Introduction: Tobacco remains the world's leading preventable cause of death, with the majority of tobacco-caused deaths occurring in low- and middle-income countries. The first global health treaty, the Framework Convention on Tobacco Control (FCTC), outlines a set of policy initiatives that have been demonstrated as effective in reducing tobacco use. Article 11 of the FCTC focuses on using the tobacco package to communicate tobacco-caused harms; it also seeks to restrict the delivery of misleading information on the pack about the product.The objective of his study is to establish a surveillance system for tobacco packs in Nigeria to assess pack compliance with in-country health warning label requirements. The Tobacco Pack Surveillance System (TPackSS) monitors whether required health warnings on tobacco packages are being implemented as intended and identifies pack designs that might violate the communication of harm-related information and undermine the impact of the country's tobacco packaging laws.
Methods: Tobacco cigarette packs were collected in three cities in 2019-2020. The intention was, to the extent possible, to construct a census of 'unique' pack presentations available for purchase in Nigeria. We implemented the TPackSS standardized Protocol for acquiring packs from 36 diverse neighborhoods across three cities. At the time of purchase, data on the price and place of acquisition of each pack were recorded. We photographed packs, coded, and archived them. Each pack was coded for compliance according to the current health warning label laws. Each pack was coded by two independent coders consistently. We routinely measured intercoder reliability and only retained variables for which a good level of reliability was achieved.
Results: Across the three cities in Nigeria, the team collected 90 tobacco packs. Overall, 77% of packs evaluated for HWL compliance complied with all the relevant common indicators of HWL compliance. There was a 92% compliance with the location of the HWL (e.g. top or bottom of pack, front or back panel) with in-country requirements. Of the four compliance indicators, the size of the HWL (the minimum required coverage) showed the lowest compliance (31%) (i.e. the HWL was too small on most of the packs). Label elements (such as color contrast or content of warnings) showed 85% compliance overall.
Conclusions: The analysis of the packs showed various levels of compliance with Health Warning Label provisions for Nigeria. Periodic evaluations are required to ensure that minimum requirements are met.
Introduction: We evaluated the tobacco odor intensity of cigarettes based on a large consumer panel and explored the differences of odor intensity perception based on sex, age and smoking habits.
Methods: The perceived intensity of tobacco odor of cigarettes was evaluated using a consumer group method. A consumer panel of 240 volunteers (80 smokers, 80 ex-smokers and 80 non-smokers) was asked to smell eleven unlit cigarettes and then report their tobacco odor intensity in a specific questionnaire.
Results: All volunteers clearly determined the presence of tobacco odor in all cigarettes. There is a general decrease of the perceived odor intensity with age, for both males and females. Moreover, tobacco odor perceived intensity, among all volunteer groups (smokers, non-smokers, ex-smokers), was higher for females than for males. Non-smokers declared the highest perceived tobacco odor intensities, followed by ex-smokers and smokers, who recorded the lowest perceived odor intensity. Perceived odor intensity decreased with age, with a higher rate for females compared to males, but independently of the smoking habits.
Conclusions: Regular and untrained consumers confirmed that a tobacco odor of different intensity can be perceived during the smelling of unlit cigarettes. This perceived intensity depends on sex, age and smoking habits.
Introduction: The state of California has enacted progressive anti-tobacco policies, including Proposition 56 in 2016. In response, the alternative and emerging tobacco product (ATP) industry has increased its political activity. This study explores the association between the proportion of people voting against Proposition 56 and tobacco/ATP retail density.
Methods: We conducted a retrospective analysis using data on licensed California tobacco retailers, which were then cross-referenced for categorization using Yelp. Proportion voting against Proposition 56 was obtained from the Secretary of State's website. A series of linear regression tests were performed between population-normalized retailer density and voting proportion at the county level before and after adjusting for covariates such as age, gender, race/ethnicity and median household income.
Results: The total number of licensed tobacco retailers increased by 29.31% from 2015 to 2019. Association between proportion voting against Proposition 56 and retail density was significant during voting and during periods of policy implementation and post-implementation (2016-2018) for non-specialized tobacco retailers. For specialized/ATP retailers, significance was only detected during the post-implementation period (2018-2019) after normalization. Proportion voting against Proposition 56 was also a significant predictor of increase in total number of non-specific (β=0.48, p=0.008) as well as specialized tobacco and/or ATP retail storefronts (β=0.21, p=0.001) from 2016 to 2018.
Conclusions: This study provides initial evidence of the association between tobacco retail density and voting patterns for anti-tobacco policy. Future research should examine the role of tobacco retail density on variation in local support for state tobacco control initiatives, including tailoring outreach to specific voting census blocks in communities with heavy retail presence.
Introduction: Most adolescent and young adult (youth) smokers and users of novel nicotine products wish to quit. Little is known, at a population level, about youth cessation activities, and the counselor's experiences in working with youth smoking and nicotine product cessation.
Methods: A questionnaire was mailed to all 98 municipalities in Denmark on 31 October 2022. Youths were defined as those aged 16-25 years. The participation rate was 96% (n=94). Simple descriptive statistics were performed.
Results: This survey explored youth-targeted smoking and nicotine product cessation activities and ex-periences from municipality counselors across the whole nation. Overall, 60% of the Danish municipal counselors had low/very low/no personal experience with youth cessation interventions, 89% found it dif-ficult to work with youth counseling, 90% found it difficult to recruit youth to nicotine cessation services, and only 25% of the active municipalities were described as highly experienced. A higher percentage of the highly experienced municipalities reported that they share the responsibility of recruitment to cessation services with schools, counsel youths in separate groups from adults, and have good experiences with online counseling.
Conclusions: This Danish nationwide survey showed that even in a country with very well-organized and free-of-charge cessation counseling programs, very few municipalities give assistance to youth, and most find it difficult to work with youth. Cessation services have been designed for adult smokers and seem to have failed to meet the needs of young smokers and users of novel nicotine products, at least in Denmark. There is an urgent need for research on how to effectively recruit youth to cessation services, and what works to help youth quit.
Introduction: Electronic nicotine delivery systems (ENDS) have recently emerged as a public health threat globally. Despite the low proportion of e-cigarette users (1.22%) reported in the Global Adult Tobacco Survey-2, the Government of India enacted the Prohibition of E-cigarettes Act 2019 (PECA), prohibiting all forms of ENDS/ENNDS. The current analysis presents nationally representative findings on the level of awareness of e-cigarettes in India and its correlates and characteristics of those aware of e-cigarettes.
Methods: The current secondary analysis from GATS-2 among adults aged ≥15 years from all states and Union Territories of India used a standard protocol for data collection and management. A multi-stage cluster sampling design was used. The respondents who were aware of e-cigarettes were included (n=2524). Binomial logistic regression analysis was conducted, and adjusted odds ratios (AORs) with 95% CI, were calculated to measure the associations between independent and dependent variables.
Results: Only 3.4% of the respondents were aware (either heard or seen) of e-cigarettes and their awareness was found significantly higher among males (AOR=2.07; 95% CI: 1.90-2.24), urban population (AOR=2.83; 95% CI: 2.61-3.07), and higher education (AOR=0.41; 95% CI: 0.38-0.45).
Conclusions: Public awareness campaigns about the harms of e-cigarettes and the law (PECA) need to be rolled out in urban and rural areas. Capacity-building exercises of implementers and enforcers at the grassroots level could also support communicating the harms to hard-to-reach groups. Further, regular compliance monitoring of the legislation and prosecution of violators would facilitate its effective implementation at the national and sub-national levels.
Introduction: The purpose of this survey was to assess the prevalence of hookah smokers among children and adolescents aged 12-16 years in Belarus.
Methods: This survey involved 3485 people, including 1737 girls and 1726 boys, and included 6 questions from the main questionnaire of the GYTS aimed at hookah consumption. The statistical processing was performed using the SUDAAN software package; a 95% confidence interval was calculated to calculate weighted prevalence estimates and standard errors.
Results: According to the GYTS carried out in the Republic of Belarus in 2021, hookah smoking is becoming increasingly popular. The number of adolescents who have ever smoked a hookah is 9.3%. The prevalence of regular hookah smokers is quite low (0.9%). But there are justified fears that teens who have never smoked cigarettes but have tried hookah are more likely to start smoking cigarettes and become regular cigarette smokers two years later.The frequency of hookah use naturally increases with age. The number of adolescents who have ever smoked a hookah among those aged 14, 15 and 16 years (10.7%, 11.7% and 18.2%, respectively), was higher than among students aged 12 years (5.5%) or 13 years (5.6%) (p<0.001); hookah smoking was higher among students in the 9th and 10th grades (13.0% and 14.2%, respectively), then among students in the 7th grade (5.1%) (p<0.001).
Conclusions: This national survey provides the first data of prevalence of hookah smoking among children and adolescents in Belarus and allows us to conclude that the growing popularity of waterpipe tobacco smoking dictates the need for timely recommendations on waterpipe smoking policy.
Introduction: Hospital staff discussing smoking with children and their families can impact tobacco control, which is crucial in reducing the harmful effects of tobacco smoke exposure. Our study aims to assess staff comfort level in discussing smoking with patients or their families, and coworkers, after the implementation of a hospital-wide tobacco control policy.
Methods: This cross-sectional study included 2340 staff members who completed an anonymous online survey in a large urban children's hospital in 2019. The main outcomes of interest were the comfort level in discussing smoking with patients or their families, and co-workers. We used multivariable logistic regression to identify whether the comfort level varied by sex, age, job type, and smoking status.
Results: Most of the respondents (83.8%) were female, 41.2% were aged 18-35 years, 57.6% worked as clinical staff, and 15.5% were ever smokers. Compared to males, females were less likely to feel very comfortable in asking patients or their families about their smoking tobacco (adjusted odds ratio, AOR=0.72; 95% CI: 0.56-0.92) or talking to co-workers about the health risks associated with their smoking (AOR=0.71; 95% CI: 0.54-0.93). Staff who were non-smokers were less likely to feel very comfortable in talking to co-workers about the health risks associated with their smoking (AOR=0.60; 95% CI: 0.45-0.78). The odds of feeling very comfortable in discussing smoking were consistently lower among those aged 18-35 years than their older counterparts. Clinical staff were more likely than non-clinical staff to feel very comfortable in discussing with patients and their parents about smoking, but there was no difference when talking to co-workers.
Conclusions: We found differences in staff comfort level in discussing smoking with patients or their families, and coworkers, by sex, age, job type, and smoking status. These results can guide training and identify potential barriers and improve tailored tobacco control training programs and policies for hospital staff.