Increased Tobacco Use Research Articles

Smartphones: A Catalyst for Tobacco Control Training in India

The tobacco crisis confronting low- and middle-income countries (LMICs) requires scale-up of effective tobacco control programs, such as Tobacco Free Teachers-Tobacco Free Society (TFT-TFS). We previously demonstrated the efficacy of TFT-TFS in increasing tobacco use cessation among teachers and schools’ adoption of tobacco control policies in Bihar, India. To scale TFT-TFS, we are now pioneering a smartphone-based mobile learning strategy to train principals (or their designees) in Madhya Pradesh to implement and monitor TFT-TFS in schools. Research underscores the transformative potential of mobile learning: a flexible, scalable, and cost-effective alternative to in-person training methods. Our study is a unique opportunity to test a training approach that could have implications for wider and more efficient delivery of other public health programs. The strategic use of gamification and digital storytelling enhances the TFT-TFS mobile training app. Gamification mechanics—including points, leaderboards, and digital badging—foster a dynamic learning environment to enhance learning outcomes. This approach propels continuous participant engagement toward understanding and implementation of TFT-TFS’s six monthly themes and four program components. The TFT-TFS smartphone training program weaves in elements of Indian culture, notably the symbolic use of colors and kites. The Indian kite festival celebrates communal harmony through healthy competition. Similarly, the app employs the idea of school kites, which are divided into six blank segments corresponding to the TFT-TFS monthly themes. Participants navigate each module, engaging with animated videos, digital assessments, and interactive activities. Upon a principal’s successful completion of each monthly theme’s program components, the school’s kite receives a new color, unlocking the subsequent theme. The TFT-TFS smartphone training showcases a unique interactive mobile learning application that integrates gamification and tests how to scale up an effective tobacco control program in schools in India and other LMICs. The TFT-TFS smartphone-based training app may also have relevance to other public health-related training efforts in resource-constrained areas.

Abstract B042: Gender-affirming cessation support for LGBTQ+ tobacco users: Establishing TheQuitAlliance

Abstract Background. The LGBTQ+ community faces various stressors, including stigma, discrimination, and harassment, which are linked to their sexual orientation or gender identity. Additionally, they are targeted by tobacco companies through marketing, which increases tobacco use and other health problems. LGB adults use commercial tobacco products at a higher rate than the general population (25.1% versus 18.8%), and tobacco use is even higher among transgender adults according to the CDC. Without peer support, counseling, nicotine replacement therapy (NRT), and community resources to address barriers to quitting, tobacco users are less likely to succeed in quitting. Research has shown that gender-affirming tobacco cessation interventions can be highly effective in helping LGBTQ+ individuals quit tobacco; however, little is known about its effectiveness in Latinx communities and other groups with intersectional identities. Methods. To improve access to culturally tailored and gender-affirming cessation resources that acknowledge the unique experiences and stressors faced by our community, Cedars-Sinai Cancer COE developed TheQuitAlliance, a LGBTQ+ focused tobacco cessation program. This multi-level approach involved web-based resources, information and presentation to the community. A series of gender affirming support groups facilitated by trained Spanish speaking tobacco cessation specialists who are members of the LGBTQ+ community was offered to tobacco users. The first steps involved improving their knowledge on how tobacco affects specific populations, such as transgender, non-binary, gender non-conforming individuals, people living with HIV, youth, and the types of nicotine replacement therapies available. RESULTS: In 2023, our partners The Wall Las Memorias and Latino Equality Alliance implemented a screening tool using the Ask, Advise, and Refer model, expanded outreach efforts, and successfully identified N=242 LGBTQ+ tobacco users who were referred to our virtual gender affirming support group. Among current smokers who participated in a series of three support groups, 85% (17 of 20) indicated positive attitudes towards the importance of changing their smoking behaviors, readiness to change, and having control over their ability to make positive change right now, while 90% are committed to taking steps towards change right now (18 of 20). In 2024, The Wall Las Memorias reached 500 LGBTQ+ community members and linked 70 tobacco users to cessation support groups. Conclusion. Our survey indicated that participating in a gender affirming cessation intervention can increase self-efficacy to take steps towards quitting tobacco. Through safe spaces created by The Quit Alliance, we found that LGBTQ+ tobacco users are also able to make connections with others to be supported in their journey to becoming tobacco free. Citation Format: Victor Crisanto, Alexandra Caro, Reener Balingit, Zul Surani. Gender-affirming cessation support for LGBTQ+ tobacco users: Establishing TheQuitAlliance [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B042.

Rural-urban differences in smoking quit ratios and cessation-related factors: Results from a nationally representative sample.

There are significant rural/urban disparities that exist in cancer and chronic disease morbidity and mortality, many of which are attributed to increased tobacco use prevalence in rural populations compared to urban. Understanding differences in rural and urban tobacco use patterns is key to developing targeted interventions. Using nationally representative data from Wave 5 of the Population Assessment of Tobacco Use and Health (PATH), we examined weighted frequencies and conducted multivariable logistic regression to examine the use of cessation supports in people who currently smoke with a quit attempt in the last 12months (recent attempters) by rural and urban status and geographic region. Our second objective was to examine lifetime quitting in rural versus urban people who smoke and by geographic region. Rural people who recently attempted to quit were less likely to use any FDA-approved cessation aids, less likely to use Nicoctine Replacement Therapy (NRT), and less likely to be exposed to a home smoking ban in the adjusted analysis. The adjusted odds of quitting were lower in the rural Northeast, Midwest, and South compared to the urban regions. Findings from this data can serve to inform the development of targeted interventions for rural communities.

Use of tobacco during COVID-19: A qualitative study among medically underserved individuals.

The COVID-19 pandemic produced stress for people around the world. The perception that tobacco can be a coping tool for stress relief suggests that the conditions during the COVID-19 pandemic can provide insight into the relationship between stress and tobacco use patterns, particularly among those most at risk for severe COVID-19 disease. The goal was to identify the impacts of the COVID-19 pandemic on tobacco use and preparedness for smoking cessation among individuals who smoke and are older and medically underserved. We conducted in-depth interviews with 39 patients to learn about individuals' smoking behavior during the COVID-19 pandemic. We used a modified grounded theory approach to code and analyze all qualitative data. We conducted thematic analysis to identify key factors associated with smoking behaviors during COVID-19. Our results indicated that increases in perceived stress and social isolation may have been associated with increased tobacco use during the COVID-19 pandemic. Pandemic-related social isolation contributed to increases in smoking, despite respondents being concerned about the severity of COVID-19. While many respondents felt that smoking relieved their stress from the pandemic, they appeared unaware of the stress-inducing properties of tobacco use. Our findings indicate that pandemic-related stress impacted smoking behavior among older, medically underserved smokers. Results may assist clinicians in addressing the role of tobacco use in response to highly stressful events. Smoking cessation strategies should consider the implications of stress on smoking behavior, including smoking relapse in response to highly stressful events-particularly for medically underserved populations.

Impact of Heating Conventional Cigarettes with a Novel Device on Health-related Biomarkers and Cigarette Use Patterns among Chinese Adult Smokers Unwilling to Quit: A Pilot Randomized Controlled Trial.

We evaluated the impact of heating conventional cigarettes with a novel heated tobacco product (HTP) device on biomarkers and cigarette use patterns in Chinese adult smokers unwilling to quit smoking. In this pilot randomized controlled trial, 50 eligible participants were allocated to either Control group (smoking conventional cigarettes) or HTP device group (switching to using heated conventional cigarettes by the HTP device). Participants in the HTP device group went through a 2-day run-in period then used heated conventional cigarettes exclusively for 5 days, followed by flexible use for 14 days. Five biomarkers of exposure (BoEs) were measured at baseline and on Day 7. Thirteen biomarkers of biological effect (BoBEs) were measured at baseline and on Day 21. Safety, daily cigarette consumption, craving, withdrawal symptoms, and device acceptability, were assessed. BoE levels decreased by 26.4 % to 71.4% from baseline in the HTP device group, while BoBE levels did not significantly change in either group. In the HTP group, 56% exclusively used heated conventional cigarettes during the flexible use period, experiencing reduced cravings and withdrawal symptoms, while dual users consumed more cigarettes. Mild to moderate device-related reactions were reported in 36% of users. Satisfaction, taste, and harm reduction belief scores averaged 7.4, 6.6, and 8.7 (out of 10), respectively. Switching to heated cigarettes with the HTP device may reduce short-term exposure to smoke toxicants. However, it can lead to increased tobacco use among dual users. Further investigation is needed to confirm these preliminary findings. This study is the first to evaluate the impact of heating conventional cigarettes with a novel heated tobacco product (HTP) device on health-related biomarkers and cigarette use patterns among Chinese adult smokers. This novel HTP device can directly heat conventional cigarettes without the necessity for specifically designed tobacco products, avoiding potential additive risks of traditional HTPs. If the results of this study could be further verified by randomized controlled clinical trials with larger sample sizes, this novel HTP device could serve as a short-term harm reduction alternative for smokers unwilling to quit.

Changes in Smoking Behavior in the COVID-19 Pandemic: A Single Center Study in Family Practice

Objective: There are controversial studies on smoking addiction in the COVID-19 pandemic. While some studies show increased tobacco use during the pandemic, others report increased smoking cessation attempts. This study examined changes in tobacco use and quit intentions during the COVID-19 pandemic compared to pre-pandemic. Methods: A cross-sectional study was designed and three groups were formed by including patients over 18 years of age, who were smokers, and who presented to the Education Family Health Center and had RT-PCR test results for COVID-19. Among these patients, patients with COVID-19 symptoms and complaints and positive RT-PCR test results constituted the COVID-19 positive group, patients who were COVID-19 negative but isolated due to their contacts constituted the contact group, and healthy people without any COVID-19 contact and symptoms constituted the healthy group. Demographic characteristics, smoking status before the COVID-19 pandemic, change in smoking status after COVID-19 test result or contact, and Fagerström nicotine dependence test results were compared. Results: Of the total 131 participants enrolled in the study, 70 were in the healthy group, 31 were in the COVID-19 negative group, and 30 were in the COVID-19 positive group. Men were predominant in three groups (60%, 83.9%, and 73.3% in normal, COVID-19-neg, and COVID-19-positive groups, respectively) with a small significant difference (p=0.048). The mean ages were 41.09±12.85, 38.21±11.69, and 39.47±11.66 years in the healthy, COVID-19 negative, and COVID-19 positive groups, respectively, with no significant difference (p>0.05). Fagerström dependence scores were 1.82±1.05, 1.53±0.86, and 1.40±0.72 in the healthy, COVID-19 negative, and COVID-19 positive groups, respectively, and were not statistically different (p>0.05). Smoking prevalence decreased by 1.13 (±4.17) cigarettes per day in the healthy group, by 3.97 (±5.31) cigarettes in the COVID negative group, and by 10.14 (±7.86) cigarettes in the COVID positive group, with a statistically significant decrease in smoking prevalence in all three groups (p

Abstract 2152: Evaluating beliefs and perceived competence about tobacco cancer prevention practices in Texas local mental health authorities

Abstract Tobacco use is causally associated with 18 cancers and is a leading cause of preventable death. Individuals experiencing mental illness use tobacco at an elevated rate and consequently suffer from greater cancer-related morbidity and mortality. Unfortunately, local mental health authorities (LMHAs), a common setting to receive mental health services, do not prioritize tobacco dependence treatment despite robust evidence that tobacco cessation can enhance mental health in addition to reducing cancer incidence. Beliefs (Health Belief Model) and competence (Self Determination Theory) both play an integral role in shaping behavior. Consequently, this study examined employee and provider tobacco-related beliefs and competence in LMHAs to contextualize their tobacco intervention practices. The frequency of beliefs and competence related to provision of evidence-based tobacco cessation care was collected by e-survey from organizational representatives of 30 of the 39 LMHAs in Texas in 2021. Queries included if respondents agreed that patients should concurrently quit drugs/alcohol and tobacco (N=30 employees) and if they believed patients want to quit cigarette and non-cigarette (i.e., other) tobacco products (n=16 direct service providers). Providers were also asked if they thought that they had the competence to help patients quit smoking and other tobacco use, if they could tailor cessation treatment to patient needs, and about their intervention practices. Only 40% of LMHA representatives endorsed that patients should quit tobacco at the same time as other drugs. Furthermore, only 50% of providers believed that patients want to quit smoking and other tobacco use, respectively. About 70% of providers believed that they have the skills to help patients quit smoking and other tobacco use, respectively, but only 56% reported that they can tailor treatment. Finally, only 56% and 38% of providers recommend that patients stop smoking or other tobacco use, respectively, with 25% recommending smokers switch to vapes or smokeless tobacco products. Contrary to LMHA employee and provider beliefs, research indicates that most patients want to quit tobacco use and that concurrent tobacco use treatment can enhance patient sobriety for non-nicotine substance use disorders. Results demonstrate high levels of misinformation on concurrent tobacco and substance use treatment in LMHAs, which can subvert the provision of evidence-based cessation care. Educational interventions are needed to shift these beliefs, increase competence, and increase tobacco use intervention provision. This will not only help to address cancer disparities among patients but also improve mental health- a critical goal of LMHAs. Future research should investigate how to target tobacco-related beliefs, competence, and intervention behavior in LMHAs to broaden the reach of cancer prevention strategies. Citation Format: Ammar D. Siddiqi, Maggie Britton, Tzuan A. Chen, Isabel Martinez Leal, Anastasia Rogova, Midhat Z. Jafry, Bryce Kyburz, Teresa Williams, Lorraine R. Reitzel. Evaluating beliefs and perceived competence about tobacco cancer prevention practices in Texas local mental health authorities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2152.

Interpersonal ethnic-racial discrimination and tobacco products: The moderating role of critical action.

The present study aimed to understand the role of critical action, sociopolitical participation, an essential form of consciousness in the relationship between interpersonal discrimination and the use of tobacco products. The present study was part of a more extensive longitudinal study on students' genetic and environmental experiences. To examine these associations, 164 racially minoritized college students (Mage = 19.86, SD = 0.28) were surveyed for this study. Findings indicated that the relation between interpersonal ethnic-racial discrimination (IERD) and tobacco products was moderated by critical action. Specifically, IERD was associated with greater use of tobacco products when students had low critical consciousness-critical action. The relation between IERD and the use of tobacco products became nonsignificant when students had high critical action. Critical action was protective in mitigating increased tobacco use in the context of discrimination experiences. Research, clinical, and policy implications are discussed in efforts to reduce tobacco-related disparities among racially minoritized college students. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

An expenditure analysis revealing how Philip Morris advertisements coincide with tobacco policymaking in Switzerland.

Prior research has linked media tobacco promotion to increased tobacco use and favorable perceptions of tobacco products. Switzerland's tobacco lobby employs advertisements to sway policy decisions in its favor, yet no recent research has assessed this in detail. Our study aims to provide detailed estimates of tobacco industry (TI) advertisement costs, focusing on Philip Morris International (PMI) in Switzerland, and examine potential chronological links between TI advertisement campaigns and parliamentary discussions on tobacco bills. By spreading knowledge on this issue, we aim to support the development of future tobacco advertisement regulations. We conducted an expenditure analysis of tobacco-related press advertisements in Swiss print media published between August 2020 and August 2021, accessed through the media intelligence firm Argus Data Insights. Advertisement costs were estimated using publicly available data. We plotted expenditure sums of PMI against key parliamentary session dates featuring discussions on proposed tobacco control measures, such as tighter restrictions on advertising. Over 12 months, 501 advertisements with tobacco-specific headlines were published in Swiss press media. Of these, 437 advertisements (87.22%) were linked to PMI. PMI accounted for 88.21% (CHF 6486969) of total advertisement expenditure. Notably, PMI advertisements coincided with key political sessions discussing tobacco legislation in parliament, with a limited presence outside these periods. PMI advertisements were published parallel to key moments of parliamentary discussions, suggesting an attempt by TI to potentially influence discussions. Applying such an advertisement monitoring methodology helps understand the contextual conditions of public health in Switzerland. By analyzing TI advertisements in print media, we sought to highlight regulatory gaps and support the creation of stricter advertising regulations. We recommend continuing such research to strengthen tobacco control policymaking. Key public health efforts should include raising awareness of TI tactics, implementing a comprehensive ban on tobacco advertising, and strategically engaging with the media in tobacco control campaigns.

Tobacco, Alcohol, Illegal Drug and Substance Use, Sociodemographic Variables and Psychological Distress Symptoms in Individuals Aged 50-65

Aim: The aim of the study is to evaluate the relationship between tobacco, alcohol, illegal drug and substance use, demographic variables and symptoms of psychological distress in individuals aged 50-65 living in the city center of XXXXXXX, and to create a risk profile based on these variables. Materials and Methods: The data of the study were collected through survey forms. Participants filled out the sociodemographic-clinical data form, Fagerström Nicotine Dependency Test (FNDT), Symptom Checklist 90-Revised (SCL90-R). Results: Three hundred twelve participants, 154 women and 158 men, were included in the study. 43.3% of the participants were smoking, 10.3% were using alcohol, and 3.8% were using illegal drugs and substances. The SCL90-R subscale scores and overall symptom severity were significantly higher in smokers and alcohol users compared to non-users, except for somatization. Moderate significant positive correlations were found between the FNDT scale score and the SCL90-R scale scores. It was found that male gender increased tobacco use by approximately 10.7 times (OR:10.7, 95% CI [5,721, 20,113]), a one-unit increase in paranoia increased it by 3.4 times (OR:3.4, 95% CI [2,373, 4,963]), while a one-unit increase in age decreased it by 0.9 times (OR:0.9, 95% CI [0,900, 0,976]). Conclusion: It has been observed that tobacco and alcohol use in early old age is closely related to symptoms of psychological distress.It can be said that preventive interventions for the psychological health of the community may be important in combating tobacco and alcohol use.

Cannabis cravings predict cigarette use in schizophrenia: a secondary analysis from two cannabis abstinence studies

ABSTRACT Background: People with schizophrenia have high rates of cannabis use disorder (CUD) as well as co-use of tobacco. Tobacco may be used to alleviate cannabis cravings. Objectives: We conducted a secondary analysis of 7 and 28 days of cannabis abstinence from two datasets of participants with CUD with and without schizophrenia to assess cannabis craving, cannabis use in grams per day (GPD) and cigarettes per day (CPD). Methods: We recruited 49 participants (schizophrenia n = 29; control n = 20; 2% female) with CUD. All participants received weekly behavioral support sessions to assist with cannabis abstinence/reduction. GPD and CPD were assessed with the 7-day Timeline Follow-back; the Marijuana Craving Questionnaire (MCQ) assessed compulsivity, emotionality, expectancy and purposefulness subscales. Effects of GPD and MCQ subscales on CPD at days 7 and 28 were assessed with analysis of covariance. Results: At day seven, participants with schizophrenia scored higher on compulsivity (t = 2.72, df = 46.8, p < .01), emotionality (t = 2.48, df = 45.2, p = .02), and purposefulness (t = 2.32, df = 39.41, p = .02) craving subscales than control participants. There was a significant interaction between high purposefulness craving and low GPD on high CPD at day seven (F1,23 = 4.76, p = .039) and day 28 (F1,13 = 7.02 p = .02) in schizophrenia participants but not control participants. Conclusion: We found preliminary evidence that due to cannabis craving intensity, people with schizophrenia and CUD may use more cigarettes when reducing cannabis use, as compared to CUD participants without schizophrenia. Strategies to manage cannabis craving and avoid increasing tobacco use will be useful to implement in intervention strategies. Clinical Trial Name Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on Cannabis Use and Cognitive Outcomes in Schizophrenia URL: www.clinicaltrials.gov; Registration Number: NCT03189810;

Tobacco and Illicit Drug Use and Drug Use Disorders Among Employees of Businesses Affected by the 9/11 Attacks on the World Trade Center in New York City

Objective To study the New York City area population after the September 11, 2001, 9/11 attacks, focusing on tobacco and drug use and drug use disorders. An abundance of research has identified the important mental health sequelae stemming from exposure to disasters, especially vulnerability to the development of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). There also is a body of literature on the association of disaster exposure with alcohol use/misuse, but far less research on tobacco and other drug use/disorders. Methods A terrorism-affected sample (N = 379) was assessed nearly 3 years after the attacks using structured diagnostic interviews, providing predisaster and postdisaster prevalence and incidence of tobacco and drug use, changes in tobacco and drug use, and predisaster and postdisaster prevalence and incidence of drug use disorders in relation to the 9/11 attacks. DSM-IV criteria were fully assessed using structured diagnostic interviews for psychiatric disorders including PTSD, MDD, panic disorder, generalized anxiety disorder, and alcohol and drug use disorders. Results Tobacco use did not increase significantly, and no predictors of increased tobacco use could be found for any subgroups, including disaster trauma exposures. Drug use (largely cannabis) increased initially but decreased by 3 years after the attacks. Drug use disorders, which were associated with other psychiatric disorders, were rare and primarily began prior to 9/11. Conclusions The overall lack of increase of tobacco use or predictors of increased use found after the disaster and the low rates of new drug use disorders suggest that universal screening for increased tobacco use and new drug use disorders by clinicians may have very low yield. Regardless, postdisaster settings provide suitable circumstances for general discussions about self-care including concern for increased tobacco use, avoiding drug use, and guidance on healthier means of managing stress than through substances. Additionally, because existing tobacco and drug use are endemic in populations, the postdisaster setting can serve as a reminder for clinicians to assess these problems generally and provide appropriate referrals when needed. Postdisaster circumstances offer opportunities to disseminate and promote public health messages and address issues of substance use and misuse.

Exploring the influence of behavioral factors on depression and anxiety scores during the COVID-19 pandemic: insights from the Virginia statewide COVIDsmart longitudinal study

BackgroundAmidst the COVID-19 pandemic, there has been growing concern about the declining mental health and healthy behaviors compared to pre-pandemic levels. Despite this, there is a lack of longitudinal studies that have examined the relationship between health behaviors and mental health during the pandemic. In response, the statewide COVIDsmart longitudinal study was launched. The study’s main objective is to better understand the effects of the pandemic on mental health. Findings may provide a foundation for the identification of public health strategies to mitigate future negative impacts of the pandemic.MethodsFollowing online recruitment in spring of 2021, adults, ages 18 to 87, filled out social, mental, economic, occupational, and physical health questionnaires on the digital COVIDsmart platform at baseline and through six monthly follow-ups. Changes in the participant’s four health behaviors (e.g., tobacco and alcohol consumption, physical activity, and social media use), along with sex, age, loneliness score, and reported social and economic (SE) hardships, were analyzed for within-between group associations with depression and anxiety scores using Mixed Models Repeated Measures.ResultsIn this study, of the 669 individuals who reported, the within-between group analysis indicated that younger adults (F = 23.81, p < 0.0001), loneliness (F = 234.60, p < 0.0001), SE hardships (F = 31.25, p < 0.0001), increased tobacco use (F = 3.05, p = 0.036), decreased physical activity (F = 6.88, p = 0.0002), and both positive and negative changes in social media use (F = 7.22, p = 0.0001) were significantly associated with worse depression scores. Additionally, females (F = 6.01, p = 0.015), younger adults (F = 32.30, p < 0.0001), loneliness (F = 154.59, p < 0.0001), SE hardships (F = 22.13, p < 0.0001), increased tobacco use (F = 4.87, p = 0.004), and both positive and negative changes in social media use (F = 3.51, p = 0.016) were significantly associated with worse anxiety scores. However, no significant changes were observed in the within-between group measurements of depression and anxiety scores over time (p > 0.05). Physical activity was not associated with anxiety nor was alcohol consumption with both depression and anxiety (p > 0.05).ConclusionsThis study demonstrates the longitudinal changes in behaviors within the context of the COVID-19 pandemic. These findings may facilitate the design of preventative population-based health approaches during the COVID-19 pandemic or future pandemics.

The Triple "S" Impact of COVID-19: Nationwide Evidence of the Impact of the Stress Associated With Restrictive Measures on Substance Use, Sleep, and Social Connectedness in Qatar.

Countries worldwide implemented social and movement restrictions to contain the spread of coronavirus disease 2019 (COVID-19). Unfortunately, such restrictions have adversely impacted people's lifestyles. The goal of this study was to assess the impact of COVID-19-related restrictive measures on substance use, sleep, and social connectedness in Qatar's population. A web-based survey was conducted between January 2021 and February 2021 targeting adults ≥18 years of age who were residing in Qatar between March and August 2020. A total of 1408 participants completed the survey. Of tobacco users in our sample, 36% reported increased tobacco use since the start of home confinement, while 41.6% of alcohol users reported decreased alcohol use. Concerning sleep, 46.1% reported an increase in average sleep duration per day (0.77h mean increase, 95% CI: 0.66-0.88, P<0.001), and a third of participants reported poorer sleep quality. Of the participants, 39.6% felt socially disconnected. Perceived stress was found to be an independent predictor for increased use of tobacco, deterioration in sleep quality, and increased sleep duration during home confinement. Restrictive measures related to COVID-19 resulted in both positive and negative impacts on the lifestyle of Qatar's population. Emphasis should be placed on encouraging people to adopt healthy strategies for coping with various stressors that arise during future home confinement measures. It is also necessary to address the persistence of adverse consequences in the postpandemic era.

Persistence of anxiety among Asian Americans: racial and ethnic heterogeneity in the longitudinal trends in mental well-being during the COVID-19 pandemic.

To examine within-individual time trends in mental well-being and factors influencing heterogeneity of these trends. Longitudinal telephone survey of adults over 3 waves from the New York City (NYC) Metropolitan area during the COVID-19 Pandemic. Participants reported depression using the Patient Health Questionnaire (PHQ)-8, anxiety using the Generalized Anxiety Disorder (GAD)-7, and past 30-day increases in tobacco or alcohol use at each wave. Adjusted mixed effects logistic regression models assessed time trends in mental well-being. There were 1227 respondents. Over 3 study waves, there were statistically significant decreasing time trends in the odds of each outcome (adjusted OR (95% CI) 0.47 (0.37, 0.60); p < 0.001 for depression; aOR (95% CI) 0.55 (0.45, 0.66); p < 0.001 for anxiety; aOR (95% CI) 0.50 (0.35, 0.71); p < 0.001 for past 30-day increased tobacco use; aOR (95% CI) 0.31 (0.24, 0.40); p < 0.001 for past 30-day increased alcohol use). Time trends for anxiety varied by race and ethnicity (p value for interaction = 0.05, 4 df); anxiety declined over time among white, Black, Hispanic, and Other race and ethnicity but not among Asian participants. In a demographically varied population from the NYC Metropolitan area, depression, anxiety and increased substance use were common during the first months of the pandemic, but decreased over the following year. While this was consistently the case across most demographic groups, the odds of anxiety among Asian participants did not decrease over time.

Influence of Neighborhood Socioeconomic Status on Adverse Outcomes in Pregnancy.

To evaluate whether ZIP-code level neighborhood socioeconomic status (SES) is associated with adverse pregnancy outcomes. A retrospective study of 2009-2014 Oregon Health and Science University (OHSU) births with maternal ZIP codes in one of 89 Portland metropolitan area ZIP codes. Deliveries with ZIP codes outside of the Portland metro area were excluded. Deliveries were stratified by SES based on ZIP code median household income: low (below 10th percentile), medium (11th-89th percentile), and high (above 90th percentile). Univariate analysis and multivariable logistic regression with medium SES as the reference group evaluated perinatal outcomes and strength of association between SES and adverse events. This study included 8118 deliveries with 1654 (20%) classified as low SES, 5856 (72%) medium SES, and 608 (8%) high SES. The low SES group was more likely to be younger, have a higher maternal BMI, have increased tobacco use, identify as Hispanic or Black, and less likely to have private insurance. Low SES was associated with a significantly increased risk of preeclampsia (RR 1.23 95% CI 1.01-1.49), but this was no longer significant after adjusting for confounders (aRR 1.23 95% CI .971-1.55). High SES was negatively associated with gestational diabetes mellitus (GDM), even after adjusting for confounders (aRR 0.710, 95% CI 0.507-0.995). In the Portland metropolitan area, high SES was associated with a lower risk of GDM. Low SES was associated with a higher risk of preeclampsia before accounting for covariates. ZIP code-based risk assessment may be a useful indicator in detecting healthcare disparities.

The Optimizing Lung Screening Trial (WF-20817CD): Multicenter Randomized Effectiveness Implementation Trial to Increase Tobacco Use Cessation for Individuals Undergoing Lung Screening

One-half of all people who undergo lung cancer screening (LCS) currently use tobacco. However, few published studies have explored how to implement effective tobacco use treatment optimally during the LCS encounter. Was the Optimizing Lung Screening intervention (OaSiS) effective at reducing tobacco use among patients undergoing LCS in community-based radiology facilities? The OaSiS study (National Cancer Institute [NCI] Protocol No.: WF-20817CD) is an effectiveness-implementation hybrid type II cluster randomized trial of radiology facilities conducted in partnership with the Wake Forest National Cancer Institute Community Oncology Research Program research base. We randomly assigned 26 radiology facilities in 20 states to the intervention or usual care group. Staff at intervention facilities implemented a variety of strategies targeting the clinic and care team. Eligible patient participants were aged 55 to 77 years undergoing LCS and currently using tobacco. Of 1,094 who completed a baseline survey (523 intervention group, 471 control group) immediately before the LCS appointment, 956 completed the 6-month follow-up (86%retention rate). Fifty-four percent of those who reported not using tobacco at 6months completed biochemical verification via mailed cotinine assay. Generalized estimating equation marginal models were used in an intention-to-treat analysis to predict 7-day tobacco use abstinence. The average self-reported abstinence among participants varied considerably across facilities (0%-27%). Despite a significant increase in average cessation rate over time (0%at baseline to approximately 13%at 6months; P< .0001), tobacco use did not differ by trial group at 14days (OR, 0.96; 95%CI, 0.46-1.99; P= .90), 3months (OR, 1.17; 95%CI, 0.69-1.99; P= .56), or 6months (OR, 0.97; 95%CI, 0.65-1.43; P= .87). The OaSiS trial participants showed a significant reduction in tobacco use over time, but no difference by trial arm was found. ClinicalTrials.gov; No.: NCT03291587; URL: www. gov.

Co-Use, Simultaneous Use, and Mixing of Cannabis and Tobacco: A Cross-National Comparison of Canada and the US by Cannabis Administration Type.

Increasing cannabis legalization raises concerns that the use of tobacco, frequently used with cannabis, will also increase. This study investigated the association between the legal status of cannabis in places of residence and the prevalence of cannabis and tobacco co-use, simultaneous use, and mixing by comparing the prevalence among adults in Canada (prior to cannabis legalization) vs. adults in US states that had legalized recreational cannabis vs. US states that had not as of September 2018. Data were drawn from the 2018 International Cannabis Policy Study, conducted with respondents aged 16-65 in Canada and the US recruited from nonprobability consumer panels. Differences in the prevalence of co-use, simultaneous use, and mixing between tobacco and different cannabis products were examined using logistic regression models by legal status of place of residence among past-12-month cannabis consumers (N = 6744). Co-use and simultaneous use in the past 12 months were most common among respondents in US legal states. Among cannabis consumers, co-use and simultaneous use were less common in US legal states, while mixing was less frequent in US states with both legal and illegal cannabis compared to Canada. Use of edibles was associated with lower odds of all three outcomes, while smoking dried herb or hash was associated with higher odds. The proportion of cannabis consumers who used tobacco was lower in legal jurisdictions despite higher prevalence of cannabis use. Edible use was inversely associated with co-use, suggesting that edible use does not appear to be associated with increased tobacco use.

Changes in mental health symptoms from April (COVID-19 outbreak) to December 2020 in Norway: A two-wave study

The main objective of the study was to investigate changes in mental health symptoms from the start of the pandemic in Norway (April) to December 2020. A total of 6017 participants completed an assessment of the survey at both time points. Main Outcome Measures: Symptoms of anxiety and depression were measured at both time points. Demographic variables and potential risk factors were assessed. There were significant changes (slight increase) in anxiety and depression, but effect sizes were small. Increases in symptoms in anxiety and depression occurred more in the general population than for people with pre-existing mental health problems. Baseline level of symptoms was the most important risk factor. Other significant risk factors included female sex, students, pre-existing mental health problems, increased tobacco use, lost job, and lacking government trust. The longitudinal results replicated findings from the first phase of the pandemic, suggesting that the number of risk factors experienced is associated with symptom severity. The results suggest that mental health symptoms have been quite stable from April to December but with a slight increase among people presenting with subclinical symptoms in April. The study obtained ethical approval from the Regional Committee for Medical and Health Research (REK Nord, 123,324).

Early trajectories of cigarette and ENDS use among young adult recent Latino immigrants to U.S.

Background: Recent Latino immigrants (RLIs) to the U.S. have shown high smoking rates during their first year since arrival, raising concern about future escalation of tobacco use. Objective: To examine trajectories of cigarette and Electronic nicotine delivery systems (ENDS) use among RLIs from pre-immigration (T0) through their first (T1) and second (T2) year in the U.S. Methods: Data originated from a longitudinal study of 540 (50% females) RLIs aged 18-34. Inclusion criteria was residing in Miami/Dade County (MDC), and having immigrated from a Latin American country within the past year. Trajectories were identified by using the Proc Traj procedure (SAS©, v 9.4). Results: Rates of cigarette use per month declined from 11.8 days/month in T0 to 4.9 d/m in T2. Rates for ENDS use however, increased from T0 (1.1 d/m) to T1 (1.8 d/m) and then lowered back to 0.9 d/m in T2. Four separate cigarette and e-cigarette use trajectories were identified. Only one of them showed increase in cigarette (10.6% of RLIs), and ENDS use (4.5% of RLIs). Being male, and not completing high school were significant factors in explaining smoking trajectories. Being younger than 30 years old was largely associated with ENDS use. No evidence of a substitution effect between cigarette and ENDS use was found. Discussion/Conclusions: Interventions to discourage tobacco use among Latino immigrants should begin early in the immigration process, aimed to preserve initial reductions and dissuade those at risk of increased tobacco use overtime.