Changes In Smoking Prevalence Research Articles

Smoking status of medical students and changes during the COVID-19 pandemic

Abstract Background Smoking is a major public health threat that contributes to many diseases and deaths. This study aimed to investigate cigarette and alternative tobacco products (ATP) use and knowledge among students. Additionally, changes in smoking prevalence and contributing factors during the COVID-19 pandemic were examined. Methods The cross-sectional, anonymous online survey was conducted among students from the Faculty of Medicine, Comenius University in Bratislava, by sending e-mails with links, during November-December 2022. Our study population consisted of 783 students with a mean age of 22.7±2.7 years; 68.1 % of students studied in Slovak; 67.0 % of respondents were female; 21.8% did not have COVID-19, and 6.6% were not vaccinated. The data were analyzed by SPSS 25. Results Out of these, 89 were current smokers (11.4%), 216 ex-smokers (27.6%), and 478 non-smokers (61.0%) in the study sample, significantly higher number of smokers were men (16.2% vs 9.1%; p = 0.004), more foreigners (9.4% vs 15.6%; p = 0.021). A total of 170 medical students (21.8%) reported using any kind of alternative tobacco product, with a significant intersexual difference (27.4% males vs. 18.9% females; p < 0.001), more Slovaks (22.9% vs. 19.4%; p = 0.503). The pandemic did not affect a significant change in classic nicotine product intake for 11.4%; 11.8% of students decrease intake; while 8.0% increased their intake. 17.5% of users of ATP did not change their habits during the pandemic; 7.0% of students decrease intake; 12.6% increased. Respondents who were smokers and ex-smokers reported an increase in alcohol consumption during the pandemic more frequently than non-smokers (23.6% and 21.5% vs. 10.7%, respectively). Conclusions The results show the high consumption of different tobacco products, and the lack of knowledge and awareness among medical students, future healthcare providers, who should serve as a model for their patients and the public. Supported by KEGA 015UK-4/2022 Key messages • As future healthcare providers, medical students will play key role in health promotion and disease prevention, and they should serve as a model for their patients and the general public as well. • Our study emphasizes increasing awareness and education regarding tobacco use and the need for intervention in the field of disease prevention at medical faculties.

Tobacco control policies implementation and future lung cancer incidence in Saudi Arabia. A population-based study

BackgroundDespite the implementation of the monitor tobacco products and prevention package (MPOWER) in Saudi Arabia since 2011, the impact of the policy implantation on smoking prevalence and lung cancer incidence have not been evaluated. ObjectivesWe aimed to estimate the potential reduction in future lung cancer incidence in Saudi Arabia that could be prevented if the highest level of tobacco control policies MPOWER score were implemented. MethodsPopulation-based lung cancer incidence data was used to predict lung cancer incidence in Saudi Arabia up to year 2039. We used hypothetical smoking prevalence that would be expected if countries had applied the highest-level implementation of MPOWER tobacco control policies score. We used potential impact fraction on the hypothetical smoking prevalence data to estimate the potentially preventable lung cancer cases taking into account latency periods between changes in smoking prevalence and development of cancer risks. After the hypothesized highest level of MPOWER tobacco policies implementation. Resultsthe national tobacco smoking prevalence has declined by 55% from 13.17% in 2020 to 5.91% in 2039. If the highest-level MPOWER is implanted, more than half the tobacco smoker rate will be reduced, and a total of 9783 lung cancer cases would be potentially prevented in 2039. ConclusionFurther implementation of effective messages is needed to reduce tobacco-related cancers. By doing so, we can gain valuable insights into the impact of these policies on public health outcomes in the broader context of the region and identify potential areas for further improvement and intervention.

What was the impact of tobacco taxes on smoking prevalence and coronary heart disease mortality in the United States −2005-2016, and did it vary by race and gender?

Tobacco taxes have reduced smoking and coronary heart disease (CHD) mortality, yet few studies have examined heterogeneity of these associations by race and gender. We constructed a yearly panel (2005–2016) that included age-adjusted cigarette smoking prevalence and CHD mortality rates across all 50 U.S. States and the District of Columbia using the Behavioral Risk Factor Surveillance System and Wide-ranging Online Data for Epidemiological Research. We examined associations between changes in total cigarette excise taxes (i.e., federal and state) and changes in smoking prevalence and CHD mortality, using linear regression models with state and year fixed effects. Each dollar of tobacco tax was associated with a reduction in age-adjusted smoking prevalence 1 year later of −0.4 [95% CIs: −0.6, −0.2] percentage points; and a relative reduction in the rate of CHD mortality 2 years later of −2.0% [95% CIs: −3.7%, −0.3%], or −5 deaths/100,000 in absolute terms. Associations between tobacco taxes and smoking prevalence were statistically significantly different by race and gender and were strongest among Black non-Hispanic women (−1.2 [95% CIs: −1.6, −0.8] percentage points). Associations between tobacco taxes and CHD mortality were not statistically significantly different by race and gender, but point estimates for percent changes were highest among Black non-Hispanic men (−2.9%) and Black non-Hispanic women (−3.5%) compared to White non-Hispanic men (−1.8%) and White non-Hispanic women (−1.5%). These findings suggest that tobacco taxation is an effective intervention for reducing smoking prevalence and CHD mortality among White and Black non-Hispanic populations in the United States.

A cluster-randomized trial of a brief multi-component intervention to improve tobacco outcomes in substance use treatment

BackgroundSmoking prevalence is high among people in substance use disorder (SUD) treatment, and program interventions to address smoking are often complex and lengthy. This cluster-randomized trial tested whether a brief multi-component intervention impacted tobacco outcomes among staff and clients.MethodsSeven SUD treatment programs were randomly assigned to the multi-component intervention or to waitlist control. The 6-month intervention included a leadership motivation assessment, program incentives, 4 staff training sessions and a leadership learning community session. Survey data were collected from staff and clients at pre- and post-intervention. Outcomes were first compared across condition (intervention vs waitlist control), and then examined pre- to post-intervention with condition collapsed.ResultsStaff in the intervention (n = 48) and control conditions (n = 26) did not differ at post-intervention on smoking prevalence, self-efficacy to help clients quit, or practices used to help clients quit smoking. Intervention clients (n = 113) did not differ from controls (n = 61) in smoking prevalence or receipt of tobacco services. Pre-post comparisons collapsed across condition showed a decrease in client and staff smoking prevalence, which could not be attributed to the intervention, and a decrease in client receipt of cessation medication.ConclusionThe brief multi-component intervention did not support changes in smoking prevalence or in tobacco-related services received by clients. Other intervention features are needed to reduce smoking among SUD clients.Trial registrationRandomization occurred at the program level and outcomes measured are program-level measures. Accordingly, the trial is not registered.

Increased Nicotine Consumption in Australia During the First Months of the COVID-19 Pandemic.

Mixed findings have been reported about the impact of the COVID-19 pandemic on smoking behavior in different populations. In this study, we aimed to quantify changes in smoking prevalence through the proxy of nicotine consumption in the Australian population from 2017 to 2020 inclusive. Estimates of nicotine consumption between 2017 and 2020 were retrieved from a national wastewater monitoring program that covers up to 50% of the Australian population. National sales data for nicotine replacement therapy (NRT) products from 2017 to 2020 were also acquired. Linear regression and pairwise comparison were conducted to identify data trends and to test differences between time periods. The average consumption of nicotine in Australia decreased between 2017 and 2019 but increased in 2020. Estimated consumption in the first half of 2020 was significantly higher (~30%) than the previous period. Sales of NRT products increased gradually from 2017 to 2020 although sales in the first half of the year were consistently lower than in the second half. Total nicotine consumption increased in Australia during the early stage of the pandemic in 2020. Increased nicotine consumption may be due to people managing higher stress levels, such as from loneliness due to control measures, and also greater opportunities to smoke/vape while working from home and during lockdowns in the early stage of the pandemic. Tobacco and nicotine consumption have been decreasing in Australia but the COVID-19 pandemic may have temporarily disrupted this trend. In 2020, the higher impacts of lockdowns and working from home arrangements may have led to a temporary reversal of the previous downward trend in smoking during the early stage of the pandemic.

Changes in Smoking Prevalence from Adolescence to Adulthood among Asian Americans: Evidence of Selective Acculturation across Gender

It is well established that immigrant adolescents have lower smoking rates than their native-born counterparts. Although smoking rates among immigrants have been theorized to increase with U.S. acculturation, this hypothesis has seldom been tested using longitudinal data spanning multiple developmental stages. The authors address this limitation using data from the National Longitudinal Study of Adolescent to Adult Health to model age-based smoking trajectories by gender and nativity status among Asian Americans (ages 10–33 years), adjusting for a range of control covariates. Trajectory analyses indicate that the gap between immigrants and natives generally increases as individuals age, but this process varies by gender, with immigrant women exhibiting a significantly less steep smoking growth trajectory ( b = −.011, p < .001) compared with native-born men (and all other nativity-gender combinations), whereas immigrant men show no significant smoking trajectory slope difference compared with native men. In summary, results suggest a gendered acculturation process for smoking behavior among Asian Americans.

Deadly declines and diversity – understanding the variations in regional Aboriginal and Torres Strait Islander smoking prevalence

Deadly declines and diversity – understanding the variations in regional Aboriginal and Torres Strait Islander smoking prevalence

Trends in smoking prevalence in urban and rural China, 2007 to 2018: Findings from 5 consecutive nationally representative cross-sectional surveys.

BackgroundTobacco smoking is a leading cause of premature death in China, especially among adult men. Since the implementation of the Framework Convention on Tobacco Control in 2005, nationwide tobacco control has been strengthened, but its long-term impact on smoking prevalence is unclear.Methods and findingsFive nationally representative surveys of the China Chronic Disease and Risk Factor Surveillance (CCDRFS) were conducted in 2007, 2010, 2013, 2015, and 2018. A total of 624,568 adults (278,605 men and 345,963 women) aged 18 to 69 years were randomly selected from 31 provinces (or equivalent) in China. Temporal changes in smoking prevalence and patterns (e.g., percentages of those smoking manufactured cigarettes, amount smoked, and age at smoking initiation) were analyzed, overall and by sex, urban or rural residence, year of birth, education and occupation, using linear regression methods. Among men, the standardized prevalence of current smoking decreased from 58.4% (95% confidence interval [CI]: 56.1 to 60.7) to 50.8% (95% CI: 49.1 to 52.5, p < 0.001) between 2007 and 2018, with annual decrease more pronounced in urban (55.7% [95% CI: 51.2 to 60.3] to 46.3% [95% CI: 43.7 to 49.0], p < 0.001) than rural men (59.9% [95% CI: 57.5 to 62.4] to 54.6% [95% CI: 52.6 to 56.6], p = 0.05) and in those born before than after 1980. Among rural men born after 1990, however, the prevalence increased from 40.2% [95% CI: 34.0 to 46.4] to 52.1% ([95% CI: 45.7 to 58.5], p = 0.007), with the increase taking place mainly before 2015. Among women, smoking prevalence remained extremely low at around 2% during 2007 to 2018. No significant changes of current smoking prevalence (53.9% to 50.8%, p = 0.22) were observed in male patients with at least 1 of major chronic diseases (e.g., hypertension, diabetes, myocardial infarction, stroke, chronic obstructive pulmonary disease (COPD)). In 2018, 25.6% of adults aged ≥18 years smoked, translating into an estimated 282 million smokers (271 million men and 11 million women) in China. Across 31 provinces, smoking prevalence varied greatly. The 3 provinces (Yunnan, Guizhou, and Hunan) with highest per capita tobacco production had highest smoking prevalence in men (68.0%, 63.4%, and 61.5%, respectively), while lowest prevalence was observed in Shanghai (34.8%). Since the children and teenage groups were not included in the surveys, we could not assess the smoking trends among youths. Furthermore, since the smoking behavior was self-reported, the smoking prevalence could be underestimated due to reporting bias.ConclusionsIn this study, we observed that the smoking prevalence has decreased steadily in recent decades in China, but there were diverging trends between urban and rural areas, especially among men born after 1980. Future tobacco control strategies should target rural young men, regions with high tobacco production, and patients suffering from chronic diseases.

Tobacco smoking during the coronavirus pandemic in the older adults from Lombardy region

Introduction Given the strong impact of the pandemic on smoking habits and psychological well-being in the Italian general population, it is important to analyze those effects also in the older adults, as they represent the demographic segment most affected by the pandemic. However, to date, the scientific evidence on the issue is still limited. Methods In November 2020, a telephone based cross-sectional survey was conducted on a representative sample of 4,400 older adults (aged 65 and over) from Lombardy region, northern Italy. Compared to the previous year, we evaluated changes in smoking habits and psychological well-being, through validated scales. Through unconditional multiple logistic models, we also assessed whether smoking was a determinant of poor psychological well-being and its deterioration during the pandemic. Results No changes in smoking prevalence were observed in the older adults. Compared to never smokers, smoking resulted a determinant of poor sleep quality (odds ratio, OR = 1.45; 95% confidence interval, CI: 1.10-1.92), of presence of depressive symptoms (OR = 1.89; 95% CI: 1.36-2.62), of anxiety (OR = 1.45; 95% CI: 1.10-1.92), and hopelessness (OR = 1.50; 95% CI: 1.14-1.96). During the pandemic, being a smoker resulted a determinant of reducing sleep quantity (OR = 1.36; 95% CI: 1.02-1.83) and increasing (or starting) using psychotropic drugs (OR = 1.85; 95% CI: 1.16-2.96). Conclusions In the older adult population from Lombardy region, smoking habits did not change substantially during the pandemic, but tobacco smoking deteriorated psychological well-being. During emergency periods, the safeguard of psychological well-being is an additional reason to encourage smoking cessation.

Implementing tobacco-free policy in residential substance use disorders treatment: Practice changes among staff

IntroductionImplementing tobacco-free policies in substance use disorders (SUD) treatment may reduce tobacco-related, health disparities. This study examined adoption of tobacco-related policy and practices in six residential programs participating in a California-sponsored, 18-month, tobacco-free policy intervention. MethodsDirectors (N=6) completed surveys of tobacco-related policies before and after the intervention. Staff completed cross-sectional surveys assessing tobacco-related training, beliefs, practices, workplace smoking policy, tobacco cessation program services, and smoking status pre- (n=135) and post-intervention (n=144). ResultsDirector surveys indicated no programs had tobacco-free grounds, one provided tobacco-related staff training, and two provided nicotine replacement therapy (NRT) pre-intervention. At post-intervention, 5 programs had implemented tobacco-free grounds, 6 provided tobacco cessation training, and 3 provided NRT. Across all programs, staff were more likely to report smoke-free workplaces (AOR = 5.76, 95% CI1.14,29.18) post- versus pre-intervention. Staff positive beliefs towards addressing tobacco use were higher post-intervention (p<0.001). Odds of clinical staff reporting tobacco-related training participation (AOR = 19.63, 95% CI14.21,27.13) and program-level provision of NRT (AOR = 4.01, 95% CI 1.54, 10.43) increased post- versus pre-intervention. Clinical staff reporting they provided tobacco cessation services were also higher post-intervention (p= 0.045). There were no changes in smoking prevalence or quit intention among smoking staff. ConclusionA tobacco-free policy intervention in SUD treatment was associated with implementation of tobacco-free grounds, tobacco-related training among staff, more positive staff beliefs towards and delivery of tobacco cessation services to clients. The model may be improved with greater emphasis on staff policy awareness, facilitating availability of NRT, and reducing staff smoking.

Heated tobacco products for smoking cessation and reducing smoking prevalence.

Heated tobacco products for smoking cessation and reducing smoking prevalence.

Modeling the public health impact of e-cigarettes on adolescents and adults.

Since the introduction of electronic cigarettes to the U.S. market in 2007, vaping prevalence has surged in both adult and adolescent populations. E-cigarettes are advertised as a safer alternative to traditional cigarettes and as a method of smoking cessation, but the U.S. government and health professionals are concerned that e-cigarettes attract young non-smokers. Here, we develop and analyze a dynamical systems model of competition between traditional and electronic cigarettes for users. With this model, we predict the change in smoking prevalence due to the introduction of vaping, and we determine the conditions under which e-cigarettes present a net public health benefit or harm to society.

Return on investment of Canadian tobacco control policies implemented between 2001 and 2016

ObjectivesTo determine the return on investment (ROI) associated with tobacco control policies implemented between 2001 and 2016 in Canada.MethodsCanadian expenditures on tobacco policies were collected from government sources. The economic...

Impact of Medicaid expansion on smoking prevalence and quit attempts among those newly eligible, 2011-2019.

INTRODUCTIONLow-income populations have higher rates of smoking and are disproportionately affected by smoking-related illnesses. This study assessed the long-term impact of increased coverage for tobacco cessation through Medicaid expansion on past-year quit attempts and prevalence of cigarette smoking.METHODSUsing data from CDC’s annual Behavioral Risk Factor Surveillance System 2011–2019, we conducted difference-in-difference regression analyses to compare changes in smoking prevalence and past-year quit attempts in expansion states versus non-expansion states. Our sample included non-pregnant adults (18–64 years old) without dependent children with incomes at or below 100% of the Federal Poverty Level (FPL).RESULTSRegression analyses indicate that Medicaid expansion was associated with reduced smoking prevalence in the first two years post-expansion (β=-0.019, p=0.04), but that this effect was not maintained at longer follow-up periods (β=-0.006, p=0.49). Results of regression analyses also suggest that Medicaid expansion does not significantly impact quit attempts in the short-term (β=-0.013, p=0.52) or at longer term follow-up (β=-0.026, p=0.08).CONCLUSIONSExpanded coverage for tobacco cessation services through Medicaid alone may not be enough to increase quit-attempts or sustain a reduction in overall prevalence of smoking in newly eligible populations over time. Medicaid programs should consider additional strategies, such as public education campaigns and removal of barriers, to support cessation among enrollees.

Was the implementation of standardised tobacco packaging legislation in England associated with changes in smoking prevalence? A segmented regression analysis between 2006 and 2019

Background and aimIn 2016, England initiated the implementation of standardised tobacco packaging, introduced in conjunction with minimum pack sizes and other measures included in the 2014 European Tobacco Products Directive,...

Exposure\u2013lag response of smoking prevalence on lung cancer incidence using a distributed lag non-linear model

The prevalence of smokers is a major driver of lung cancer incidence in a population, though the “exposure–lag” effects are ill-defined. Here we present a multi-country ecological modelling study using a 30-year smoking prevalence history to quantify the exposure–lag response. To model the temporal dependency between smoking prevalence and lung cancer incidence, we used a distributed lag non-linear model (DLNM), controlling for gender, age group, country, outcome year, and population at risk, and presented the effects as the incidence rate ratio (IRR) and cumulative incidence rate ratio (IRRcum). The exposure–response varied by lag period, whilst the lag–response varied according to the magnitude and direction of changes in smoking prevalence in the population. For the cumulative lag–response, increments above and below the reference level was associated with an increased and decreased IRRcum respectively, with the magnitude of the effect varying across the lag period. Though caution should be exercised in interpretation of the IRR and IRRcum estimates reported herein, we hope our work constitutes a preliminary step towards providing policy makers with meaningful indicators to inform national screening programme developments. To that end, we have implemented our statistical model a shiny app and provide an example of its use.

Trends in smoking prevalence by occupations defined in the Japan Standard Occupational Classification: A repeated cross-sectional analysis of the Comprehensive Survey of Living Conditions, 2001-2016

Objectives Few studies have focused on the relationship between smoking habits and occupation in Japan. This study aimed to examine the changes in smoking prevalence by occupation, specifically those occupations defined in the Japan Standard Occupational Classification (JSOC).Methods We analyzed data from the Comprehensive Survey of Living Conditions, a large nationally representative survey conducted in Japan every three years, between 2001 and 2016. Survey participants were asked whether they (1) "never smoked," (2) "smoked daily," (3) "smoked occasionally but not every day," or (4) "used to smoke daily (before, at least one month)." Participants who answered (2) "smoked daily" or (3) "smoked occasionally but not every day" were considered "current smokers." Age-standardized smoking prevalence was computed based on the JSOC (10 categories: administrative and managerial; professional; clerical; sales; services; security; agriculture, forestry, and fishing; transport; manufacturing, construction, mining, carrying, cleaning, and packaging; and unemployment). The analyses were restricted to workers and unemployed men and women aged 25 to 64 years old.Results Between 2001 and 2016, the smoking prevalence (of the entire population aged 25 to 64 years old) decreased from 56.0% (95% confidence interval [95% CI]: 55.8-56.3%) to 38.4% (95% CI: 38.1-38.6%) among men, and from 17.0% (95% CI 16.8-17.2%) to 13.0% (95% CI 12.8-13.1%) among women. In 2016, the smoking prevalence for clerical (the lowest smoking prevalence) and transport workers (the highest smoking prevalence) was 27.9% (95% CI: 27.0-28.8%) and 48.3% (95% CI: 46.8-49.7%), respectively, for men, and 9.4% (95% CI: 9.0-9.7%), and 38.5% (95% CI: 32.6-44.5%), respectively, for women. Between 2001 and 2016, the smoking prevalence for men decreased for all occupations, whereas for women, the smoking prevalence decreased for all occupations except for security and for transport workers. The largest reduction rate of smoking prevalence between 2001 and 2016 for men and for women was observed in clerical workers (-21.0%) and sales workers (-7.2%), respectively. We also found that clerical workers had the lowest smoking prevalence across the 5-year age categories for both sexes, especially the younger age, which resulted in the largest differences in smoking prevalence by occupation among men aged 30 to 34 years old.Conclusion We confirmed that, between 2001 and 2016, the lowest and highest smoking prevalence for both sexes is found among clerical workers and among transport workers, respectively. Although smoking prevalence has declined among working-aged men and women between 2001 and 2016, large differences by occupations consistently exist in Japan. It is necessary to take measures against smoking habits in consideration of their social backgrounds and work environments.

Cost-effectiveness of a Smoking Cessation Intervention for Parents in Pediatric Primary Care

Parental smoking adversely affects parents' and children's health. There are effective interventions delivered in pediatric settings to help parents quit smoking. The cost-effectiveness of this type of intervention is not known. To evaluate the cost-effectiveness of a parental smoking cessation intervention, the Clinical Effort Against Secondhand Smoke Exposure (CEASE) program, delivered in pediatric primary care, compared with usual care from a health care organization's perspective. This economic evaluation used data on intervention costs and parental smoking cessation collected prospectively as part of the CEASE randomized clinical trial. Data were collected at pediatric offices in 5 US states from April 2015 to October 2017. Participants included parents of children attending 10 pediatric primary care practices (5 control, 5 intervention). Data analysis was performed from October 2019 to August 2020. The trial compared CEASE (practice training and support to address family tobacco use) vs usual care. The overall cost and incremental cost per quit of the CEASE intervention were calculated using microcosting methods. CEASE effectiveness was estimated using 2 trial outcomes measures assessed in repeated cross-sections: (1) change in smoking prevalence assessed by parental report for intervention vs usual care practices at 2 weeks after program initiation (baseline) and at 2-year follow-up and (2) changes in the proportion of smokers who achieved cotinine-confirmed smoking cessation in the previous 2 years at baseline vs follow-up. Monte Carlo analyses were used to provide 95% CIs. The study included a total of 3054 participants (1523 at baseline and 1531 at follow-up); 2163 (70.8%) were aged 25 to 44 years old, and 2481 (81.2%) were women. Over 2 years, the total cost of implementing and sustaining CEASE across 5 intervention practices was $115 778. The incremental cost per quit for CEASE compared with usual care was $1132 (95% CI, $653-$3603), according to the change in parent-reported smoking prevalence, and $762 (95% CI, $418-$2883), according to cotinine-confirmed cessation. CEASE was cost-effective at a willingness-to-pay threshold of $2000 per quit in 88.0% of simulations based on the parent-reported smoking prevalence and 94.6% of simulations based on cotinine-confirmed smoking cessation measures. These findings suggest that the CEASE intervention was associated with an incremental cost per quit that compared favorably with those of other clinical smoking cessation interventions. CEASE is inexpensive to initiate and maintain in the clinical pediatric setting, suggesting that it has the potential for a high impact on population health.

Impact of tobacco control policies implementation on future lung cancer incidence in Europe: An international, population-based modeling study.

SummaryBackgroundDespite recent trends in declining smoking rates, tobacco smoking remains the most preventable cause of cancer in Europe. We aimed to estimate numbers and proportions of future lung cancer cases that could be potentially prevented over a 20-year period if countries in Europe were to achieve a comprehensive implementation of tobacco control policies.MethodsHistorical data from population-based cancer incidence (or mortality) was used to predict sex-specific lung cancer incidence for 30 European countries up to 2037. Hypothetical country-specific smoking prevalence that would be expected if countries would have achieved the highest-level implementation of tobacco control policies (defined by the maximum total score of the Tobacco Control Scale, TCS) was estimated by combining national prevalence data on current smoking and data on the status of implementation of key tobacco control policies. Resulting numbers and proportions of potentially preventable lung cancer cases were estimated taking into account latency periods between changes in smoking prevalence and excess cancer risks.FindingsIn Europe, an estimated 1·65 million lung cancer cases (21·2%, 19·8% in men and 23·2% in women) could be prevented over a 20-year period with the highest-level implementation of tobacco control policies. Large variation was seen in European regions and countries reflecting the current level of tobacco control, with the largest potential for prevention in Western Europe (24·5%), Southern Europe (23·1%) and Eastern Europe (22·5%), and the lowest but still substantial potential for further prevention in Northern Europe (12·5%). In women, among whom lung cancer incidence is expected to increase, we estimated somewhat larger proportions of preventable lung cancer cases ranging from 9·9 to 33·9% as compared to men (8·6–28·5%). In the final year of study period (2037), these proportions even exceed 50% in women for some countries.InterpretationImproved and expanded implementation of evidence-based tobacco control policies at the most comprehensive level could reduce future lung cancer incidence considerably across Europe.FundingThe study was funded by the 10.13039/501100005972German Cancer Aid (“Deutsche Krebshilfe”), grant number 70112097.

Offering nicotine patches to all households in a community with high smoking rates: Pilot test of a population-based approach to promote tobacco cessation.

BackgroundThe objective of this project is to determine the effectiveness of targeting a community with a high smoking rate with the distribution of free-of-charge nicotine patches in order to promote tobacco cessation.Methods/DesignOne small community with an elevated smoking rate (compared to national and provincial averages) has been identified. All households in the community will be sent a letter offering one smoker (18 years or older; 10 or more cigarettes per day) in the household a free-of-charge mailed five-week supply of nicotine patches (up to a total of 800 five-week kits will be available for distribution). Participants receiving nicotine patches will be asked to complete a six-month follow-up survey assessing tobacco cessation defined as 30-day point prevalence abstinence. In addition, attempts will be made to employ ongoing national population surveys containing cigarette smoking variables to compare changes in smoking prevalence in the target community to other communities with similar characteristics.DiscussionWe will examine whether the concentrated distribution of mailed nicotine patches will result in a measurable reduction in smoking rates in the target community. If demonstrated, this would provide support for the targeted population-level distribution of an effective individual-level public health intervention.Clinical Trials registrationNCT04534231