Nicotine & Tobacco Research最新文献

Introduction: Globally, tobacco use rates in Muslim communities, particularly among men, are significantly higher than in non-Muslim communities. In the United Kingdom, there are also low rates of help-seeking among British Muslims who use tobacco. Ramadan could be a "window of opportunity" to support tobacco use behavior change but we lack the voice of British Muslim communities on culturally tailored cessation support. We undertook a public and patient involvement and engagement (PPIE) project to gain views from representatives of these communities.

Aims and methods: Discussions with 15 PPIE representatives from, or who worked with, a variety of British Muslim communities identified through gatekeepers, social media, and snowballing approaches. Key points and views from PPIE discussions were summarized into broad themes.

Results: Opportunities and challenges with culturally adapting tobacco cessation support to Ramadan were raised. "Light touch" positive religious messaging connected to tobacco cessation was recommended, and overemphasizing religion in messaging content to be avoided. Quitting during Ramadan was felt challenging due to fasting, precluding the use of nicotine replacement products or medication, and reinforcing tobacco use as part of fast-breaking routines. Instead, PPIE representatives suggested quitting in advance of Ramadan or promoting cessation afterward by capitalizing on tobacco reduction achieved during Ramadan. There was support for digital cessation approaches, but it was felt many in their communities would prefer traditional approaches, including interpersonal support and messaging through influential community members.

Conclusions: "Light touch" culturally tailored tobacco cessation support before or after Ramadan was felt more promising than supporting cessation initiation during Ramadan.

Implications: Members of British Muslim communities identified challenges with using Ramadan as a "window of opportunity" for tobacco behavior change and favored quitting ahead of time for Ramadan or capitalizing on tobacco behavior change achieved during Ramadan to promote a quit attempt afterward. Taking a "light touch" approach with religiously tailored messaging could help engage Muslim people who smoke in cessation support. However, avoiding any strong or negatively framed tobacco-related messages linked to religious phrases or imagery is important. This work reinforces the importance of engaging with communities when considering culturally adapting interventions to prevent misdirected adaptions.

Introduction: Despite high smoking prevalence in people from low- and middle-income countries living with severe mental illness (SMI), smoking cessation interventions adapted for this population and context are lacking. This article describes the adaptation process of a smoking cessation intervention for people living with SMI in South Asia.

Methods: The adaptation process followed the first nine steps of the Escoffery framework for adapting health interventions, complemented by the Stirman adaptation classification to document the modifications. This was conducted by an interdisciplinary codesign team comprising people living with SMI, caregivers, and experts in mental health, smoking cessation, and behavioral science from India, Pakistan, and the United Kingdom. Stakeholders were consulted throughout. Evidence-based interventions were selected and contextual modifications to content and delivery identified. Staff were trained both in-person and online. The acceptability of the intervention was assessed through final consultations with community advisory panels.

Results: A UK intervention, SCIMITAR+, was selected to be adapted, drawing also on the TB & Tobacco and Smart Guide interventions from South Asia. Content and delivery adaptations focused on adding an additional "life after quitting" step, ensuring materials were understandable, with culturally relevant examples and pictures, avoiding stigmatizing SMI, incorporating caregiver support and flexible scheduling of sessions alongside routine appointments, offering hybrid delivery, and including female cessation advisors.

Conclusion: We systematically adapted a UK smoking cessation intervention for people living with SMI, tailoring it for implementation in India and Pakistan. The next steps (10 and 11 of the Escoffery framework) would be to implement and evaluate it in a pilot feasibility trial.

Implications: In this article, we describe the adaptation process for a smoking cessation intervention in South Asia for people living with SMI. The codesign approach, involving people living with SMI, their caregivers, healthcare providers, and experts in mental health, smoking cessation, and behavioral science, enhanced the intervention's relevance for the new target population.There is still a significant gap in the literature explaining how such interventions are developed. This lack of detailed reporting hinders the ability to assess the appropriateness of adaptations and limits guidance for other initiatives. By addressing this gap, this article aims to improve transparency and show how two adaptation frameworks (the Escoffery adaptation framework and the Stirman classification of adaptations) were used in low-resource settings, which can inform future adaptation and implementation efforts.

Introduction: Middle-aged and older adults (aged ≥ 45 years) have historically been overlooked in tobacco research and policy despite a quit rate that is half of younger adults and the greatest near-term harms of tobacco use. A scoping review was conducted on smoking cessation treatment efficacy and its impact on health outcomes among middle-aged and older adults who smoke. This review was reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA) extension for scoping reviews.

Aims and methods: Five databases were searched for relevant studies: PubMed, Scopus, Web of Science, PsycINFO, and Cochrane Library. Inclusion criteria were: Randomized controlled trials (RCTs) or systematic reviews published since 2008 in English; middle-aged (45-64 years) or older adult (≥ 65 years) populations who were smoking combustible cigarettes or e-cigarettes at enrollment in a tobacco cessation treatment trial; and ≥3-month follow-up period. Outcomes included health effects of smoking cessation or smoking abstinence rates.

Results: A total of 44 articles met eligibility criteria (42 RCTs and two reviews). Six focused on health outcomes, 36 focused on cessation outcomes, and four studies examined both health outcomes and cessation success. Six-month cessation rates ranged from 13% to 52%. Most studies did not stratify by age, but those that did suggested older adults achieved cessation rates equal to or exceeding younger adults with combined intervention of counseling and cessation medications.

Conclusions: Many of the studies did not explicitly focus on older adults, but instead focused on medical conditions more prevalent within aging populations. Future research on older adults should clarify age definitions and report stratified analyses by age.

Implications: A scoping review of RCT studies on the effectiveness and health outcomes of smoking cessation interventions in middle-aged (45-64 years) and older adults (≥ 65 years) yielded a total of 44 relevant articles. Results showed that middle-aged and older adult smokers are just as, if not more successful at quitting smoking than their younger counterparts using a combined intervention of counseling and cessation medications. Many of the studies did not explicitly focus on older adults, but instead focused on medical conditions more prevalent within aging populations. Future research on older adults should clarify age definitions and report stratified analyses by age.

Introduction: Indonesia has one of the highest prevalences of smoking among males globally, and province-level policies are a key tool for addressing this challenge. We aimed to describe the implementation and characteristics of province-level smokefree policies in Indonesia, and assess their impact on self-reported smoking and indoor second-hand smoke (SHS) exposure.

Methods: Data from two nationally-representative "RISKEDSAS" surveys (2013 and 2018) were employed for individual-level outcomes. Using data from the Smokefree Policy Evaluation Monitoring Dashboard, provinces were categorized into "control" and "intervention" groups based on policy implementation between these years, with intervention provinces categorized as "low" or "medium-to-high" strength of regulation. We fitted logistic regression models adjusted for respondents' characteristics within a difference-in-differences framework for odds of smoking and SHS exposure outcomes, with interaction terms between year and policies' strength of regulation representing policy effects.

Results: Although interaction terms representing policy effects showed no reduction in odds of smoking in response to policies with low strength of regulation (OR: 1.01, 95% CI = 0.97-1.06, p = .502), we found a modest reduction in odds of smoking associated with medium-to-high regulation strength policies (OR: 0.92, 95% CI = 0.90-0.95, p < .001). Policies of both strengths of regulation were significantly associated with a 7% reduction in odds of indoor SHS exposure (OR: 0.93).

Conclusions: Although most Indonesian provinces now implement smokefree policies, further strengthening key policy dimensions including monitoring, enforcement and compliance, and efforts to tackle barriers to implementation, are needed to maximize impact.

Implications: Indonesia has one of the highest prevalences of smoking among males globally, resulting in a significant attributable disease burden and economic costs. To our knowledge no previous study has attempted to assess impact of province-level smokefree policies in Indonesia. Our analysis found modest impacts of province smokefree policies, and greater effectiveness of those with medium-to-high strength of regulation, while also suggesting occurrence of positive spillover effects to geographically contiguous non-implementing provinces. It also highlights continuing gaps in dimensions of smokefree policies including monitoring, enforcement and compliance.

Introduction: Tobacco use is common among United States Veterans; however, most research is a decade old, does not examine the range of tobacco products, nor consider the role of Veteran-specific factors (eg, Veterans Health Administration [VHA] health insurance).

Aims and methods: We examined tobacco use (current, former) by Veteran status using a national sample; and among Veterans, associations between VHA health insurance and VA-connected service disability status and tobacco use. We used annual cross-sectional datasets (2021-2023) from the National Health Interview Survey (n = 78 277). Weighted multivariable multinomial logistic regression models examined the relationship between Veteran status and current and former: (1) tobacco use (ie, cigarettes, cigars, pipes, e-cigarettes, smokeless; any); (2) combustible tobacco use; and (3) polytobacco use, adjusting for sociodemographics, health status, and survey year. We replicated all models within the Veteran sample, adding variables for VHA health insurance status and VA-connected service disability status.

Results: Veterans (7.9% of the sample) had higher odds of all current and former tobacco outcomes, with the highest adjusted odds ratios (aOR) for current use of: cigars (aOR = 1.97), pipes (aOR = 1.70), polytobacco use (aOR = 1.55), and cigarettes (aOR = 1.41), compared to non-Veterans. In Veteran models, those with VHA health insurance had higher odds of current cigarette (aOR = 1.47) and combustible tobacco use (aOR = 1.28).

Conclusions: Veterans were more likely to report current tobacco use compared to non-Veterans, with variation in odds by product type. Veterans who use the VHA for healthcare have increased odds for cigarette and combustible tobacco use. Clinicians working with Veterans should routinely screen for all tobacco products.

Implications: Veterans have historically used tobacco products at higher rates compared to non-Veterans, partially due to the normalization of use within military culture. Existing research is dated and does not examine the association of Veterans status with individual product types, including newer products. These findings highlight new patterns of use, including high prevalence of cigar use, and opportunities to educate Veterans, both within and outside the VHA, about the relative harms of different tobacco products and to implement culturally-informed cessation programs for Veterans.

Introduction: Flavors play an important role in e-cigarette use among both young people and adults, but evaluations of flavored e-cigarette policies have focused almost exclusively on youth. This longitudinal study examined how flavored e-cigarette policies affect tobacco use over time for different adult age groups using data from the Population Assessment of Tobacco and Health (PATH) Study.

Methods: Adults aged 21 or above at Wave 5 (2018-2019) comprised the analytic sample. Multilevel models were used to examine changes in past 30-day and established e-cigarette use, and past 30-day tobacco use other than e-cigarettes at Wave 7 (2022-2023) for residents of states that had (vs had not) implemented flavored e-cigarette policies between Waves 5 and 7. Sociodemographic variables and state-level tobacco control policies (eg, e-cigarette tax, clean indoor air) were controlled. Regression models tested effects overall and by age group: 21-24, 25-29, 30-39, 40, or above. Full-sample and replicate weights accounted for the complex sample design and nonresponse.

Results: Among those exposed to a flavored e-cigarette policy, there was a significant decrease in odds of past 30-day e-cigarette use for those age 21-24 (AOR = 0.59; 95% CI: 0.36, 0.97) and in odds of established e-cigarette use for those age 25-29 (AOR = 0.32; 95% CI: 0.14, 0.76) compared to those who were unexposed, adjusting for covariates. There was no change in use of tobacco products other than e-cigarettes by flavored policy exposure.

Conclusions: Flavored e-cigarette policies are effective at reducing past 30-day and established e-cigarette use among younger adults (aged 21-29). The impact among older adults (30 or above) is less evident.

Implications: Using longitudinal data and multilevel models, this study demonstrates how flavored e-cigarette policies influence e-cigarette use (and other tobacco product use) for younger adults (21-29). We find limited evidence of policies influencing older adults (30 or above). This work suggests that flavored e-cigarette policies may play an important role in stopping young people from initiating e-cigarette use, and in stopping older young adults who are 25-29 from progressing to more established e-cigarette use.

Introduction: This study examined the association between combined state and local tobacco retail licensing (TRL) laws and tobacco retailer density across all California localities from 2012 to 2021, using 2016 as a midpoint.

Aims and methods: Data on licensed tobacco retailers (2012-2021) were obtained from the California Department of Tax and Fee Administration and local laws from the American Lung Association. The outcome was tobacco retailer density (retailers/1000 population). The exposure variable was a pre- and post-2016 state law (change in licensing fee and products covered), with an interaction between the strength of local city/town/unincorporated county TRL law (categorized as weak, moderate, and strong) and the exposure variable. Multilevel linear models accounted for sociodemographic factors.

Results: The post-2016 state law (β = -0.15, 95% CI = -0.17% to -0.13%) and strong local TRL laws were negatively associated with tobacco retailer density (β = -0.05, 95% CI = -0.09% to -0.01%). Conversely, moderate TRL laws were positively associated with tobacco retailer density (β = 0.05, 95% CI = 0.01% to 0.09%). Also, having a strong local TRL law after the state law was passed was significantly associated with lower tobacco retailer density (β = -0.17, 95% CI = -0.25% to -0.09%). There was no significant association between the state and local law interaction and any of the local-level sociodemographic variables.

Conclusions: Strong local TRL laws are associated with lower tobacco retailer density when there is a comparable state law in place.

Implications: This study shows that when combined, strong local and state tobacco licensing laws are significantly associated with lower tobacco retailer density. The findings showed that a moderate local tobacco licensing law (ie a TRL lacking important provisions, such as fines and penalties for selling to minors) may not be sufficient to reduce retailer density.

Introduction: Despite successful public health campaigns, tobacco use persists as a major cause of preventable illness and death. While tobacco taxation is recognized as an effective control strategy, concerns remain about potential financial strain on lower socioeconomic groups. This study investigates the relationship between household tobacco expenditure and financial stress in Australia, a country with high tobacco taxes and declining smoking rates.

Methods: Household data from the 2015-16 Australian Household Expenditure Survey were analyzed (N = 10 036). Financial stress was measured using a scale based on nine self-reported indicators. Respondents were asked to report if their household had experienced any of these difficulties, for example, inability to pay utility bills or going without meals. Negative binomial regression models assessed the association between tobacco expenditure share and financial stress, adjusting for sociodemographic factors, household wealth, and other expenditures.

Results: Financial stress was more prevalent among households that did (45.0%; (95% CI = 42.5 to 47.5)) versus did not (25.4%) purchase tobacco. All levels of tobacco expenditure were significantly associated with higher financial stress bivariably, after controlling for covariates. For instance, households in the second-lowest tobacco expenditure share quintile had a higher mean financial stress score than non-purchasing households (RR = 1.59, CI = 1.36 to 1.85, p < .001).

Discussion: In Australia, financial stress is prevalent among tobacco-purchasing households, and household tobacco expenditure is significantly associated with increased financial stress even at modest levels of spending, that is, the lower quintiles of tobacco expenditure. These findings underscore the need for targeted policies to mitigate financial strain and support smoking cessation among vulnerable populations.

Introduction: Understanding e-cigarette use among those with multiple intersecting marginalized identities is important since those individuals might experience intersectional minority stress, which is associated with tobacco use. This study examined the prevalence of e-cigarette use at the intersection of race-ethnicity and sexual identity among US adults.

Methods: We analyzed the pooled 2021-2023 National Health Interview Survey (NHIS) dataset adult samples (N = 86 655). We conducted an adjusted binomial logistic regression analysis to predict past-30-day e-cigarette use with sexual identity (straight, gay/lesbian/bisexual/something else [LGB+]), race-ethnicity (non-Hispanic White, non-Hispanic Black/African American, non-Hispanic Asian, non-Hispanic American Indian and Alaska Native, Hispanic, and Other races) and an interaction term between sexual identity and race-ethnicity in one model, adjusted for age, education, cigarette smoking, and diagnoses of chronic diseases. The results were stratified by sex and the adjusted predicted margins were estimated.

Results: Among total respondents, 5.5% (weighted) reported past-30-day e-cigarette use, 5.3% were LGB+, 11.8% were non-Hispanic Black, 6.1% were non-Hispanic Asian, 1.4% were non-Hispanic American Indian and Alaska Native, and 17.2% were Hispanic. The overall interaction effect between sexual identity and race-ethnicity on outcome was significant among total respondents (p = .004) and females (p < .001), but not males. Among females, the adjusted predicted margins for current e-cigarette use between LGB+ individuals and heterosexual individuals in Hispanic groups (4.0% vs 1.0%) were significantly different from those in the non-Hispanic White group (4.4% vs 3.4%).

Conclusions: Sexual minority adults in Hispanic groups, particularly Hispanic sexual minority females, may be at increased risk of e-cigarette use compared to Hispanic heterosexual females.

Implications: This study highlights the risk of e-cigarette use among sexual minority adults in non-White racial-ethnic groups, particularly Hispanic sexual minority females. These findings underscore the need for future research to understand the unique drivers of e-cigarette use among Hispanic sexual minority females.

Introduction: In 2014, Senegal emerged as a leader in tobacco control in the WHO African Region (AFRO) after adopting one of the strongest national tobacco control laws in AFRO. Among other measures, the law included a comprehensive ban on tobacco advertising, promotion, and sponsorship (TAPS) at the point-of-sale (POS), including a ban on product display. The goal of this study was to assess retailer compliance with the TAPS ban in Dakar, Senegal, 10 months after its implementation at the POS.

Methods: Using a purposive sampling strategy, retail audits were performed at 309 tobacco retailers in 12 neighborhoods of Dakar. Data collectors used Kobo Toolbox, a web-based data collection platform. A checklist was developed based on the TAPS provisions, Euromonitor data, and a previous compliance packaging and labeling study conducted in Dakar. The survey included neighborhood name and location, hub location, POS type, tobacco products for sale, and type of tobacco advertising, promotion, and product displays observed.

Results: Overall compliance with the ban on all TAPS at the POS was observed at <5% (n = 15) of stores surveyed and varied by retailer type. Compliance with the ban on product display was 6.1% (n = 19), while compliance with all other components of the TAPS ban combined was higher, at 67.3% (n = 208). Philip Morris International and Imperial Tobacco products and marketing were responsible for most violations observed.

Conclusions: Low levels of compliance 10 months after implementation may suggest weak enforcement from local authorities and intentional undermining of advertising bans from the tobacco industry.

Implications: Exposure to TAPS at the POS increases impulse buying, normalizes tobacco products and use, and increases likelihood of youth initiation. There is a dearth of implementation literature for tobacco control policies in the WHO African Region. This study provides monitoring and compliance data in Dakar, Senegal 10 months after implementation of a national TAPS ban. This study presents data for policymakers in Senegal and similar low- and middle-income settings on specific areas of a tobacco control law that may require additional enforcement measures for better compliance.