Hand-rolled Cigarettes Research Articles

Trends in Daily Cigarette Consumption Among Smokers: A Population Study in England, 2008-2023.

This study aimed to estimate time trends in cigarette consumption among smokers in England between 2008 and 2023 and toexplore differences by key potential moderators. We used data from 57778 adult cigarette smokers participating in a nationally representative monthly cross-sectional survey between January 2008 and September 2023. We estimated monthly time trends in mean daily consumption of (1) any, (2) manufactured, and (3) hand-rolled cigarettes among all smokers and by main type of cigarettes smoked, smoking frequency, age, gender, occupational social grade, region, nicotine replacement therapy use, and vaping status. Overall cigarette consumption fell from 13.6 [95% CI = 13.3 to 13.9] to 10.6 [10.5 to 10.8] per day between January 2008 and October 2019 (a 22% decrease), then remained stable up to September 2023. Over this period, the proportion mainly orexclusively smoking hand-rolled cigarettes increased (from 30.6% [29.1%-32.1%] in 2008 to 52.1% [49.7%-54.5%] in 2023). As a result, manufactured cigarette consumption fell by 47%, from 9.5 [9.2-9.8] per day in January 2008 to 5.0 [4.7-5.3] in September 2023, while hand-rolled cigarette consumption increased by 35%, from 4.2 [3.9-4.4] to 5.6 [5.3-5.9], respectively. The decline in overall cigarette consumption was observed across all subgroups, but was greater among non-daily smokers, younger smokers, and those who vaped. Over the last 15 years, the average number of cigarettes consumed each day by smokers in England has fallen by almost a quarter, but has plateaued since October 2019. There has been a sharp decline in the number of manufactured cigarettes consumed and an increase in the number of hand-rolled cigarettes consumed, as smokers have increasingly shifted towards using hand-rolled tobacco. While average cigarette consumption in England has fallen over the past 15 years, this declining trend has stalled (and reversed in some population groups) since 2019. The availability of cheap, hand-rolled tobacco appears to be undermining policies that aim to reduce smoking by raising the price of tobacco (eg, through taxation) and could be targeted to reignite the decline in cigarette consumption.

Gambaran Nikotin pada Pra Lansia Perokok Linting (Tembakau) di Desa Pohgading Timur Kecamatan Pringgabaya

Background: Cigarettes are a type of tobacco product produced from the Nicotiana Tabacum, Nicotiana Rustica and other species. Cigarettes are cylinder-shaped from paper measuring between 70 – 120 mm long with a diameter of around 10 mm containing chopped tobacco leaves. There are two types of cigarettes, namely hand-rolled cigarettes and electronic cigarettes which are usually called vape or vapor. Objective: To find out the description of nicotine in hand-rolled (tobacco) smokers in East Pohgading village, Pringgabaya subdistrict. Method: The research is a descriptive analytical method. By taking samples using purposive sampling technique. Results: The results of the research that was carried out obtained samples of 42 elderly people who used hand-rolled cigarettes (tobacco), 41 samples were positive and 1 was negative for nicotine. Conclusion: Results from the urine of pre-elderly respondents who smoked hand-rolled (tobacco) were positive for nicotine as many as 41 people and 1 person was negative.

Characterising smoking and nicotine use behaviours among women of reproductive age: a 10-year population study in England

BackgroundTobacco smoking affects women’s fertility and is associated with substantial risks of adverse pregnancy outcomes. This study explored trends by socioeconomic position in patterns of smoking, use of non-combustible nicotine products, and quitting activity among women of reproductive age in England.MethodsData come from a nationally representative monthly cross-sectional survey. Between October 2013 and October 2023, 197,266 adults (≥ 18 years) were surveyed, of whom 44,052 were women of reproductive age (18–45 years). Main outcome measures were current smoking, vaping, and use of nicotine replacement therapy (NRT), heated tobacco products (HTPs), and nicotine pouches; mainly/exclusively smoking hand-rolled cigarettes and level of dependence among current smokers; past-year quit attempts among past-year smokers; and success of quit attempts among those who tried to quit. We modelled time trends in these outcomes, overall and by occupational social grade (ABC1 = more advantaged/C2DE = less advantaged).ResultsSmoking prevalence among women of reproductive age fell from 28.7% [95%CI = 26.3–31.2%] to 22.4% [19.6–25.5%] in social grades C2DE but there was an uncertain increase from 11.7% [10.2–13.5%] to 14.9% [13.4–16.6%] in ABC1. By contrast, among all adults and among men of the same age, smoking prevalence remained relatively stable in ABC1. Vaping prevalence among women of reproductive age more than tripled, from 5.1% [4.3–6.0%] to 19.7% [18.0–21.5%], with the absolute increase more pronounced among those in social grades C2DE (reaching 26.7%; 23.3–30.3%); these changes were larger than those observed among all adults but similar to those among men of the same age. The proportion of smokers mainly/exclusively smoking hand-rolled cigarettes increased from 40.5% [36.3–44.9%] to 61.4% [56.5–66.1%] among women of reproductive age; smaller increases were observed among all adults and among men of the same age. Patterns on other outcomes were largely similar between groups.ConclusionsAmong women of reproductive age, there appears to have been a rise in smoking prevalence in the more advantaged social grades over the past decade. Across social grades, there have been substantial increases in the proportion of women of reproductive age who vape and shifts from use of manufactured to hand-rolled cigarettes among those who smoke. These changes have been more pronounced than those observed in the general adult population over the same period.

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

First experience with nicotine products and transition to regular tobacco use: a secondary data analysis in 28 European countries

ObjectiveThe majority of tobacco users have had their first contact with nicotine at a young age. The aim of this study was to explore the association between the first tobacco...

PENENTUAN STRATEGI PEMASARAN HASIL TEMBAKAU DI TENGAH NAIKNYA TARIF CUKAI DAN PEREDARAN ROKOK ILEGAL

The tobacco products industry in Indonesia is facing two big challenges: increasing excise rates and the circulation of illegal cigarettes. An increase in excise rates increases cigarette prices and can reduce demand. On the other hand, illegal cigarettes offer cheaper prices and are competitors to legal products. CV Gagak Hitam is a cigarette company that was founded in 2004 and is still running the tobacco products industry in the form of hand-rolled kretek cigarettes (SKT) and machine-made kretek cigarettes (SKM) amidst rising excise rates and the circulation of illegal cigarettes. This research focuses on determining marketing strategies for tobacco products at CV. Black Crow uses SWOT analysis. The analysis results show that CV. Black Crow has several strengths, such as a strong brand, wide distribution network, and consumer loyalty. However, CV Gagak Hitam also has several weaknesses, such as high prices and a negative image of tobacco products related to health. Opportunities that can be utilized by CV. Black Crow is increasing public awareness of health and the development of digital technology. The threats facing this industry are increasing excise rates, the circulation of illegal cigarettes, and increasingly stringent government regulations. Marketing strategies that can be implemented by CV. Gagak Hitam in the midst of this situation is developing innovative products at competitive prices, strengthening brand image and increasing consumer awareness, utilizing digital technology to reach consumers and increase marketing efficiency, as well as working with the government to overcome the circulation of illegal cigarettes. Keywords: tobacco products; excise rates; illegal cigarettes; marketing strategy swot analysis.

Filtered and Unfiltered Cigarette Effect on White Rats Male Reproduction (Rattus norvegicus L.)

Cigarette smoke can cause various health problems, one of which is a decrease in fertility in males. The purpose of this study was to determine the effect of smoke exposure between with and without filter hand-rolled kretek cigarettes (SKT) and white cigarettes on white rats male reproduction: sperm quality in the form of sperm motility and viability, also the structure of seminiferous tubules. This study used 5 treatment groups (KP), namely controls not given exposure to cigarette smoke (KP0), exposure to unfiltered kretek cigarette smoke (KP1), exposure to filtered kretek cigarettes (KP2), exposure to unfiltered white cigarette smoke (KP3) and exposure to secondhand smoke. filtered white cigarettes (KP4) with treatment placement arrangement in a Completely Randomized Design (CRD) and if there is a significant difference, a Duncan Multiple Range Test (DMRT) is carried out. The results obtained on sperm quality, namely sperm motility and viability, decreased. Good quality at KP0 then the quality decreases successively starting from KP1, KP2, KP3 and KP4. The results on histpathological observations of the seminiferous tubules, there were no pathological changes found in all treatments. In contrast to the histopathology of seminiferous tubules, the number of spermatogenic cells showed a significant difference between treatments with the least average spermatogenic count and a decrease in the number of cells from spermatogonia cells to spermatid cells, namely in the treatment group exposure to filtered white cigarette smoke (KP4). Overall, the exposure that caused the most severe impact on all measured parameters was in the treatment group of filtered white cigarette smoke (KP4).

Investigation of the technological profile of illegally distributed tobacco derivatives and smoking products

The current investigation includes technological assessment and interpretation of the profile of tobaccos, tobacco derivatives and smoking products illegally distributed in Bulgaria, as officially provided for expertise in the Tobacco and Tobacco Products Institute (TTPI) by external contractors (legitimate state structures) in 2021. The physical and chemical properties of the tobacco objects, depending on their nature, were determined according to standardized methods. The biggest share in the analyses (139 in total) took the determination of tobacco cut width (39%) and particle size fractionation (37%), which supported the observation that the illicit tobacco market in Bulgaria is recently dominated by cut tobacco for hand-rolled cigarettes. In the cut tobacco predominated long and medium-sized strands, but in widely varying proportions (42.27-81.78% and 9.98-38.46%, respectively), with cut width in 0.59-1.06 mm range. The sieve analysis and the expert examination of the tobacco derivatives revealed that they were undoubtedly technological tobacco waste, and, respectively, that accentuated data must be communicated to consumers about the risks associated with the smoking of such tobacco articles. It was found that all illicitly traded fine-cut tobacco blends produced considerably higher tar (12.25-16.05 mg/cig) and CO (12.74-16.94 mg/cig) emissions than the limits set for conventional cigarettes.

Tobacco consumption in Mozambique in 2005 and 2015.

The burden related to smoking exposure is growing in many low-income settings. We aimed to quantify the use of smoked and smokeless tobacco in Mozambique in 2014/2015, and to compare the estimates with those obtained in 2005. A cross sectional study was conducted in 2014/2015 on a representative sample of the Mozambican population aged 15 to 64 years, following the World Health Organization Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS). Prevalence estimates with 95% confidence intervals were computed for different categories of tobacco consumption. The age-standardised prevalence in the age-group 25-64 years was compared with results from a STEPS survey conducted in 2005. Between 2005 and 2014/2015, the prevalence of daily smoking decreased from 9.1% to 3.4% (p < 0.05) in women and from 33.6% to 27.3% (p < 0.05) in men. There was a significant decrease in the daily consumption of hand-rolled cigarettes among women (from 3.1% to 1.4%, p < 0.05). Among men, there was a decrease in the prevalence of daily consumption of smokeless tobacco (from 3.5% to 1.0%, p < 0.05). In 2014/2015, both manufactured and hand-rolled cigarette consumption were more prevalent among men, while the use of smokeless tobacco was more common among women; the consumption of both hand-rolled cigarettes and smokeless tobacco were more prevalent in rural settings. In Mozambique, there was a decrease in the prevalence of daily smokers in both genders and of daily consumption of smokeless tobacco among men between 2005 and 2014/2015. Efforts are needed to maintain the positive trends.

How has Expenditure on Nicotine Products Changed in a Fast-Evolving Marketplace? A Representative Population Survey in England, 2018-2022.

In the last 5 years, there has been a dramatic shift in the types of nicotine products being purchased. This study aimed to estimate how much users spend on types of cigarettes and alternative nicotine products (e-cigarettes, nicotine replacement therapy (NRT), heated tobacco, and nicotine pouches) and describe changes between 2018 and 2022. Monthly representative cross-sectional survey in England. 10 323 adults who smoked cigarettes or used alternative nicotine reported their average weekly expenditure on these products, adjusted for inflation. Smokers spent £20.49 [95% CI = 20.09-20.91] on cigarettes each week (£27.66 [26.84-28.50] and £15.96 [15.49-16.28] among those who mainly smoked manufactured and hand-rolled cigarettes, respectively), e-cigarette users spent £6.30 [5.99-6.55] (£8.41 [7.17-9.78], £6.42 [5.58-7.39], and £5.93 [5.64-6.30] among those who mainly used disposable, pod, and refillable devices, respectively), NRT users £6.11 [5.53-6.69], and heated tobacco users £13.87 [9.58-20.09]. Expenditure on cigarettes grew by 10% from September 2018 to July 2020, then fell by 10% from July 2020 to June 2022. These changes coincided with a 13% reduction in cigarette consumption and a 14% increase in the proportion mainly smoking hand-rolled cigarettes. Expenditure on e-cigarettes was stable between 2018 and late 2020, then rose by 31% up to mid-2022. Expenditure on NRT increased slowly in 2018-2020 (+4%) and more quickly thereafter (+20%). Inflation-adjusted expenditure on cigarettes has fallen since 2020, such that the average smoker in England currently spends the same on cigarettes each week as in 2018. This has been achieved by smoking fewer cigarettes and switching to cheaper hand-rolled cigarettes. Expenditure on alternative nicotine has increased above inflation; users spent around a third more on these products in 2022 than between 2018-2020. People in England continue to spend substantially more on smoking cigarettes than using alternative nicotine products. The average smoker in England spends around £13 a week (~£670 a year) more than people using only e-cigarettes or NRT. The average expenditure on manufactured cigarettes is double that of hand-rolled cigarettes.

STUDY OF ORGANOLEPTIC AND PHYSICAL AND CHEMICAL CHARACTERISTICS OF PRODUCTS FROM SMOKING ROLLING TOBACCO

Products from rolling smoking tobacco, they are also “hand-rolled”, are currently a trending phenomenon in the development of the tobacco products market, both in the Russian Federation and abroad. In view of the fact that maximum allowable values for the content of nicotine, tar and carbon monoxide in smoke are set for cigarettes, manufacturers produce tobacco blendings for cigarettes with a high content of components such as reconstituted tobacco and extended stem, on the one hand, regulating toxicity, and on the other hand, reducing flavoring properties. This leads to the fact that modern cigarettes, in terms of taste and aroma of tobacco smoke, poorly meet consumer taste preferences. By creating products from rolling smoking tobacco, combining different types of tobacco, using paper for self-rolling paper of different composition and breathability, as well as changing the mass of tobacco and the diameter of the product, the consumer can create an ideal product that meets all his taste preferences. In connection with the growing popularity of hand-rolled cigarettes, the relevance of research on their qualitative characteristics is growing. This article discusses such qualitative characteristics as the chemical composition and technological properties of samples: raw tobacco; tobacco blendings with and without a vein; rolling smoking tobacco of various brands. The main purpose of the research is to study the influence of the design of the product (diameter, weight, air permeability of paper) on the tasting assessment. For each type of smoking tobacco, products (hand-rolled) of various weights and diameters have been made, using four types of paper, differing in composition and air permeability. The dependence of the tasting evaluation of products from rolling smoking tobacco on the air permeability of the paper and the design features of the products (fiber width, weight and diameter of the products) has been established.

The Prevalence of Tobacco, Heated Tobacco, and E-Cigarette Use in Poland: A 2022 Web-Based Cross-Sectional Survey.

Monitoring tobacco use on a regular schedule is a basic tool of tobacco control policy. This study aimed (1) to assess the current prevalence and patterns of tobacco and e-cigarette use, as well as (2) to identify socioeconomic factors associated with smoking behavior among adults in Poland. This cross-sectional study was carried out in March 2022 on a nationwide, representative sample of 1090 adults in Poland. The computer-assisted web interview (CAWI) technique was used. Daily tobacco smoking was declared by 28.8% of respondents (27.1% of females and 30.8% of males; p = 0.2) and 4.2% were occasional smokers (4.2% of females and 4.3% of males; p = 0.8). Most of the current smokers (62.1%) smoked regular cigarettes and 25.2% smoked hand-rolled cigarettes. The prevalence of daily e-cigarette use was 4.8% (4.0% among females and 5.6% among males; p = 0.2). Daily heated tobacco use was declared by 4.0% of respondents (5.1% of females and 2.9% of males; p = 0.07). Age, having children, and educational level were significantly associated with current daily tobacco smoking. This study revealed a high prevalence of tobacco and e-cigarette use among adults in Poland. The presented data underscore the importance of further improvements in adopting a comprehensive tobacco control strategy in Poland.

Evaluation of COVID-19 impact on DELAYing diagnostic-therapeutic pathways of lung cancer patients in Italy (COVID-DELAY study): fewer cases and higher stages from a real-world scenario

IntroductionCOVID-19 has disrupted the global health care system since March 2020. Lung cancer (LC) patients (pts) represent a vulnerable population highly affected by the pandemic. This multicenter Italian study aimed to evaluate whether the COVID-19 outbreak had an impact on access to cancer diagnosis and treatment of LC pts compared with pre-pandemic time.MethodsConsecutive newly diagnosed LC pts referred to 25 Italian Oncology Departments between March and December 2020 were included. Access rate and temporal intervals between date of symptoms onset and diagnostic and therapeutic services were compared with the same period in 2019. Differences between the 2 years were analyzed using the chi-square test for categorical variables and the Mann–Whitney U test for continuous variables.ResultsA slight reduction (−6.9%) in newly diagnosed LC cases was observed in 2020 compared with 2019 (1523 versus 1637, P = 0.09). Newly diagnosed LC pts in 2020 were more likely to be diagnosed with stage IV disease (P < 0.01) and to be current smokers (someone who has smoked more than 100 cigarettes, including hand-rolled cigarettes, cigars, cigarillos, in their lifetime and has smoked in the last 28 days) (P < 0.01). The drop in terms of new diagnoses was greater in the lockdown period (percentage drop −12% versus −3.2%) compared with the other months included. More LC pts were referred to a low/medium volume hospital in 2020 compared with 2019 (P = 0.01). No differences emerged in terms of interval between symptoms onset and radiological diagnosis (P = 0.94), symptoms onset and cytohistological diagnosis (P = 0.92), symptoms onset and treatment start (P = 0.40), and treatment start and first radiological revaluation (P = 0.36).ConclusionsOur study pointed out a reduction of new diagnoses with a shift towards higher stage at diagnosis for LC pts in 2020. Despite this, the measures adopted by Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC pts.

Consumption Demand for Tobacco Products in Thailand: A Case Study of Domestic Cigarettes, Imported Cigarettes and Pipe Tobacco

The three objectives of this research were to identify the influence of the factors affecting the demand for tobacco products, including domestic cigarettes (DC), imported cigarettes (IC), and hand-rolled cigarettes (HRC), and the elasticity of the demand of the three groups of consumers in the adolescent, working age, and elderly age groups; estimate the consumer surplus of each type of cigarette for each age group; and estimate the relationship in the demand model and cigarette price model with a simultaneous equation model (SEM) system by using the three-stage least squares (3SLS) method with time series data from 1989 to 2019. The research results illustrated that the demand factors had different impacts on the number of consumers of each type of cigarette in each age range. The elasticity of demand suggests that domestic cigarettes are luxury goods for adolescents but are normal goods for elderly consumers. In contrast, import cigarettes are luxury goods for working age people and hand-rolled cigarettes are normal goods for elderly consumers. Moreover, domestic cigarettes are a substitution for imported cigarettes for working age consumers and hand-rolled cigarettes customers, while imported cigarettes are a substitution for adolescent domestic cigarette customers, and hand-rolled cigarettes are also a substitution for adolescent domestic cigarette and adolescent imported cigarette customers. Price is the most sensitive factor for working age imported cigarette customers, while elderly hand-rolled cigarette customers comprise the largest customer base for Thailand’s tobacco products. According to the results, the relevant agencies should be very careful in implementing measures to raise tobacco prices.

PREVALENCE OF SMOKING AND ALCOHOL CONSUMPTION AMONG RURAL POPULATION IN RUSSIA

Significance. Tobacco smoking and alcohol consumption are the major public health problem. These causes lead to the increased morbidity rates, excess mortality, decreased healthy life expectancy, lost health, deteriorated heredity and health of children, high health costs associated with prevention, diagnosis, treatment, and rehabilitation. Alcohol consumption and smoking among rural dwellers are important factors hindering effectiveness of programs aimed at demographic, infrastructural and socio-economic development of rural areas. Purpose. To analyze prevalence of bad habits (tobacco smoking and alcohol consumption) among rural dwellers both in dynamics (1994-2019) and by main socio-demographic groups. Material and methods. Results of the Russian Monitoring of Economic Situation and Health of the Higher School of Economics (RLMS-HSE) (1994—2019) served the study information basis. To meet the study purpose, a subsample of rural dwellers residing in settlements with population under 1000 people was developed. The subsample included men and women of five age groups: 1). under 18; 2). 18-25 years; 3). 26-45 years; 4). 46-60 years; and 5). over 60. The total subsample number equalled to 34 833 people, including 15 741 males (45.2%) and 19 942 females (54.8%). The analysis of multivariate distribution of the respondents' answers was carried out using the SPSS 17.0 statistical data processing package. Results. There was a gradual decrease in the share of smokers among rural males from the maximum of 67.4% in 2003 to 47.1% in 2019.The share of smokers among rural females reached its maximum in 2011 (11.9%) with a subsequent decline to 8.7% in 2019, with the share of female somokers increasing 2.8 times during the study period. A smooth upward trend in the share of women smoking in the active childbearing age of 26-45 years was identified (from 4.1% in 1994 to 21.1% in 2019). The average age of the smoking debut decreases with every new generation in both males and females. With age the share of smokers of "quality" tobacco (filtered) decreases with a proportional increase in the share of smokers of "low-quality" tobacco (unfiltered cigarettes, cigarettes, hand-rolled cigarettes). A detailed age-specific analysis of the number of cigarettes smoked shows that the smoking intensity in men decreases with age, while it increases in woman. Gender differences in the dynamics in alcohol consumption were revealed. From 1994 to 2005, a noticeable decrease in the share of alcohol consumers was registered among males (from 69.3% to 59.5%, respectively), while the share of alcohol consumers among females remained almost changed during this perios (42.0%-45.0%). The rise in consumption in 2006 was more pronounced among females (by 26.4%) compared to males (by 21.3%). As a result, the difference between the share of male and female alcohol consumers decreased during the study period (from 27.1% in 1994 to 13.3% in 2019). Increase in the share of alcohol consumers in 1994-2019 equalled to 2.9% in males and 16.7% in females. Among rural males aged 18-25, the share of alcohol consumers decreased by 26.4% in 1994-2019, while among females of the same age it increased by 17.2%. Decreased consumption was observed in the age group of 26-45 years, both among males (from 78.7% in 1994 to 65.1% in 2019) and females (by 4.3% compared to 1994). The trend in alcohol consumption in the 46-60 year group is of the utmost concern: the share of male alcohol consumers decreased from 68.4% to 61.0%, while it increased (by 19.3%) among females, resulting in a lower difference between the level of male and female alcohol consumption (from 38.6% in 1994 to 3.2% in 2019). Among rural dwellers over 60 the situation is similar: men began to drink less (by 13.3%), while women started to drink more (by 10.3%). Conclusion. The study has identified the increased tobacco and achohol consumption among rural females. With a lower tobacco consumption among females compared to males, negative growth trends have been noted in both the share of female smokers in rural areas and intensity of smoking. A trend towards a significant increase in alcohol consumption has been identified in both young females aged 18-25 and women over 45. In 1994-2019, tobacco consumption among rural males of all age groups, especially males under 18 and males aged 18-25 decreased. Alcohol consumption among males also significantly declined, especially in the youth cohort.

Investigating Causal Relationships Between Exposome and Human Longevity: A Mendelian Randomization Analysis

Background: Environmental factors are associated with human longevity, but their specificity and causality remain mostly unclear. By integrating the innovative “exposome” concept developed in the field of environmental epidemiology, this study aims to determine the components of exposome causally linked to longevity using Mendelian randomization (MR) approach. Methods: A total of 4587 environmental exposures extracting from 361,194 individuals from the UK biobank, in exogenous and endogenous domains of exposome were assessed. We examined the relationship between each environmental factor and two longevity outcomes (i.e., surviving to the 90th or 99th percentile age) from various cohorts of European ancestry. Significant results after false discovery rates correction underwent validation using an independent exposure dataset. Findings: Out of all the environmental exposures, seven age-related diseases and pathological conditions were causally associated with lower odds of longevity, including coronary atherosclerosis (odds ratio=0·0012, 95% confidence interval [0·0002, 0·0096], P=2·0×10-10), widely defined ischaemic heart disease (0·0028, [0·0001, 0·066], P=0·0003), Alzheimer’s disease (0·80, [0·72, 0·89], P=3·0×10-5), hypertension (0·17, [0·11, 0·25], P=1·4×10-17), diabetes (0·016, [0·0034, 0·079], P=3·1×10-7), high cholesterol (0·14, [0·058, 0·36], P=3·4×10-5), and venous thromboembolism (0·90, [0·83, 0·98], P=0·004). Five physiological properties and lifestyles were identified to affect longevity. Among them, higher body mass index, greater body fat, and previously smoking hand-rolled cigarettes were adversely associated with longevity. While faster walking pace and higher education attainment were positively associated with longevity. Interpretation: The present study highlights several targets for achieving longevity, including management of cardiometabolic factors, Alzheimer’s disease, venous thromboembolism, smoking, and advancement of physical activity, educational attainment, and overall health. Our results warrant further studies to elucidate the underlying mechanisms of these reported causal associations. Funding Statement: This study was supported by grants from the National Natural Science Foundation of China (91849126), the National Key R&D Program of China (2018YFC1314700), Shanghai Municipal Science and Technology Major Project (No.2018SHZDZX01), ZJLab, Shanghai Center for Brain Science and Brain-Inspired Technology, Tianqiao and Chrissy Chen Institute, and the State Key Laboratory of Neurobiology and Frontiers Center for Brain Science of Ministry of Education, Fudan University. Declaration of Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethics Approval Statement: This study is based on publicly available summarized data. Individual studies within each genomewide association study received approval from a relevant institutional review board, and informed consent was obtained from participants or from a caregiver, legal guardian, or other proxy.

CONTENT ANALYSIS OF CIGARETTE PACKS IN INDONESIA: REGULATORY NON- COMPLIANCE AND PRODUCT PROMOTION ADVANTAGE

Background: A cigarette pack is the most intimate property and frequently seen by smokers every time they want to start smoking. It gives tobacco industry the opportunity to scrutinize every single space including the inside part of the pack to promote tobacco product and it is often called a mini billboard.Objective: To analyze possible violations if any against the existing regulations on packaging and labelling and to uncover packaging design and types of promotional elements on cigarette packs. Methods: A purposive sample based on the assessment and discussion with the representatives of National Agency of Drug and Food Control that generated a total of 42 cigarette packs representing 18 sample from Jakarta, 5 most popular brands, 18 special edition packs, and 1 illegal cigarettes. The observation units, variables and observable signs that covered the materials, size, content of the entire pack including the cigarettes stick were set by Southeast Asia Tobacco Control Alliance and analyzed against the existing regulation.Results: There were two brands produced in 2019 that did not comply with the latest sets of Pictorial Health Warning. About 40.5% of sample (n=17) did not include information on production dates on the pack as mandated by Government Regulation Number 109/2012. The back panels of the top of pictorial health warning in all machine-made cigarettes were partially bunged up by excise tax stamps with exception of hand-rolled clove cigarettes. The tobacco industry took the advantage of the cigarette packs’ violations for product promotion, among others providing information on filter technology, promoting the upcoming tobacco-sponsored events, relating the product with imported goods by mentioning the country of brand origin, and using the flip lid of the pack to promote the brand name reputation. A total of 83.3% (n=35) samples gives additional products description such as bold, mild, lights, super, and special.Conclusion: The tobacco industry uses the ample spaces on both outer and inner panels of cigarette packs to promote their products, no single corners are left empty. The study confirmed violations of the regulation for product promotion.

Disparities in smoking habits in Hungarian Roma and general populations

Abstract Background Smoking status, dependence and cessation efforts of the disadvantaged Hungarian Roma living in segregated settlements were compared to those of the general population. Methods Data were collected through survey. Each study group consists of 500 randomly drawn subjects, and are representative of the adult (18-64) general and Roma population, living in two counties of North-East Hungary. Questions on smoking from the European Health Interview Survey were used with some modifications. Prevalence data were analysed according to age strata (18-29, 30-44 and 45-64 years) by chi2 test, and were compared to data from 2003 and 2014. Results In Roma the proportion of never smokers is much less compared to the general ones (men:27.27% vs.75%, women:38.6% vs.70.75%, p &amp;lt; 0.05). Less Roma reported never smoking in all age compared to 2014, increasing trend can be found in the general population since 2003. Smoking prevalence is higher in Roma in all ages (72.73% vs.20 83%; 68.42% vs.28.42%; 59.02 vs. 32.26%, p &amp;lt; 0.05, respectively). Interestingly, the prevalence of Roma men smokers is decreasing by age, in the general population the trend is the opposite. Heavy smoker status is the highest in 30-44 age group of both populations. Increasing trend of heavy smoking can be detected in the Roma, but the opposite holds for general population compared to 2014. Half of the Roma smoke within 5 minutes after wakeup (50% vs. 36.92%, p &amp;lt; 0.05), smoke hand-rolled cigarettes (68.91%vs 30.77%, p &amp;lt; 0.05), higher proportion of them tried to quit (34.78% vs. 23.38%, p &amp;lt; 0.05) but smaller proportion of them obtained advise on how to quit (48.53% vs.59.09%, p &amp;lt; 0.05). Initiation starts earlier age among them (men: 15.1 vs.16.6, women: 16.2 vs.18.2, p &amp;lt; 0.05). Conclusions Regular smoking (especially heavy) is much higher in the Roma and decreasing by age compared to the general in all age-groups. The 30-44 age group of Roma mean are exclusively heavy smokers but half of the Roma show effort to quit. Key messages Tailoring cessation programs for Roma men especially those belong to 30-44 age group is a priority to reduce tobacco-related adverse effects. Complex public health programmes that taking into account special socio-cultural environment and lower formal education level of the Roma are needed.

The trace of airborne particulate matter from smoking e-cigarette, tobacco heating system, conventional and hand-rolled cigarettes in a residential environment

Indoor particle number concentrations and size distributions were monitored in a typical, residential living room, considering two independent variables: smoking activities (using e-cigarettes, tobacco heating systems (THS), conventional and hand-rolled cigarettes) and the operation of the air conditioning (AC) system. Each smoking device exhibited its own characteristic size distribution (its own “trace”), in the room atmosphere, which was also affected by the AC operation. All devices emitted ultrafine and fine particles especially in the range around 100 nm. The minimum average PM number or mass concentrations in any size were observed for the THS (either with the AC on or off). The PM1 number concentrations were maximum when conventional cigarettes were smoked, especially when the AC was off. In the case of the coarse particles, the PM(1–10) number concentrations were maximum when hand-rolled cigarettes were smoked (and AC was on). When the AC was off, the maximum PM(1–10) number concentration was recorded when the e-cigarette was used. The effect of the AC on particle number concentrations depended on their size and their origin. A factorial ANOVA corroborated that the two independent variables affected significantly (at p < 0.05) the airborne PM number concentrations. Specifically, low versus high air temperature, fan operation or not, affected differently particles in different size ranges and for different smoking activities.

Effectiveness of a new multi-component smoking cessation service package for patients with hypertension and diabetes in northern Thailand: a randomized controlled trial (ESCAPE study)

BackgroundSmoking cessation is an achievable behavioral change, which reduces the risks of cardiovascular diseases, cancers and tobacco-related diseases. There is a need for an effective smoking cessation service for low and middle income country settings where the smoking rate is generally very high whilst a cessation service is not usually accessible. This study devised a new smoking cessation service package and assessed its effectiveness in the primary health care setting of northern Thailand.MethodsThis randomized controlled trial was centered at Maetha district hospital, Lampang province, Thailand, and its network of mobile non-communicable disease clinics at seven primary care units. A total of 319 eligible patients who consented to participate in the study, were randomly allocated to an intervention arm (160) and a control arm (159), applying block randomization. The multi-component intervention service consisted of:regular patient motivation by the same nurse over a 3-month period;a monthly piCO+ Smokerlyzer test for 3 months;continual assistance from a trained family member, using a smoking-cessation- diary; andoptional nicotine replacement chewing gum therapy.The control group received the routine service comprising of brief counseling and casual follow-up. Smoking cessation, confirmed by six months of abstinence and the piCo+ Smokerlyzer breath test, was compared between the two services after a year follow-up.The trial is registered as an international current control trial at the ISRCTN registry. ISRCTN89315117.ResultsThe median age of the participants was 64 years, with females constituting 28.84%. Most of the participants smoke hand-rolled cigarettes (85%). The intervention arm participants achieved a significantly higher smoking cessation rate than the control arm 25.62% vs 11.32%, with an adjusted odd ratio of 2.95 and 95% confidence interval 1.55–5.61.ConclusionIn relation to accessing smoking cessation services within the primary health care setting, participants who received the evidence-based intervention package were about three times more likely to succeed in giving up smoking than those who received the routine service. Utilizing community resources as major intervention components, the evidence from this trial may provide a useful and scalable smoking cessation intervention for low and middle income countries.Trial registrationCurrent controlled trials ISRCTN89315117.WHO international clinical trial identifier number: U1111–1145-6916; 3/2013.