Tobacco Use Insights最新文献

Background: Secondhand smoke (SHS) exposure remains a critical public health concern, especially for adolescents, who are more susceptible to its harmful effects and may initiate smoking as a result. SHS, comprising both mainstream and sidestream smoke, contains over 7000 chemicals, many of which are carcinogenic. Adolescents exposed to SHS are more likely to experiment with smoking due to environmental influences, peer pressure, and familial smoking behavior.

Objective: This study aims to examine the relationship between SHS exposure and smoking attitudes and behaviors among adolescents aged 13-15 in the Gaza Strip, where SHS exposure and tobacco use remain prevalent.

Methods: Data were obtained from the 2019 Global Youth Tobacco Survey (GYTS), a cross-sectional, school-based survey targeting students in Gaza. The study employed a two-stage cluster sampling design to ensure a representative sample. SHS exposure was assessed in multiple contexts, including home, public enclosed spaces, and outdoor areas. Smoking attitudes, initiation behaviors, and demographic variables were also analyzed using descriptive statistics, Chi-square tests, and multivariable logistic regression to identify predictors of smoking behaviors.

Results: Of the 1536 adolescents surveyed, 62.3% reported SHS exposure at home, and 53.9% reported exposure in enclosed public spaces. Adolescents exposed to SHS were significantly more likely to experiment with smoking, with curiosity (62.2%) and peer influence being key motivators. Additionally, SHS exposure in both indoor and outdoor environments was associated with a higher likelihood of shisha experimentation. Females reported higher SHS exposure rates than males across all environments (P < .001).

Conclusion: SHS exposure significantly increases the risk of smoking initiation among adolescents in the Gaza Strip. These findings emphasize the need for targeted public health interventions, including stricter smoke-free legislation, parental education, and awareness campaigns aimed at reducing SHS exposure and preventing smoking uptake in youth.

[This corrects the article DOI: 10.1177/1179173X241298524.].

Background: The availability of novel nicotine products like oral nicotine pouches (ONP) has been rising in South Asian countries, including Pakistan. We aimed to assess ONP marketing strategies at point-of-sale (POS) and understand the perceptions among consumers and sellers regarding its use in Karachi, Pakistan. Methods: We conducted a mixed-methods study in low, middle, and high socioeconomic neighborhoods of District East Karachi. For the quantitative component, we used a cross-sectional design, collecting data through observations and surveys. The observation checklist included items about advertising, product placement, display, and promotional aids. The survey questionnaire included questions on marketing tactics, product placement, and advertising strategies for ONP. For the qualitative component, we conducted in-depth interviews with ONP consumers and sellers to explore their perceptions and understand marketing strategies. Frequencies and percentages were used to report quantitative data, while thematic analysis was conducted for qualitative findings. Results: We observed 90 POS of ONP and found that 20% (n = 18) were located within 200 meters of schools. ONP advertisements were found in 67% (n = 60) of the surveyed shops, 59% (n = 53) displayed ONP next to candy, and 70% (n = 63) displayed at child's eye level. A higher proportion of consumers (n = 66, 73%) use ONP as a cessation aid for tobacco. Most sellers (n = 48, 53%) were approached by the companies to sell ONP, and 40% received a commission while achieving the targets on ONP sell. About one-fourth of sellers (n = 21, 23%) reported selling ONP to students less than 18 years. Our qualitative findings revealed marketing strategies, peer influence, ease of use in tobacco-restricted areas, and the perception of reduced harm compared to cigarettes as key drivers of ONP consumption. Conclusion: Our study highlights a critical public health concern and offers valuable insights that could inform the development of policies to regulate tobacco sales.

Medications for smoking cessation can double quit rates but are underused in primary care. This qualitative study aimed to explore: (1) patients' perspectives regarding having their general practitioner (GP) use a proactive approach to smoking cessation treatment using an encounter decision aid (DA), and (2) their expectations regarding their GP's role. We conducted qualitative semi-structured interviews with participants of the FIRST randomized trial (adults who smoke daily with any level of motivation for tobacco quitting). In the FIRST study, the intervention was a half-day course teaching GPs to use a proactive approach using a DA. Control GPs received a 1-h refresher training. Phone interviews were run 5-16 weeks after a routine visit with their GP. A thematic data analysis was performed with 20% double independent coding. We conducted 20 semi-structured interviews (mean age 49 years, 55% female). In the intervention group (n = 12), 7 participants appreciated the DA, saw it as useful, usable, and valuable. Two participants did not find it helpful and 3 did not recall having used it. Participants felt their GP provided moral support, more than from a specialist (cardiologist or pulmonologist) because their GP knows them better and has more time during the visit. They felt that the most important factor influencing smoking cessation was their own motivation, not treatment. Most participants appreciated the DA. Most participants did not perceive medications as part of quitting. They thought quitting was a matter of motivation. A DA could be an acceptable way to encourage use of treatments to aid with tobacco cessation. An early presentation of treatment options to all persons who smokes may encourage them to request a treatment when ready to quit smoking. Patient perceptions of the role of GPs and treatments for smoking cessation may be a barrier to seeking help to quit.

Background: New therapeutic cessation approaches are being tested in clinical trials to engage and retain people who smoke. Our team is conducting a pragmatic randomized clinical trial (RCT) to evaluate a new treatment for tobacco dependence, but enrolling participants and ensuring adherence has been more challenging than in previous trials.

Objective: To determine the predictors of enrollment and adherence in the RCT.

Design: A secondary analysis of data from a tobacco cessation RCT.

Methods: Data was collected during a two-group RCT testing the efficacy of an integrative guided imagery vs behavioral treatment, with both conditions involving six weekly, hour-long sessions over 9 weeks.

Results: Of the 1074 randomized participants, 803 (74.8%) enrolled (completed the first session), and 631 (78.6%) of those were adherent (attended all scheduled sessions). Variables associated with enrollment included age (adjusted odds ratio [AOR], 1.01; 95% CI, 1.0003-1.02; P = 0.04) and state of residence (West Virginia vs New York (NY), AOR, 0.66; 95% CI, 0.46-0.94; P = 0.02), with older participants and those from NY more likely to enroll. Variables associated with adherence included race (Black vs White) (AOR, 2.09; 95% CI, 1.05-4.16; P = 0.04), higher education (at least some college vs high school or less) (AOR, 2.27; 95% CI, 1.58-3.26; P < 0.0001), marital status (all others vs single/never married) (AOR, 1.66; 95% CI, 1.11-2.48; P = 0.01), and state of residence (Arizona vs NY) (AOR, 0.52; 95% CI, 0.34-0.78; P = 0.002). Within Arizona, older age increased enrollment, while higher education and marriage improved adherence. Within NY, higher education was associated with both increased enrollment and adherence, while higher number of household smokers, and not reporting substance use were associated with increased adherence.

Conclusion: Enrolling and retaining people who smoke in cessation trials requires novel strategies. Identifying predictors of enrollment and adherence offers valuable insights for overcoming barriers in future tobacco cessation RCTs.

Introduction: Multiple tobacco product (MTP) use may intensify nicotine dependence and reduce the chances of quitting success. Characterizing MTP use in people with HIV (PWH) in low- and middle-income countries (LMICs) is needed to guide cessation approaches in this group. This study aimed to identify patterns and correlates of MTP use among PWH in a single clinic. Methods: This study was conducted among PWH at a clinic in Chennai, India. Participants completed an in-person survey providing information on tobacco use, demographics, and cessation-related factors. This analysis focused on PWH who reported current tobacco use. We used Fisher's exact test (categorical variables) and the Wilcoxon rank-sum test (continuous variables) to assess statistical differences in demographics and cessation-related factors between PWH who used single vs multiple tobacco products. Results: Of 154 PWH adults surveyed, 58 (37.7%) reported current tobacco use. Most PWH currently using tobacco were male (n = 49/58, 84%), with a median age of 21 years (IQR: 10). Forty-six percent (n = 27/58; 95% CI: 33% - 60%) reported MTP use, combining three products (IQR: 3) on average. Those who used multiple products were more likely to have a higher education level (n = 12/27, 44%; 95% CI: 25% - 65%) compared to those who used a single product (n = 2/16, 12%; 95% CI: 1% - 38%) (P-value = 0.03). A lower proportion of participants who reported MTP use were unemployed (n = 1/27, 97%; 95% CI: 0% - 19%) compared to those who used a single product (n = 5/16, 31%; 95% CI: 11% - 59%) (P-value = 0.04). All other factors, including gender, primary language, marital status, and cessation-related factors, were comparable between PWH who used a single tobacco product and those who used multiple products. Conclusion: Among PWH who currently smoke, almost half use tobacco combined multiple products. MTP use in PWH was linked to higher education levels and employment in this single clinical setting.

Introduction: Smoking causes disparate health outcomes among people living with HIV, who also experience higher rates of food insecurity compared to HIV-negative adults.

Objective: Aiming to characterize household food insecurity among HIV + smokers in Vietnam, we surveyed 182 smokers undergoing HIV-care at 5 clinics in Hanoi, Vietnam.

Methods: We estimated the proportion of food insecurity among our sample using the Household Food Insecurity Access Scale and analyzed covariates associated with food insecurity, like income, and moderators of smoking, like drug use.

Results: Food insecurity was reported by 13.3% of our sample. The mean (SD) of years living with HIV was 12.8 (6.45). Moderate-to-severe food insecurity was associated with tobacco dependence [RR = 1.68 (1.27, 2.22); P = .05] and readiness-to-quit smoking [RR = .45 (.24, .86); P = .002].

Conclusions: Our findings suggest people living with HIV who smoke are vulnerable to food insecurity and face very high or high tobacco addiction. We also find evidence that food insecurity is linked to several other conditions that alone or together are barriers to quitting. Considering these findings and the increasing interest in HIV and co-existing chronic conditions like smoking and food insecurity, further research is needed to understand how food insecurity and tobacco use intersect and impact people living with HIV who experience these concomitant conditions.

New nicotine products such as e-cigarettes, heated tobacco and smokeless tobacco/nicotine products, are popular among young people. Most regret having started using these products, but little is known about how to help adolescents and young adults to quit most effectively. This systematic review aimed to identify all existing studies on the efficacy of cessation interventions on the use of novel nicotine and tobacco products in adolescents and young adults. Original randomized controlled trials on cessation of use of e-cigarettes, heated tobacco and smokeless nicotine/tobacco products aimed at young people aged between 15 and 25 were included. The exclusion criteria were interventions on cessation of cigarette/conventional tobacco smoking and studies that focused on preventing initiation rather than cessation. Both researchers independently screened articles and extracted data. The risk of bias was assessed. A total of 345 papers were screened for eligibility, and 9 original studies were included. All studies were conducted in the United States. Populations ranged from 24 to 2588. Five studies reported significant effects of the study interventions, of which 4 were extensive multi-component smokeless tobacco cessation interventions in a high school or college setting. The fifth effective intervention was an SMS text-based e-cigarette cessation program. Low-grade evidence suggests that multi-component interventions that include counseling and an SMS text-based cessation program that is also based on behavioral support may be effective in the cessation of the use nicotine products in adolescents and young adults. Further research that includes cessation of the use of all new tobacco- and nicotine products is needed.

Introduction: India is one of the few countries to have banned production, manufacture, import, export, transport, sale, distribution, storage and advertisement of electronic cigarettes (e-cigarettes). With the advent of technology, these product are being marketed extensively on internet despite the ban. Objective: To assess promotion and sales of e-cigarettes on the internet, and social networking sites (SNS); and to assess the levels of awareness regarding e-cigarettes among youth participants and the source of receiving information on e-cigarettes. Methodology: In 2022, a survey was conducted with youth (18-24 years), along with a desk review to identify influencers promoting, and e-stores selling e-cigarettes in India. Further, a content analysis was conducted on the identified influencers and online stores. Results: 370 youth with a mean age of 21.1 ± 1.7 years participated in the survey. 66.6% of participants reported being aware of e-cigarettes through social media. Instagram (46%) was identified as the most popular social networking platform for promoting e-cigarettes. 189 influencers promoting e-cigarettes on Instagram were identified and their posts positively portrayed e-cigarettes (trendy/cool, flavours, hedonic value, features cessation aid and cost-effective). Additionally, 83 e-stores (49 Indian and 34 international) were identified as selling e-cigarettes in India. Findings from content analysis of both influencers and e-stores highlighted issue of international cross-border marketing. Conclusion: To safeguard youth and achieve a path to Tobacco-free generation; there is a dire need for strengthening the monitoring and enforcement of PECA 2019, especially to address international cross-border advertisements and sales of e-cigarettes. Additionally establishing strong reporting violation mechanisms is also needed. Furthermore, educating youth, retailers, policy makers and community via sensitization programs on detrimental effects of e-cigarette use and existing policies related to e-cigarettes in India is crucial.

Background: Marketing of flavored tobacco products has drawn concern because they are used disproportionately by young people. Online retailers have marketed e-cigarette liquids and devices to minors despite knowing it is illegal. The onset of the COVID-19 pandemic resulted in substantial increases in online purchasing, however, there has been limited study of possible shifts in online tobacco product marketing associated with this change.

Objectives: We sought to identify types of tobacco regulatory violations in 2021-2022, marketing claims made by retailers, the extent to which retailers had processes in place to deter minors from browsing websites, and the types of flavors promoted.

Design and methods: Our observational study was based on an initial sample of 100 tobacco retailers that had received FDA Warning Letters in 2020-2021. Using methods validated in previous research, we coded the letters for retailer information, violation type, and for retailers with an online presence, the types of products sold, and their marketing claims.

Results: Most retailers with violations were in the US South (48%), 65% had an online presence at the time of analysis, and 53% had a website that offered online product sales. The most common type of violation was the sale of new tobacco products without required marketing authorization (83%). For the retailers in the sample with active websites, 42% were still selling a product that the FDA had indicated was marketed unlawfully. Among these retailers with active websites, 32% did not have processes in place to deter access by minors. Advertised flavors focused on food (eg, mango, honey) and concepts (eg, "love", "classic").

Conclusions: Online retailers appeared less likely to remediate tobacco product violations identified by the FDA after the onset of the COVID-19 pandemic than before it, and few websites had strong processes in place that would deter youth browsing.