INTRODUCTIONWorkplace smoking cessation programs are effective in reducing smoking prevalence among employees with a lower socioeconomic position (SEP). However, effective participation of these employees remains challenging. This study evaluates a communication training program designed to equip managers with the skills to personally and actively engage employees in workplace smoking cessation initiatives.METHODSThis study, conducted in the Netherlands (September 2021–March 2023), used Intervention Mapping to develop a 90-minute interactive webinar to improve managers’ knowledge, attitudes, self-efficacy, and communication skills related to talking with employees about smoking cessation. A total of 107 managers participated. A mixed-methods approach was used for evaluation, including pre- and post-webinar questionnaires (completed by 50 participants) and two rounds of semi-structured interviews with 18 managers, around 3 and 12 months post-training.RESULTSThe training led to a small increase in self-efficacy regarding smoking cessation conversations from 3.2 to 3.5 on a scale of 1 to 5 (p=0.015). In the first round of interviews, 5 of the 18 managers had engaged in personal conversations with employees about smoking cessation. Facilitators were a strong belief in one's own ability to succeed; opportunities to practice communication skills; positive past experiences addressing smoking behavior; supportive company regulations and national smoke-free policies and assistance provided by colleagues. Barriers included low confidence in communication skills; perceived time burden; limited motivation or perceived role responsibility; the social sensitivity of the topic and fear of negative reactions; the absence of an in-house cessation program and insufficient organizational support. One year post-training, only one manager had consistently implemented personal communication strategies, while most others cited unchanged barriers and a lack of organizational support as reasons for inaction.CONCLUSIONSWhile managers recognized the importance of personal communication for smoking cessation, implementation and maintenance were limited due to personal and organizational barriers. Future training programs should be more extensive and ensure structural organizational support for workplace smoking cessation initiatives.

INTRODUCTIONThe Global Youth Tobacco Survey (GYTS) is a cross-sectional, schoolbased survey that provides insight into tobacco use and related behaviors among adolescents aged 13–15 years. This study examines trends in tobacco-related attitudes, education, and media exposure among Polish youth, using data from the 2022 GYTS alongside previous surveys conducted in 2003 and 2016.METHODSThe study sample was stratified by geographical regions: rural areas, small towns, and large cities. Data were collected from 98 schools across Poland, involving 95 schools (96.9%), 224 classes (97.8%), and 3985 students (78.9%). The primary analysis focused on 3573 students aged 13–15 years. Data from 2003 and 2016 GYTS editions were also used for comparison. Sampling, data weighting, and the methodological framework followed WHO guidelines.RESULTSBetween 2003 and 2022, there was a notable decline in the proportion of Polish adolescents receiving tobacco education in school, from 61.4% to 43.1%. Perceptions of the harms of secondhand smoke also fell substantially, from 65.8% to 34.4%. Support for smoke-free policies weakened, with a decline in support for both indoor and outdoor smoking bans. Exposure to anti-tobacco messages in media dropped dramatically, from 89.4% in 2003 to 34.9% in 2022. On the other hand, perceptions that smoking enhances social interactions rose from 40.8% to 45.5%, while tobacco industry advertising and depictions of tobacco use in media remained prevalent, though declining over time.CONCLUSIONSThe findings suggest concerning trends in tobacco-related attitudes and behaviors among Polish adolescents, indicating weakened prevention efforts and a shift towards pro-tobacco norms. The decline in tobacco education, public support for smoke-free policies, and media exposure to anti-tobacco messages highlight the need for renewed public health interventions. Strengthening school-based education, reinforcing smoke-free policies, and regulating tobacco portrayals in media are critical to reversing these trends. Additionally, policy measures such as plain packaging and a ban on tobacco displays at points of sale are necessary to protect future generations from tobacco initiation. Without decisive action, there is a risk of undermining the progress made in tobacco control.

INTRODUCTIONNicotine pouches have recently gained popularity among adults in Saudi Arabia, but limited information is available about the common symptoms’ users may experience. This study looks into how frequently users report gastrointestinal and psychological symptoms and explores possible links with different personal and behavioral factors.METHODSWe conducted an online cross-sectional survey among adult Saudis who used nicotine pouches in the recent half year. The survey collected demographic data, patterns of usage, and gastrointestinal symptoms self-assessed. Psychiatric status was assessed using the Arabic DASS-21 version. Data were analyzed using SPSS version 29 with the help of descriptive and logistic regression analysis.RESULTSA total of 1214 individuals participated. Most (80.8%) reported at least one gastrointestinal symptom – mainly bloating (66.7%), nausea (47.9%), and heartburn (46.7%). Around 39.3% of participants reported psychological symptoms, with mild symptoms being the most common (19.9%). The analysis showed that people with lower education and income levels were more likely to report psychological symptoms (p=0.004 and p<0.001). A slight trend was also noted among current smokers, though not statistically significant (p=0.076).CONCLUSIONSThe study found that many users of nicotine pouches report gastrointestinal and psychological symptoms. The symptoms seem more common among individuals with lower socioeconomic status. Although the findings do not imply direct effects, they indicate that there should be greater awareness and more research, especially long-term research, to establish how nicotine pouch use can be attributed to health problems.

A significant association has been established between tobacco-smoking and alcohol consumption. However, few studies have investigated this association according to tobacco product type. This study aimed to investigate alcohol dependence according to smoking status. The analysis targeted 31465 participants of the Japan Society and New Tobacco Internet Survey 2023, including 19927 never smokers (63.3%), 6545 ex-smokers (20.8%), 2461 cigarette smokers (7.8%), 1496 heated tobacco product (HTP) smokers (4.8%), and 1036 dual smokers (3.3%). Participant characteristics, including sex, age, and body mass index (BMI), were recorded. Alcohol-dependence status was defined as an alcohol use disorders identification test (AUDIT) score of >13. The Tobacco Dependence Screener (TDS) test was conducted to assess nicotine dependence. Participants had a median age 47 years (interquartile range, IQR: 33-62) and a median BMI of 21.6 kg/m2 (IQR: 19.6-24.0). While never smokers showed the lowest AUDIT scores (median: 1), cigarette, HTP, and dual smokers exhibited significantly higher AUDIT scores than never smokers (cigarette: 3, HTP: 4, dual smoker: 4; all p<0.001). Dual smokers showed the highest rate of alcohol dependence (14.9%), followed by HTP smokers (10.7%), cigarette smokers (10.5%), ex-smokers (7.8%), and never smokers (2.2%). In logistic regression analysis, factors related to smoking status - such as number of tobacco products consumed per day, TDS scores, and smoking type - were significantly related to alcohol dependence, along with demographic factors of age and sex. Dual smokers were four times more likely to be alcohol dependent than never smokers (adjusted odds ratio, AOR=4.07; 95% CI: 3.09-5.46). Smoking status is significantly associated with alcohol consumption status.

INTRODUCTIONOral smokeless tobacco (OST) is a major preventable risk factor for oralcancer. Nicotine replacement therapy (NRT), a commonly used pharmacologicaltreatment in tobacco cessation interventions that help in reducing thewithdrawal symptoms that individuals might experience in their attempt toquit. This systematic review aimed to assess NRT's effectiveness onOST cessation and reduction rates, addressing gaps in prior studies byincorporating recent research across diverse populations, includingdeveloping and developed countries.METHODSA systematic search was conducted across PubMed, Cochrane, Embase, and Web ofScience. The inclusion criteria were: English articles (2004 to June 2024),OST users of both genders, NRT intervention, control group (generic,placebo, or no intervention), and a 7-day point prevalence of OST abstinenceand reduction at week 12. Studies were excluded if they lacked relevantoutcomes, were non-English, or published before 2004. Data abstraction formswere used to extract study characteristics and results. The PracticalMeta-Analysis Effect Size Calculator determined the effect sizes anddirections. The risk of bias was assessed using CochraneCollaboration’s tool.RESULTSEleven studies were included with 40–1067 sample size. Seven wereeffective on OST abstinence, with effect sizes ranging from d=0.10 to d=0.54and odds ratios from OR=1.67 to OR=4.10. One study demonstrated OSTreduction (d=0.16 for dips/day and d=0.17 for cans/week). Nicotinedependence, NRT dosage, self-efficacy and social support were identified askey factors influencing the NRT’s effectiveness in the includedstudies.CONCLUSIONSNRT can aid in OST cessation. Combination of NRT with other interventionssuch as coach calls and web-based interactive setting can enhance the OSTabstinence rate. The evidence, though promising, is limited by studyvariability, and inconsistent outcome reporting. Future studies shouldexplore self-efficacy, social support, and NRT dosage with larger samplesizes for better assessment.

Tobacco use patterns have dramatically shifted, with electronic cigarettes (e-cigarettes) rapidly increasing in popularity despite uncertainty about their health impacts. This study examines adherence to preventive cancer screening guidelines among cigarette smokers, e-cigarette users, and non-smokers, addressing a critical gap in understanding how tobacco use influences engagement in preventive healthcare. A total of 445132 adult respondents were queried from the 2022 Behavioral Risk Factor Surveillance System data. Analytic samples were restricted to age- and sex-eligible sub-cohorts for each cancer type, therefore including adults 50-75 years, women 50-74 years, and women 21-65 years for colon, breast and cervical screening, respectively. Within these analytic samples, we assessed the association between socioeconomic characteristics, smoking status, and screening adherence using weighted logistic regression, adjusted for relevant factors. Screening adherence was lowest among cigarette smokers, intermediate among e-cigarette users, and highest among non-smokers. Compared to non-smokers, cigarette smokers had significantly lower odds of adhering to colorectal (AOR=0.75; 95% CI: 0.58-0.81), breast (AOR=0.57; 95% CI: 0.52-0.61), and cervical cancer screening (AOR=0.67; 95% CI: 0.62-0.72). E-cigarette users also showed reduced adherence to colorectal (AOR=0.90; 95% CI: 0.81-0.95) and breast cancer screening (AOR=0.75; 95% CI: 0.70-0.81) but not cervical cancer screening. E-cigarette users exhibited suboptimal adherence to recommended cancer screenings, suggesting that perceptions of reduced risk associated with vaping do not translate into improved preventive healthcare behaviors. Targeted public health initiatives addressing risk misconceptions and healthcare access barriers are necessary to improve screening rates among all tobacco users.

Smoking during pregnancy remains a significant global public health concern. Midwives, as frontline healthcare providers, play a crucial role in supporting smoking cessation among pregnant women. This study aimed to explore the factors associated with the implementation of smoking practices by midwives in Greece. We conducted a cross-sectional survey between December 2022 and December 2023 among 150 midwives working in the 1st and 2nd Health Districts of Greece, as well as in private practices. Data were collected using a self-administered, anonymized questionnaire assessing demographics, knowledge, opinions, perceptions, and smoking cessation practices. Composite scores were calculated for knowledge, opinions, perceptions, and practices. Exploratory factor analysis was applied to examine the structure of midwives' opinions and perceptions. Multivariate linear regression was used to identify independent predictors of smoking cessation practices. Among the respondents, 78% had not received formal education on smoking cessation, although 77.3% expressed a desire for training. Only 35.3% recognized that secondhand smoke affects newborns, and 32.7% felt confident in supporting pregnant women to quit smoking. Factor analysis identified two key dimensions: midwives' contribution to smoking cessation during pregnancy, and information and help to stop smoking during pregnancy, explaining 27.7% and 16.9% of the variance, respectively. Multivariate regression revealed that both factors were independently associated with more frequent implementation of smoking cessation practices (p<0.05). The study underscores the pivotal role of midwives in smoking cessation during pregnancy and highlights the importance of perceptions, self-efficacy, and access to information in shaping their practices. Targeted education and institutional support are essential to strengthen midwives' capacity to deliver effective smoking cessation interventions. These findings can inform policy and training programs aiming to improve maternal and neonatal outcomes by reducing tobacco use during pregnancy.

INTRODUCTIONLittle is known about e-cigarette device and flavor preferences among pregnant women. The purpose of this study was to identify classes of e-cigarette use based on device and flavor preferences among pregnant women who report dual use of e-cigarettes and cigarettes.METHODSA sample of pregnant women (n=118), aged 18–40 years, living in the US, with dual cigarette and e-cigarette use, completed a cross-sectional online survey. Participants reported e-cigarette characteristics including past 30-day e-cigarette device (cartridge-based, JUUL, tank, and disposable) and flavor use (tobacco, mint, spice, sweet, alcohol, combined), and use of e-cigarettes containing delta-9-tetrahydrocannabinol (THC) in pregnancy. We used latent class analysis to classify subgroups based on e-cigarette preferences in pregnancy and examined the association of sociodemographic variables and cigarette smoking frequency with class membership.RESULTSWe found four distinct classes of e-cigarette preferences: Class 1) tobacco, mint, and sweet JUUL (50.4%); Class 2) THC, all flavors, and JUUL (28.1%); Class 3) THC, all flavors, and all device (12.4%); and Class 4) THC, tobacco, mint, sweet, and tank device (9.1%). Pregnant women who smoked ≥11 cigarettes per day, compared to those who smoked 1–10 per day, were 5.22 (95% CI: 1.85–14.70) and 5.55 times (95% CI: 1.49–20.61) as likely to use THC, all flavors, and JUUL and all devices, respectively, compared with those who used tobacco, mint, and sweet flavors with JUUL.CONCLUSIONSPregnant dual users of cigarettes and e-cigarettes are a heterogenous group. Device and flavor differences should be considered when developing targeted messaging campaigns and prevention strategies.