Cigarette Availability Research Articles

Cigarette availability and affordability among school-going adolescent smokers in Zambia: Results from the 2011 Global Youth Tobacco Survey

ABSTRACT Introduction: Cigarette smoking is a major cause of preventable disease and death globally. In several countries in sub-Saharan Africa, there is a dearth of knowledge on adolescent’s access to cigarette smoking despite cigarette access being a critical determinant of smoking initiation among adolescents. Objective: The objective of this study is to understand the availability and affordability of cigarettes among school-going adolescent smokers in Zambia. Methods: This study utilized the secondary data from the 2011 Global Youth Tobacco Survey done in Zambia. Logistic regression was used to obtain unadjusted ratios (uOR) and adjusted odds ratios (AORs) and 95% confidence interval (CI) to examine cigarette availability and affordability among adolescent smokers. Results: A total of 1857 adolescents were included in the analysis. Of these, 13.8% had tried smoking, 25.39% had not been refused sell of cigarettes due to age, 20.70% had obtained cigarettes through buying from a store, shop, or from katemba, 21.09% were not asked proof of age when buying cigarettes, and 25% were not refused the purchase of cigarettes due to age. In multivariate analysis, cigarette availability and affordability were associated with trying cigarette smoking (AOR: 7.74, CI: 1.24–50.88: AOR: 2.181, CI: 1.13–4.22). Conclusion: Cigarette availability and affordability were associated with an adolescent trying cigarette smoking. Adolescents in Zambia could buy cigarettes without being refused due to age or asked for proof of age. Cigarette availability and affordability among adolescents play a critical role in smoking initiation among them. There is a need to augment policy on protecting adolescents by demanding proof of age whenever the adolescents are buying cigarettes.

Responses to Real-World and Hypothetical Menthol Flavor Bans Among US Young Adults Who Smoke Menthol Cigarettes.

Menthol cigarette bans have been implemented in some US states and localities, and a federal ban is being proposed by the FDA. This study asks how young adults who use menthol cigarettes respond to changes in menthol cigarette availability. An online survey of young adults ages 18-34 who reported smoking menthol cigarettes on ≥7 of 30 days around Thanksgiving 2019 (n = 734), oversampling Massachusetts-the first state with a menthol ban. Participants reported their tobacco use behavior following real-world menthol cigarette bans or predicted their behavior under a hypothetical federal ban. Most respondents who exclusively smoked versus dual used with e-cigarettes continued smoking/using combustible tobacco following real-world bans (95.3% vs. 86.9%), accessing menthol cigarettes from other jurisdictions. Fewer who smoked exclusively responded by using e-cigarettes compared to those who dual used (3.9% vs. 43.7%). Quitting all tobacco use (ie, no smoking, vaping, or any tobacco use) was uncommon for both groups (3.6% vs. 9.0%). Under a hypothetical ban, majorities of those who exclusively smoke and who dual use predicted they would continue smoking (72.2% vs. 71.8%); fewer who smoke exclusively would use e-cigarettes compared to those who dual use (14.7% vs. 41.4%). Those who smoke exclusively were more likely to report quitting all tobacco compared to those who dual use (29.6% vs. 12.4%). Under real-world and hypothetical menthol cigarette bans, most respondents continued smoking. However, more young adults continued smoking following real-world bans, reflecting the limitations of local/state restrictions when menthol cigarettes are available in other jurisdictions. This survey asked young adults who use menthol cigarettes how they responded to real-world changes in the availability of menthol cigarettes; 89% reported continuing to smoke. Those who smoked exclusively were far less likely to respond by switching to e-cigarettes compared to people who dual used both products. Under a hypothetical federal menthol cigarette ban, 72% of young adults predicted that they would continue smoking. Quitting all tobacco was less common in the real-world scenario compared to the hypothetical ban. Access to menthol cigarettes in other jurisdictions and flavored cigars likely dampen the public health benefit of menthol cigarette bans.

Within-person associations between psychological and contextual factors and lapse incidence in smokers attempting to quit: A systematic review and meta-analysis of ecological momentary assessment studies.

When attempting to stop smoking, discrete smoking events ('lapses') are strongly associated with a return to regular smoking ('relapse'). No study has yet pooled the psychological and contextual antecedents of lapse incidence, captured in ecological momentary assessment (EMA) studies. This systematic review and meta-analysis aimed to synthesize within-person psychological and contextual predictor-lapse associations in smokers attempting to quit. We searched Ovid MEDLINE, Embase, PsycINFO and Web of Science. A narrative synthesis and multi-level, random-effects meta-analyses were conducted, focusing on studies of adult, non-clinical populations attempting to stop smoking, with no restrictions on setting. Outcomes were the association between a psychological (e.g. stress, cravings) or contextual (e.g. cigarette availability) antecedent and smoking lapse incidence; definitions of 'lapse' and 'relapse'; the theoretical underpinning of EMA study designs; and the proportion of studies with pre-registered study protocols/analysis plans and open data. We included 61 studies, with 19 studies contributing ≥ 1 effect size(s) to the meta-analyses. We found positive relationships between lapse incidence and 'environmental and social cues' [k = 12, odds ratio (OR) = 4.53, 95% confidence interval (CI) = 2.02, 10.16, P = 0.001] and 'cravings' (k = 10, OR = 1.71, 95% CI = 1.34, 2.18, P < 0.001). 'Negative feeling states' was not significantly associated with lapse incidence (k = 16, OR = 1.10, 95% CI = 0.98, 1.24, P = 0.12). In the narrative synthesis, negative relationships with lapse incidence were found for 'behavioural regulation', 'motivation not to smoke' and 'beliefs about capabilities'; positive relationships with lapse incidence were found for 'positive feeling states' and 'positive outcome expectancies'. Although lapse definitions were comparable, relapse definitions varied widely across studies. Few studies explicitly drew upon psychological theory to inform EMA study designs. One of the included studies drew upon Open Science principles. In smokers attempting to stop, environmental and social cues and cravings appear to be key within-person antecedents of smoking lapse incidence. Due to low study quality, the confidence in these estimates is reduced.

Momentary associations between affect and craving as a function of perceived smoking opportunity in young adults smoking 1–5 cigarettes per day: An ecological momentary assessment study

BackgroundVery light daily smoking (1–5 cigarettes/day) is associated with adverse consequences and is prevalent among young adults. Evidence suggests that perceived smoking opportunity modulates links between affect and craving in adults with heavier smoking patterns (e.g., > 10 cigarettes per day), but there is a lack of similar data in young adults with very light daily smoking patterns. This study addresses this gap by investigating the associations between affect and craving as a function of perceived smoking opportunity under naturalistic conditions. MethodsForty-one young adults aged 18–25 (M=21.03, SD=1.75) who reported smoking 1–5 cigarettes per day (M=3.2, SD=1.2) completed intermittent ratings of momentary affective valence and arousal, smoking craving, and perceived smoking opportunity on smartphones five times per day for seven days. ResultsMultilevel analyses suggested that when participants felt more pleasant or unpleasant, they were likely to report more intense craving. When smoking opportunity was perceived as high, affective arousal was positively associated with craving; this association was not observed when opportunity to smoke was perceived as low. ConclusionsThese findings indicate that higher momentary intensity of affective valence (both negative and positive) is linked to stronger momentary craving in young adults who report very light daily smoking. Anticipating an opportunity to satisfy craving by smoking may strengthen the association between reported affective arousal and craving in this population. These results highlight the potential benefits of coping with craving (e.g., by regulating affect) for those who engage in light tobacco use, especially in environments with high cigarette availability.

Cigarette availability and affordability among Chinese youth smokers: Findings from the 2019 China Youth Tobacco Survey.

Preventing youth from tobacco use is a priority for tobacco control in China, and the government has taken many measures such as introducing tobacco control in the health education curriculum, banning smoking in school, promoting smoke-free household, and advocacy campaigns. The objective of this study was to understand the availability and affordability of cigarettes for middle school (MS) and high school (HS) students in China. The data were extracted from the 2019 China National Youth Tobacco Survey, which was a school-based cross-sectional survey with a nationally representative sample of 288192 MS and HS students. The survey employed a randomized multistage stratified cluster sampling design with probability proportional to size sampling method and used an anonymous self-administrated questionnaire to collect data. The availability and affordability of cigarettes were analyzed, and all parameter estimates were weighted to account for the complex sampling design. In 2019, an estimated 80.5% of current smokers who were aged <18 years bought cigarettes in the past 30 days. Among them, 83.3% (83.0% of males and 85.2% of females; and 76.5% in MS and 87.6% in HS) had not been refused purchase of cigarettes because they were underage, with 84.1% in urban and 82.9% in rural areas, and 87.3% in central, 83.4% in eastern, and 80.5% in western regions of China. Among current smokers who bought cigarettes in the past 30 days, 77.3% had bought a pack of cigarettes (20 cigarettes) costing >10 RMB and at least 61.4% had more pocket money per week than the cost of a pack of cigarettes. Although 84.2% of current smokers bought cigarettes by the pack, 9.2% of current smokers reported that they bought cigarettes as sticks. Although the youth smoking rate dropped down from 2014 to 2019, the proportion of youth smokers that bought cigarettes was still high in China. Due to the high amount of pocket money, the current cigarette price was not an effective price barrier to prevent youth smoking. Selling cigarettes by the stick worsens the situation. Strengthening the enforcement of the 2021 Law on the Protection of Minors, increasing tobacco taxes and prices, and forbidding the selling of cigarette sticks, might assist the progress in youth tobacco control.

Factors Associated with the Dual Use of Electronic Cigarettes and Cigarettes among Thai Undergraduate Students Who Smoked Cigarettes.

This study proposed to identify factors associated with the dual use of electronic cigarettes (e-cigarettes) and cigarettes among undergraduate students who smoked cigarettes. This cross-sectional study employed a self-administered, anonymous online questionnaires to collect information from undergraduate smokers in northern Thailand. Of the 494 participants, 82.8% were dual users of e-cigarettes and cigarettes. The two main reasons for using e-cigarettes were an absence of cigarette smoke odor (76.8%) and availability of flavors (70.7%). Undergraduate smokers who initiated smoking at ≥18 years old were more likely to be dual users than those who initiated smoking at younger age (adjusted odds ratio [aOR]: 2.79, 95% confidence intervals [CI]: 1.32–5.89, p = 0.007). Undergraduate smokers who smoked ≥11 cigarettes daily were more likely to be dual users than those who smoked less (aOR: 2.64, 95% CI: 1.52–4.61, p = 0.001). Conversely, undergraduate smokers who had attempted to quit during the past year were less likely to be dual users (aOR: 0.26, 95% CI: 0.12–0.56, p = 0.001). In conclusion, dual use of e-cigarettes and cigarettes among undergraduate smokers was associated with older age at cigarette smoking initiation, a higher number of cigarettes smoked daily, and having no past year’s cigarette quit attempts.

Factors associated with electronic cigarettes use among adolescents in Jakarta, Indonesia

PurposeThis study aimed to examine factors associated with electronic cigarette use among adolescents aged 15–19 in Jakarta, Indonesia.Design/methodology/approachThe study was a school-based survey involving 1,318 students from 14 high schools in Jakarta. A multistage cluster sampling methodology was used. The authors used the chi-square test and multiple logistic regression to examine the association between electronic cigarette use and sociodemographic, social influences, health risk perceptions, availability, affordability and conventional cigarette smoking status.FindingsOverall, 6.3% of females and 29% of males reported ever having used electronic cigarettes. Electronic cigarette use was independently associated with sex, school locations, conventional cigarette smoking status, peer use, availability and perceptions that electronic cigarettes aid conventional cigarette smoking cessation. Compared with non-smokers, lifetime (AOR: 8.740, 95% CI: 5.126–14.901) and current conventional cigarette smokers (AOR: 18.380, 95% CI: 10.577–31.938) were more likely to use electronic cigarettes.Social implicationsThe use of electronic cigarettes among adolescents was considerably high in this study. Therefore, the tobacco control policy should be extended to regulate the marketing and use of all types of tobacco products and not just conventional cigarettes.Originality/valueThe study explored beyond individual lifestyle factors that contributed to electronic cigarette use in Indonesia such as affordability, school locations and availability of electronic cigarettes. These issues have not been specifically discussed in previous studies.

Predicting the first smoking lapse during a quit attempt: A machine learning approach

BackgroundJust-in-time adaptive interventions (JITAI) aim to prevent smoking lapse using tailored support delivered via mobile technology in the moments when it is most needed. Effective smoking cessation JITAI rely on the development of accurate decision rules that determine when someone is most likely to lapse. The primary goal of the present study was to identify the strongest predictors of first lapse among smokers undergoing a quit attempt. MethodsSmokers attending a clinic-based smoking cessation program (n = 74) were asked to complete ecological momentary assessments five times daily on study-provided smartphones for 4 weeks post-quit. A three-stage modeling process utilized Cox proportional hazards regression to examine time to lapse a function of 31 predictors. First, univariate models evaluated the relationship between each predictor and time to lapse. Second, the elastic net machine learning algorithm was used to select the best predictors. Third, backwards elimination further reduced the set of predictors to optimize parsimony. ResultsUnivariate models identified seven predictors significantly related to time to lapse. The elastic net algorithm retained five: perceived odds of smoking today, confidence in ability to avoid smoking, motivation to avoid smoking, urge to smoke, and cigarette availability. The reduced model demonstrated inadequate approximation to the non-penalized baseline model. ConclusionsAccurate estimation of moments of high risk for smoking lapse remains an important goal in the development of JITAI. These results demonstrate the utility of exploratory data-driven approaches to variable selection. The results of this study can inform future JITAI by highlighting targets for intervention.

Pattern and quitting of tobacco smoking among Egyptian university students.

University students are at high risk of practicing the smoking habit being exposed to smoking peers and easier cigarette availability. This study aims to explore prevalence, attitude and pattern of tobacco smoking and quitting among Beni-Suef University students. A cross-sectional study was conducted from March to May 2019. A total of 4,599 students were selected by using randomized multi-stage sampling using self-administered questionnaire for data collection. The mean age of students found to be smokers was 20.8 ± 1.42 years. Males: Females' ratio was 2:1 (66 vs.34%). Prevalence of smoking was 17.4%. Students of non-medical and non-health colleges showed a significant high smoking rate (18.8 and 18.3% respectively) than students in health faculties (15.2%); p=0.017. Participants believed that they might smoke because of: peers' pressure (73.3%), stress (71.4%), imitating popular figures (61.7%) and availability of money (60.4%). Regarding smoking provinces; 86.1% did smoke in coffee-shops, 73.1% in university yards and only 16.87% used to smoke at home Regarding the attitudes of smokers and nonsmokers towards smoking; the acceptance of indoor smoking was significantly higher (85.6%) among smokers than non-smokers (6.42%); p=0.0001. Of note; 51.2% of smokers versus 86.3% of non-smokers agreed to ban smoking in public places (P=0.001). Majority of smokers (72.1%) had the desire to stop smoking while (57.8%) tried to stop smoking but failed. Smoking is becoming a habit among university students and initiative of a smoke free environment should be encouraged and subject and method.

SmokingOpp: Detecting the Smoking 'Opportunity' Context Using Mobile Sensors.

Context plays a key role in impulsive adverse behaviors such as fights, suicide attempts, binge-drinking, and smoking lapse. Several contexts dissuade such behaviors, but some may trigger adverse impulsive behaviors. We define these latter contexts as 'opportunity' contexts, as their passive detection from sensors can be used to deliver context-sensitive interventions. In this paper, we define the general concept of 'opportunity' contexts and apply it to the case of smoking cessation. We operationalize the smoking 'opportunity' context, using self-reported smoking allowance and cigarette availability. We show its clinical utility by establishing its association with smoking occurrences using Granger causality. Next, we mine several informative features from GPS traces, including the novel location context of smoking spots, to develop the SmokingOpp model for automatically detecting the smoking 'opportunity' context. Finally, we train and evaluate the SmokingOpp model using 15 million GPS points and 3,432 self-reports from 90 newly abstinent smokers in a smoking cessation study.

Perceptions of Use Patterns and Health Consequences Associated With Mentholated Cigarettes Among U.S. Adults.

Despite declines in overall cigarette smoking in the United States, menthol cigarette smoking prevalence has increased among young adults (18-25 years) and remains constant among older adults (26 years and older). Disparities in menthol cigarette use exist, with higher prevalence among younger adult smokers and among racial/ethnic minority populations. Menthol in cigarettes has been shown to play a role in increasing smoking initiation and making it more difficult to quit smoking. Little research focuses on perceptions of the addictive potential and health consequences of menthol cigarette use. This analysis uses data from a national panel of U.S. adults (n = 1,303) surveyed in 2016. Participants were asked to what extent they agreed with various statements regarding menthol use among demographic and tobacco use subgroups. These data reveal disparities in perceptions of the impact of menthol use, with Black, non-Hispanic, and Hispanic adults and adults with lower income and less education misperceiving the health effects and addiction potential of menthol in cigarettes. Determining how and to what extent population subgroups understand the effect of menthol cigarette use can inform public education strategies and, in turn, policy efforts to ban or restrict menthol cigarette availability.

Cigarette and E-Cigarette Retail Marketing on and Near California Tribal Lands.

Introduction. Retail settings are major channels for the tobacco industry to market commercial tobacco products. However, few studies have examined marketing strategies on Tribal lands. The resulting evidence is important, especially given that American Indian/Alaska Native (AI/AN) youth and adults have the highest smoking prevalence of any racial/ethnic group in the United States. In this study, we examined cigarette, e-cigarette, and vape/vaporizer availability, advertising, and price-reducing promotions in retail settings on and within a 1-mile radius of Tribal lands in California. Method. Trained AI/AN community health representatives (n = 8) conducted store observations (n = 96) using a checklist adapted from the Standardized Tobacco Assessment for Retail Settings observation tool. Chi-square analyses were performed to look for potential differences in availability, exterior advertising, and price promotions for cigarettes, e-cigarettes, and vapes between stores. Results. All stores sold cigarettes and over 95% sold menthol cigarettes. Nearly 25% of stores on Tribal lands were located inside a casino, and 40.4% of stores on Tribal lands offered a Tribal member discount. Stores within a 1-mile radius of Tribal lands sold significantly (p < .01) more e-cigarettes (69.8%), including flavored e-cigarettes (53.4%), compared to stores on Tribal lands (37.7% and 28.3%, respectively). Price promotions for cigarettes were significantly (p < .01) more common in stores located within a 1-mile radius of Tribal lands (46.5%) than stores on Tribal lands (22.6%). Discussion. To our knowledge, this study is the first to use store observations to examine cigarette and e-cigarette availability, advertising, and price promotions in retail settings on and near California Tribal lands. We recommend future studies build on our initial efforts to take an AI/AN Tribal community-engaged approach in assessing and documenting tobacco marketing practices on and near Tribal lands. Tribal governments can consider tobacco policies to help reduce smoking disparities and advance health equity for their communities.

Socioeconomic Status, Social Context, and Smoking Lapse During a Quit Attempt: An Ecological Momentary Assessment Study.

Low socioeconomic status (SES) is linked to failure to quit smoking. Health inequity models suggest that low SES smokers experience barriers to quitting in part due to greater exposure to pro-smoking social contexts. The current study examined longitudinal associations among socioeconomic status, pro-smoking social context factors (i.e., exposure to other smokers, places where smoking was allowed), cigarette availability, and smoking lapse during a quit attempt. Ecological momentary assessments (EMA) were gathered from a multiethnic sample of 365 smokers engaged in a quit attempt. A multilevel structural equation model estimated a latent variable for SES indicated by income, education, health insurance, and employment, associations among EMAs for pro-smoking social contexts and cigarette availability, and indirect effects of SES through, pro-smoking social contexts and cigarette availability to subsequent smoking lapse. Lower SES scores were associated with a higher likelihood of smoking lapse. Decomposition of the path from SES to smoking lapse into indirect effects showed significant paths through exposure to places where smoking is allowed and cigarette availability. Additionally, significant serial indirect paths from SES through both exposure to other smokers and places where smoking was allowed, in turn, through cigarette availability, and, ultimately, to smoking lapse were noted. Consistent with models positing that SES influences health behaviors via contextual factors, the current study demonstrated that low SES smokers attempting to quit experienced greater pro-smoking social contexts that affected subsequent risk for lapse.

Evaluating the influences of social support and smoking cues on daily smoking abstinence among socioeconomically disadvantaged adults

IntroductionPerceived social support and smoking cues, such as cigarette availability, are important factors that affect smoking cessation outcomes. However, very few studies examine the influences of social support and smoking cues on lapse during a quit attempt. MethodsSocioeconomically disadvantaged smokers participating in a smoking cessation program at a safety net hospital completed smartphone-based ecological momentary assessments (EMAs) for two consecutive weeks (1-week pre-quit through 1-week post-quit). A mixed-effects logistic regression model was used to evaluate whether perceived support to quit smoking, perceived pressure to quit smoking, and situational cues (i.e., being offered a cigarette) were related to the likelihood of reporting smoking cigarettes on any EMA within a day. ResultsPerceived social pressure and support to quit were not related to daily smoking status. Participants were more likely to smoke on days when they were offered a cigarette compared to days when no such event occurred (OR = 3.31 [95% CI = 1.21, 9.06]). This effect was also significant after adjusting for perceived social pressure to quit and support to quit (OR = 3.38 [95% CI = 1.23, 9.31]). ConclusionThe results suggest that being offered a cigarette negatively impacts smoking cessation. The results reinforce the need for including cigarette refusal skills in smoking cessation treatment to reduce the likelihood of smoking lapse among socioeconomically disadvantaged adults.

Tobacco use among Latinx adolescents: exploring the immigrant paradox

BackgroundResearch suggests that an immigrant paradox exists where those who were not born in the United States (1st generation) have significantly better health than those who were born in the U.S. (2nd generation or more). The aim of the current study was to examine the immigrant paradox with respect to tobacco-related perceptions and parenting influences in smoking initiation among Latinx adolescents.MethodsData came from the 7th and 10th grade Healthy Passages™ assessments of Latinx participants in three U.S. urban areas (N = 1536) who were first (18%), second (60%), and third (22%) generation. In addition to demographics, measures included perceived cigarette availability and peer smoking, intentions and willingness to smoke, and general monitoring by parents. Parents reported on generational status and their own tobacco use. The primary outcome was participant’s reported use of cigarettes.ResultsBy 10th grade, 31% of Latinx youth had tried a cigarette, compared to 8% in 7th grade. After controlling for age, gender, and socioeconomic status, regression analyses indicated that there were no significant differences related to generational status in cigarette smoking initiation in either 7th or 10th grade. Youth tobacco-related perceptions, general parental monitoring, and parental tobacco use predicted Latinx adolescent cigarette use initiation by 10th grade.ConclusionsLatinx adolescents might not have deferential smoking rates based on generation status, suggesting that the immigrant paradox concept may not hold for smoking initiation among Latinx adolescents. Rather, factors influencing cigarette initiation generally in adolescents as a group appear to apply to Latinxs as well.

An ecological momentary intervention for smoking cessation: The associations of just-in-time, tailored messages with lapse risk factors

BackgroundSmartphone apps can provide real-time, tailored interventions for smoking cessation. The current study examines the effectiveness of a smartphone-based smoking cessation application that assessed risk for imminent smoking lapse multiple times per day and provided messages tailored to current smoking lapse risk and specific lapse triggers. MethodsParticipants (N=59) recruited from a safety-net hospital smoking cessation clinic completed phone-based ecological momentary assessments (EMAs) 5 times/day for 3 consecutive weeks (1week pre-quit, 2weeks post-quit). Risk for smoking lapse was estimated in real-time using a novel weighted lapse risk estimator. With each EMA, participants received messages tailored to current level of risk for imminent smoking lapse and self-reported presence of smoking urge, stress, cigarette availability, and motivation to quit. Generalized linear mixed model analyses determined whether messages tailored to specific lapse risk factors were associated with greater reductions in these triggers than messages not tailored to specific triggers. ResultsOverall, messages tailored to smoking urge, cigarette availability, or stress corresponded with greater reductions in those triggers than messages that were not tailored to specific triggers (p's=0.02 to <0.001). Although messages tailored to stress were associated with greater reductions in stress than messages not tailored to stress, the association was non-significant (p=0.892) when only moments of high stress were included in the analysis. ConclusionsMobile technology can be used to conduct real-time smoking lapse risk assessment and provide tailored treatment content. Findings provide initial evidence that tailored content may impact users' urge to smoke, stress, and cigarette availability.

Effect of Personal Factors, Family Support, Pocket Money, and Peer Group, on Smoking Behavior in Adolescents in Surakarta, Central Java

Background : According to WHO and Global Youth Tobacco Survey, Indonesia is the third largest country with current smokers in the world, including young smokers. It is widely known that smoking is hazardous to health and detrimental to economy. Surakarta is one of the major cities in Central Java where the prevalence of current smokers has been increasing among adolescents. This study aimed to determine the effect of personal factors, family support, pocket money, and peer group, on smoking behavior in adolescents in Surakarta, Central Java. Subje cts and Method : This was an analytic observational study using cross-sectional design. This study was carried out in 5 sub-districts in Surakarta, Central java, from February to March 2017. A sample of 50 adolescent smokers and 150 adolescent non-smokers was selected for this study by fixed disease sam­pling. The dependent variable was current smoking status. The independent variables were cigarette availability, peer-group, family support, pocket money, cigarette advertisement, attitude toward smoking, subjective norm, perceived preventive behavioral control, and intention. The data were collected by a set of questionnaire. The data were analyzed by path analysis. Results : Smoking behavior was affected by strong intention (b= 3.7; 95% CI=2.5 to 4.9; p<0.001), and weak perceived behavioral control (b=3.1; 95% CI= 1.7 to 4.5; p<0.001). Intention to smoke was affected by weak perceived preventive behavioral control (b= 2.1; 95% CI= 1.1 to 3.2; p<0.001), weak preventive subjective norm (b= 1.8; 95% CI= 0.7 to 2.9; p= 0.001), negative attitude (b= 1.9; 95% CI= 0.8 to 2.9; p<0.001), and exposure to cigarette advertisement (b= 1.6; 95% CI= 0.5 to 2.6; p= 0.004). Weak perceived preventive behavioral control was affected by pocket money ≥ Rp 10.000 (b= 1.3; 95% CI= 0.5 to 2.0; p= 0.001). Weak preventive subjective norm was affected by weak family support (b= 2.1; 95% CI= 1.3 to 2.8; p<0.001) and smoker peer-group (b= 1.4; 95% CI= 0.6 to 2.1; p<0.001). Cigarette advertisement was affected by cigarette availability (b= 0.7; 95% CI= 0.1 to 1.3; p= 0.028). Conclusion : Smoking behavior was directly affected by strong intention and weak perceived behavioral control. Smoking behavior was indirectly affected by weak preventive subjective norm, negative attitude, exposure to cigarette advertisement, pocket money ≥ Rp.10.000, weak family support, smoker peer-group, and cigarette availability. Keyword : path analysis, smoking behavior, intention, adolescents. Correspondence: Ardiansyah Pandayu. Master Program in Public Health, Sebelas Maret University, Surakarta. Email: ardiansyahpandayu07@gmail.com. Mobile: +6287864018631. Journal of Health Promotion and Behavior (2017), 2 (2): 98-111 https://doi.org/10.26911/thejhpb.2017.02.02.01

Nicotine levels, withdrawal symptoms, and smoking reduction success in real world use: A comparison of cigarette smokers and dual users of both cigarettes and E-cigarettes

IntroductionTo evaluate how experienced dual users used cigarettes and e-cigarettes in real-world use and under different levels of cigarette availability. MethodsDual users (cigarettes+e-cigarettes; n=74) and a smoke-only group (just cigarettes; n=74) engaged in a 26-day study with two ad lib use intervals, a week of 75% cigarette reduction and three days of 100% cigarette reduction. After a week of ad lib use of products, all participants were asked to reduce smoking by 75% (dual users were free to use their e-cigarettes as they wished), followed by another week of ad lib use. All participants were then asked to reduce smoking by 100% (cessation) for three days. Primary outcomes were biological samples (carbon monoxide, urinary nicotine and cotinine). Participants also provided real-time reports of product use, craving, and withdrawal symptoms using a smartphone app. ResultsDual users did not smoke fewer cigarettes than smoke-only participants during ad lib periods, but quadrupled their use of e-cigarettes during smoking reduction periods. Dual users were significantly more likely to maintain 100% reduction (97.1% vs. 81.2%). Amongst women, dual use was associated with higher nicotine levels and withdrawal suppression. DiscussionAmong a group of experienced dual users, e-cigarettes helped maintain smoking reduction and reduced some withdrawal symptoms, although both withdrawal symptoms and nicotine levels varied as a function of gender.

"It's Easy to Get Fags": A Qualitative Study of Disadvantaged Young People's Perspectives on Cigarette Availability and Access.

Reducing young people's access to cigarettes is a key element of smoking prevention policies. This article explores how young people source cigarettes following the increase in the UK minimum age of sale from 16 to 18 years. Semi-structured individual, paired and triadic interviews with 60 disadvantaged young people aged between 12 and 17. Participants were recruited from clubs and voluntary organizations offering advice and support to disadvantaged young people. Most participants said they sourced cigarettes from shops, but understandings of "buying cigarettes from shops" included using intermediaries for proxy purchases. Access from social sources was contingent on reciprocation, and blackmarket sources were avoided. The distinction between potential and actual sources reflected participants concerns about their presentation of self. Those who bought cigarettes directly from shops accrued status and power in negotiating social hierarchies. Participants therefore highlighted their smoking related competencies, that is, ability to secure regular retail access to tobacco, while downplaying the significant difficulties they experienced. The presentational dimension of youth cigarette access highlights a need for caution in associating self-reported changes in young people's cigarette sources straightforwardly with access policies. The conflation of direct retail purchases with proxy purchases, and the interrelationship between commercial and social cigarette sources also raises issues for interpreting data on "usual" cigarette sources from national surveys. Findings suggest that some young people may still be both reliant on making retail cigarette purchases following the increase in the age of sale in the United Kingdom, and experiencing significant difficulties making these. This study highlights the self-presentational dimension of youth cigarette access in a particular community context, and the important distinction between the apparent range of sources available and their social acceptability in young people's social networks. Young smokers tended to conflate direct retail purchases with proxy purchases, raising issues for interpreting survey data on "usual" cigarette source. The presentational dimension of youth cigarette access also highlights a need for caution in associating self-reported changes in young people's cigarette sources with access policies. Despite participants' stated easy access, few were able to buy cigarettes directly, underscoring the effectiveness of youth access policies.

Gender and stimulus control of smoking behavior.

Gender differences in smoking behavior have been proposed to account for poorer outcomes among women attempting to quit. Specifically, it has been suggested that women's smoking behavior is less motivated by nicotine-seeking and more driven by environmental cues. To date, however, few real-world studies have examined the hypothesis that women's smoking is under greater stimulus control. One hundred and ninety four daily smokers (men = 107; women = 87) completed 3 weeks of ecological momentary assessment (EMA) monitoring that provided data on real-world smoking behavior by reporting on situational contexts shown by previous research to influence smoking behavior (including social setting, cigarette availability, alcohol consumption, and mood). Analyses of particular cues found few gender differences; however, men's smoking increased to a greater extent compared with women's when they were with others who were smoking. Idiographic analyses that allow individual subjects to have different directions of linkage to situational cues also were conducted to assess how predictable subjects' smoking was from a range of contextual characteristics. Compared with women, men's smoking was significantly more closely tied to food/alcohol consumption and tended to be more closely tied to social context. No other gender differences were found. EMA analyses suggest that men and women are similarly influenced by cues, including mood. Where there were gender differences, it was men rather than women whose smoking behavior was more influenced by cues. The data contradict the hypothesis that women's smoking is more influenced by cues.