Addictive Products Research Articles

Whether Pension Program Stimulates the Consumption of Addictive Products: Evidence from China’s New Rural Pension Scheme

ABSTRACT Much attention has been paid to evaluating the policy effects of pension programs, but few studies have focused on possible inefficiencies stemming from their implementation. Drawing on a quasi-natural experiment associated with the adoption of China’s New Rural Pension Scheme (NRPS), this study explores the impact of the NRPS on food consumption among rural residents. A difference-in-differences (DID) analysis is performed using panel data from the 2009 and 2013 National Rural Fixed Observation survey. Results show that participation in the NRPS improves residents’ dietary quality by increasing the consumption of recommended foods and decreasing the consumption of non-recommended foods. However, the results also show that the NRPS is associated with increased consumption of addictive and unhealthy products, especially in households with lower average levels of education, poorer self-reported health, and older adults over age 60. Findings suggest that when examining the possible health effects of new pension policies, it is essential to account for potential increases in the intake of unhealthy and addictive products, such as cigarettes and alcohol.

Threats to youth from cannabis industry and profits: NIDA

Nora Volkow, M.D., director of the National Institute on Drug Abuse (NIDA), called out the profit‐driven cannabis, tobacco, gambling, social media, and processed food industries for their harms to youth. She had some choice words for commercial interests involved in the addiction field in a Sept. 26 blog. Preying on the vulnerable — with drugs, social media, gambling, processed food, and other addictive products — is something she knows how to zone in on as an evil.

Social media plus profits spell danger for youth: NIDA director

Putting profits over public health is not endorsed by Nora Volkow, M.D., director of the National Institute on Drug Abuse (NIDA). She had some choice words for commercial interests involved in the addiction field in a brave Sept. 26 blog. Preying on the vulnerable — with drugs, social media, gambling, processed food, and other addictive products — is something she knows how to zone in on as an evil.

Crime and Nourishment: A Narrative Review Examining Ultra-Processed Foods, Brain, and Behavior

Recently, there has been increased scientific and clinical interest in the potential harms associated with ultra-processed foods, including poor mental health, aggression, and antisocial behavior. Research spanning epidemiology, mechanistic pre-clinical work, addiction science, microbiome and exposome science, and human intervention trials has underscored that nutrition is of relevance along the criminal justice continuum. As such, the emerging dietetics research is salient to the thousands of international psychologists and allied mental health professionals that are engaged in justice work, including forensics, prevention, and intervention. In addition, relationships between nutrition and behavior relate to “food crime”, an emergent area unifying criminal justice researchers with psychology, public health, and other interdisciplinary sectors. Food crime scrutinizes the vast harms, including non-communicable diseases and adverse behavioral outcomes, as influenced by the distribution of addictive ultra-processed food products. Here, we examine the emergent research, including biophysiological mechanisms, and evidence indicating that dietary patterns/components intersect with psychosocial vulnerabilities linked with risks of antisocial behavior and justice involvement. Viewed through a prevention lens, the study of nutrition and aggressive behavior should be prioritized, especially if the outcomes emerge as externalities of the global consumption of ultra-processed food. In the context of criminal justice and behavior, there is a need for forensic examination of how industry influence and power structures can undermine matters of food justice.

Selective Classes and Early Health Inequalities in Comprehensive Schools in Finland.

The origin of inequalities in health outcomes has been explained by health selection and social causation models. Health selection processes operate particularly at school age. We study, if student allocation to teaching groups with aptitude tests (selective vs general class) differentiates adolescents by health behaviors and mental health. Finnish schoolchildren 12-13 years from 12 selective classes, n = 248; 41 general classes, n = 703 answered a questionnaire on addictive products (tobacco, snus, alcohol, and energy drinks), digital media use, and mental health (health complaints, anxiety, and depression). Structural equation modeling was conducted to identify structures between outcomes, SEP (socioeconomic position), class type, and academic performance. Students in the selective classes reported less addictive digital media and addictive products use than students in the general classes. Differences in academic performance or SEP between the class types did not solely explain these differences. Mental health was not related to the class type. SEP was indirectly associated with health behaviors via the class type and academic performance. Selecting students to permanent teaching groups with aptitude tests differentiates students according to risky health behaviors. The impact of education policies using student grouping should also be evaluated in terms of students' health.

Partial Nicotine Reduction and E-Cigarette Users’ Puffing Behaviors Among Adults Aged 21 to 35 Years

The advent of salt-based, high-nicotine electronic nicotine delivery systems [e-cigarettes] has contributed to their epidemic use among young people in the US, necessitating the need for policies to address the addictiveness of these products. To evaluate the effect of partial nicotine reduction on new-generation e-cigarette users' puffing behaviors. This randomized crossover clinical trial was conducted at the Clinical Research Lab for Tobacco Smoking at Florida International University in Miami between April 15, 2022, and October 17, 2023. Using a volunteering sampling method by distributing flyers and advertisements, current e-cigarette users (who preferred 5% nicotine concentration), aged 21 to 35 years, were included. In a crossover design, participants completed 2 sessions of the same product (JUUL or NJOY) that differed by nicotine concentration (3% [JUUL] or 2.4% [NJOY] and 5% [JUUL or NJOY]) in random order. In each session, participants vaped up to 60 minutes ad libitum, preceded by 12 hours of nicotine abstinence. The primary outcomes were puffing topography parameters (eg, total session time, puffing time, total puffing number, interpuff interval, total inhaled volume, average puff volume, duration, and flow rate) measured during each session and plasma nicotine measured before and after each session. Among 735 participants who were approached for eligibility, 675 were excluded, and 10 did not complete session 2. Of the 50 remaining current e-cigarette users (mean [SD] age, 23 [3] years; 56% men), 23 (46%) were low nicotine dependent. The median topography parameters were significantly higher during the e-cigarette use sessions with 3% or 2.4% nicotine concentration compared with 5% nicotine concentration for 3 outcomes: puffing time (1.3 minutes [IQR, 0.3-9.4 minutes] vs 1.2 minutes [IQR, 0.2-5.6 minutes]; P = .02), puff duration (2.6 seconds [IQR, 0.8-6.9 seconds] vs 2.4 seconds [IQR, 0.4-6.6 seconds]; P = .02), and total inhaled volume (1990.0 mL [IQR, 279.0-24 400.0 mL] vs 1490.0 mL [IQR, 148.0-14 300.0 mL]; P = .05). The median plasma nicotine boost observed in the 5% nicotine concentration condition (0.0060 mg/L [IQR, 0.0001-0.0249 mg/L]) was significantly higher than that in the 3% or 2.4% session (0.0043 mg/L [IQR, 0.0008-0.0225 mg/L]) (P = .001). Additionally, deeper puffing (increased average puff duration and average puff volume) was observed in participants with higher nicotine dependence (1.42 seconds [95% CI, 1.12-1.80 seconds]; P = .03) and male users (1.38 mL [95% CI, 1.09-1.75 mL]; P = .04) in response to nicotine reduction. This randomized crossover clinical trial provides direct evidence that partial nicotine reduction in salt-based e-cigarettes was associated with acute compensatory puffing and the potential for increased exposure to toxicants. However, given the reduced nicotine delivery associated with nicotine reduction, the acute compensatory response observed in this study may not preclude a population benefit due to the marketing of less addictive products. These results suggest that at least for current e-cigarette users, partial nicotine reduction can lead to enhanced exposure to some toxicants in the short term. ClinicalTrials.gov Identifier: NCT05205382.

Viral Hepatitis and HIV Screening in Seasonal Mountain Workers: Feasibility and Results of a First French Experiment

Introduction: The Mobile Hepatitis Team (MHT) was set up in 2013, with main objective was to increase outreach screening care treatment access and cure of our target population. Target population was drugs users, prisoners, homeless, precarious people, migrants, and psychiatric patients. Seasonal workers working in mid-mountain ski resorts in the Eastern Pyrenees constitute a population at risk of viral hepatitis and HIV. This young population presents sexual risk behaviors and consumption of addictive products without regular access to care because of their mobility, moving from one workplace to another according to the seasons. They do not have a regular general practitioner, do not perform screening tests and there is no access to care other than the mandatory occupational medicine visit at the beginning of the season. In previous actions on the health aera of the high cantons of the department of Pyrénées-Orientales. We met with invested partners who referred us to this specific population of seasonal workers and their lack of access to screening and care, except for the occupational medicine hiring visit, organized before the beginning of the winter season, late November in early December. Objective: To detect viral hepatitis and HIV in a population at viral risk and far from care and offer them immediate treatment of the type of linkage to care “TEST TO CURE”. Methodology: 2-weeks HCV HBV and HIV finger sticks by trained nurses and orientation to the hepatology or the infectious units. Results: only 28 HCV finger sticks were completed. We also met 4 patients with known HCV serology. Three patients received DAA treatment and one patient spontaneous cured with negative RNA. One new patient had RNA C positive on balance sheet without social rights. We oriented him towards sour social worker to treat him later. Two patients had 2 real time HCV viral load not detected (including one post treatment follow-up) and one RNA negative without antiviral treatment, in case of HCV spontaneous clearance. For HBV, 16 finger sticks were completed, all negative. We did not meet as many seasonal workers as originally planned. This is why we conducted a second session over 2 days only targeted on these temporary accommodations. We realized 26 HCV and HIV finger sticks. One patient was HIV positive. HIV serology was unknow until our screening session. Nobody was HCV positive but 62% of screened people were drugs users or former drugs users. Discussion: our study was a success even the low number of people screened in the first 2-week session. The second 2-day session was more efficient. It was the first experience of hepatitis and HIV screening in this population of seasonal mountain workers. Conclusion: despite all limits, hepatitis and HIV screening among seasonal mountain workers was an innovative and efficient action. This action could be easily replicated in all populations of seasonal workers, whether in the mountains or by the sea.

What are the characteristics of disposable electronic cigarettes users in Switzerland? A quantitative study among 14–25 year olds

IntroductionDisposable electronic cigarettes (DEC) appeared in Switzerland in 2020. The aim of this study is to determine the prevalence of DEC use among youth (14–25 year olds) living in French-speaking...

The Joint Effect of Marketing and Extended Self-psychology on Consumer BehaviorThe Example of the "Soft" Addiction Market

The history of addictive consumer goods (tobacco, alcohol, sugar) has witnessed global developments in the modern era. As Siminji puts it: "Commodities like tea, sugar, liqueurs, and tobacco, whose consumption by laborers fit into the rhythm of laborers' lives. The centuries were centuries of rapid change in consumption when England was transforming a rural, agrarian, and pre-capitalist society in a way that was neither methodical nor smooth. People enjoyed sugar while work schedules were sped up, the pace of rural urbanization accelerated, and the factory system took shape and became widespread. These changes increasingly influenced patterns of eating habits." And in China, with the advent of the new century and the catalyst of the Internet, more new addictive consumer products are either moving from a regional product to a national one, as in the case of betel nut or completing the transition from cigarettes to e-cigarettes. Therefore some perceptions of traditional addictive substances or the traditional use of addictive substances have changed, and while the dangers of traditional addictive substances such as cigarettes, high alcohol, and sugar have been well known, addictive consumer products such as e-cigarettes, low alcohol such as beer, and betel nut have been widely promoted and disseminated when people do not yet have sufficient knowledge of them.

Smoking Behaviour and Its Impact on the Quality of Life of the Beneficiary Families of Social Assistance Funds in East Java, Indonesia

The government implements social assistance programs for poor families and vulnerable groups. Therefore, the implementation is still facing various challenges. One of the toughest challenges is smoking behaviour. As the income has been increasing, the cigarette’s expense is also high. Cigarette’s expenditure substitutes other basic needs, such as nutritional foods, health, and education expenses. This study analyses smoking behaviour in social assistance recipients and its impact on quality of life. By using qualitative method, particularly the Rapid Assessment Procedure, data were obtained through in-depth interviews. The study uses purposive method to collect samples in East Java, both Malang City and Kediri Regency. Results show that all the informants have family members who were heavy smokers. The daily cigarette’s expenditure of social assistance’s recipients was significant compared to their daily expenses. It substitutes basic needs expenses and affects their quality of life specifically for nutritional, health, and child’s education status. Furthermore, due to nicotine addiction, it is very difficult for smokers to reduce the number of cigarette consumption, even though at difficult economies. Smoking behaviour also leads to family conflicts. It is important to regulate social assistance recipients who still disburse their budget for temptation goods such as cigarette. In addition, government must inform the negative impacts of smoking, as well as promote the healthy life behaviour using the existing program, Family Capacity Building Meeting/Pertemuan Peningkatan Kemampuan Keluarga (P2K2). As part of effective solutions to reduce smoking prevalence, unaffordable cigarette price is important due to lowering the consumption of addictive product.

Compulsion to consume highly processed foods: addiction or 'para-addiction'.

Compulsion to consume highly processed foods: addiction or 'para-addiction'.

Human Development and Alcohol Consumption: State and Relationship in Russian Regions

Introduction. The study of the relationship between the costs of purchasing a typical addictive product – alcoholic beverages and the human development index in the regions of Russia is due to the need to overcome population decline, improve the level of education and life of the population. The purpose of the article is to analyze human development in the Russian regions on the basis of the results obtained under the influence of spending on the consumption of alcoholic beverages. Materials and Methods. The initial research data are United Nations Development Programme and Rosstat statistics for Russian regions for 2000–2017. A regression analysis of the relationship between the share of expenses on alcoholic beverages in the structure of the household final consumption expenses and the human development index in the regions of Russia was carried out. For each region, the coefficients of determination and correlation are calculated, the trends of change over the period, the direction and strength of the relationship between the human development index and the cost of alcoholic beverages are determined. Results. The analysis has showed that in 77 Russian regions in 2000–2017, the share of expenses on alcoholic beverages in the structure of the household final consumption expenses is decreasing against the backdrop of an increase in the human development index and there is an inverse relationship between these indicators. To reduce the risk of negative health impacts from the consumption of addictive products in Russian regions, the implementation of local policies to reduce inequality and increase welfare is recommended. A toolkit for methodological, analytical and predictive support of regional regulatory policy has been developed and tested. Measures to reduce the consumption of alcoholic products, the risks of non-communicable diseases and mortality in the Russian regions are proposed. Discussion and Conclusion. The data obtained indicate a steady downward trend in the share of expenses on the purchase of alcoholic beverages against the backdrop of a steady increase in the human development index in 2000–2017. The materials of the paper can be used to monitor and adjust the approaches of the state authorities to the directions of reducing the degradation of human capital from the consumption of addictive goods in troubled regions.

Vaping among youth: reasons, realization and intention to quit

PurposeVaping has become a prominent public health problem that has impacted young adults. The purpose of this study is to empirically examine the effects of different intrinsic and extrinsic motivations on young adults’ realization of excessive vaping and their intention to quit vaping.Design/methodology/approachA survey was used to collect data from 232 young vapers (primarily Generation Z and Millennials) to test the hypothesized relationships using a covariance-based structural equation model.FindingsThe findings of this study suggest that “realization of excessive vaping” is negatively associated with “sensation seeking” and positively associated with “deal proneness,” “environmental cues” and “negative repercussion.” The “intention to quit vaping” is negatively associated with “marketing cues” and positively associated with “alternative to smoking” and “environmental cues.” Finally, the “realization of excessive vaping” is positively associated with “intention to quit vaping.”Originality/valueThis study takes a two-dimensional approach to understand the complex motivations behind a relatively new addictive behavior – vaping. It contributes to the literature of addictive behavior, social cognitive theory and theory of planned behavior. Further, it has important implications for public policy and the marketing of addictive products to youths.

Налогообложение и регулирование табачной и инновационной никотинсодержащей продукции в России: новые проблемы и решения

Introduction: despite the progress in smoking reduction achieved over the past 10 years Russia is still among the leaders of the global anti-rating. the progress in reducing smoking achieved over the past 10 years Russia is still among the leaders of the global anti-rating. The effectiveness of the excise policy as the main instrument begins to decline from the illicit trade, which is expanding due to the inconsistency of the tax policy in the Eurasian Economic Union (EEU) countries. At the same time, the innovative nicotine delivery system market has been expanding, regulation of which is characterized by serious gaps. Objectives: to identify opportunities for improving regulation of traditional tobacco and innovative nicotinecontaining products markets to increase the collection of excises and achieve public health goals. Methods: comparative analysis, retrospective and counterfactual analysis, econometric estimations. Results: for the first time, econometric estimates for the Russian market were obtained on the aggregate regional (panel) data based on the simultaneous equations model using specially generated database “Addictive products in Russian regions”. The estimates show that, ceteris paribus, an increase of 1 p.p. the distance adjusted excise tax difference to the living cost ratio (DATDLC) leads to a reduction in the legal market by an average of 0.16 %. Price elasticity estimate of the legal aggregate demand is (-0.7), income elasticity is 0,8 and price elasticity of supply is 1,5. The analysis of budgetary and market statistics showed a low collection efficiency of excise taxes on ENDS; the problem of fiscal forestalling in this segment has been discovered. Conclusions: the results of the analysis allowed to propose several effective and feasible measures including the creation of an IT-system within the EEU for the exchange of information on excisable goods, the transfer of part of excise revenue to regional budgets, controlled legalization of nicotine pouches, anti-forestalling regulation in ENDS, etc.

Attitudes and Perceptions about Smoking Behavior of Students in the School Environment and Some Suggested Solutions

The trend of tobacco use is increasing among young people, students and evidence shows that tobacco smoke contains nicotine, which is a very strong addictive substance and is harmful to health, especially for children, adolescents and pregnant women. The chemicals in tobacco include acrolein, chemicals, acetaldehyde, carbon monoxide, nicotine, etc. Some of these chemicals are classified as carcinogenic. The cause of the increase of cigarettes stems from products with eye-catching, compact, flavorful, low-cost designs, etc. Tobacco is an addictive products very popular trade items in Vietnam. Today, it is not difficult to buy a pack of cigarettes from a shop, a grocery or at a supermarket. Although the mass media has propagated a lot about the harmful effects of smoking as well as the harmful effects of cigarette smoke to those around them, the proportion of smokers has not decreased. This situation is happening not only in adults but also in young people. Especially, smoking is creeping into the school where nurturing future talents. Although the harmful effects of cigarette smoking as well as the effects of cigarette smoke are widely known by the school as well as the media, the percentage of students smoking is increasing. This paper aims to study the smoking behavior of the students therefore we can assess the effectiveness of the mission of promoting health education to students and young people and finding solutions reduce student smoking rate.

Magnitude, risk factors of addictive behaviors among school students in Southern Tunisia

Abstract Background The use of addictive product is an important public health problem rapidly spreading around the world threatening the users, their families and environments, causing serious health problems and devastating societies in psychological and economical terms. During adolescence, these substances are harmful to health, affecting the developing of brain. This study aimed at investigating the prevalence, the determinants and the impact of addictive behaviors (AB) among school students (SS). Methods This was a cross-sectional study including a three-stage randomized sample of 1210 SS from different public schools of Southern Tunisia, on April 2021, using an anonymous self-administered questionnaire. AB were defined as the consumption of at least one of the following products: tobacco, illicit drugs and alcohol. Results Overall, 723 SS were females (59.8%), with a sex ratio (Male/Female) of 2.3. The average age was 15.64±2.05 years. In total, 793 cases (65.5%) were from rural areas. The prevalence of addictive behaviors was 18.7% (225). It was 13.9% (168) for current smoking, 3.1% (37) for alcohol consumption and 1.7% (20) for illicit drug use. Factors independently associated with AB in logistic multivariate analysis were male gender (Adjusted Odds Ratio (AOR)=10.2;p<0.001), secondary school studies (AOR=1.5;p=0.008), age ≥14 years (AOR=2.5;p<0.01) and living alone or sharing home with friend (AOR=2.29;p=0.004). These AB had statistically negative impact on SS, notably for low school marks and academic failure (OR = 2.5;p=0.01 and OR = 1.66;p=0.002, respectively). Moreover, the perceived stress scale was statistically higher among SS with AB (OR = 1.4;p=0.03). Conclusions Addictive behaviors among SS were alarmingly prevalent in Southern Tunisia, which was correlated with socio-demographic, cultural and educational factors. New preventive and therapeutic strategies should be urgently initiated to ensure a safe educational and psychological environment for SS. Key messages Addictive behaviors among SS were alarmingly prevalent in Southern Tunisia. Addictive behaviors among SS were correlated with socio-demographic, cultural and educational factors.

Cigarette Promotions in U.S. Pharmacies.

The sale of tobacco products within American pharmacies has generated controversy for several decades, leading two U.S. states and 45 municipalities to adopt tobacco-free pharmacy policies. While previous research has reported cheaper cigarette prices in pharmacies, compared to other retailers, little is known about cigarette promotions in pharmacies, which are associated with increased youth smoking and unplanned cigarette purchases among adults. Between May and August 2015, trained data collectors conducted store audits at 2128 tobacco retailers located within 97 U.S. counties in 40 states. Observations were made for three types of cigarette promotions: special price (e.g., $0.30 off/pack), multi-pack promotions (e.g., buy one pack, get one free), and cross-product promotions (e.g., buy a pack of cigarettes and a get free can of snus). We calculated weighted estimates of the proportion of pharmacies and other retailer types with cigarette promotions and used weighted multivariable logistic regression to compare cigarette promotions by tobacco retailer type, accounting for clustering at the county level and controlling for county-level demographic characteristics. Cigarette promotions were observed in 94.0% of pharmacies, more than any other retailer type (e.g., convenience stores: 82.0%, tobacco stores: 77.0%). All retailer types had lower odds of promotions for Marlboro, Newport, Camel, menthol, or any interior cigarette promotion, compared to pharmacies. Nearly all pharmacies offered in-store cigarette promotions and pharmacies had greater odds of offering cigarette promotions than all other retailer types. Whether voluntarily or legislatively, tobacco-free pharmacies would eliminate a prevalent retail source of cigarette promotions. This is the first known national study to examine prevalence of cigarette promotions in U.S. pharmacies compared to other retailer types. Nearly all pharmacies offered in-store cigarette promotions and pharmacies had greater odds of offering cigarette promotions than all other retailer types. These findings underscore the inherent contradiction of pharmacies serving both as an important component of the health care system, but also as purveyors and promotors of addictive and lethal tobacco products. Whether voluntarily or legislatively, tobacco-free pharmacy policies would eliminate a prevalent retail source of cigarette promotions.

The Determinants of Household Spending on Alcohol and Tobacco in Tanzania

The increasing effects caused by alcohol and tobacco calls for necessary interventions. This is not only in developed countries, but also in developing countries which seems to be affected more by this problem. Studies show that 80% of smokers worldwide are living in developing countries where tobacco related diseases have become major factors contributing toward high morbidity. Moreover, excessive alcohol consumption has been among global public health problems, where it accounts for about 6% of mortality and 5% of disability in the world. In addition, the prevalence of Alcohol Use Disorders (AUD) was reported at 4% globally while in Africa it was 3%. Tanzania being the developing country and located in Africa is also at risk to be affected more if the necessary measures to control this unhealthy behaviour are not taken. However, due to limited information about the structure and behaviour of people in spending and consumption of these addictive products in Tanzania, it will be difficult to prepare relevant measures to curb those problems. Therefore, by using Tobit regression model, this study examined the influence of socioeconomic characteristics on alcohol and tobacco spending. This study found factors such income, culture, and change in preference over time to have a significant relationship with spending on alcohol and tobacco. This study creates a base for alcohol and tobacco spending behaviour in Tanzania. After determining spending behaviour, further studies need to be conducted to examine consumption behaviour and its effects to prepare relevant measures to control the risks of alcohol and tobacco in Tanzania.

New Zealand Smokers' Perceptions of Tobacco Endgame Measures: A Qualitative Analysis.

New Zealand's equity-focused endgame goal (Smokefree 2025) aims to reduce smoking prevalence to minimal levels (ie, <5%) in all population groups by 2025. Inadequate progress has stimulated discussion of innovative measures to reduce prevalence; because few studies have explored how marginalized groups perceive these measures, we addressed this knowledge gap. In November and December 2020, we conducted 20 in-depth interviews with people who smoked daily, were aged between 21 and 53, earned less than the median income (NZD33 900), and had marginal or inadequate income sufficiency. We explored participants' smoking history and used an elicitation exercise to probe their views on smokefree policies, including potential endgame measures. We used qualitative descriptive analysis and reflexive thematic analysis to interpret the data. Participants favored increasing personal support to quit and reducing nicotine levels in cigarettes, but generally opposed tobacco excise tax increases and paying people to quit. While many privileged their right to "choose," some recognized that stronger policies could restore the loss of agency addiction caused. Participants felt smoking's powerful addictiveness remained poorly understood, and called for smoking to be recognized and treated as an addiction. Several participants supported intensifying existing measures or introducing new measures. However, their use of tobacco industry rhetoric to frame smoking as a choice they had made could inadvertently reinforce the stigma they experienced. Reframing cigarettes as an addictive product engineered by a deceptive industry, may make it easier for participants to access the expanded support and compassion they sought. Policy measures, such as reducing the nicotine level in cigarettes, could support endgame goals; however, greater public understanding of addiction is needed to reduce stigma, support self-efficacy, and foster smoking cessation. Industry denormalization campaigns could challenge views of smoking as a personal choice, decrease self-blame among people who smoke, and present endgame goals as likely to enhance agency.

A Qualitative Study of Perceptions and Practices Related to Areca Nut Use Among Adolescents in Mumbai, India.

Areca nut, commonly known as supari, is widely used in India. In addition to tobacco and alcohol, it has been identified as one of the contributory factors for high rates of oral cancer in the country. This qualitative study explored perceptions and practices around the use of areca nut by conducting in-depth interviews and focus group discussions with 61 school-going adolescents in the city of Mumbai, India. Respondents used low-priced sachets of sweetened, flavored areca nut called supari. They perceived supari as harmless because it was sweet, it had a fresh after-taste as compared to bitter-tasting smokeless tobacco products. How can something sweet be harmful was a common argument offered by respondents. Respondents invariably compared and contrasted areca nut to more harmful and addictive tobacco products; perceiving supari to have milder or inconsequential health effects. Supari use was initiated with friends, a sibling, or a cousin. It was almost always used with friends. Respondents also reported difficulty in refusal to use when offered supari by friends. Parental response to finding out about the child's supari use was often muted in comparison to extreme reactions associated with the child's tobacco use. Perceptions of low risk or relative harmlessness of the product, social influence, and the features of the product itself influence adolescents' use of areca nut. Although more research on perceptions of risk, with larger samples, is required, these findings are useful for school-based tobacco prevention and cessation programs and health policy-makers. The study findings have implications for prevention and cessation programs, and policymakers. School-based health education programs should allocate special sessions on areca nut use. Focused mass media communication campaigns describing its harms and association with oral cancer are required for the larger community. As was done for tobacco, Indian policymakers will have to evaluate the marketing, commerce, and distribution of areca nut and create appropriate laws. More research, with larger nationwide samples, is required to examine perceptions of areca nut.