the odds of tobacco (aOR = 0.58, p < .001), cannabis (aOR = 0.64, p < .001), and concurrent tobacco and cannabis (aOR = 0.58, p < .001) use. Similarly, investment in social and emotional development reduced the odds of tobacco (aOR = 086, p < .001), cannabis (aOR = 0.83, p < .001), and concurrent tobacco and cannabis (aOR = 0.81, p < .001) use. Good physical health reduced the odds of tobacco (aOR = 0.52, p < .1), cannabis (aOR = 0.63, p < .05), and concurrent TCU (aOR = 0.54, p < .05). Major depressive episodes increased the likelihood of cannabis use (aOR = 1.62, p < .001)., Conclusions: Investment in cognitive, social, and emotional aspects of human capital development, and physical health among black youth is protective against TCU. Efforts to sustain human capital development among black adolescents may contribute to reducing TCU disparities., Implications: This is one of few studies to examine human capital development factors and their associations with TCU among black youth. Efforts to eliminate tobacco/cannabis-related disparities among black youth should also invest in social, emotional, cognitive, and physical health development opportunities., (© The Author(s) 2023. 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: People with serious mental illness (SMI) are more likely to smoke and less likely to receive tobacco treatment. Implementation strategies may address clinician and organizational barriers to treating tobacco in mental healthcare., Methods: A cluster-randomized trial (Clinic N=13, Client N=610, Staff N=222) tested two models to promote tobacco treatment in community mental healthcare: standard didactic training vs. Addressing Tobacco Through Organizational Change (ATTOC), an organizational model that provides clinician and leadership training and addresses system barriers to tobacco treatment. Primary outcomes were changes in tobacco treatment from clients, staff, and medical records. Secondary outcomes were changes in smoking, mental health, and quality of life (QOL), and staff skills and barriers to treat tobacco., Results: Clients at ATTOC sites reported a significant increase in receiving tobacco treatment from clinician at weeks 12 and 24 (ps<0.05) and tobacco treatments and policies from clinics at weeks 12, 24, 36, and 52 (ps<0.05), vs. standard sites. ATTOC staff reported a significant increase in skills to treat tobacco at week 36 (p=0.05), vs. standard sites. For both models, tobacco use medications, from clients (week 52) and medical records (week 36), increased (ps<0.05), while perceived barriers decreased at weeks 24 and 52 (ps<0.05); 4.3% of clients quit smoking which was not associated with model. QOL and mental health improved over 24 weeks for both models (ps<0.05)., Conclusions: Standard training and ATTOC improve use of evidence-based tobacco treatments in community mental healthcare without worsening mental health, but ATTOC may more effectively address this practice gap., Competing Interests: Declaration of Competing Interest Dr. Schnoll has received medication and placebo free from Pfizer and has provided consultation to Pfizer, GlaxoSmithKline, and Curaleaf. Dr. Beidas is principal at Implementation Science & Practice, LLC. She receives royalties from Oxford University Press, consulting fees from United Behavioral Health and OptumLabs, and serves on the advisory boards for Optum Behavioral Health, AIM Youth Mental Health Foundation, and the Klingenstein Third Generation Foundation outside of the submitted work., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Tobacco use by youth and young adults can lead to significant long-term health problems. We aim to understand transitions in tobacco use patterns among these groups and the factors that affect transition patterns., Methods: Using the five waves of data from the nationally representative Population Assessment of Tobacco and Health (PATH) Study (2013-2019), we conducted latent class analysis and latent transition analysis to understand tobacco use classes and the longitudinal transitions between classes. We also adjusted for covariates, including demographics, individual behaviors, household environment, and psychosocial factors, to capture their effects on class transition probabilities., Results: Three tobacco use behaviors were identified: non-current user (C1), moderate e-cigarette user (C2), and poly-tobacco user (C3). At baseline (Wave 1), 94.4% of participants were classified as C1, 3.2% as C2, and 2.4% as C3, and the distribution shifted towards C2 and C3 over time. Progression to the next class represented the most common transitions (14.1% C2 to C3, 10.7% C1 to C2), while the direct progression from C1 to C3 was rare (0.6%). Being male, White, adult, living in smoking-allowed households, past-year alcohol use, drug use, internalizing problems, and social media follower of tobacco brands were associated with a faster progression to poly-tobacco use., Conclusions: The transition patterns implied that e-cigarette use might be an intermediate progression from non-current use into poly-tobacco use. Individual behaviors, household environment, and psychosocial factors are associated with elevated risks of progression. The findings may inform tobacco prevention and cessation policies among youth and young adults., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Introduction: Poly-tobacco use (PTU), or the concomitant use of two or more nicotine and tobacco products, are a growing public health concern. Adults reporting increased psychological distress (PD) experience profound nicotine and tobacco health-related disparities. Sexual minority (SM) adults report more PTU and higher levels of PD than heterosexuals, yet little is known about patterns of nicotine and tobacco use and its relationship to PD in SM populations., Aims and Methods: The purpose of this study was to investigate sexual identity differences in PD and PTU. Data were drawn from the 2016-2018 National Health Interview Survey (N = 83 017), an annual cross-sectional survey of a nationally representative sample of U.S. adults. PD was assessed using the Kessler Psychological Distress Scale (K6). We fit sex-stratified, weighted, adjusted logistic models to compare PTU and PD by sexual identity., Results: PTU was more prevalent in adults with higher K6 scores. Female adults and SM adults had significantly higher K6 scores and were significantly more likely to experience serious PD when compared to their male and heterosexual counterparts., Conclusions: The current study provides a snapshot of trends in PTU in relation to PD, gender, and sexual identity. Findings suggest higher rates of both PD and PTU in SM adults. Further research examining the mechanisms underlying this disparity is critical to the development of effective intervention and prevention strategies., Implications: Little is known about sex and sexual identity differences in the relations between patterns of tobacco product use and PD. This study is the first to examine the effect of gender and sexual identity on both PD and PTU. SMs reported higher rates of PD and were more likely to be poly-tobacco users. As new ways of engaging nicotine/tobacco continue to proliferate, health risks will endure especially for marginalized populations. An increased understanding of the psychological and social correlates of PTU in SMs is warranted., (© The Author(s) 2022. 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.)

Objective: Previous studies have found positive associations between internalizing and externalizing symptoms and the initiation of tobacco use among adolescents. However, few studies have examined the relationship between these symptoms and sustained tobacco use patterns or how they may vary as a function of sex. The current study examined whether these symptoms predict initiation and sustained use of multiple tobacco products within a longitudinal cohort design., Method: Waves 1-3 of the Population Assessment of Tobacco and Health Study (2013-2016) were used to assess relationships between internalizing and externalizing symptoms, sex, and tobacco use categories (cigarettes, e-cigarettes, poly-tobacco use, other tobacco use) in 6,170 adolescents ( M age = 13.42, SD = 1.10) who were tobacco naive at Wave 1., Results: Internalizing and externalizing symptoms predicted initiation of several tobacco categories at the 2-year follow-up. Examining sustained use patterns revealed a more consistent relationship with externalizing symptoms across tobacco categories, whereas associations with internalizing symptoms were limited. Sex moderated the relationship between elevated internalizing symptoms and increased odds of subsequent e-cigarette and poly-tobacco initiation, with stronger relationships observed among females. In addition, the relationship between elevated externalizing symptoms and sustained other tobacco use was stronger in females as compared with males., Conclusions: Although both internalizing and externalizing symptoms predict tobacco initiation across several product categories, externalizing symptoms may reflect a more reliable signal of sustained tobacco use in adolescents. Mental health symptoms and subsequent tobacco use differed by sex, with females demonstrating stronger relationships for several products.

Introduction: People with disabilities report a higher prevalence of cigarette use than people without disabilities. However, evidence is limited on the relationships between disability type, degree of functional difficulty, and other tobacco product use., Methods: Data from the 2019 U.S. National Health Interview Survey were used to estimate the prevalence and odds of tobacco product use for 6 disability types and degree of functional difficulty. Bivariate and multivariable analyses conducted in 2021 examined the associations between tobacco product use and disability type., Results: Compared to adults who reported no difficulty, current cigarette use prevalence was higher for adults who reported a lot of difficulty/cannot do at all to vision (21.5% vs 13.1%), hearing (19.6% vs 13.6%), mobility (20.0% vs 12.9%), and cognitive (25.4% vs 12.9%) disability questions. The odds of current cigarette (AOR=1.32), pipe (AOR=1.85), and smokeless tobacco (AOR=1.57) use were significantly higher for adults who reported a lot of difficulty/cannot do at all to any disability question and significantly higher for current cigarette (AOR=1.24), e-cigarette (AOR=1.33), pipe (AOR=1.45), and smokeless tobacco (AOR=1.29) use for adults who reported some difficulty to any disability question than those who reported no difficulty. Pipe use was correlated with mobility difficulty (AOR=1.68), and smokeless tobacco use was correlated with hearing difficulty (AOR=1.95)., Conclusions: People who reported difficulty with vision, hearing, mobility, or cognition had a higher cigarette use prevalence than people without disabilities. Other tobacco use differed by disability type. Future research should tailor tobacco interventions to reduce these disparities., (Copyright © 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: We assessed patterns and correlates, including demographic characteristics, psychological factors, and social role transitions, of young adults' tobacco use over time., Methods: In the fall of 2010, we recruited a cohort of 3146 students from 11 colleges in North Carolina and Virginia. Participants completed baseline and at least two survey waves between 2010 and 2019., Results: The sample was 49.8% female, 15.7% non-white, and 6.6% Hispanic. Longitudinal latent class analysis revealed a five-class model with distinct patterns and correlates of tobacco use. Limited Use (52.6% of sample) had minimal use. College-Limited Combustible Tobacco Users (18.6%) had moderate probability of cigarette, cigar, and waterpipe smoking, which decreased to no use post-college. Intermittent Sustained Polytobacco Users (10.9%) had low probability of use that continued post-college. College Polytobacco with Continued Cigarette and E-Cigarette Users (14.5%) had high probability of use of cigarette smoking and increasing probability of e-cigarette, both of which continued post-college. Sustained Polytobacco Users (5.7%) had moderate probability of use of tobacco products across all waves., Conclusions: Patterns of tobacco use varied considerably. In most classes, tobacco use was highest during freshman year and in three classes, use continued post-college. Prevention activities should focus on first-year students and target those at risk for post-college tobacco use., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Introduction: In recent years, cigarette use has decreased, but alternative tobacco product and cannabis use has increased in young adults. Thus, research regarding intraindividual changes in tobacco product and cannabis use in this population, and related psychosocial predictors, is warranted., Methods: We analyzed data from 3,006 young adults (M age  = 24.56 [SD = 4.72], 54.8% female, 31.6% sexual minority, 60.2% racial/ethnic minority) in a 2-year, 5-wave longitudinal study (2018-2020). Latent growth modeling analyzed the outcomes of past 6-month use of cigarettes, e-cigarettes, traditional cigars, little cigars/cigarillos, smokeless tobacco (SLT), hookah, and cannabis across Waves 1-5 among all participants; psychosocial predictors included depressive symptoms, adverse childhood experiences (ACEs), and personality traits., Results: Results indicated decreases in likelihood of using each tobacco product over time, but no significant change in likelihood of cannabis use. Psychosocial predictors of baseline use across products included depressive symptoms and extraversion, as well as ACEs and openness for nearly all products (e.g., except traditional cigars). Psychosocial predictors of less decreases in use likelihood over time included: for cigarettes and traditional cigars, ACEs; for e-cigarettes, extraversion; for little cigars/cigarillos, depressive symptoms and extraversion; for SLT, openness; and for hookah, neuroticism (controlling for sociodemographics). Predictors of greater decreases in likelihood of use over time included: for e-cigarettes and hookah, conscientiousness; and for cannabis, agreeableness., Conclusions: Interventions to reduce young adults' use might target distinct risk/protective factors for using different products (and combinations). Moreover, results regarding decreasing likelihood of using tobacco products but not cannabis over time warrant replication and explanation in other samples., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Current knowledge about the promotion of long-term physical activity (PA) maintenance in cancer survivors is limited. The aims of this study were to 1) determine the effect of self-regulatory BCTs on long-term PA maintenance, and 2) identify predictors of long-term PA maintenance in cancer survivors 12 months after participating in a six-month exercise intervention during cancer treatment., Methods: In a multicentre study with a 2 × 2 factorial design, the Phys-Can RCT, 577 participants with curable breast, colorectal or prostate cancer and starting their cancer treatment, were randomized to high intensity exercise with or without self-regulatory behaviour change techniques (BCTs; e.g. goal-setting and self-monitoring) or low-to-moderate intensity exercise with or without self-regulatory BCTs. Participants' level of PA was assessed at the end of the exercise intervention and 12 months later (i.e. 12-month follow-up), using a PA monitor and a PA diary. Participants were categorized as either maintainers (change in minutes/week of aerobic PA ≥ 0 and/or change in number of sessions/week of resistance training ≥0) or non-maintainers. Data on potential predictors were collected at baseline and at the end of the exercise intervention. Multiple logistic regression analyses were performed to answer both research questions., Results: A total of 301 participants (52%) completed the data assessments. A main effect of BCTs on PA maintenance was found (OR = 1.80, 95%CI [1.05-3.08]) at 12-month follow-up. Participants reporting higher health-related quality-of-life (HRQoL) (OR = 1.03, 95%CI [1.00-1.06] and higher exercise motivation (OR = 1.02, 95%CI [1.00-1.04]) at baseline were more likely to maintain PA levels at 12-month follow-up. Participants with higher exercise expectations (OR = 0.88, 95%CI [0.78-0.99]) and a history of tobacco use at baseline (OR = 0.43, 95%CI [0.21-0.86]) were less likely to maintain PA levels at 12-month follow-up. Finally, participants with greater BMI increases over the course of the exercise intervention (OR = 0.63, 95%CI [0.44-0.90]) were less likely to maintain their PA levels at 12-month follow-up., Conclusions: Self-regulatory BCTs improved PA maintenance at 12-month follow-up and can be recommended to cancer survivors for long-term PA maintenance. Such support should be considered especially for patients with low HRQoL, low exercise motivation, high exercise expectations or with a history of tobacco use at the start of their cancer treatment, as well as for those gaining weight during their treatment. However, more experimental studies are needed to investigate the efficacy of individual or combinations of BCTs in broader clinical populations., Trial Registration: NCT02473003 (10/10/2014)., (© 2021. The Author(s).)

Importance: Although e-cigarettes are not approved as a cessation device, many who smoke believe that e-cigarettes will help them quit cigarette smoking successfully., Objective: To assess whether people who recently quit smoking and who had switched to e-cigarettes or another tobacco product were less likely to relapse to cigarette smoking compared with those who remained tobacco free., Design, Setting, and Participants: This cohort study analyzed a nationally representative sample of US households that participated in 4 waves of the Population Assessment of Tobacco and Health Study (conducted 2013 through 2017), combining 2 independent cohorts each with 3 annual surveys. Eligible participants were individuals who smoked at baseline, had recently quit at the first follow-up, and completed the second follow-up survey., Exposures: Use of e-cigarettes or alternate tobacco products at follow-up 1 after recently quitting smoking., Main Outcomes and Measures: Weighted percentage of participants with over 12 months abstinence by follow-up 2., Results: Of a total of 13 604 participants who smoked cigarettes at baseline, 9.4% (95% CI, 8.7%-10.0%) recently had quit smoking (mean age, 41.9; 95% CI, 39.7-46.6 years; 641 [43.2%] women) Of these, 22.8% (95% CI, 19.7%-26.0%) had switched to e-cigarettes, with 17.6% (95% CI, 14.8%-20.5%) using them daily. A total of 37.1% (95% CI, 33.7%-40.4%) used a noncigarette tobacco product and 62.9% (95% CI, 59.6%-66.3%) were tobacco free. Rates of switching to e-cigarettes were highest for those who were in the top tertile of tobacco dependence (31.3%; 95% CI, 25.0%-37.7%), were non-Hispanic White (26.4%; 95% CI, 22.3%-30.4%), and had higher incomes (annual income ≥$35 000, 27.5%; 95% CI, 22.5%-32.4% vs <$35 000, 19.3%; 95% CI, 16.3%-22.3%). At follow-up 2, unadjusted relapse rates were similar among those who switched to different tobacco products (for any tobacco product: successfully quit, 41.5%; 95% CI, 36.2%-46.9%; relapsed with significant requit, 17.0%; 95% CI, 12.4%-21.6%; currently smoking, 36.2%; 95% CI, 30.9%-41.4%). Controlled for potential confounders, switching to any tobacco product was associated with higher relapse rate than being tobacco free (adjusted risk difference, 8.5%; 95% CI, 0.3%-16.6%). Estimates for those who switched to e-cigarettes, whether daily or not, were not significant. While individuals who switched from cigarettes to e-cigarettes were more likely to relapse, they appeared more likely to requit and be abstinent for 3 months at follow-up 2 (17.0%; 95% CI, 12.4%-21.6% vs 10.4%; 95% CI, 8.0%-12.9%)., Conclusions and Relevance: This large US nationally representative study does not support the hypothesis that switching to e-cigarettes will prevent relapse to cigarette smoking.

Background: This systematic review described the association between electronic nicotine delivery systems and electronic non-nicotine delivery systems (ENDS/ENNDS) use among non-smoking children and adolescents aged <20 years with subsequent tobacco use., Methods: We searched five electronic databases and the grey literature up to end of September 2020. Prospective longitudinal studies that described the association between ENDS/ENNDS use, and subsequent tobacco use in those aged < 20 years who were non-smokers at baseline were included. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess risk of bias. Data were extracted by two reviewers and pooled using a random-effects meta-analysis. We generated unadjusted and adjusted risk ratios (ARRs) describing associations between ENDS/ENNDS and tobacco use., Findings: A total of 36 publications met the eligibility criteria, of which 25 were included in the systematic review (23 in the meta-analysis) after exclusion of overlapping studies. Sixteen studies had high to moderate risk of bias. Ever users of ENDS/ENNDS had over three times the risk of ever cigarette use (ARR 3·01 (95% CI: 2·37, 3·82; p<0·001, I2: 82·3%), and current cigarette use had over two times the risk (ARR 2·56 (95% CI: 1·61, 4·07; p<0·001, I2: 77·3%) at follow up. Among current ENDS/ENNDS users, there was a significant association with ever (ARR 2·63 (95% CI: 1·94, 3·57; p<0·001, I2: 21·2%)), but not current cigarette use (ARR 1·88 (95% CI: 0·34, 10·30; p = 0·47, I2: 0%)) at follow up. For other tobacco use, ARR ranged between 1·55 (95% CI 1·07, 2·23) and 8·32 (95% CI: 1·20, 57·04) for waterpipe and pipes, respectively. Additionally, two studies examined the use of ENNDS (non-nicotine devices) and found a pooled adjusted RR of 2·56 (95% CI: 0·47, 13·94, p = 0.035)., Conclusion: There is an urgent need for policies that regulate the availability, accessibility, and marketing of ENDS/ENNDS to children and adolescents. Governments should also consider adopting policies to prevent ENDS/ENNDS uptake and use in children and adolescents, up to and including a ban for this group., Competing Interests: The authors have declared that no competing interests exist.

Background: It was observed that adult users start tobacco use in childhood or adolescence. The influence of digital and print media, social acceptance among peers, and in order to mimic role models from films attracts youth towards tobacco. Hence this study was conducted to assess the prevalence of smokeless tobacco (SLT) use among school-going adolescents with the assessment of the influencing factors such as exposure at school, home, and public places along with the role of various media in SLT use by adolescents., Methods: Cross sectional study was conducted with 860 students of class 9th -12th enrolled in schools. Purposive sampling of three schools was done from the study area to reach desired sample size. All the students of class 9th - 12th within selected schools were given chance to participate in the study. Data collection was done using pretested modified Global Youth Tobacco Survey (GYTS) questionnaire., Results: Consumption of smokeless tobacco (SLT) was observed in 79 (11%) of 714 subjects. Significantly higher proportion (18.4%) of study subjects consumed SLT who were exposed to tobacco at school premises and 19.1% of study subjects who were exposed to teacher using SLT in schools compared to non-exposed group. (p=0.016). It was observed that 8.1% of subjects without any exposure to tobacco at home and 9.8% of subjects without exposure to tobacco at outdoor public space consumed SLT. Consumption of SLT use was highest (16.7%) among subjects exposed to tobacco advertisement or promotion through social media (p=0.04)., Conclusion: High prevalence of SLT was detected among adolescents in school. Factors such as exposure to tobacco at home, public places, school and school teacher using SLT, exposure of tobacco advertisement and promotion via different modes of media was found to be significantly associated with the use of SLT in the adolescents of school., .

Tobacco Consumption (TC) is one of the main causes of the deterioration of health; however, there are few studies linking its consumption with diet and nutrition among university students. The objective of this study is to test the association of smoking with anthropometry, diet and sleep quality among Chilean university students. Cross-sectional study. University students (n = 1454) from the North, South and Central parts of Chile were evaluated. A self-assessment survey was used to evaluate healthy and unhealthy eating habits. Nutritional status was evaluated by Body Mass Index (BMI). Two surveys were used to assess sleep quality: the Questionnaire of Insomnia and the Epworth Scale. Finally, participants were consulted about Tobacco Consumption: 30% of the students consume tobacco and have a higher score in unhealthy food consumption, less frequent weekly breakfast consumption (< 0.01), lower daily fruit (< 0.01) and vegetables (< 0.05) consumption, higher alcohol consumption (< 0.05) and daily junk food consumption (< 0.05) compared to non-consuming students. Men who consume tobacco present greater insomnia (< 0.001), sleep latency (< 0.001) and daytime sleepiness (< 0.05) compared to non-consumers; and women who consume tobacco have a higher weight (< 0.001) and BMI (< 0.01). When performing logistic regression, tobacco consumption is positively associated with major alcohol consumption (< 0.001), whereas fish (< 0.05) and vegetable (< 0.05) consumption was negatively associated. In conclusion, students of both sexes who smoke have more unfavorable health factors and a poorer quality of life., Competing Interests: Conflict of interest statement The authors declare no conflict of interest., (©2021 Pacini Editore SRL, Pisa, Italy.)

Individuals most often use several rather than one substance among alcohol, cigarettes or cannabis. This widespread co-occurring use of multiple substances is thought to stem from a common liability that is partly genetic in origin. Genetic risk may indirectly contribute to a common liability to substance use through genetically influenced mental health vulnerabilities and individual traits. To test this possibility, we used polygenic scores indexing mental health and individual traits and examined their association with the common versus specific liabilities to substance use. We used data from the Avon Longitudinal Study of Parents and Children (N = 4218) and applied trait-state-occasion models to delineate the common and substance-specific factors based on four classes of substances (alcohol, cigarettes, cannabis and other illicit substances) assessed over time (ages 17, 20 and 22). We generated 18 polygenic scores indexing genetically influenced mental health vulnerabilities and individual traits. In multivariable regression, we then tested the independent contribution of selected polygenic scores to the common and substance-specific factors. Our results implicated several genetically influenced traits and vulnerabilities in the common liability to substance use, most notably risk taking (b standardised = 0.14; 95% confidence interval [CI] [0.10, 0.17]), followed by extraversion (b standardised = -0.10; 95% CI [-0.13, -0.06]), and schizophrenia risk (b standardised = 0.06; 95% CI [0.02, 0.09]). Educational attainment (EA) and body mass index (BMI) had opposite effects on substance-specific liabilities such as cigarette use (b standardised-EA = -0.15; 95% CI [-0.19, -0.12]; b standardised-BMI = 0.05; 95% CI [0.02, 0.09]) and alcohol use (b standardised-EA = 0.07; 95% CI [0.03, 0.11]; b standardised-BMI = -0.06; 95% CI [-0.10, -0.02]). These findings point towards largely distinct sets of genetic influences on the common versus specific liabilities., (© 2020 The Authors. Addiction Biology published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Objective: We assessed the prevalence and factors associated with living with tobacco/nicotine product users among nicotine-naïve adolescents., Methods: Data were from the 2018 Florida Youth Tobacco Survey that included 34,183 adolescents who were never-tobacco product users and provided information about living with tobacco/nicotine users., Results: More than a quarter of adolescents lived with a tobacco/nicotine user. Girls were more likely than boys and middle-schoolers were more likely than high-schoolers to live with someone who uses cigarettes, cigars, and poly-tobacco. Compared to non-Hispanic Whites, Hispanics were less likely to live with someone who uses cigarettes, electronic nicotine delivery systems, cigars, and poly-tobacco. Adolescents who reported currently having asthma were more likely to report living with someone who smokes cigarettes, hookah, and poly tobacco., Conclusions: To reduce and ideally eliminate exposure to smoke/aerosol emitted from tobacco products in nicotine-naïve adolescents, individual and family-centered interventions, coupled with state-wide tobacco prevention strategies are warranted.

Background: Tobacco vaporizers are devices that heat tobacco without burning it. There is currently a scarcity of studies about the addictiveness of tobacco vaporizers or their effects on cigarette withdrawal symptoms., Goals: To assess the perceived dependence of users of tobacco vaporizers and the perceived effects of these products on cigarette withdrawal symptoms., Methods: Enrollment of participants through the internet from 2016 to 2018. Participants were self-selected visitors to an anti-addiction website, current and past users of tobacco vaporizers aged ≥18., Results: We included 139 users of IQOS tobacco vaporizers. All participants were current (49.6%) or former cigarette smokers at the time when they began to use the tobacco vaporizer. Among the 135 current users, the median dependence on vaporizers was 80 on a scale from 0-100 (25th and 75th percentiles: 50 and 90), and 63.6% reported being somewhat to totally afraid of becoming dependent on the vaporizer. Half (51%) reported that they were less dependent on vaporizers than on combustible cigarettes, 43.8% were equally dependent on both products and 5.2% were more dependent on vaporizers than on cigarettes. Only one cigarette withdrawal symptom was reported by participants, "craving" for combustible cigarettes, and among respondents who experienced craving, 83.9% found that the IQOS vaporizer relieved it "a lot" to "totally"., Conclusions: In this self-selected online sample of IQOS users, the perceived dependence on this tobacco vaporizer was relatively high and almost two thirds of respondents were afraid of becoming dependent on IQOS. Most participants perceived that IQOS relieved the craving to smoke combustible cigarettes.

Background: Adolescent alcohol use was found to be influenced by parental and peer alcohol use. Drinking behaviors also differed by gender. However, previous studies mainly focused on adolescents' substance use in relation to the same substance use among their salient others. Hence, this study investigated the cross-substance relationships of alcohol and tobacco use of parents and peers with adolescents' problematic alcohol use, separately by gender., Methods: Data were derived from 4445 adolescents aged 12-17 years from the 2014 National Survey of Substance Use, a nationally representative survey in Taiwan. Problematic alcohol use was assessed using the Alcohol Use Disorders Identification Test (AUDIT). Multivariate multinomial logistic regression was used, stratified by gender., Results: For males, maternal (adjusted odds ratio [aOR] = 1.73) and peer (aOR = 2.57) alcohol use was related to social drinking (AUDIT < 2); paternal (aOR = 3.58), maternal (aOR = 2.18), peer alcohol use (aOR = 5.37), and their own tobacco use (aOR = 4.72) were related to problem drinking (AUDIT ≥ 2). For females, maternal (aOR = 2.26) and peer (aOR = 2.84) alcohol use was related to social drinking; maternal (aOR = 2.35) and peer tobacco use (aOR = 3.48), and paternal (aOR = 4.56) and peer alcohol use (aOR = 3.36) were linked to problem drinking., Conclusions: Both male and female adolescents' alcohol use was associated with their peer alcohol use, and gender differences were found in relation to their parental and peer substance use. Specifically, the parental role-modeling of smoking was only significant in mother-daughter dyads. These findings could inform multifaceted adolescent alcohol prevention programs, tailoring for males and females and also targeting their parental and peer substance use., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background and Objectives: While health risks associated with tobacco cigarette use are well-known, additional risks of dual use are poorly understood. This study compared mental and behavioral health risk factors associated with the current dual use of e-cigarettes and conventional tobacco cigarettes with current exclusive users of tobacco cigarettes and nonusers of either e-cigarettes or tobacco cigarettes., Methods: Data from the 2016 National Behavioral Risk Factor Surveillance System (BRFSS) were analyzed (N = 277,034). Current dual use was defined as the current use of tobacco cigarettes and the use of e-cigarettes, everyday or some days. Multivariate logistic regression analysis was used to assess associations between dual use and mental and behavioral health risks compared with exclusive tobacco cigarette users and nonusers., Results: Compared with nonusers, current dual use was associated with increased odds of having more than 14 days of self-reported poor physical health (adjusted odd ratio [AOR], 1.9; P < .01), more than 14 days of self-reported poor mental health (AOR, 1.8; P < .01), a diagnosis of depression (AOR, 2.2; P < .001); using smokeless tobacco products (AOR, 1.6; P < .05), alcohol use (AOR, 1.6; P < .01), and marijuana use (AOR, 8.3; P < .001) than current exclusive users of tobacco cigarettes., Conclusions and Scientific Significance: The concurrent use of e-cigarettes and tobacco cigarettes is associated with increased odds of having behavioral and mental health problems. These findings may be indicative of increased health risks associated with dual use, compared with the exclusive use of tobacco cigarettes, and have important implications for public health interventions and policies aimed at mitigating health risk behaviors. (Am J Addict 2020;00:00-00)., (© 2020 American Academy of Addiction Psychiatry.)

Importance: Opioid use disorder and opioid deaths have increased dramatically in young adults in the US, but the age-related course or precursors to opioid use among young people are not fully understood., Objective: To document age-related changes in opioid use and study the childhood antecedents of opioid use by age 30 years in 6 domains of childhood risk: sociodemographic characteristics; school or peer problems; parental mental illness, drug problems, or legal involvement; substance use; psychiatric illness; and physical health., Design, Setting, and Participants: This community-representative prospective longitudinal cohort study assessed 1252 non-Hispanic White individuals and American Indian individuals in rural counties in the central Appalachia region of North Carolina from January 1993 to December 2015. Data were analyzed from January 2019 to January 2020., Exposures: Between ages 9 and 16 years, participants and their parents were interviewed up to 7 times using the Child and Adolescent Psychiatric Assessment and reported risk factors in 6 risk domains., Main Outcomes and Measures: Participants were assessed again at ages 19, 21, 25, and 30 years for nonheroin opioid use (any and weekly) and heroin use using the structured Young Adult Psychiatric Assessment., Results: Of 1252 participants, 342 (27%) were American Indian. By age 30 years, 322 participants had used a nonheroin opioid (24.2%; 95% CI, 21.8-26.5), 155 had used a nonheroin opioid weekly (8.8%; 95% CI, 7.2-10.3), and 95 had used heroin (6.6%; 95% CI, 5.2-7.9). Childhood risk markers for later opioid use included male sex, tobacco use, depression, conduct disorder, cannabis use, having peers exhibiting social deviance, parents with legal involvement, and elevated systemic inflammation. In final models, childhood tobacco use, depression, and cannabis use were most robustly associated with opioid use in young adulthood (ages 19 to 30 years). Chronic depression and dysthymia were strongly associated with any nonheroin opioid use (OR. 5.43; 95% CI, 2.35-12.55 and OR, 7.13; 95% CI, 1.99-25.60, respectively) and with weekly nonheroin opioid use (OR, 8.89; 95% CI, 3.61-21.93 and OR, 11.51; 95% CI, 3.05-42.72, respectively). Among young adults with opioid use, those with heroin use had the highest rates of childhood psychiatric disorders and comorbidities., Conclusions and Relevance: Childhood tobacco use and chronic depression may be associated with impaired reward system functioning, which may increase young adults' vulnerability to opioid-associated euphoria. Preventing and treating early substance use and childhood mental illness may help prevent later opioid use.

Introduction: The aim of this study was to determine whether Electronic Nicotine Delivery Systems (ENDS) device type (disposable devices, replaceable cartridges, and refillables) at initial or first ENDS use predicts subsequent initiation of combustible tobacco products (cigarettes, hookah, cigars) among adolescents and/or differentiates between those who initiate use of both ENDS and combustible tobacco products at the same time., Methods: The study examined data from the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS), a longitudinal population-based cohort of students in major metropolitan areas of Texas (n = 3907; N = 461 069). Data were collected every 6 months, from 2014 to 2018; 33.9% (n = 1324; N = 151 784) of the sample initiated ENDS use across this period. Unadjusted and adjusted logistic regression models were used to assess the odds of initiating combustible tobacco products at a subsequent or similar wave as ENDS initiation, given initial ENDS device type., Results: After adjusting for sociodemographic factors, the odds of initiating combustible tobacco use subsequent to ENDS initiation were significantly lower among those who reported using Cartridges as their initial device type compared to those who reported Refillables as their initial device type (adjusted odds ratio = 0.42 [0.18-0.98], p = .05). In addition, after controlling for sociodemographic variables, the odds of initiating combustible tobacco use in the same wave as ENDS initiation were significantly higher among those who reported using Cartridges as their initial device type, compared with those who reported Refillables as their initial device type (adjusted odds ratio = 2.31 [1.05-5.10], p = .04). No significant differences were found in adjusted models when Disposables were compared to Refillables and Cartridges to Disposables., Conclusion: ENDS device type differentiates between adolescents who start using combustible tobacco products at the same time as initial ENDS use, or subsequently., Implications: Previous research has shown ENDS use predicts subsequent combustible use among adolescents, but there is lack of research on the role of specific ENDS device types and the timing of initiation. Findings from this longitudinal study show that initiation of combustible tobacco product use varies by initial ENDS device type among adolescents. These findings can become a focal point for developing interventions for adolescents and could have regulatory implications for ENDS 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: Tobacco use is a current public health epidemic that puts individuals at risk for many health conditions and diseases, and adolescents are at high risk for the initiation and persistence of tobacco use behaviors partly due to engagement with social media content. The objective of this study is to examine the association between engaging in social media behaviors and patterns of electronic nicotine delivery systems (ENDS) and tobacco use at a 1-year follow-up among 11 279 adolescents from the PATH study., Methods: Five social media variables were questioned at Wave 2 and then compared to ENDS and tobacco status transitions (i.e., initiation, persistence, and escalation) at a 1-year follow-up, respectively. Survey-weighted multivariable logistic regression models were used to calculate adjusted odds ratios and 95% confidence interval., Results: Passive behaviors on social media were related to higher likelihoods of starting to use ENDS and other tobacco products. Additionally, active behaviors on social media were related to higher likelihoods for the initiation and persistence of tobacco use. In particular, sending tobacco content to other users was further associated with a higher likelihood of escalation of tobacco product use., Discussion: Both exposure to and interactions with social media tobacco content had a significant impact on the patterns of ENDS and tobacco use in adolescents. Due to the amount of time adolescents spend engaging with online content, social media may be a critical place in which to intervene, possibly with the use of antitobacco or tobacco prevention messages., Implications: The results of this study have implications for public health and the policies surrounding adolescents and their exposure to social media. Reducing the ENDS and tobacco content to which adolescents are exposed has the potential to decrease the instances of initiation and persistence of ENDS and tobacco use. Intervening on social media may prevent or slow the progression of ENDS and tobacco use, and increase motivation and actions toward the cessation of tobacco use in adolescents., (© 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.)

Tobacco addiction is highly co-morbid with a variety of mental health conditions, including schizophrenia, mood and anxiety disorders. Nicotine, the primary psychoactive compound in tobacco-related products is known to functionally modulate brain circuits that are disturbed in these disorders. Nicotine can potently regulate the transmission of various neurochemicals, including dopamine (DA), γ-amino-butyric acid (GABA) and glutamate, within various mesocorticolimbic structures, such as the ventral tegmental area (VTA), nucleus accumbens (NAc) and prefrontal cortex (PFC), all of which show pathologies in these disorders. Many neuropsychiatric diseases have etiological origins during neurodevelopment, typically occurring during vulnerable periods of adolescent or pre-natal brain development. During these neurodevelopmental periods, exposure to extrinsic drug insults can induce enduring and long-term pathophysiological sequelae that ultimately increase the risk of developing chronic mental health disorders in later life. These vulnerability factors are of growing concern given rising rates of adolescent nicotine exposure via traditional tobacco use and the increasing use of alternative nicotine delivery formats such as vaping and e-cigarettes. A large body of clinical and pre-clinical evidence points to an important role for adolescent exposure to nicotine and increased vulnerability to developing mood and anxiety disorders in later life. This review will examine current clinical and pre-clinical evidence that pinpoints specific mechanisms within the mesocorticolimbic circuitry and molecular biomarkers linked to the association between adolescent nicotine exposure and increased risk of developing mood and anxiety-related disorders. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Raising the minimum legal age (MLA) of tobacco sales from 18 to 21 (Tobacco 21 [T21]) has recently been implemented nationwide as a method to reduce tobacco use, but empirical data on youth knowledge of T21 policies and related pathways to tobacco use are limited., Methods: Data were collected from the 2018 Kansas Communities That Care Student Survey. Knowledge of the MLA was compared between T21 and non-T21 regions using a quasi-experimental design. Logistic regression and mediation analysis were conducted to assess the association between knowledge of the MLA, influencing factors, and intention to use tobacco., Results: Of 16 949 students (aged between 11 and 18) completing the T21 survey, fewer students responded correctly about the MLA in T21 than in non-T21 regions (37.4% vs. 46.3% responded correctly, 27.6% vs. 24.2% responded incorrectly, respectively). In T21 regions, Hispanics and students who support T21 were more likely to respond correctly about the MLA. Among current non-tobacco users in T21 regions, students who responded correctly about the MLA were less likely to report intention to use tobacco (adjusted odds ratio [AOR] = 0.7, 95% confidence interval [CI]: [0.6-0.8]) than those who responded incorrectly. The pathway from knowledge of the MLA to intention to use tobacco was significantly mediated by increased support for T21 (p = .002), perceived difficulty in accessing cigarettes (p = .042), and reduced susceptibility to peer influence (p = .027)., Conclusions: Knowledge of the MLA was inversely associated with intention to use tobacco among youth. Educational campaigns to raise awareness and support for T21 among youth may improve the impact of T21 policies., Implications: This study examined youth knowledge of the MLA to purchase tobacco products, and whether knowledge of the MLA was associated with reduced intention to use tobacco. It also examined other influencing factors (eg, perceived support for T21) and potential mediation pathways linking knowledge of the MLA with intention to use tobacco. Given the nationwide adoption of T21, educational campaigns to promote knowledge of the policy may improve its impact., (© 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: The U.S. Food and Drug Administration (FDA) is required by law to inform the public about levels of harmful and potentially harmful tobacco constituents in a format that is "understandable and not misleading to a lay person." Our study addresses a critical gap in research on communicating such information for smokeless tobacco (SLT) products., Methods: The design included random assignment to one of the experimental (online interactive) conditions differing in presentation format or a control condition (receiving no information). Experimental respondents viewed information on levels and health risks of 5 harmful constituents in up to 79 products. Outcome measures included knowledge of health risks of constituents, perception of constituent variability in SLT products, disease risk ratings, self-reported SLT use, and side-by-side product comparisons. The sample of 333 SLT users, 535 cigarette smokers, and 663 nontobacco users participated at baseline, time of intervention, and 6 weeks postintervention., Results: Presentation formats showed few systematic differences so were combined in analyses. Experimental condition respondents increased their knowledge about constituent health effects and their perceptions of constituent variability in SLT products, from baseline to postintervention, and relative to the control condition. Changes in respondents' ratings of disease risk and their estimates of constituent exposure from specific products were observed, but not in self-reported SLT use., Conclusions: Interactive online graphic and numeric presentation formats can be efficient in increasing people's knowledge of health effects and perceived variation of constituents in SLT products. Further research on longer-term behavioral assessment, and usefulness of this approach for regulatory agencies, is needed., Implications: Research on communicating the information about harmful constituents in SLT products to lay persons is critically lacking. This study proposes novel formats for effective communication about the levels and the health effects of SLT constituents to multiple user groups. The lack of misperceptions among study participants that some tobacco products are safe suggests that such formats can potentially be used for public display of SLT constituent data by the FDA and regulatory agencies in other countries., (© 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: Tobacco product prices and consumers' income are the two major economic determinants of tobacco demand. The affordability of tobacco products is dependent on the price of tobacco products relative to consumer income. Increase in tobacco tax is expected to lead to higher price, lower affordability, and reduced consumption. Price elasticity and affordability elasticity are used in analyzing the effect of tobacco tax increases on tobacco consumption and public health. The availability of both parameters raises the question of which one to apply in policy discussions., Aims and Methods: Using global data on cigarette consumption, price, income, and tobacco control measures for 169 countries over 2007-2016, this study estimated the price elasticity and affordability elasticity of cigarette consumption by country income classification using country-specific fixed effects model for panel data., Results: The estimates show that the restriction of equal strength of the effects of price and income changes on tobacco consumption maintained in affordability elasticity estimation is valid for low- and middle-income countries, while it is rejected for high-income countries., Conclusions: Affordability elasticity may prove to be a useful parameter to explain and predict the sensitivity of consumers to tobacco tax and price policy changes under conditions of robust economic growth, which are more likely to be observed in countries with initial low- or middle-income setting. It can provide a reasonable benchmark for tobacco tax and price increase necessary to effectively reduce affordability and consumption of tobacco, which can form a basis for building systematic tax and price increases into the tobacco tax policy mechanism., Implications: Price elasticity measures the sensitivity of consumers to changes in real prices, holding real income constant. Affordability elasticity measures the sensitivity of consumers to price changes adjusted for inflation and income changes. Existing scientific literature on tobacco demand abounds in both price and affordability elasticity estimates, without providing a clear explanation of the theoretical and policy implications of using one parameter over the other. By estimating and comparing price and affordability elasticities for high-income and low-and-middle-income countries separately, this article offers a guide to the practitioners in tobacco taxation for evaluating the effectiveness of tax-induced price increases on tobacco consumption., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.)

Background: Use of nicotine vaping products (NVPs) to replace smoking is often influenced by perceived harmfulness of these products relative to smoking. This study aimed to identify factors that conjointly influenced NVP relative harm perception among smokers and ex-smokers., Methods: Data (n = 11,838) from adult smokers and ex-smokers (quit < 2 years) who participated in the 2016 ITC 4 Country Smoking and Vaping Surveys in Australia, Canada, England and the US were analyzed. Decision tree models were used to classify respondents into those who perceived vaping as less harmful than smoking ("correct" perception) versus otherwise ("incorrect" perception) based on their socio-demographic, smoking and vaping related variables., Results: Decision tree analysis identified nicotine replacement therapy (NRT) harmfulness perceptions relative to smoking, perceived vaping portrayal in the media and other sources as positive, negative or balanced, recency of seeking online vaping information, and age as the key variables that interacted conjointly to classify respondents into those with "correct" versus "incorrect" harm perceptions of vaping relative to smoking (model performance accuracy = 0.70-0.74). In all countries, NRT relative harmfulness perception and vaping portrayal perception were consistently the two most important classifying variables, with other variables showing some country differences., Conclusions: In all four countries, perception of NVP relative harmfulness among smokers and recent ex-smokers is strongly influenced by a combination of NRT relative harmfulness perception and vaping portrayal in the media and other sources. These conjoint factors can serve as useful markers for identifying subgroups more vulnerable to misperception about NVP relative harmfulness to benefit from corrective intervention., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Similar to other countries, the government of Germany has implemented various restrictions of social life in March 2020 to slow the spread of COVID-19 pandemic. This results in millions of people being isolated for long periods, which may increase feelings of worry and anxiety. As the consumption of alcohol and tobacco is an often used dysfunctional strategy to cope with such feelings, these restrictions might cause an increase of consumption. Already at the beginning of the COVID-19 pandemic, the World Health Organization (WHO) warned that increased alcohol consumption during the lockdown can increase the prevalence of alcohol use disorders in the future. However, up to now little is known about the changes in alcohol-drinking behavior and tobacco smoking in the general population during the COVID-19 pandemic., Methods: To address this theme, we investigated the changes in alcohol and tobacco consumption in the German population aged between 18 and 80 years via an online survey., Results: In total, 3,245 persons participated in the survey; 35.5% of them reported an increase in drinking during the lockdown (42.9% did not change their drinking behavior, 21.3% drank less, and 0.3% started drinking). The odds of consuming more alcohol during lockdown were associated with middle age, higher subjective stress due to the COVID-19 pandemic, a lower agreement with the importance of the restrictions, and consuming alcohol more than once per week before the lockdown. Also, 45.8% of the participants increased their smoking during the lockdown. The odds of smoking more during lockdown were associated with higher subjective stress due to the COVID-19 pandemic., Conclusion: These findings suggest that it is important to start campaigns to inform the general population about potential long-term effects of increased alcohol and tobacco consumption and to raise the health-care professionals' awareness of this topic., (© 2021 S. Karger AG, Basel.)

Introduction: The COVID-19 pandemic may have resulted in a change in life routines for tobacco users, but little is known about the rationale underlying these changes. Methods: A convenience sample of young adults ages 21-28 ( n  = 29) were recruited online May-July 2020 to participate in semi-structured interviews about nicotine use behaviors specific to cigarillos and e-cigarettes. Audio-recorded interviews were 60-90 min long and were conducted remotely. Participants were asked opinions and behavioral effects of the COVID-19 pandemic on tobacco use. Verbatim transcripts and field notes from each interview were coded by a trained researcher using a codebook developed using inductive and deductive approaches. Thematic analysis was used to examine product access, use frequency, stress and use triggers. Results: Most current users reported tobacco use stayed the same or increased since the pandemic and attributed this to being home more with greater time/boredom. COVID-19 impacted purchasing behaviors such as purchasing products in greater quantities, through the Internet, or at a different store due to perceived cleanliness. Few reported using tobacco products less frequently and not smoking in public due to the perception of risks associated with smoking and COVID-19, plus having to take off their mask to smoke. Lack of social use modified shared product use, flavors selected, and setting of use. Financial impacts included increased product costs and job loss. Few mentioned wanting to quit due to the pandemic. Discussion: Current tobacco users have experienced major changes in their tobacco use routines during the COVID-19 pandemic.

Cognitive effects of tobacco use among women with schizophrenia, bipolar disorder or depression have not been studied extensively as most studies focussed on men smokers. As part of a study on prevalence and cognitive effects of tobacco use, women with schizophrenia, bipolar disorder and depression were assessed for cognitive functioning using an information questionnaire derived from the Indian Post Graduate Institute Battery of Brain Dysfunction (PGIBBD) and the Trail Making Tests (TMT) A and B. The community dwelling women were clinically diagnosed and recruited from the outpatient department of a free tertiary care teaching hospital in India. The sample consisted of 321 women, 141 with schizophrenia (SZ), 80 with Bipolar Disorder (BD) and 100 with Recurrent Depressive Disorder (RDD). Tobacco users answered statistically significantly fewer questions on the PGIBBD Information Questionnaire. Users also took significantly more time to complete both TMT-A and TMT-B. Age, years of schooling and tobacco use were all significant co-variates for performance on cognitive tests. Tobacco users had lower motor speed and lesser visual scanning, poorer flexibility of thinking and working memory. Women with schizophrenia performed the worst. Tobacco use may exacerbate the cognitive dysfunction associated with major mental illnesses among women., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Limited evidence has been established on associations between tobacco use and mental morbidity and health compromising behaviours. The study aimed to investigate the associations between tobacco use, mental problems, and health risk behaviour among adolescents attending school in Indonesia., Methods: Nationally representative data were studied from 11,124 adolescents that took part in the cross-sectional "Indonesia Global School-Based Student Health Survey (GSHS) in 2015"., Results: The prevalence of current tobacco use was 12.8%. In adjusted logistic regression analysis, compared to non-current or never tobacco users, current tobacco use was associated with eight of eight mental problem indicators (lonely, anxiety, no close friend, suicidal ideation, suicide plan, suicide attempt and current alcohol use), two of four dietary risk behaviours (soft drink and fast food consumption) and seven of ten other health risk behaviours (in a physical fight, bullied, injury, ever sex, school truancy, and two sub-optimal hand hygiene behaviours)., Conclusion: Compared to nontobacco users, current tobacco users had significantly higher mental problem indicators and health risk behaviours. Multiple comorbidity with tobacco use should be targeted in interventions.

Introduction: The dual use of smoked and smokeless tobacco (SLT) poses a serious challenge to tobacco control efforts. This article examines the trends and patterns of this usage in India during the period 2009-2010 and 2016-2017., Methods: Data from two rounds of nationally representative cross-sectional Global Adult Tobacco Survey (GATS) conducted in 2009-2010 and 2016-2017 have been used. Dual use was assessed based on current smokers and SLT users in both rounds., Results: Findings reveal that dual use in India has dropped from 5.3% during 2009-2010 to 3.4% during 2016-2017, a decline of nearly 10 million dual users. However, some states have added nearly 4.6 million new dual users during this period. While dual use continues to remain high in rural areas, there has been a manifold increase in urban areas. Findings revealed that intention to quit tobacco was lower among dual tobacco users as compared to single users with considerable difference between urban and rural areas., Conclusion: Easy availability and affordability of SLT products compared to smoking products and restrictions on smoking in public places may have pushed current smokers and dual users to take to or intensify their SLT consumption. Measures relating to awareness, pricing, taxation, and enforcement of tobacco control laws should focus on all forms of tobacco, especially targeting high dual burden in rural and urban settings., Implications: Dual form of tobacco users represent 12% of all tobacco users in the country. The study reveals that intention to quit tobacco among dual users is significantly lower than that among single tobacco product users. This requires improving public awareness about the morbidity and mortality that arises from the use of all forms of tobacco products. Efforts to restrict the availability of tobacco products should focus on licensing the sale of all tobacco products. Reduction in dual tobacco use will not only result in multiplied health benefits but also help in achieving the Non-Communicable Diseases targets under the United Nations Sustainable Development Goals., (© 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.)

Most tobacco-focused clinical trials are based on locally conducted studies that face significant challenges to implementation and successful execution. These challenges include the need for large, diverse, yet still representative study samples. This often means a protracted, costly, and inefficient recruitment process. Multisite clinical trials can overcome some of these hurdles but incur their own unique challenges. With recent advances in mobile health and digital technologies, there is now a promising alternative: Remote Trials. These trials are led and coordinated by a local investigative team, but are based remotely, within a given community, state, or even nation. The remote approach affords many of the benefits of multisite trials (more efficient recruitment of larger study samples) without the same barriers (cost, multisite management, and regulatory hurdles). The Coronavirus Disease 2019 (COVID-19) global health pandemic has resulted in rapid requirements to shift ongoing clinical trials to remote delivery and assessment platforms, making methods for the conduct of remote trials even more timely. The purpose of the present review is to provide an overview of available methods for the conduct of remote tobacco-focused clinical trials as well as illustrative examples of how these methods have been implemented across recently completed and ongoing tobacco studies. We focus on key aspects of the clinical trial pipeline including remote: (1) study recruitment and screening, (2) informed consent, (3) assessment, (4) biomarker collection, and (5) medication adherence monitoring. Implications With recent advances in mobile health and digital technologies, remote trials now offer a promising alternative to traditional in-person clinical trials. Remote trials afford expedient recruitment of large, demographically representative study samples, without undo burden to a research team. The present review provides an overview of available methods for the conduct of remote tobacco-focused clinical trials across key aspects of the clinical trial pipeline., (© 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.)