Comprehensive Tobacco Control Research Articles

Health Risks Associated with Tobacco Consumption in Humans: An Overview

Tobacco use remains a significant public health concern globally, with over 8 million anticipated deaths annually by 2030, despite declining rates in some high-income nations. Smoking is prevalent worldwide, particularly in developing and middle-income countries, where over 80% of smokers reside. The inhalation of tobacco substances leads to various diseases, including cancer and respiratory ailments, resulting in more deaths than AIDS, tuberculosis, and other major causes combined. Secondhand smoke exposure also poses significant health risks. The economic burden of tobacco-related deaths and diseases is substantial, especially in low- and middle-income economies, where almost 80% of tobacco-related deaths occur. Lack of awareness, societal influence, and ineffective enforcement of anti-tobacco laws contribute to widespread tobacco use. Although anti-tobacco campaigns and policies have shown some success, challenges persist, particularly in rural areas where tobacco dependence is high. In India, despite declining tobacco use attributed to awareness campaigns and increased taxes on cigarettes, certain demographics, such as middle-aged individuals, illiterates, and rural residents, continue to have high tobacco consumption rates due to inadequate implementation of anti-tobacco norms and limited access to information. Quitting smoking can significantly extend life expectancy and reduce the risk of smoking-related diseases. However, nicotine addiction poses a challenge, with only a small percentage of users successfully quitting without assistance. Professional support and cessation drugs can double the likelihood of successful quitting, and nicotine replacement therapy has shown effectiveness. Overall, there is no safe level of cigarette use, emphasizing the importance of comprehensive tobacco control efforts to mitigate the global health and economic impacts of tobacco use. This review deals with the health risks associated with tobacco consumption in humans. Keywords: Tobacco, Nicotine, Carcinogens, Cancer, Cardiovascular diseases.

Prevalence and Assessment of Knowledge, Attitudes, and Practices of Tobacco Use Among Medical and Dental Students in Bhubaneswar, Odisha.

Background Tobacco use remains a significant global public health concern, causing millions of preventable and premature deaths annually and imposing substantial economic burdens. India, the second-largest producer and consumer of tobacco products worldwide, bears a significant burden of tobacco-related morbidity and mortality. Medical and dental students represent the future healthcare workforce and role models; hence, their tobacco consumption and attitude would play a vital role in tobacco control. This study aims to estimate the prevalence and assess the knowledge, attitudes, and behaviors regarding tobacco use among medical and dental students in Bhubaneswar, Odisha. Methods A descriptive cross-sectional study was conducted using the Global Health Professional Students Survey (GHPSS) questionnaire. The study included third-year Bachelor of Medicine and Bachelor of Surgery (MBBS) and Bachelor of Dental Surgery (BDS) students from two private medical and two dental colleges in Bhubaneswar, Odisha. Data were collected from February to April 2019 through anonymous self-administered questionnaires, and descriptive and bivariate analyses were performed. Results A total of 400 students were surveyed, with 16% reporting being current smokers (24.3% males, 8.7% females). Furthermore, 36.8% had tried cigarettes and other tobacco products. Nonsmokers demonstrated stronger support for comprehensive tobacco control policies, such as banning advertising and smoking in public places, compared to current smokers. Most students acknowledged the importance of recording tobacco use history and providing educational materials; however, only around 40% had received formal training on smoking cessation. Conclusion The findings highlight the need for targeted intervention among medical and dental students for tobacco cessation. It is vital to foster a positive attitude toward tobacco control among future healthcare professionals. Health professional institutions should take proactive steps to prevent tobacco use among students and develop initiatives to motivate successful cessation training. Investing in tobacco control education for healthcare professionals is crucial to empower them in tobacco cessation efforts and promote healthier societies.

Is "tobacco harm reduction" possible? Other countries' experiences and perspectives, and how they could inform tobacco control in Japan

"Tobacco harm reduction" is defined as a method to minimize harm and risk of death and disease without eliminating tobacco and nicotine use. In Japan, where heated tobacco products (HTPs) are prevalent, the tobacco industry is progressively endorsing the concept of "tobacco harm reduction." Therefore, stakeholders in tobacco control must urgently share perspectives and experiences surrounding this issue. This discussion paper aimed to propose four requirements for effectively implementing "tobacco harm reduction" as a public health measure: (1) disease risk reduction, (2) cigarette smoking cessation, (3) no additional public health concerns, and (4) regulatory authorities held by health agencies, and compile information on them regarding nicotine-containing electronic cigarettes (e-cigarettes) and HTPs. Another aim was to summarize policies related to "tobacco harm reduction" adopted by an international organization (World Health Organization (WHO) and health authorities in foreign countries (the United States of America (USA), the United Kingdom (UK), Australia, Italy, and the Republic of Korea) to explore the implications of these requirements on Japan's approach. Regarding the first three requirements, scientific evidence indicated that e-cigarettes offers some level of risk reduction and can assist with cigarette smoking cessation. The potential uptake of e-cigarettes among youth and their possibility to serve as a gateway to combusted cigarette use is a concern, though a definitive causal link is yet to be established between the uptake of e-cigarette in youth and the subsequent use of different tobacco products. There is insufficient scientific evidence for any of the three requirements for HTPs. Regarding the official policies, WHO took the position that the same regulations should be applied to all tobacco products. Only the UK and USA officially established a health system based on the concept of "tobacco harm reduction"; even in Italy and the Republic of Korea, where HTPs are relatively widespread, health authorities denied any risk reduction by introducing HTPs. The UK officially adopted a smoking cessation policy with e-cigarettes. The USA established a modified risk tobacco product system under federal legislation enacted in 2009, whereas of June 2023, no HTP or e-cigarettes were recognized as explicitly reducing health risk. Regarding the fourth requirement, the UK and USA institutionalized "tobacco harm reduction" under health authorities' regulation independent of the tobacco industry. The introduction of a tobacco harm reduction policy in Japan should be considered only in line with health authorities' regulation and implementation of comprehensive tobacco control measures independent of the tobacco industry.

Impact of Traditional and New Media on Smoking Intentions and Behaviors: Secondary Analysis of Tasmania's Tobacco Control Mass Media Campaign Program, 2019-2021.

Tasmania, the smallest state by population in Australia, has a comprehensive tobacco control mass media campaign program that includes traditional (eg, television) and "new" channels (eg, social media), run by Quit Tasmania. The campaign targets adult smokers, in particular men aged 18-44 years, and people from low socioeconomic areas. This study assesses the impact of the 2019-2021 campaign program on smokers' awareness of the campaign program, use of Quitline, and smoking-related intentions and behaviors. We used a tracking survey (conducted 8 times per year, immediately following a burst of campaign activity) to assess campaign recall and recognition, intentions to quit, and behavioral actions taken in response to the campaigns. The sample size was approximately 125 participants at each survey wave, giving a total sample size of 2000 participants over the 2 years. We merged these data with metrics including television target audience rating points, digital and Facebook (Meta) analytics, and Quitline activity data, and conducted regression and time-series modeling. Over the evaluation period, unprompted recall of any Quit Tasmania campaign was 18%, while prompted recognition of the most recent campaign was 50%. Over half (52%) of those who recognized a Quit Tasmania campaign reported that they had performed or considered a quitting-related behavioral action in response to the campaign. In the regression analyses, we found having different creatives within a single campaign burst was associated with higher campaign recall and recognition and an increase in the strength of behavioral actions taken. Higher target audience rating points were associated with higher campaign recall (but not recognition) and an increase in quit intentions, but not an increase in behavioral actions taken. Higher Facebook advertisement reach was associated with lower recall among survey participants, but recognition was higher when digital channels were used. The time-series analyses showed no systematic trends in Quitline activity over the evaluation period, but Quitline activity was higher when Facebook reach and advertisement spending were higher. Our evaluation suggests that a variety of creatives should be used simultaneously and supports the continued use of traditional broadcast channels, including television. However, the impact of television on awareness and behavior may be weakening. Future campaign evaluations should closely monitor the effectiveness of television as a result. We are also one of the first studies to explicitly examine the impact of digital and social media, finding some evidence that they influence quitting-related outcomes. While this evidence is promising for campaign implementation, future evaluations should consider adopting rigorous methods to further investigate this relationship.

Exploring the prevalence, knowledge, attitudes and influencing factors of e-cigarette use among university students in Palestine: a cross-sectional study

ObjectivesE-cigarettes have gained popularity, especially among young adults. This study aims to determine the prevalence of e-cigarette smoking, assess knowledge and attitudes and identify associated factors among Palestinian university students.DesignA...

Racial and Ethnic Disparities in Adolescent Combustible Tobacco Smoking from 2014 to 2020: Declines are lagging among non-Hispanic Black Youth.

We quantified the linear trend in combustible tobacco smoking among adolescents in the United States from 2014 to 2020, then compared these trends across racial and ethnic category. We also tested the effect of e-cigarette use on these trends for all youth and across racial and ethnic categories. We pooled and analyzed seven years of National Youth Tobacco Survey (NYTS) data for n=124,151 middle and high school students from 2014 to 2020. Weighted logistic regression analyses calculated the annual change in combustible tobacco smoking (i.e., cigarettes, cigars, and hookah) from 2014 to 2020. Stratified analyses examined linear trends for non-Hispanic White (NHW), NH-Black (NHB), Hispanic/Latino, and NH-Other (NHO) youth. All models controlled for sex, grade level, and past 30-day e-cigarette use. Combustible tobacco smoking from 2014 to 2020 dropped by more than 50% for NHW youth, more than 40% for Latino and NHO youth, compared to just 16% among NHB youth. From 2014 to 2020, odds of combustible tobacco smoking declined by 21.5% per year for NHWs, which was significantly greater than Hispanic/Latinos (17% per year; p=0.025), NHOs (15.4% per year; p=0.01), and NHBs (5.1% per year; p<0.001), adjusting for sex, grade, and e-cigarette use. Trends and disparities in trends by race and ethnicity were observed independent of e-cigarette use. Combustible tobacco smoking declined for all youth but at significantly different rates across races and ethnicity. Notably, declines in combustible tobacco smoking are lagging among NHB youth. Interventions are critically needed to address this disparity. A direct, evidence-based intervention to reduce combustible tobacco smoking among NHB youth is critically needed. Such tobacco control initiatives should follow the Best Practices for Comprehensive Tobacco Control Framework, incorporating sustainable funding for school-based intervention, public health education, and adult cessation.

A longitudinal analysis of the impact of the local tobacco retail availability and neighbourhood deprivation on male smoking behaviours in Shanghai, China

Some evidence from Western high-income countries suggests local tobacco retail availability and neighbourhood deprivation may influence smoking behaviours. However, this assertion has not been considered in China, where 44% of males continue to smoke. Data were analysed from Chinese males (n = 2054) who participated in Waves 3–5 (2009–2015) of the International Tobacco Control (ITC) China Survey by linking information on tobacco retail availability (estimated through population weighted Kernel Density of tobacco retailers in 2019) and neighbourhood deprivation (calculated as a composite score derived from the 2010 Chinese census) across Shanghai. Generalised Estimating Equation models were fitted to examine the impacts of local tobacco availability and neighbourhood deprivation on smoking behaviours (current smoking versus current non-smoking, quitting versus current smoking, longer durations of smoking abstinence versus current smoking) using the longitudinal data. Examining the impacts separately, participants living in neighbourhoods with greater availability and higher levels of deprivation were less likely to maintain longer durations of smoking abstinence in both unadjusted and adjusted models. Neighbourhood deprivation, but not availability, was found to be associated with higher odds of being a current smoker. Examining the impacts jointly, neighbourhood deprivation was still positively associated with current smoking and negatively associated with longer durations of smoking abstinence, but the negative association between availability and longer durations of smoking abstinence disappeared. The findings offer some evidence that greater tobacco retail availability and deprivation are obstacles on prolonged smoking cessation among males in Shanghai, China. Policymakers should consider small-area level place-based restrictions in China, such as reducing the availability of tobacco, as part of a comprehensive tobacco control strategy aimed at addressing the high prevalence of smoking.

Tobacco Market Transformation in Hungary

Smoking has emerged as a longstanding global concern, with a significant number of individuals within our immediate and bariatric circles becoming addicted to this detrimental habit. The gravity of the issue is reflected in the staggering statistics, as smoking claims the lives of more than six million people worldwide annually, earning its notorious title as the leading cause of preventable death according to the World Health Organization (WHO). Despite strict regulations and restrictions on smoking imposed by many countries to combat the escalating health risks, smoking habits persist as a major problem, particularly among young people. In the 1960s, smoking was widely accepted in society, and smoking rates remained high across nations. However, the tides began to turn with the growing awareness of the dire health risks associated with smoking. Health professionals and policymakers took active measures against smoking, contributing to a decline in its prevalence. Nevertheless, the extent of change in smoking habits varies significantly from country to country. The intricate web of factors influencing smoking habits encompasses social and economic elements, stress and mental health considerations, as well as the alluring temptations surrounding tobacco products. Raising awareness about the devastating health impacts of smoking and taking relentless action against this harmful habit are pivotal in reducing smoking rates globally. However, it is crucial to acknowledge the diverse cultural, socioeconomic, and psychological aspects that underpin smoking behavior to implement effective strategies tailored to specific regions and demographics. To combat the persistent smoking epidemic, comprehensive and integrated efforts are required, ranging from targeted public health campaigns to comprehensive tobacco control policies. Empowering individuals with knowledge about the hazards of smoking and equipping them with effective cessation resources can be transformative in curbing the addiction. Equally vital is fostering a supportive environment that promotes mental well-being and addresses stressors, offering healthier alternatives to cope with challenges. In conclusion, the fight against smoking demands unwavering commitment from policymakers, health professionals, and society at large. By understanding the complex drivers behind smoking habits and adopting a multifaceted approach, we can endeavor to save lives, promote healthier communities, and ultimately work towards a smoke-free future for generations to come.

Secondhand Smoke Exposure and Smoking Prevalence Among Adolescents

Secondhand smoke is a substantial risk factor for youth health globally, including in Japan, where tobacco control policies should be reassessed. To assess trends in the prevalence of secondhand smoke exposure among Japanese adolescents from 2008 to 2017 and to examine the association between its frequency and smoking during the study period. This study comprised a nationally representative, self-administered, school-based, cross-sectional survey focusing on tobacco and alcohol use and related factors among students in grades 7 to 12 (ages 12-18 years) in Japan. This random sampling survey used single-stage cluster sampling. Using the national school directory, junior and senior high schools throughout Japan were randomly extracted from each regional block. All students enrolled in the sampled schools were included as participants, and school-based surveys were completed in 2008, 2012, and 2017. Data analysis was performed from January 1 to March 15, 2023. Prevalence of secondhand smoke exposure among adolescents in Japan from 2008 to 2017 and changes in the association between secondhand smoke exposure frequency and prevalence of smoking were examined using multiple logistic regression analysis. Data were analyzed for 95 680 adolescents in 2008 (50.7% boys), 100 050 in 2012 (51.6% boys), and 64 152 in 2017 (53.9% boys). At baseline, 42.0%, 38.5%, and 34.6% of the participants were junior high school students in 2008, 2012, and 2017, respectively. Based on the 2008 surveys, 51.0% of adolescents in grades 7 to 12 were exposed to secondhand smoke in any place (≥1 day during the past 7 days), 37.2% were exposed at home, and 36.5% were exposed in public places. In 2017, 36.3% of participants were exposed to secondhand smoke in any place, 23.8% were exposed at home, and 27.0% were exposed in public places. An association between secondhand smoke exposure frequency and prevalence of smoking was observed consistently regardless of survey year, location, or pattern of exposure (adjusted odds ratios ranged from 2.29 [95% CI, 1.81-2.91] for 1-2 days at home to 11.15 [95% CI, 8.50-14.62] for 7 days in public places). Stratified analysis by higher education intention indicated that the prevalence of smoking and secondhand smoke exposure decreased but remained higher among adolescents who did not intend to pursue higher education. The association between secondhand smoke and smoking did not differ substantially between groups. In this cross-sectional study, the prevalence of secondhand smoke exposure among adolescents in Japan decreased but remained at high levels overall. There may not be a hazard-free threshold for smoking. Enhancing comprehensive tobacco control strategies is Japan's first step toward achieving smoke-free environments to protect youths. Implementation and verification of the effectiveness of smoke-free legislation should be considered.

Engaging Appalachian Youth: Lessons Learned From a Virtual Tobacco Prevention and Advocacy Training.

Engaging youth is recommended as a key component of comprehensive tobacco control to bring voice to youth perspective and to connect to community impact. Yet, limited research exists to showcase practical lessons learned in supporting skill development and engagement of youth. This practice note describes how a tailored prevention and advocacy virtual training can serve to engage and empower rural Appalachian high school students to participate in tobacco control efforts. Specifically, we describe the implementation and practical lessons learned from a two-session virtual tobacco prevention and advocacy training led by college facilitators. Participating high school students (N = 20) strongly agreed that tobacco use was a major problem facing their community and that addressing tobacco use should be prioritized. After participating in the training, students' interpersonal confidence improved and participation in self-reported advocacy increased. Students also liked the virtual platform, interaction with college students, and the opportunity to apply information learned. Youth-focused tailored training promotes skill-building and enhances self-efficacy to engage in tobacco control. Youth engagement should be integral to supporting community health initiatives, including tobacco prevention.

Factors associated with the implementation of a comprehensive tobacco cessation benefit among California Medicaid managed care plans

AbstractAlthough tobacco control efforts have been successful at reducing the rate of tobacco use in the general population, rates of use among low‐income populations persist. As a leader in tobacco control efforts, the U.S. state of California recently issued regulations regarding comprehensive tobacco cessation service requirements for state Medicaid plans (i.e., Medi‐Cal MCPs) providing health care to low‐income Californians. This research aims to evaluate the potential factors associated with the adoption of a comprehensive tobacco control program among Medi‐Cal's MCPs. In 2018, UC San Diego researchers distributed a survey to a listserv of 25 Medi‐Cal MCP health educators, for a response rate of 96%. The survey was comprised of questions related to All Plan Letter (APL) implementation of tobacco cessation services and policies. Health educators were also recruited to participate in a semi‐structured interview upon survey completion. Two years postrelease of the APL, Medi‐Cal's MCPs demonstrate low implementation of tobacco cessation services and related policies, with only one MCP (5%) fully implementing all 10 core provisions. Five consistent patterns were identified as being associated with implementation: larger MCP enrollment and staffing, lower median household income, noncapitated provider payment, participation in county tobacco control meetings, and high‐quality scores for preventive care and treatment of chronic disease. Small‐sized MCPs have been slow in fully implementing tobacco cessation services. State policymakers and tobacco control stakeholders may consider providing support to small‐sized MCPs to aid in their continued adoption of comprehensive tobacco cessation services. DHCS should also consider releasing guidance on how to engage in activities to ensure APL compliance.

Changes in E-cigarette Use, Cigarette Smoking, and Dual-Use Among the Youth (13-15 Years) in 10 Countries (2013-2019)-Analyses of Global Youth Tobacco Surveys.

The increasing use of e-cigarettes among the youth is a public health problem that needs surveillance. We report changes in e-cigarette use, cigarette smoking, and "dual use" among youth in 10 countries. Global Youth Tobacco Survey (GYTS)s from Georgia, Iraq, Italy, Latvia, Montenegro, Paraguay, Peru, Qatar, Romania, and San Marino were analyzed. Changes in prevalence of "awareness of e-cigarettes," "ever use" (even tried a few puffs) and "current use" (during last 30 days) of e-cigarettes and cigarette smoking, and "dual use" (both e-cigarette and cigarette smoking) between baseline (2013 and 2014) and most recent (2017-2019) surveys were estimated. "Awareness of e-cigarettes" and "ever e-cigarette use" significantly increased (p < .001). "Ever e-cigarette use" was highest in Italy, 93% (95% CI 90.9, 94.4). "Current e-cigarette use" significantly (p < .05) increased by > 50% in most countries. During the most recent surveys, "current e-cigarette" use was > 10% in five countries Italy (18.3%) and Latvia (18.5%) being the highest. Cigarette smoking significantly declined in Italy, Latvia, Peru, and San Marino (p < .05) but remains unchanged in other countries. "Dual use" (both electronic and conventional cigarettes) significantly increased in all countries (p < .001). During the most recent surveys "dual use" was highest in Italy (10%, 95% CI 8.1, 12.2) and Latvia (8.6%, 95% CI 7.2, 10.2). Youth aged 14 and ≥15 years the smokers, were more likely to be e-cigarette users. Awareness and use of e-cigarettes and "dual use" among youth have increased. Closer monitoring of tobacco use among youths and comprehensive tobacco control policies inclusive of e-cigarettes are needed. Secondary data analyses of serial GYTSs in 10 countries showed that both awareness of e-cigarette and e-cigarette use has increased among school-going youth aged 13-15 years. A concurrent increase in "dual use" of e-cigarettes and cigarette smoking during the last 30 days in all 10 countries indicates continued cigarette smoking in the absence of e-cigarettes because of the common risk construct of tobacco product use. Results call for continued surveillance of both e-cigarettes and cigarette smoking among school-going youth. Comprehensive tobacco control measures inclusive of e-cigarettes should be implemented to reduce tobacco use among the youth.

Programme and policy perspectives towards a tobacco-free generation in India: findings from a qualitative study

ObjectiveThis study explored multistakeholder perspectives on existing adolescent-specific tobacco control policies and programmes, to advance India’s transition towards a tobacco-free generation.DesignQualitative semi-structured interviews.SettingInterviews were conducted with officials involved in tobacco...

Impact of a Comprehensive Tobacco Control Package on Trends in Hospital Admissions for Depression in Beijing, China: Interrupted Time Series Study

Impact of a Comprehensive Tobacco Control Package on Trends in Hospital Admissions for Depression in Beijing, China: Interrupted Time Series Study

Defining indicators for the scoping stage of health impact assessment to evaluate tobacco control policy in the city of Beijing

IntroductionBeijing initiated the nation’s most comprehensive tobacco control program that adheres to the WHO Framework Convention on Tobacco Control. This study aimed to identify a set of indicators for the scoping of an Health Impact Assessment (HIA) to assess this policy.MethodsThis study used a modified Delphi process. It proposed a tobacco control health impact framework based on the Driving forces- Pressure- State- Exposure- Effect- Action model and the Determinants of Health Theory. After a review of current surveillance system and literature, a working group of 13 experts with multidisciplinary background was established to formulate indicator evaluation criteria and conduct indicator scoring. Each indicator was scored by experts according to four evaluation criteria chosen. Indicators that obtained a total score above 80% and with standard error less than 5 were selected as the final set of indicators. Kendall’s coefficient of concordance was calculated.ResultsTwenty-three out of 36 indicators were selected. Smoking prevalence, mortality rate, hospital admission rate, tobacco consumption and hospital admission fees of smoking related diseases achieved more than 90% of total scores and ranked as the top five. Kendall’s concordance coefficient was 0.218 for all indicators. For all model composition, Kendall’s concordance coefficients were statistically significant.ConclusionThis study identified a set of twenty-three indicators for scoping of HIA of a comprehensive tobacco control policy in Beijing based on a tobacco control health impact conceptual framework. The set of indicators achieved high scores and statistically significant consistency and has great potential to promote the evaluation of tobacco control policy in a global city. Further study might use the set of indicators for HIA on tobacco control policy to analyze empirical data.

The role of principled engagement in public health policymaking: the case of Zambia’s prolonged efforts to develop a comprehensive tobacco control policy

ABSTRACT Background The Framework Convention on Tobacco Control (FCTC) requires countries to develop and implement multi-sectoral tobacco control strategies, including policies and legislation. Zambia, potentially faced by a rising problem of tobacco smoking, signed the FCTC in 2008 but has been unable to enact a tobacco policy for over a decade. Objective This study explores the role of ‘principled engagement’, a key element of the theoretical framework for collaborative governance, in Zambia’s delayed success to develop a comprehensive tobacco control policy. Methods This was a qualitative case study of key stakeholders in the collaborative process of trying to develop a tobacco policy in Zambia. Participan-ts were sampled from across various sectors, including government departments and civil society, comprising anti-tobacco activists and researchers. A total of 27 key informant interviews were undertaken. We supplemented the interview data with a document review of relevant policies and legislation. Data were analysed using thematic analysis. Results Several factors hindered efforts to attain principled engagement, including the adverse legal and socioeconomic environment in which the collaborative regime evolves; poor planning of meetings and frequent changes in tobacco focal point persons; lack of active and meaningful participation; and communication challenges among the key stakeholders. These collaborative dynamics, coupled with the opposition to tobacco control efforts from within some government departments, revealed the inadequacy of the current collaborative governance regime to facilitate enactment of a comprehensive tobacco control policy in Zambia. Conclusion Efforts to develop a comprehensive tobacco control policy in Zambia will require addressing challenges such as disagreements, communication, and leadership at engagement level across interested sectors. We further argue that principled engagement has a greater role to play in unlocking these efforts and should therefore be embraced by those entrusted to lead the process to develop tobacco policy in Zambia.

Changes in tobacco imagery and smokers' depiction in Spanish top-grossing films before and after the implementation of a comprehensive tobacco control policy in Spain.

As more restrictions on tobacco marketing communication are implemented, tobacco marketing has persisted through smoking in films. Our aims were to assess changes in tobacco imagery exposure in Spanish top-grossing films before and after the banning of tobacco advertising in Spain, and to determine whether the depiction of smoking characters has changed over the years. A repeated cross-sectional study measured the tobacco content in the 10 Spanish top-grossing films in 2005, 2010 and 2015 (n=30) before and after a complete tobacco advertising ban. We conducted a descriptive and regression analysis of changes in tobacco impressions by year. The 30 films contained 1378 tobacco occurrences (90.2% positive for tobacco) with a median length of eight seconds onscreen. Total tobacco occurrences deemed positive for tobacco interests significantly increased in 2010 and 2015 compared to 2005. However, we observed decreased odds of tobacco brands appearances (OR=0.25; p<0.001) in 2010 and of implied tobacco use (OR=0.44; p=0.002), and tobacco brands appearances (OR=0.36; p<0.001) in 2015 compared to 2005. There was a change of pattern in the type of role smokers played from a leading role to a supporting one (p<0.001). The population reach of positive for tobacco occurrence in Spanish top-grossing films decreased from 15.9 (95% CI: 15.86-15.86) per 1000 spectators in 2005 to 0.8 (95% CI: 0.82-0.82) in 2015. The implementation of a ban on complete tobacco product advertising was followed by a decrease in tobacco incidents across top-grossing Spanish films. Yet, exposure to smoking in films is still unacceptably high.

Smoking: Quit to win.

The Winners of ‘Quit to Win’ Smoke-free Community Campaign organized by the Hong Kong Council on Smoking and Health. Translation of banner text: ‘13th Quit to Win Smoke-free Community Campaign Prize Presentation Ceremony’. (Image source: Hong Kong Council on Smoking and Health, with permission). In 2019, there were 1.14 billion current smokers globally, and they consumed 7.41 trillion cigarette-equivalents of tobacco (https://www.sciencedirect.com/science/article/pii/S0140673621011697). Smoking rates are high in some parts of Asia. China, India and Indonesia comprised 46% of the world's smokers in 2020 (https://www.statista.com/chart/24965/share-of-smokers-and-world-population-by-country/). Since early 1960, the detrimental impact of smoking on physical health and well-being has been reported worldwide. Smoking can damage nearly every human organ and lead to various diseases and disabilities, including cancer, heart disease, stroke, diabetes and chronic obstructive pulmonary disease. Smoking is harmful not only to the human body, but also the society and the economy. In 2012, the cost of diseases caused by smoking equated to 5.7% of global health expenditure and 1.8% of global gross domestic product (GPD; https://tobaccocontrol.bmj.com/content/27/1/58.long). Globally, 7.69 million deaths and 200 million disability-adjusted life-years (DALY) were related to smoking tobacco in 2019 (https://www.sciencedirect.com/science/article/pii/S0140673621011697). The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) opened for signature in 2003, and this treaty has been signed by 182 countries, covering more than 90% of the world population, making it one of the most widely embraced treaties in the United Nations' history. Various strategies have been advocated for tobacco control, and examples are price and tax measures to reduce the demand for tobacco and non-price measures, such as packaging and labelling of tobacco products; education, communication, training and public awareness; policies on tobacco advertising, promotion and sponsorship. Comprehensive tobacco control policies effectively reduce smoking prevalence, and the positive effects are amplified when multiple measures are implemented simultaneously at the same place (https://www.nature.com/articles/s41591-020-01210-8). With the substantial effort on tobacco control, from 1990 to 2019, there was a decline in the smoking-attributable mortality for both males and females in some countries such as China, Japan, the UK and the US (https://www.ssph-journal.org/articles/10.3389/ijph.2022.1605147/full). The effort to curtail the tobacco epidemic should be continued. At the regional level, the Asia Pacific Society of Respirology has recently added a new section on ‘Tobacco Control’ under the Environmental & Occupational Health and Epidemiology Assembly. It is anticipated that this can help to drive concerted efforts in the region on tobacco control. In my local community in Hong Kong, there is a recent 31% tax hike in tobacco smoking sales. It is gratifying to see the local effort for education and encouragement of smoking cessation. When attending the local campaign on tobacco control, I was touched by the stories shared by the quitters as their behavioural change positively impacts their community, family and personal life. None declared.

Prevalence of Adverse Health Effects of Tobacco Addiction in Different Types of Prakriti – An Observational Study

According to the National Institute on Drug Abuse, tobacco is one of the most widely used addictive items in the United States (NIDA). Addiction is a long-term illness marked by obsessive drug seeking and usage and long-term chemical and molecular alterations in the brain. Tobacco smoking is linked to 5 million fatalities worldwide, making it one of the major causes of mortality. Comprehensive tobacco control programs can significantly lower the frequency of tobacco use. The study was a cross-sectional study. Approval was taken from the institutional ethical committee. Personal interviews were conducted at Mahatma Gandhi Ayurved College, Hospital &amp; Research Centre, Salod (H), Wardha district. All the subjects were personally interviewed based on the questionnaire. The survey elicited 209 replies, and based on the findings, the following observations were made. Individuals who were addicted to tobacco chewing in the Wardha district were included in the study. One hundred percent of participants completed the survey. The evaluation used a question-and-answer format, a typical Prakriti assessment, and tobacco addiction-related questions. The study gathered 209 replies from tobacco-dependent residents in the Wardha district, who were selected based on their comments and observations. Tobacco chewing percentage was more found in males (21%) than females (2.8%). Twenty-five percent were primarily Vata Prakriti, fifty-nine percent were Pitta Prakriti, and eighteen percent were Kapha Prakriti. Compared to Pitta and Kapha Prakriti people, Vata-dominant Prakriti people are more likely to experience the negative effects of tobacco addiction.

Changes in tobacco imagery and smokers’ depiction in Spanish top-grossing films before and after the implementation of a comprehensive tobacco control policy in Spain

Changes in tobacco imagery and smokers’ depiction in Spanish top-grossing films before and after the implementation of a comprehensive tobacco control policy in Spain