Exploring the association between supportive school policy and youth tobacco use.

Strategies to reduce youth tobacco use: opportunities for local government.

Youth Tobacco Use Before and After Local Sales Restrictions on Flavored and Menthol Tobacco Products in Minnesota

The Tobacco Endgame-Eradicating a Worsening Epidemic: A Joint Opinion From the American Heart Association, World Heart Federation, American College of Cardiology, and the European Society of Cardiology.

In response to high rates of youth tobacco use, many states and localities are considering regulations on flavored tobacco products. The purpose of this study was to assess whether flavored tobacco restrictions (FTRs) in Massachusetts curb youth tobacco use over time and whether a dose-response effect of length of policy implementation on tobacco-related outcomes exists. Using a quasiexperimental design, two municipalities with a FTR (adopting municipalities) were matched to a comparison municipality without a FTR. Surveys were administered before (December 2015) and after (January and February 2018) policy implementation to high school students in these municipalities (more than 2000 surveys completed at both timepoints). At follow-up, adopting municipalities had a policy in place for 1 and 2 years, respectively. In 2019, focus groups were conducted with high school students in each municipality. Increases seen in current tobacco use from baseline to follow-up were significantly smaller in adopting municipalities compared to the comparison (-9.4% [-14.2%, -4.6%] and -6.3% [-10.8%, -1.8%], respectively). However, policy impact was greater in one adopting municipality despite shorter length of implementation. Focus groups indicated reasons for differential impact, including proximity to localities without FTRs. Restrictions implemented in adopting municipalities had positive impacts on youth tobacco awareness and use 1-2 years postimplementation. Policy impact varies depending on remaining points of access to flavored tobacco, as such policy effectiveness may increase as more localities restrict these products. In response to high rates of youth flavored tobacco use (including flavored vape products), federal, state, and localities have passed FTRs that reduce availability of flavored tobacco in youth-accessible stores. Previous research has found that FTRs may curb youth tobacco use in the short-term; however, the long-term effectiveness remains unknown.This is the first study to show FTRs can curb youth tobacco use and reduce youth awareness of tobacco prices and brands even 2 years after policy passage. Municipality-specific factors, including proximity to localities without FTRs, may attenuate policy impact, highlighting the importance of widespread policy adoption.

As adolescent tobacco use shifts from traditional cigarettes to alternative products, it is important to understand the influence of point-of-sale (POS) advertising on product use. This research investigated whether the percentage of POS advertising for a particular product, known as the share of advertising voice (SAV), moderated the relationship between exposure to POS tobacco advertisements and tobacco use among at-risk youth. Longitudinal self-report data from 746 students attending 20 alternative high schools in southern California was merged with observational data cataloging 2101 advertisements for cigarettes, e-cigarettes, cigars, and smokeless tobacco from 87 tobacco retail outlets within a half mile of the schools. Four multilevel Poisson regression models examined whether SAV interacted with POS tobacco advertising exposure to influence the use of tobacco products 1 year later. Adolescent exposure to POS tobacco advertisements was significantly associated with increased use of all four tobacco products (p < .02). When SAV was added to the model as a moderator, the results showed a significant interaction, such that increasing the SAV for e-cigarettes was associated with greater use of that product (β = 0.27, SE = 0.07, p < .001). The same moderating effect was found for smokeless tobacco (β = 0.56, SE = 0.19, p = .004) but no moderating effect was observed for cigarettes or cigars. POS SAV has the potential to influence at-risk students' use of alternative tobacco products and may be a contributing factor to recent nationwide shifts in youth tobacco use. Future studies should monitor changes in SAV to gain insight into POS marketing trends that may be impacting youth tobacco use. In addition, state and local governments should consider implementing policies that limit the volume and proportion of POS tobacco advertising for all nicotine and tobacco products available in retail environments near schools. Restrictions placed on a single product may cause unintended shifts in product selection rather than a reduction in youth tobacco use.

Tobacco use continues to be the leading preventable cause of premature death in the United States, killing over 430,000 people annually. Tobacco initiation and use among youth remains a significant public health concern. Despite declines in U.S. youth tobacco use in recent years, state and national survey results are still cause for alarm. Although traditional school-based curricular programs are the most common strategy to prevent or reduce youth tobacco use, their effectiveness may be limited because young people are immersed in a broader social context in which tobacco is readily available. Environmental strategies change this social context by focusing on policy, enforcement, and media. A compelling body of evidence suggests that interventions at the state and federal levels can, when implemented in combination, reduce youth tobacco use. The impact of policies implemented at the local levels is less well understood and effects of environmental strategies on smokeless tobacco consumption have been largely ignored. The purpose of this paper is to review the literature on environmental strategies implemented at the local level on youth use of both cigarettes and smokeless tobacco. We highlight results of the extant literature, hypothesize possible effects where research is lacking, and suggest where future studies might be warranted.

Tobacco use constitutes the largest preventable cause of death and disability in developed countries and a rapidly growing health problem in developing nations. It is responsible for 30% of all cancer deaths and 80% of lung cancer deaths and is associated with increased risk for at least 17 types of cancer. In addition to the tremendous human toll tobacco has taken in the 20th and 21st centuries, the economic costs of tobacco-related illnesses remain enormous. From 2000 to 2004, the United States spent approximately $193 billion each year on tobacco-related illnesses and lost productivity because of tobaccorelated premature death. Loss in productivity and increased health care costs associated with secondhand smoke (SHS) were reported in 2005 to have cost the United States an additional $10 billion per year. Although the United States has witnessed a decline in cigarette use, the use of other tobacco products is on the rise. Furthermore, the rate of reduction of youth tobacco use is no longer as rapidly decreasing, despite intense public education and policy efforts to reduce youth tobacco use. At the global level, the epidemic of tobacco-related disease and death has just begun, because of the several-year lag between when individuals begin using tobacco and when their health suffers. Tobacco caused 100 million deaths in the 20th century. If current trends continue, it will cause up to 1 billion deaths in the 21st century. Unchecked, tobacco-related deaths will increase to more than 8 million per year by 2030. More than 80% of those deaths will be in lowand middle-income countries. As the leading professional organization representing physicians involved in cancer treatment and research, the American Society of Clinical Oncology (ASCO) is dedicated to the prevention and treatment of cancer. The overarching goal of the tobacco cessation and control efforts of ASCO are to promote the rapid, worldwide reduction and ultimate elimination of tobacco-related disease through discouraging the use of tobacco products and exposure to secondhand tobacco smoke. The tobacco control efforts of ASCO are led by a subcommittee of the Cancer Prevention Committee. The primary tobacco control goals of ASCO are multifaceted: 1) to develop an oncology workforce that effectively integrates tobacco cessation and control into its practices; 2) to collaborate with other organizations and professional societies to promote rapid, worldwide reduction in tobacco use and ultimate elimination of tobacco-caused disease, including disease resulting from secondhand smoke; and 3) to urge oncology providers to become proponents of tobacco policy change. In 2003, ASCO released a policy statement on tobacco cessation and control, which set forth specific recommendations and called for personal accountability in eradicating tobacco use domestically and globally. Since that time, there have been significant developments in tobacco cessation and control that have changed the political and scientific landscape. In response, the ASCO Cancer Prevention Committee commissioned this update of the previous ASCO statement to reflect the evolving regulatory and policy environment. This statement reviews advancements that have been made in tobacco cessation and control since 2003 and sets forth a refined set of recommendations for addressing tobacco cessation and control based on current challenges and opportunities. Key principles in the statement are as follows:

Multiple levels of influence interplay to impact youth tobacco use. We work towards understanding important policy and environmental strategies that are associated with youth tobacco use behaviors. We utilized data from participants of the Monitoring the Future (MTF) study and linked national data from multiple sources to assess correlates of youth tobacco use behaviors across individual, family, school, community, and state-level policy influences. Higher cigarette prices had the strongest association with youth tobacco use behaviors. Demographic and socio-economic characteristics at the individual, familial, and community/school-levels were associated with youth tobacco use behaviors. In the present study, we confirm that higher cigarette prices could help to reduce youth tobacco use behaviors. Several states are still lagging behind in terms of their low cigarette tax and they should enact tax policies to reduce youth tobacco use.

The school setting is frequently used both to educate youth about risks involved in tobacco use and to implement tobacco prevention and cessation programs. Given that school-based programs have resulted in limited success, it is necessary to identify other setting-level intervention strategies. School tobacco policies represent a type of universal intervention that might have some promise for preventing or reducing tobacco use. Hierarchical linear modeling was used to assess whether school tobacco policies were related to observations of tobacco use and current smoking among 16,561 seventh through twelfth graders attending 40 middle and high schools in Illinois. Results indicated that the enforcement of school tobacco policies, but not the comprehensiveness of those policies, was associated with fewer observations of tobacco use by minors on school grounds as well as lower rates of current smoking among students. The school setting is a key system to impact youth tobacco use. Findings underscore the need to train school personnel to enforce school tobacco policy.

We examine the impact of three sets of government regulations on the demand for cigarettes by teenagers in the United States. These are: (1) the excise tax on cigarettes, (2) the Fairness Doctrine of the Federal Communications Commission, which resulted in the airing of anti-smoking messages on radio and television from July 1, 1967 to January 1, 1971,and (3) the Public Health Cigarette Smoking Act of 1970, which banned pro-smoking cigarette advertising on radio and television after January 1, 1971.Teenage price elasticities of demand for cigarettes are substantial and much larger than the corresponding adult price elasticities. The teenage smoking participation elasticity equals -1.2, and the quantity smoked elasticity equals -1.4. It follows that, if future reductions in youth smoking are desired, an increase in the Federal excise tax is a potent policy to accomplish this goal. The contention of the proponents of the advertising ban that the Fairness Doctrine failed in the case of teenagers is incorrect. According to our results, the doctrine had a substantial negative impact on teenage smoking participation rates. Extrapolations suggest that the advertising ban was no better or worse a policy than the Fairness Doctrine.

Background: Tobacco is the single largest cause of preventable death globally. An emerging body of evidence shows that tobacco is 1 of the identified causes of cancer contributing to 50% of cancers in men and 20% in women and the same is estimated to kill 10 million people by 2030. The epicenter of this epidemic is the low and middle income countries with 80% of the 1 billion smokers in the world coming from there. India is home to 275 million tobacco users and is the second largest producer and user of tobacco products after China. Many of the users demonstrate a very early smoking debut and a significant proportion of India's population falls in this group. Prevention of early tobacco debut and use of tobacco in youth is 1 of the critical ways of reducing the burden of noncommunicable diseases in the world. There is very limited information on how today's youth perceive using tobacco products, and what they think of the anti-tobacco campaigns and legislative measures. Aim: The qualitative arm aims to bridge some of the knowledge gaps related to tobacco use in today's urban youth; to understand the perceptions of the youth about tobacco. The policy piece evaluates relevant tobacco control legislations in India using a prevalidated policy analysis framework. It critically analyses the gaps of the national tobacco control mechanisms responsible for impacting the tobacco use in the youth. Methods: A qualitative grounded theory approach was followed. In a university in India, 30 young undergraduate students were recruited. Data were collected through in-depth interviews, focus groups and participant observations. The policy section critically analyzed relevant parts of the India's tobacco control law taking its lead from the qualitative data, compared it with the WHO Framework Convention of Tobacco Control (FCTC), and identifies barriers and gaps to understand how its impacting the use of tobacco in youth. Results: Peer influence and social desirability emerged as major influencers for tobacco debut. Stress, exams, depression, family problems and symptoms of stress for example headache, sleeplessness etc. were other influencers for debut. The other major theme was the perceptions and concepts on tobacco addiction and quitting. Knowledge among youth on available quitting or cessation support was very little. Most of the study participants believed that the current tobacco control measures are not effective. The policy analysis of national tobacco control measures revealed significant gaps that are currently being exploited by the tobacco industry as they continue to promote tobacco products and increase production capacity. Conclusion: This study recommends amending the Indian tobacco control law to address the gaps and implement a more stringent legislation commensurate to the tobacco use patterns and existing barriers.

Parents are essential stakeholders for policy implementation. However, data on parents' support for e-cigarette- and tobacco-related policies is limited. This study examines parents' support for five e-cigarette- and tobacco-related policies targeted to prevent youth initiation and exposure to industry marketing practices. Data were from a 2018 nationally representative sample of US parents of 11- to 18-year-old middle and high school students. Weighted adjusted logistic regression models examined correlates of support for policy outcomes, controlling for demographics. Analyses were performed among the full sample (n = 2743) and among current tobacco users (n = 355). The majority of parents, including current tobacco users, supported tobacco control efforts to protect adolescents. More than 90% of all parents supported restrictions on e-cigarette marketing to youth and 75% supported a ban on flavored e-cigarette sales. Additionally, more than 80% of all parents supported increasing the age of tobacco product sale to 21, limiting tobacco retailer density near schools, and keeping tobacco products out of view where youth shop. Presence of strict home tobacco rules or reporting a high priority to prevent child's e-cigarette use were significantly associated with higher odds of policy support. Results were similar among current tobacco users. Parents are an important group of tobacco control stakeholders and should be utilized to garner support for tobacco control policies in the context of the recent growth in youth tobacco and e-cigarette use. Parents' public support for tobacco control policies, particularly regulations on e-cigarette sales and marketing, can motivate advocates and policymakers to advance tobacco control policy agendas. Youth tobacco and e-cigarette use in the United States has increased in recent years. Parents are important stakeholders to inform policy agendas and advance efforts to restrict youth access and exposure to tobacco products. This study provides evidence that parents of adolescents are highly supportive of youth-centered tobacco control policies, particularly those that restrict access to youth-targeted e-cigarette marketing and the sale of youth-appealing flavored e-cigarettes. Utilizing policy support to mobilize parents may be an important advocacy strategy to advance tobacco control policy agendas and curb rising rates of youth e-cigarette and tobacco use.

Background Youth tobacco use, particularly e-cigarette use, remains a critical public health issue in the United States, with significant implications for oral and systemic health. Although recent regulatory interventions, such as age restrictions and limitations on flavored tobacco products, have been implemented, significant disparities in usage patterns persist across gender and racial/ethnic groups.This study analyzes trends in youth tobacco use to project future patterns and inform targeted dental public health strategies and cessation interventions. Materials and methods Data spanning 2021-2024 from a national survey of youth were analyzed to assess overall tobacco use, gender-specific patterns, e-cigarette use by gender, and variations across racial/ethnic groups (non-Hispanic White and Hispanic students). Statistical methods, including chi-square tests, z-tests for proportions, and linear regression, were applied to identify trends.Forecasting models, including simple linear regression and Holt's exponential smoothing, were applied to estimate tobacco use for 2025 and 2026. To enhance the reliability of the projections, the forecasts generated by both models were averaged using equal weights. Results Overall tobacco use decreased from 9.3% in 2021 to 7.7% in 2024, with a statistically significant drop between 2023 and 2024 (p < 0.01). Gender disparities were evident, with females showing higher use in 2023 (11.2% vs. 8.9% in males, p < 0.001), though convergence occurred by 2024. E-cigarette use mirrored this trend, with gender differences diminishing over time. Racial/ethnic analysis revealed higher initial use among non-Hispanic White students in 2021, aligning with Hispanic students by 2024. Forecasts indicate sustained declines, projecting overall use at 6.95% in 2025 and 6.2% in 2026 (p < 0.05). Conclusion The consistent reduction in youth tobacco use, including e-cigarette consumption, suggests the potential efficacy of ongoing interventions. However, persistent gender and racial/ethnic differences underscore the necessity for tailored approaches. These findings highlight opportunities for dental professionals to incorporate cessation counseling into practice, mitigating tobacco-related oral health risks, and provide a foundation for proactive public health strategies to further decrease youth tobacco use.

In 2021, Tennessee high school youth reported a cigarette smoking rate of 4.9% and an electronic cigarette (e-cigarette) use rate of 19%, surpassing national averages of 2.3% and 11.3%, respectively. In 2019, 15.5% of 8th- and 9th-grade youth in northeast Tennessee reported current e-cigarette use. Primary care providers (PCPs) can prevent youth tobacco initiation and promote cessation through screening and counseling, yet little is known about these services in Tennessee. This study explored the experiences of PCPs in northeast Tennessee regarding youth tobacco use screening and counseling and identified barriers and facilitators to these services. Semistructured interviews with 12 PCPs were conducted via Zoom between November 2023 and March 2024 using an interview guide based on McLeroy's ecological health promotion model. Transcripts were analyzed using ATLAS.ti 23.4 software. Coding and analysis followed Braun and Clarke's thematic analysis using a blended deductive-inductive approach. PCPs recognize the importance of youth tobacco use screening and counseling and employ tool-based screening, verbal questioning, motivational interviewing, and warm hand offs to behavioral health clinicians. Key barriers included knowledge gaps on e-cigarettes, balancing rapport and trust with screening and counseling, confidentiality and privacy issues, time constraints, negative social norms around tobacco use, limited community resources for youth tobacco cessation, and tobacco regulatory concerns. Facilitators included training and educational resources for PCPs, an integrated behavioral health model, and effective clinic policies and workflows. Supportive policies and quality improvement measures are needed to strengthen youth tobacco prevention and cessation efforts in northeast Tennessee and statewide.

IntroductionAs cigarette smoking has decreased among youth and young adults (YAs) in the United States, the prevalence of other tobacco and nicotine product use has increased.MethodsThis study identified common past 30-day patterns of tobacco and nicotine product use in youth (grades 6–12) and YAs (aged 18–24). Using data from the 2011–2015 National Youth Tobacco Survey (NYTS) and corresponding years of the Truth Initiative Young Adult Cohort Study (TIYAC), past 30-day use of the following products was assessed: cigarettes, e-cigarettes, any type of cigar, smokeless tobacco, hookah, and other tobacco products (pipe, bidis, kreteks, dissolvable tobacco, and snus). A user-generated program in R was used to assess all possible combinations of product-specific and polytobacco use.ResultsThe top five patterns of past 30-day use in youth were exclusive cigarette use (12.0%), exclusive cigar use (10.3%), exclusive e-cigarette use (10.0%), dual use of cigarettes and cigars (6.1%), and exclusive hookah use (5.2%). In YAs, the top five patterns were exclusive cigarette use (46.5%), exclusive cigar use (10.0%), dual use of cigarettes and cigars (6.4%), exclusive hookah use (5.9%), and dual use of cigarettes and e-cigarettes (3.9%).ConclusionsAs noncigarette tobacco and nicotine products become increasingly popular among tobacco users, further research is needed to identify predictors and correlates of specific tobacco use patterns in youth and YAs. This analysis can inform tobacco prevention efforts focusing on emerging tobacco products such as e-cigarettes and hookah. Educational and other intervention efforts should focus on the diversity of products and use patterns in these age groups.ImplicationsThis study uses population-based data to provide new information on the most prevalent patterns of past 30-day nicotine and tobacco use over a 5-year period among youth and young adults. Study findings demonstrate that youth and young adults report using tobacco and nicotine products in different combinations, with varying popularity over time. Additionally, by examining young adults as a separate group, this study highlights the unique patterns of use not previously discussed in the adult literature.