Combat Tobacco Use Research Articles

Developing Skilled Professionals to Combat Tobacco Use: Evaluating the Impact of "Aacharya -a Tobacco Treatment Training Program.

Developing Skilled Professionals to Combat Tobacco Use: Evaluating the Impact of "Aacharya -a Tobacco Treatment Training Program.

Understanding Tobacco Control: Global and National Strategies

Tobacco use is a significant global health crisis, impacting over 1.1 billion individuals and leading to approximately 8 million deaths annually. This narrative review evaluates the tobacco control policies worldwide, focusing on India, where both smoked and smokeless tobacco prevalence remains high. Historical interventions highlight ongoing efforts to combat tobacco use; however, challenges in public awareness and access to cessation resources persist. There is an urgent need for effective policies and comprehensive public health strategies to reduce tobacco consumption, underscoring the critical role of health professionals in promoting cessation efforts.

Tobacco control in Türkiye: A brief review of achievements, challenges, and prospects.

The global burden of tobacco is a significant public health concern, causing millions of deaths, illnesses, and economic losses annually. In Türkiye, tobacco use is deeply ingrained in society, with historical roots dating back to Ottoman times. The nation faces challenges such as high smoking rates, gender disparities, and the popularity of non-cigarette tobacco products. Despite these issues, Türkiye has adhered to the WHO Framework Convention on Tobacco Control (FCTC) and implemented MPOWER strategies to combat tobacco use effectively. This review aims to synthesize Türkiye's comprehensive tobacco control measures, including legislation, smoking cessation initiatives, public awareness campaigns, and taxation policies. The study examines the country's strategic actions against the backdrop of its historical context and current challenges. The review leverages data from various sources, including the Global Burden of Disease, national health surveys, and reports on tobacco control efforts and achievements. Stakeholder activities, such as those by the Turkish Ministry of Health and non-governmental organizations, are also explored. Türkiye has made substantial progress in tobacco control, evidenced by reduced tobacco consumption and addressing key challenges like gender disparities and youth smoking. However, the country continues to face obstacles such as tobacco smuggling, the rise of narghile (hookah) smoking, and ongoing high daily smoking rates. The review highlights the tobacco industry's influence in Türkiye despite strong adherence to FCTC. Türkiye's efforts in tobacco control represent a significant endeavor to mitigate the public health crisis posed by tobacco use. Through adherence to WHO FCTC guidelines and MPOWER strategies, notable progress has been achieved. Yet, challenges persist, requiring continuous, comprehensive strategies and robust enforcement. Future efforts must focus on strengthening tobacco control measures, ensuring accessibility to smoking cessation services, and countering the tobacco industry's influence, to further reduce tobacco use and its health and economic burdens.

Interventions for Preventing Tobacco Uptake among Adolescents within School Setting in South-East Asia region: A Systematic Review

Abstract Background Tobacco users disproportionately reside in lower-and-middle income countries, with many people beginning consumption of tobacco in adolescence. Countries employ interventions in schools as a means of providing health education thereby creating mass awareness among them. However, research has mostly restricted to developed nations. Objective To examine the impact of interventions implemented in preventing tobacco uptake among adolescents in school setting in South-East Asia region. Method The protocol was registered prospectively on PROSPERO (CRD42022337341). Systematic search was conducted on 6 databases: PubMed, Embase, Scopus, CINAHL, ProQuest and Web of Science. Randomized Control Trials (RCT) and Cluster RCT conducted in school set-up in South-East Asia among adolescents below 18 years’ age were included. Articles between timeline 2002–2022 were considered. Results From a total of 963 articles, total of 13 studies were included. Four were RCT, while nine were Cluster RCT. Most of the studies were targeted at change in prevalence, followed change in knowledge and attitude towards tobacco and impact on susceptibility to use tobacco. Nine studies had interventions based on Health Promoting School Framework, three were Peer-led Interventions and one was Counsellor-centred Intervention. Risk of Bias assessment revealed eight studies had low risk of bias, two had some concerns while three were high risk studies. Conclusion Interventions that focus on building a holistic environment and go beyond the usual classroom environment have primarily been implemented and found to be effective in this region. There is a need for strong, high-quality RCT studies with standardised evaluation techniques to combat tobacco use among adolescents.

Enabling tobacco treatment for gastroenterology patients via a novel low-burden point-of-care model

Background & aimSmoking is a major risk factor for multiple gastrointestinal cancers, and adversely affects peptic ulcer disease, gastroesophageal reflux, pancreatitis and Crohn’s disease. Despite key recommendations for diagnosing and treating tobacco use disorder in healthcare settings, the degree to which this is implemented in Gastroenterology (GI) clinics is unknown. We aimed to assess our providers’ practices, identify barriers for implementing evidence-based smoking cessation treatments, and address these barriers by implementing a novel low-burden point of care Electronic health record-enabled evidence-based tobacco treatment (ELEVATE), in GI clinics.MethodsAn online survey was distributed to clinic gastroenterologists. ELEVATE module training was implemented in 1/2021. Data were evaluated during pre (7/2020-12/2020) and post (1/2021-12/2021) implementation periods to evaluate the reach and effectiveness of ELEVATE. Generalized estimating equations (GEE) were used to generate rate ratios (RR) to evaluate the intervention.Results91% (20/22) of GI physicians responded to our survey, and only 20% often assisted patients who smoke with counseling. Lack of a systematic program to offer help to patients was reported by 80% of providers as an extremely/very important barrier limiting their smoking cessation practices. The proportion of current patients who smoke receiving cessation treatment increased from pre-ELEVATE to post-ELEVATE (14.36–27.47%, RR = 1.90, 95% CI 1.60–2.26, p < .001). Post-ELEVATE, 14.4% (38/264) of patients with treatment quit smoking, compared to 7.9% (55/697) of patients without treatment (RR = 1.89, 95% CI 1.26–2.82, p = .0021).ConclusionSmoking practices are frequently assessed in GI clinics but barriers limiting cessation treatment exist. The use of a low burden point of care EHR enabled smoking cessation treatment module has led to a significant improvement in the treatment of smoking and subsequent cessation in our clinics. This study sheds light on an often under-recognized source of morbidity in GI patients and identifies an efficient, effective, and scalable strategy to combat tobacco use and improve clinical outcomes in our patients.

Deciphering the link between healthcare expenditure, corruption, and COVID-19 mortality

This paper analyzes the determinants of COVID-19 mortality across over 140 countries in 2020, with a focus on healthcare expenditure and corruption. It finds a positive association between COVID-19 deaths and aging populations, obesity rates, and healthcare expenditure while noting a negative association with rural residency and corruption perception. The study further reveals that mortality is positively associated with aging populations in high-income countries and positively associated with obesity in upper-middle to high-income countries. Mortality is positively associated with healthcare expenditure, which likely reflects a country’s preparedness and ability to better track, document, and report COVID-19 deaths. On the other hand, mortality is negatively associated with corruption perception in upper-middle-income countries. Further analyses based on 2021 data reveal COVID-19 deaths are positively associated with the proportion of the population aged 65 and older in low to lower-middle-income countries, with obesity in high-income countries, and with tobacco use across most countries. Interestingly, there is no evidence linking COVID-19 deaths to healthcare expenditure and corruption perception, suggesting a post-2020 convergence in preparedness likely due to proactive pandemic responses, which might have also mitigated corruption’s impact. Policy recommendations are proposed to aid the elderly, address obesity, and combat tobacco use.

Üniversite Öğrencilerinde Tütün Kullanım Prevalansı ve İlişkili Risk Faktörleri: Trabzon, Türkiye

Background: MPOWER strategies are employed to combat tobacco use in Turkey. However, no decrease in the prevalence of use among university students has been achieved. In research conducted among university students, only smoking was generally questioned. The purpose of the present research is to evaluate the prevalence of tobacco product use and associated risk factors among university students in Trabzon, northeast of Turkey, following the restrictions imposed due to the COVID-19 pandemic. Methods: This cross-sectional study was conducted with 6445 students between December 2021 and June 2022. Data analysis was performed with chi-square test and logistic regression test backward method. Results: The prevalence of tobacco use is 26.9% in university students in Trabzon. The most frequently consumed tobacco product was cigarettes (25.0%), followed by hand-rolled cigarettes (6.5%), waterpipes (5.0%), and e-cigarettes (1.0%). Students’ tobacco use was statistically significantly associated with male gender, attending a vocational school, maternal tobacco use, paternal tobacco use, and romantic partner/close friend tobacco use. Conclusion: The prevalence found is higher than in many previous studies. Priority should be given to women as well as men in intervention programs to fight against tobacco. Programs should begin in vocational school and include students' close friends, romantic partners, or parents

Combating Tobacco Use - An Ayurvedic Approach to Prevent First, Second and Third Hand Smokers

Combating Tobacco Use - An Ayurvedic Approach to Prevent First, Second and Third Hand Smokers

Аnalysis of the consumption of tobacco products in the world and methods of its reduction applied in the EU and in Ukraine within european integration

In today's world, the health status of a society has become a real criterion for the level of socio-economic development. Many studies show that premature mortality from non-communicable diseases is usually accompanied by low or no economic growth and leads to macroeconomic problems. Combating tobacco use is one of the goals of sustainable development. The subject of this article is the consumption of tobacco products in the world and ways to reduce it. The purpose is to identify who is a consumer of tobacco products in different countries of the world, what gender, age, and income is a modern consumer, as well as to study the measures to reduce tobacco dependence that take place in the European Union, the experience of their adoption by Ukraine, and to identify the impact of these measures on smoking rates. Objectives: to investigate who the consumers of tobacco products are in different countries and what proportion of the population they represent, to identify whether there is a real relationship between income and consumption of tobacco products, to study how the portrait of a typical consumer changes with the introduction of innovative smokeless tobacco products, to determine whether legislative and fiscal methods affect the level of consumption of tobacco products. Methods: the historical method and comparative analysis were used to study the rollout of smoking cessation programmes and legislative changes related to this; statistical analysis was used to refute the hypothesis of a link between smoking and income in the country; the logical method was used to determine the factors that determine the level of consumption of tobacco products in different countries; correlation analysis was used to identify the relationship between the growth of excise tax and the reduction of smoking in Ukraine. The following results were obtained: the hypothesis of a greater propensity to smoke in low- and middle-income countries was not confirmed; the level and manner of tobacco consumption in different countries is influenced by culture; a greater number of smokers live in low- and middle-income countries, as the majority of the world's population lives there; within a particular country, a higher proportion of smokers is observed in the poor compared to the rich (although there are exceptions); the reason for this may be the lifestyle and cultural environment of the poor; higher smoking rates among the poor are a problem because they redistribute their limited budget to addictive goods; changes in legislation have introduced the concept of smokeless tobacco products, which has allowed for various restrictions to be applied to them; it has been proven that there is an inverse relationship between the amount of excise tax and smoking rates in Ukraine, so fiscal measures are working. Conclusions: Governments and socially responsible tobacco corporations now face a new challenge: to eliminate the positive image of smokeless tobacco products in the eyes of children and young people, and to address the fact that these products are the first ones they start smoking with.

Awareness and utilization of smoking cessation clinics in Saudi Arabia, findings from the 2019 Global Adult Tobacco Survey

BackgroundTobacco use remains a leading cause of premature death. To combat tobacco use, the Ministry of Health (MOH) improved access to smoking cessation clinics (SCCs) by developing fixed SCCs and mobile SCCs, which move based on demand across locations. The goal of this study was to investigate awareness and utilization of SCCs among tobacco users in Saudi Arabia and the factors that influence their awareness and utilization.MethodThis cross-sectional study used the 2019 Global Adult Tobacco Survey. Three outcome variables were employed, including tobacco users’ awareness of fixed SCCs, mobile SCCs, and utilization of fixed SCCs. Several independent variables were examined, including sociodemographic characteristics and tobacco use. Multivariable logistic regression analyses were performed.ResultsOne thousand six hundred sixty-seven tobacco users were included in this study. There were 60%, 26%, and 9% of tobacco users who were aware of fixed SCCs, aware of mobile SCCs, and visited fixed SCCs, respectively. The likelihood of being aware of SCCs increased among users residing in urban areas (fixed SCCs: OR = 1.88; 95% CI = 1.31–2.68; mobile SCCs: OR = 2.09; CI = 1.37–3.17) while it decreased among those reported self-employed (fixed SCCs: OR = 0.31; CI = 0.17–0.56; mobile SCCs: OR = 0.42; CI = 0.20–0.89). The likelihood of visiting fixed SCCs increased among educated tobacco users aged 25–34 (OR = 5.61; CI = 1.73–18.21) and 35–44 (OR = 4.22; CI = 1.07–16.64) while the odds of visiting SCCs decreased among those who were working in the private sector (OR = 0.26; CI = 0.09–0.73).ConclusionThe decision to quit smoking must be supported by an effective healthcare system that provides accessible and affordable smoking cessation services. Knowing the factors that influence the awareness and utilization of SCCs would help policymakers dedicate efforts targeting those who desire to quit smoking yet face limitations in using SCCs.

Tobacco control is integral to global COVID-19 response: an opportunity to accelerate toward SDGs

Abstract Issue Tobacco use intersects with the COVID-19 pandemic not only in terms of health consequences, but also on public health systems, economies, and the environment. Description of the problem The global tobacco supply contributes significantly to environmental pollution of the natural ecosystems. The damage is compounded by tobacco consumption and its resultant waste, which leaves a significant carbon footprint on the environment, undermining the planet’s ecological stability and intensifying climate change. Furthermore, tobacco use exacerbates inequalities and adds burdens to COVID-19-related mortality, which are major challenges to recovery from the COVID-19 pandemic. Results he pandemic has provided a chance to combat tobacco use and accelerate efforts to alleviate these challenges and accelerate progress toward Sustainable Development Goals (SDGs). The MPOWER measures from the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) can play an integral part to boost sustainable and equitable COVID-19 recovery — Monitor tobacco use (article 20); Protection from tobacco smoke (article 8); Offer help for tobacco cessation (article 14); Warn about the dangers of tobacco (article 11); Enforcing bans on tobacco advertising, promotion, and sponsorship (TAPS) (article13); and Raise tobacco taxes (article 6). Lessons To accelerate recovery, it is critical to call for actions for governments and policy-makers to strengthen synergies and policy actions to emphasise tobacco control across equity, public health, climate actions, and counteract against the tobacco industry during and beyond COVID-19 as global authorities pledge to achieve the SDGs. Key messages • Global authorities must create better synergies on policies with a prime focus on reinforcing tobacco control to recover from the pandemic. • The WHO FCTC MPOWER measures can play an integral part in COVID-19 recovery to fight tobacco use and accelerate progress toward SDGs.

Efficacy of Sin Tax and Recommendations for Implementation of Tobacco Tax Regimen in Pakistan

Behavioural economics is a comparatively recent topic that challenges the mainstream economics’ basic assumptions. It emphasizes that humans aren't always rational, aren't always self-interested, and don't always have time-consistent preferences. A sin tax is a type of sumptuary tax that is imposed on some typically socially prohibited items and services, like liquor, cigarettes, SSBs, and gambling. Sumptuary taxes, which are a type of sumptuary regulation, are presumably meant to reduce transactions involving something that society finds undesirable. Tobacco usage continues to be one of Pakistan's most pressing development concerns. Tobacco products usage is the foremost reason of death from non-communicable diseases (NCDs), such as cancer, lingering breathing illnesses, and cardio vascular diseases (CVDs). Tobacco taxation, which is widely recognized as a fundamental component of tobacco regulating policy, is utilized in Pakistan to combat tobacco use with the dual goals of public health promotion and income collection. Behind the scenes, the tobacco industry's success is based on a lack of understanding of real economics. Despite the fact that tobacco usage is linked to a number of negative health outcomes, higher health costs, and overworked health systems, the tax incomes it creates often encourage policy inertia in low-income countries like Pakistan. It is important that while taxing the sin of tobacco consumption the basic goal should be discouraging the behaviour and not income generation.

Tobacco control measures in COVID-19 recovery: an opportune time to restore equity and planetary health.

Tobacco intersects with the COVID-19 pandemic not only in terms of health consequences, but also environmental change and planetary health. Tobacco use exacerbates inequalities, causes catastrophic environmental degradation and climate change and adds burdens to COVID-19-related mortality, which are major challenges to recovery from the COVID-19 pandemic. However, the pandemic has provided a chance to combat tobacco use and accelerate efforts to alleviate these challenges in response. The MPOWER measures introduced by the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) can play a crucial role in COVID-19 recovery to fight tobacco use and contribute to sustainable and equitable development. To accelerate recovery, it is critical to call for actions for governments and policy-makers to strengthen synergies and coordinate policy actions emphasising tobacco control and cessation across equity, public health, and climate actions as global authorities pledge to achieve the Sustainable Development Goals (SDGs) and net zero emissions targets as part of the Climate Change Conference 2021 (COP26).

Tobacco messages encountered in real-time among low socio-economic position groups: a descriptive study

BackgroundTobacco advertising disproportionately targets low socio-economic position (SEP) groups, causing higher rates of tobacco use in this population. Anti-tobacco public health education campaigns persuade against use. This study measured real-time exposure of pro- and anti-tobacco messages from low SEP groups in two American cities.MethodsIndividuals in low SEP groups (N = 95), aged 18–34 years old, who were smokers and non-smokers, from the Boston and Houston areas, took part in a mobile health study. They submitted images of tobacco-related messages they encountered via a mobile application for a 7-week period. Two coders analyzed the images for message characteristics. Intercoder reliability was established using Krippendorff’s alpha and data were analyzed descriptively.ResultsOf the submitted images (N = 131), 83 were pro-tobacco and 53 were anti-tobacco. Of the pro-tobacco messages, the majority were cigarette ads (80.7%) seen outside (36.1%) or inside (30.1%) a convenience store or gas station and used conventional themes (e.g., price promotion; 53.2%). Of the anti-tobacco messages, 56.6% were sponsored by public health campaigns or were signage prohibiting smoking in a public area (39.6%). Most focused on the health harms of smoking (28.3%).ConclusionLow SEP groups in this study encountered more pro-tobacco than anti-tobacco messages at places that were point-of-sale using price promotions to appeal to this group. Anti-tobacco messages at point-of-sale and/or advertising regulations may help combat tobacco use.

Making Strides Together against Tobacco Use.

In the Western Pacific Region, more than 3 million people die each year as a result of tobacco use - a problem for health and a threat to social and economic development. Countries around the world made a commitment by adopting the WHO Framework Convention on Tobacco Control of which implementation was then further facilitated by WHO's MPOWER package. Recognizing the importance of data as a powerful tool for tobacco control, this special supplement presents papers showcasing efforts by a number of Western Pacific countries and areas and data around these efforts to combat tobacco use and further advance progress in the battle against it. Despite the substantial progress that countries and areas have made in tobacco control, there is still much to be done in order to sustain the momentum to fight against this preventable killer and the industry which promotes it in our continued fight against the world's deadliest epidemic.

Cigarette and E-Cigarette Use and Smoking Cessation Practices among Physicians in Poland.

Physicians play a key role in combating tobacco use. This study aims to evaluate the knowledge, attitude, and behaviors toward smoking cessation and vaping cessation interventions among physicians in Poland; to identify factors shaping physicians’ behaviors toward smoking and vaping cessation interventions; and to assess differences in the tobacco cessation interventions recommended for cigarette smokers and users of electronic cigarettes (e-cigarettes). A questionnaire-based survey was conducted in 2018 among physicians attending mandatory public health training courses delivered at the School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland. The questionnaire included 25 questions related to tobacco product use and smoking cessation interventions. Data were obtained from 423 physicians (64.3% female; mean age 32.0 ± 5.8 years) with response rate of 84.6%. Current cigarette smoking was declared by 7.8% of participants; 1.9% of participants were e-cigarette users and 1.9% used heated tobacco. Smoking cessation interventions were offered more often to patients who smoked cigarettes than those who used e-cigarettes (p < 0.001). Physicians’ behaviors toward smoking cessation and vaping cessation interventions were associated with (p < 0.05) physicians’ smoking status and self-declared knowledge about smoking cessation methods. Among physicians in Poland, discussion of smoking cessation was not common behavior and limited mainly to identification of smoking status.

Rationale and design of a study to test the effectiveness of a combined community health worker and text messaging-based intervention for smoking cessation in India (Project MUKTI).

Nearly 275 million individuals in India consume tobacco every day, with more than 1 million dying annually as a result. Few people in India have access to smoking cessation services, an essential component of combating tobacco use globally. We hypothesize that a strategy of systematic community health worker (CHW) based counseling that covers eligible people who smoke in a geographical area, combined with text messaging support, will result in improved quit rates. The study is a cluster randomized controlled trial that will be conducted at 2 sites in India. Sixteen clusters will be randomized into either an intervention or control arm. A total of 560 smokers between the age of 18 and 70 will be recruited from their home through CHWs. Smokers at all stages of change will be offered the intervention, which is based on the transtheoretical model of change. Pre-contemplative participants will be offered health education and motivational interviewing through CHWs. They will also be offered a low frequency form of text messaging, focused on health education and the benefits of quitting. Participants who are actively contemplating quitting smoking will be offered a more intensive intervention, with more frequent visits by CHWs and more intensive text messaging support. Contemplative participants will be encouraged to set a quit date, and all participants will be assessed periodically for stage of change to provide the appropriate intervention. Participants who set a quit date will be encouraged to use NRT to help with quitting. Control group participants are provided with brief smoking cessation advice only, at the start of the trial. The primary outcome will be self-reported abstinence for the past 14 days, biochemically verified by exhaled CO levels (cut-off 10 ppm) assessed at the end of 1 year of the intervention. We will test whether a CHW-based intervention that incorporates motivational interviewing, text messaging and supportive counseling can prove effective in systematically helping smokers quit.

Australian community pharmacist experiences with smoking cessation and opinions of health warnings on individual cigarette sticks.

We aimed to identify the experiences of Australian community pharmacists with smokers and their associated perceptions of effective health warnings on individual cigarette sticks. A mixed-methods online survey was distributed to Australian pharmacists through pharmacy-specific social media pages, and the Pharmaceutical Society of Australia, followed by semi-structured face-to-face interviews with pharmacists in Townsville, Australia, who were purposively sampled. The interviews continued until data saturation was achieved. Participants described their experiences with smokers, perceptions and effectiveness ratings of current cigarette packaging warnings, and 12 text warnings (divided into four themes) on individual cigarette sticks, and their general opinions on effective anti-tobacco health warnings. Seventy pharmacists participated in the survey and 17 pharmacists in the interviews. Both groups of pharmacists cited smoking-related personal or close-contact illness, pressure by family members or physicians and the financial costs of smoking as being the main drivers for quit attempts. Most interviewed pharmacists interact with smokers several times per week. Cigarette stick warnings describing mortality consequences (especially the 'minutes of life lost' warning) and the financial consequences of tobacco use were rated as significantly more effective than current packaging warnings (odds ratio [OR] = 2.23; 95% confidence interval [CI]: 1.12-4.12, P = 0.02, and 1.97; 95%CI: 1.01-3.84, P = 0.04, respectively). Pharmacists have considerable experience assisting smokers with quitting and based on these experiences believe that novel and tangible health warnings on cigarette sticks may be an effective future measure to combat tobacco use. Further research on the opinions of a more diverse range of health professionals and the general community will generate more robust findings regarding this method of intervention.

Islam and Motivation to Quit Smoking: Public Health Policy Implications.

In the WHO Eastern Mediterranean Regional Office some 14years ago, a 'religiously inspired approach' was proposed to combat tobacco use. This promoted a useful debate in the region. The purpose of this paper is to argue the need to identify the role which Islamic beliefs and teachings play (1) in influencing individual motivation to quit smoking and (2) in gaining support for public policies to reduce smoking. Ramadan and Hajj are taken as key points. These, it is argued, are times when Muslim religious motivation to abstain from smoking is strongest. This paper concludes that there is an insufficient evidence base on which to adopt a religiously inspired approach. All of civil society, including religious Muslim authorities, should rather supplement the efforts of health professionals to encourage smoking cessation.

News Briefs

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