The Theory of Reasoned Action has been widely used to explain adolescent tobacco and nicotine product (TNP) use, focusing on intentions and subjective norms. However, the 'reactive pathway', emphasizing situational influences and willingness to use, better predicts TNP use in adolescents. While prior research has examined willingness for cigarettes and e-cigarettes, its application to the broader range of available TNPs is limited. This study investigates adolescent characteristics across varying levels of TNP use willingness. We hypothesized that perceived harm and addictiveness would be associated with willingness to use tobacco. Secondary school students aged 14-15 years (n=348) completed a survey that assessed demographics and TNP use history, willingness to use TNPs, peer use, and perceived harm and addictiveness of TNPs. Descriptive statistics were used to characterize the population overall and by willingness to use TNPs. Multivariable logistic regression models estimated associations between TNP-specific willingness to use, gender, race, ethnicity, and peer use with TNP-specific perceived harm and addictiveness. Across the TNPs, 22.1% were current users, 23.3% were willing non-users and 54.7% were non-willing non-users. Significant differences in perceived harm by willingness were for cigarettes, e-cigarettes, and hookah, while perceptions of addictiveness varied by willingness group for all TNPs with the exception of cigarillos (all p<0.05). Willing non-users had lower odds of perceived addictiveness (smokeless tobacco, OR=0.29; 95% CI: 0.11-0.81; cigar, OR=0.33; 95% CI: 0.15-0.70) and harm (e-cigarettes, OR=0.38; 95% CI: 0.19-0.76; pipe, OR=0.41; 95% CI: 0.17-0.98; cigarillos/little cigars, OR=0.34; 95% CI: 0.12-0.92; cigars, OR=0.24; 95% CI: 0.11-0.54) compared to non-willing non-users. Adolescents have varying levels of susceptibility to using TNPs. In order to develop effective interventions for adolescents, the diverse range of available TNPs with specific risks and appeal need to be considered.CLINICAL TRIAL REGISTRATION: The study is registered on the official website of ClinicalTrials.govIDENTIFIER: ID NCT05396911.

INTRODUCTIONSmoking and alcohol consumption are two harmful yet socially accepted habits in Poland. The main focus of this study was to assess patterns of tobacco and alcohol consumption in Polish transplant patients.METHODSA survey was conducted between June and November 2023 at a transplantation center in Poland. The participants in the study were kidney, liver, or pancreas transplant recipients (aged 19–81 years). A structured questionnaire was applied to assess self-reported use of tobacco and alcohol in the pre-transplantation (pre-tx) and post-transplantation (post-tx) periods.RESULTSData from 215 eligible transplant recipients were analyzed. The median age was 51 years (IQR: 38.5–60.5), and 56.7% of the patients were male. Most patients (79.1%) received a kidney transplant, 20.5% a liver transplant, and 5.6% a pancreas transplant. In this cohort, tobacco use decreased by 33.7% and alcohol use decreased by 40.5% post-tx compared to pre-tx. Regarding cigarette smoking, 92% of post-tx patients did not smoke at all (vs 81.1% pre-tx). The use of e-cigarettes or heated tobacco remained relatively unchanged, with abstinence declared by 91.5% pre-tx versus 93.9% post-tx (p=0.351). When asked about alcohol consumption within the last year, 67.6% of respondents indicated that they did not consume alcohol at all (vs 50.2% pre-tx), and 26.3% had occasionally consumed alcohol (vs 40% pre-tx). More than half of the participants reported no change in their tobacco and alcohol consumption patterns (65.4% and 57.1%, respectively).CONCLUSIONSThe results of our study indicated a decrease in the use of traditional tobacco products and alcohol following transplantation. However, the use of e-cigarettes or heated tobacco remains stable and should be further examined. Therefore, it is important to develop targeted interventions to support tobacco and alcohol cessation among transplant patients.

The environment plays a significant role in influencing smoking experiments, which contributes to the emergence of new smokers among Thai adolescents. This research aims to identify the relationship between risk behaviors by identifying the predictors of current tobacco usage based on the characteristics of new smokers. This cross-sectional study analyzed pooled secondary data from nationally representative surveys conducted between 2004 and 2021 by the Tobacco Control Research and Knowledge Management Center (TRC) and the National Statistical Office (NSO) of Thailand. The dataset included anonymous responses from 36067 adolescents aged 15-18 years. Smoking status was the dependent variable, categorized into smokers and non-smokers, while independent variables such as geographical location, family and peer influences, and early exposure to smoking were analyzed to identify factors that influence smoking behavior. The ACBGWO algorithm identified key factors influencing smoking initiation among Thai adolescents aged 15-18 years, including geographical location, family hierarchy, purchasing behavior, environmental exposure, and gender. Smoking prevalence was highest in the Southern region (10.91%) and lowest in the Central region (6.38%). Adolescents who were the third child in a family reported a smoking rate of 8.92%, while those who purchased cigarettes themselves exhibited a 100% prevalence, reflecting weak enforcement of age-related sales regulations. Environmental exposure, such as noticing cigarette butts in fresh food markets, was associated with a prevalence of 11.31%. Gender differences were pronounced, with 15.35% of males smoking compared to 0.37% of females. The algorithm achieved an accuracy of 99.63%, effectively identifying critical predictors, highlighting the need for targeted interventions addressing social, environmental, and regulatory factors. The study identified geographical location, peer and family influence, and early exposure to smoking as critical predictors of smoking initiation among Thai adolescents. These findings underscore the need for targeted interventions addressing these factors to effectively reduce youth smoking initiation in Thailand, despite existing public health measures.

This study examines the long-term effect of the COVID-19 pandemic on the reach and impact of one US state tobacco quitline while taking into account quitline offers of free nicotine replacement therapy (NRT). This is a pre-post analysis from January 2017 through June 2023 of the reach and impact of Michigan's tobacco quitline after the start of the COVID-19 pandemic. We assess quitline reach (number of callers per month), effectiveness (self-reported 30-day abstinence at 6 months), and impact (number of new ex-tobacco users per month). We examine the main effects and interactions between pandemic status (i.e. pre vs post March 2020) and quitline offers of free NRT. The COVID-19 pandemic had a persistent negative effect on quitline reach (p=0.002) and impact (p<0.001). Abstinence rates decreased transiently during the first year of the pandemic. Offering free NRT had a positive effect on quitline reach (p<0.001) and impact (p<0.001) before and after the start of the pandemic. For quitline reach, we found a significant interaction between pandemic and free NRT effects with a substantial decrease in the mean number of callers per month after the pandemic during months when free NRT is being offered (750; 95% CI: 545-1033, pre-pandemic vs 302; 95% CI: 233-392, post-pandemic) compared to months when free NRT is not being offered (247; 95% CI: 187-327, pre-pandemic vs 159; 95% CI: 114-221, post-pandemic). There is a critical need to assess and address the ongoing effects of the COVID-19 pandemic on tobacco quitline reach and impact.

This policy case study evaluates Ukraine's implementation of tobacco control measures, using guidance from the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) and its COP8 decision during the ongoing Russian invasion. The study assesses Ukraine's efforts across three pillars: 1) surveillance, 2) legislation and public health gains, and 3) adherence to the WHO FCTC Article 5.3. Despite war-related disruptions and a humanitarian crisis, Ukraine has upheld and strengthened policies like tobacco taxation, new pictorial health warnings on cigarette packs, advertising bans, and smoking restrictions, largely due to strong policy leadership and international collaborations driven by the European Union integration. Successes and political leadership over the past decade have reinforced Ukraine's compliance with the WHO FCTC. However, continued threats from the tobacco industry, especially efforts to weaken legislation and obstruct enforcement of regulations on new and emerging nicotine and tobacco products, remain a serious concern. This analysis underscores the vital role of a resilient public health infrastructure and sustained international support in protecting tobacco control progress, particularly during times of crisis.

INTRODUCTIONYoung adult users of e-cigarettes have expressed intention to quit using these products. The purpose of this study was to explore the experiences of young adult e-cigarette users with trying to quit e-cigarettes.METHODSUsing an explanatory sequential mixed-methods design, a convenience sample of young adults living in the US in 2021 who had used e-cigarettes in the past 30 days completed a cross-sectional survey (n=592), and then a subsample of participants (n=25) completed a follow-up Zoom interview. Relationships between e-cigarette dependence and quitting were examined along with differences between motives for use, abstinence experiences, and stress intolerance of those who had and had not tried to quit e-cigarettes, and associations between quitting e-cigarettes and covariates. Interviewees discussed quit attempts and reasons to quit e-cigarettes. All interviews were transcribed verbatim, data were coded, and emergent themes were compared to quantitative results.RESULTSMost participants (73.5%) had attempted to quit using e-cigarettes. Variables associated with quit attempts included past cigarette smoking (AOR=1.72; 95% CI: 1.06–2.81), cognitive coping (AOR=0.056; 95% CI: 0.42–0.75), loss of control (AOR=1.45; 95% CI: 1.08–1.94), and cue exposure (AOR=1.40; 95% CI: 1.12–1.76). Increased e-cigarette dependence was associated with more e-cigarette quit attempts (p<0.001) and shorter periods of abstinence from using e-cigarettes (p<0.001). Emergent interview themes described social (e.g. environments), emotional (e.g. using when distressed), and physical (e.g. withdrawal symptoms, including headaches and shaking) barriers to quitting e-cigarettes.CONCLUSIONSTobacco prevention messages, research, and cessation services should consider that young adults may experience co-occurring distress during e-cigarette quit attempts.

INTRODUCTIONThis is a prospective, interventional pilot study that seeks to evaluate the impact of MediaSense, a media-literacy-based vaping prevention program, in adolescents including an oversample of those with asthma.METHODSDuring July and December 2022, participants in Nebraska were recruited via electronic health record (EHR)-based messaging, and MediaSense was self-administrated by interactive e-learning with REDCap surveys before and after the intervention. Regression analysis evaluated changes in vaping media literacy, vaping expectancy, and harm perception pre- and post-intervention. Factor analysis was conducted on 22 items on usability, to determine which latent factors were most related to interactive e-learning modules.RESULTSAdolescents aged 12–17 years participated in the MediaSense intervention (n=67; 59.7% with asthma). The pre- and post-intervention surveys showed a 148% increase in vaping media literacy (ranging 0–6; 2.9 vs 4.5, p<0.0001). Vaping expectancy (ranging1–5) decreased from 3.6 to 1.2 (p<0.0001), and the perception of vaping as harmful rose from 40.3% to 86.0% (p<0.0001). Participants rated the intervention highly on usability, technical assistance, design, content clarity, navigation, flow, multimedia, interactivity, and learning outcomes. Two distinct factors were identified in the factor analysis: motivating and engaging content (Factor 1) and user-friendly module design (Factor 2). Participants with higher usability ratings of the e-modules (Factor 1: B=0.6; 95% CI: 0.3–0.9, p=0.0004; Factor 2: B=0.7; 95% CI: 0.4–1.0, p=0.0001), and those with asthma (vs no asthma: B=0.5; 95% CI: 0.1–0.9, p=0.01) had significantly higher vaping refusal and media literacy.CONCLUSIONSThe MediaSense program demonstrated acceptability and feasibility in recruiting and preventing adolescent vaping through EHR and digital interventions. Media literacy helps adolescents to critically evaluate vaping-related marketing messages, resist persuasive marketing, and make informed decisions.

Tobacco is a global public health issue that kills half of its users. Even though the Framework Convention on Tobacco Control (FCTC) mandates countries to implement tobacco cessation programs as a cost-effective approach to assist smokers in quitting and reduce the burden of tobacco use, only one-third of the world's population has access to effective cessation services. Many governments have failed to provide comprehensive, accessible tobacco cessation services due to financial constraints and the belief that people are to blame for tobacco addiction. The World Health Organization's Package of Essential Non-Communicable Diseases (WHO PEN) recommends incorporating tobacco cessation and lifestyle advice into primary healthcare as a cost-effective means of avoiding non-communicable diseases. Despite nearly two decades have passed since ratifying the Framework Convention on Tobacco Control (FCTC), Oman has made little progress in developing a national comprehensive tobacco cessation program. A comprehensive multisectoral effort is necessary to explore the challenges and opportunities for implementing an effective national tobacco cessation program in Oman, which should be part of effective tobacco control legislation aimed at reversing the tobacco trend and assisting smokers in quitting tobacco products. This narrative review aims to explore tobacco use in Oman, its health impacts, strengths, weaknesses, opportunities, and threats, and puts forward recommendations for implementing a tobacco cessation program.