IntroductionThere is majority support in parliament and across the United Kingdom to implement a “smoke-free generation” policy which would mean people born on or after January 1, 2009, could never legally be sold tobacco. To explore the potential impact this policy could have, we estimated the number of young adults (18–25 years) currently taking up smoking each year by area across the United Kingdom.MethodsUsing data from the Office for National Statistics (ONS), Annual Population Survey (APS), and Smoking Toolkit Study (STS), we estimated the total number of 18- to 25-year-olds taking up smoking each year, based on national estimates of population size (ONS) and the proportion who reported ever having regularly smoked (STS). We used local data on adult smoking rates (APS) to apportion the national estimated number of young adults taking up smoking to specific areas.ResultsAround 127 500 18- to 25-year-olds in the United Kingdom start smoking regularly each year (~350 each day); 105 700 each year in England, 11 500 in Scotland, 6500 in Wales, and 3800 in Northern Ireland. Uptake estimates varied across localities: for example, North East Lincolnshire had the highest proportion of young adults taking up smoking each year (3.9%) and Wokingham had the lowest (0.9%).ConclusionsDespite reductions in smoking prevalence over recent decades, hundreds of young adults in the United Kingdom start smoking every day.ImplicationsData on rates of uptake among individual local authorities can be used to focus attention locally prior to the introduction of new age of sale laws.

IntroductionDigital technology is increasingly used to support interventions targeting smoking cessation in people with severe mental illness (SMI). However, little is known about their implementation and effectiveness in this population. We aimed to determine the effectiveness, stakeholder experiences, factors influencing implementation, and quality of reporting of digital interventions for smoking cessation in adults living with SMI.MethodsFive online bibliographic databases were searched for articles published between December 31, 2000 and January 31, 2023. Studies involving adults accessing treatment for alcohol and substance use disorders, neurocognitive disorders, and terminal illnesses were excluded. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A Mantel–Haenszel random-effects meta-analysis of randomized controlled trials was conducted. Participant experience and intervention implementation were explored using a narrative synthesis. Quality of reporting of interventions was assessed using the Template for Intervention Description and Replication checklist.ResultsThirty-one studies enrolling 3794 participants were included. Meta-analysis of biochemically verified abstinence at longest follow-up (month 1 to month 6) did not find an overall effect in favour of intervention (risk ratio = 0.66, 95% confidence interval = −0.005 to 1.37). Interventions tailored to people with SMI were perceived as acceptable. Implementation strategies concentrated on overcoming practical challenges at the participant/user level.ConclusionsNo evidence of the effectiveness of digital interventions to support smoking cessation in people with SMI was found. The importance of tailoring interventions to the needs of people with SMI is highlighted. Robust reporting of implementation is required to enhance future efforts to support smoking cessation in adults with SMI.ImplicationsThe findings of this review add to the emerging evidence on digital interventions to support smoking cessation among people with SMI. We highlight the importance of tailoring interventions to the population, particularly considering the role of mental illness and the side effects of psychotropic medication in the accessibility and usability of digital interventions.

IntroductionThe public health impact of a tobacco tax increase depends on the extent to which the industry passes the increase onto consumers, also known as tax-pass through. In 2020, the Netherlands announced tax increases aimed at increasing the retail price by €1 per 20 factory-made (FM) cigarettes and €2.50 per 50 g of roll-your-own (RYO) tobacco. This study examines the pass-through rate after the tax increase, and whether this differed by type of tobacco and brand segment.Aims and MethodsSelf-reported prices of 117 tobacco brand varieties (cigarettes = 72, RYO = 45) pre- and post-tax increases were extracted from the 2020 International Tobacco Control Netherlands Surveys (n = 2959 respondents). We calculated the tax pass-through rate per variant, examining differences between the type of tobacco and brand segments.ResultsOn average, cigarette prices increased by €1.12 (SD = 0.49; 112% of €1) and RYO prices by €2.53 (SD = 0.60; 101% of €2.50). Evidence of differential shifting across segments was found, with evidence of overshifting in non-discount varieties. The average price of discount varieties increased by €0.20 less than non-discount varieties. Similarly, the net-of-tax price decreased in discount varieties (cigarettes = −€0.02; RYO = −€0.05), but increased in non-discount varieties (cigarettes = +€0.14; RYO = +€0.20).ConclusionsDespite the large tax increase, the industry increased prices in line with or above the required level. Through differential shifting, the price gap between discount and non-discount varieties has widened, which may reduce the public health impact of the tax increase. Measures aimed at reducing price variability should be strengthened in taxation policy, such as the European Tobacco Tax Directive (TTD).ImplicationsWe found that the industry used differential shifting after a significant tobacco tax increase in the Netherlands. Prices increased more than required in higher-priced products, but not in lower-priced products. This pattern was found both for FM cigarettes and RYO tobacco. Through differential shifting, the industry undermines the potential public health impact of tobacco tax increases, by offering a relatively cheaper alternative, which discourages people to quit or reduce consumption. The revision of the European TTD provides an opportunity to address the widening price gap—both between and within product segments—across the European Union.

IntroductionStudies consistently demonstrate smoking is a socially contagious behavior, but less is known about the influence of social connections on vaping. This study examined associations between having close social connections who smoke or vape and relevant smoking and vaping outcomes.Aims and MethodsThis was a representative cross-sectional survey of adults (≥16 years) in England. Participants (n = 1618) were asked how many people they discuss important matters with (ie, close social connections) and how many of them smoke/vape. We tested associations between (1) smoking and (2) vaping among close social connections and participants’ own smoking and vaping status; harm perceptions of e-cigarettes (among current smokers); attempts and success in quitting smoking (among past-year smokers); and use of e-cigarettes as a smoking cessation aid (among past-year smokers who tried to quit).ResultsAdults with ≥1 close social connection who smoke were more likely than those with none to smoke themselves (32.8% vs. 9.4%; ORadj = 7.23[95% CI: 4.74 to 11.0]) and had an uncertain lower likelihood to quit (12.2% vs. 19.8%; ORadj = 0.46[0.17–1.23]). Those with ≥1 close social connection who vape were more likely than those with none to vape themselves (29.6% vs. 6.3%; ORadj = 5.16[3.15–8.43]) and to use e-cigarettes in their most recent attempt to quit (57.0% vs. 27.9%; ORadj = 18.0[1.80–181]), and had an uncertain higher likelihood to perceive e-cigarettes as less harmful than cigarettes (30.8% vs. 12.2%; ORadj = 2.37[0.82–6.90]).ConclusionsIn England, we replicated well-established associations with smoking and found similar evidence for vaping. People were much more likely to vape and to use e-cigarettes to quit smoking if they had close social connections who vaped.ImplicationsThe cross-sectional design means it is not clear whether smoking/vaping among close social connections influences people to smoke/vape themselves, or whether people who smoke/vape select to form close social connections with others who similarly smoke/vape. Further research is required to establish causality. If the associations we observed are causal, interventions that encourage smokers to switch to vaping may have positive spillover effects on social connections’ perceptions of e-cigarettes and the use of these products to support smoking cessation.

IntroductionReducing the prevalence of smoking is a national priority; however, there is limited evidence on what smoking cessation supports are utilized, accessible, and effective among Aboriginal and Torres Strait Islander people. This paper describes a cohort profile of Aboriginal and Torres Strait Islander people who smoke and want to quit to inform tailored smoking cessation interventions.Aims and MethodsAboriginal and Torres Strait Islander people residing in New South Wales, Australian Capital Territory (ACT), and Victoria, who were smokers wanting to quit, were recruited through health services and online advertisements from May to October 2022. Descriptive and inferential statistics were used to summarize participant characteristics and explore factors associated with previous use and adherence to Nicotine Replacement Therapy (NRT) and intention to use Quitline services.ResultsOne hundred and sixty-five participants were recruited. Almost all (93.9%) had made at least one previous quit attempt, and 40.6% had used behavioral support. The majority believed NRT was safe (80.6%), effective (70.3%), and tried NRT previously (89%). Preferred forms of NRT for current quit attempts were nicotine patches (85.5%) and inhalers (69.7%). Intention to use Quitline was found to be higher among participants aged 31–45 years compared to participants under 30 years (AOR = 3.12, 95% CI: 1.01 to 9.76).ConclusionsAboriginal and Torres Strait Islander people are highly motivated to be smoke-free. However, efforts to enhance access and adherence to cessation supports are needed. The rapid recruitment and interest in the mailout cessation support should be scaled up to support Aboriginal and Torres Strait Islander peoples to quit.ImplicationsThe Australian Government has recently launched a national tobacco strategy which includes targets for reducing smoking prevalence to less than 27% among Aboriginal and Torres Strait Islander peoples. In order to meet these targets Aboriginal and Torres Strait Islander people who smoke and want to quit should have access to culturally safe and responsive support. We found that Aboriginal and Torres Strait Islander people have made quit attempts, accessed evidence-based smoking cessation care, and have positive attitudes towards NRT. However, acknowledging relapse, further evidence is required to understand the factors associated with sustained quitting.

IntroductionThe sale of factory-made cigarettes with menthol as a characterizing flavor has been prohibited in Great Britain since May 2020. However, menthol accessories like flavored filters for roll-your-own (RYO) tobacco can be sold legally, possibly undermining the policy. This study aimed to explore the association between RYO and menthol cigarette smoking.Aims and MethodsData were collected between October 2020 and October 2023 from a monthly population-based cross-sectional survey, with 82 120 adults (≥18) living in Great Britain providing complete data. Logistic regression models assessed the association between predominant RYO tobacco use and menthol cigarette smoking, and whether it differed by sociodemographic characteristics, unadjusted and adjusted for age, gender, ethnicity, nation, and socioeconomic position. Time trends in RYO tobacco use among people smoking menthol cigarettes were modeled over the study period.ResultsThere has been no clear decrease in menthol cigarette smoking prevalence among people who smoke (~14%) following the ban. Predominant RYO use increased among people smoking menthol cigarettes from 49.6% (95% CI: 42.2 to 57.0) in October 2020 to 61.9% (95% CI: 57.5 to 66.0) in June 2022, after which it remained stable. Predominant RYO use was more common among people smoking menthol than non-flavored cigarettes overall (adjusted odds ratio (ORadj) = 1.30, 95% CI: 1.14 to 1.49) and across demographic subgroups. This association was most pronounced in middle-aged compared with older people (35 vs. 65 years ORadj = 1.18, 95%CI: 1.01 to 1.35), and in ethnic minorities compared with White people (ORadj = 1.56, 95% CI: 1.03 to 2.36).ConclusionsThere was a substantial increase in RYO use among people smoking menthol cigarettes in the first two years after the ban, from approximately 50% to 60%.ImplicationsThe availability of menthol accessories may have undermined the ban on factory-made mentholated cigarettes in Great Britain. Roughly one in seven people who smoke cigarettes still report smoking menthol cigarettes and among these, about two-thirds predominantly use RYO tobacco. Since there has been no noteworthy change in the prevalence of menthol cigarette smoking since October 2020, new measures will likely be necessary to achieve a further reduction. For example, menthol accessories could be banned or their advertising and availability heavily restricted.

IntroductionAustralia’s limited social housing has created geographically concentrated locales of poverty with high smoking rates. The impact of social housing on smoking initiation among adolescent residents is unknown, despite adolescence being a critical period for smoking prevention. We examine the relationship between social housing residency and smoking initiation among adolescents to quantify the likelihood of smoking uptake among social housing residents compared to a similar cohort in other tenures, accounting for socioeconomic factors and household exposure to smoking.MethodsWe analyzed data on 15- to 18-year-old adolescents (n = 3132) from the Household, Income and Labour Dynamics in Australia survey (2001–2019). We applied inverse probability treatment weights to maximize exchangeability between social housing tenants and their counterparts in other tenures. We quantified the risk of smoking 5 years after exposure measurement among those in social housing on both an absolute and relative scale. Baseline covariates included household income, age at study entry, sex, family type, smoking at baseline, highest household education, and household exposure to smoking.ResultsAdolescent residents in social housing had a 17% greater risk of smoking 5 years after baseline measurement than their counterparts in all other tenures (Average Treatment Effect (ATE): 0.165, 95% confidence interval [CI] = 0.02 to 0.31). On the relative scale, those in social housing had 1.80 times (95% CI = 0.95 to 2.66) higher risk of being a smoker than those in other tenures.ConclusionsAdolescents residing in social housing have a higher risk of becoming smokers as young adults than their counterparts in other tenures, irrespective of smoking exposure in their own homes.ImplicationsThis study investigates the impact of social housing on smoking initiation among adolescents, revealing that those residing in social housing have a higher risk of becoming smokers in young adulthood, independent of smoking exposure at home. The research highlights the contribution of social housing to ongoing disparities in smoking rates in Australia and emphasizes the need to further understand and review social housing provision from the perspective of its consequences on health. Moreover, the results advocate for comprehensive policies that extend beyond individualized harm reduction strategies to promote social inclusion and address health inequalities associated with smoking in adolescents.

IntroductionThere is considerable interest in raising the age of sale of tobacco above the conventional age of 18 years. We systematically reviewed whether raising the minimum legal sales age of tobacco (MLSA) to 20 or above is associated with a reduced prevalence of smoking compared to an MLSA set at 18 or below.Aims and MethodsFollowing a preregistered protocol on PROSPERO (ref: CRD42022347604), six databases of peer-reviewed journals were searched from January 2015 to April 2024. Backward and forward reference searching was conducted. Included studies assessed the association between MLSAs ≥20 with cigarette smoking or cigarette sales for those aged 11–20 years. Assessments on e-cigarettes were excluded. Pairs of reviewers independently extracted study data. We used ROBINS-I to assess the risk of bias and GRADE to assess the quality of evidence. Findings were also synthesized narratively.ResultsTwenty-three studies were reviewed and 34 estimates of association were extracted. All extracted studies related to Tobacco 21 laws in the United States. Moderate quality evidence was found for reduced cigarette sales, moderate quality evidence was found for reduced current smoking for 18–20-year-olds, and low-quality evidence was found for reduced current smoking for 11–17-year-olds. The positive association was stronger for those with lower education. Study bias was variable.ConclusionsThere is moderate quality evidence that Tobacco 21 can reduce overall cigarette sales and current cigarette smoking amongst those aged 18–20 years. It has the potential to reduce health inequalities. Research in settings other than the United States is required.ImplicationsThis systematic review on raising the minimum legal sale age of tobacco to 20 or above demonstrates there is moderate quality evidence that such laws reduce cigarette sales and moderate quality evidence they reduce smoking prevalence amongst those aged 18–20 years compared to a minimum legal sale age of 18 years or below. The research highlights potential benefits in reducing health inequalities, especially for individuals from lower educational backgrounds. Studies are limited to the United States, highlighting a need for more global research to assess the impact of these policies in other settings.

BackgroundNicotine pouches have emerged as a novel way to administer concentrated nicotine and come as a white powder in flavored, microfiber pouches placed between the cheek and gums to dissolve without requiring spitting. While marketed as a safe alternative to smoking, nicotine pouches have the potential for toxic exposure to users.Case PresentationWe present a case of a 21-year-old male with acute nicotine toxicity through repeated administration of nicotine pouches. Over the course of 12 hours, he consumed 15 extra-strength nicotine pouches (10.9 mg per pouch) as a study tool to prepare for the next-day exams. He presented to the emergency department with bizarre behavior requiring admission for persistent confusion and nausea which resolved after 24 hours.ConclusionsThis case represents the first case of acute nicotine toxicity secondary to nicotine pouch use. These pouches are emerging as a novel way to use nicotine and present a serious risk of inadvertent overdose and harm.ImplicationsNicotine pouches are emerging as a novel way to use nicotine, and second to e-cigarettes, are the most frequently used nicotine product among youth. These pouches, which lack clear warning labels, are promoted among social media forums and present a serious risk of inadvertent overdose and harm, especially among young adults. Healthcare professionals should be aware of this risk, especially from acute, repeated exposures, and should ensure the public is cautioned appropriately.

IntroductionIn China, standard smoking cessation practices are rarely used by health care service providers (HSPs). WeChat, a popular social media app, has been widely used in China.Aims and MethodsIn this single-blind, randomized trial, undertaken in China with 8-week interventions and follow-up to 34 weeks, 1887 HSPs were randomly selected to the intervention (n = 942) or control group (n = 945) from October 2020 to October 2021. The intervention group received regular smoking cessation training program messages from the professional team for 8 weeks and followed for 34 weeks. The control group received thanks messages for 8 weeks, and follow-up to 34 weeks. Both groups received a hard copy of the manual after randomization. The primary outcome measure was the utilization rate of behavioral and pharmacotherapy interventions for smoking patients from 9 to 34 weeks. This trial is registered at ClinicalTrials.gov (number NCT03556774).ResultsHSPs in the intervention group demonstrated a better overall utilization rate of smoking cessation at 20-week follow-up compared to the control group (35.54% vs. 31.41%, p = .036). Additionally, both groups showed a significant increase in the adoption of various components of the 5A’s model—including “Assess,” “Assist: set a quit date,” “Assist: recommend cessation program,” “Assist: provide information,” “Assist: recommend medication,” and “Arrange”—at the 9-week follow-up relative to baseline. Notably, at the 20-week follow-up, the intervention group reported significantly enhanced utilization rates for all these components, except “Assist: set a quit date.”ConclusionsThe “WeChat WeQuit” training program effectively enhanced smoking cessation intervention adoption among Chinese HSPs.Implications“WeChat WeQuit” training program was effective in increasing the provision of effective tobacco cessation interventions by Chinese-speaking HSPs to patients with cigarette smoking, which could provide valuable insights into bridging the gap between need and services for smoking cessation in China.