Levels Of Tobacco Use Research Articles

Recent evidence on rates and factors influencing smoking behaviours after release from smoke-free prisons: a scoping review.

Smoke-free prison policies have been introduced in some countries, in part to address very high levels of tobacco use in people in prison. However, relapse rates post-release remain high. This papers aims to improve understanding of post-release smoking and/or vaping behaviour is necessary to inform support for a priority population. The authors searched health, social science and criminal justice databases for studies about smoking/vaping behaviours among people released from smoke-free prisons. Studies were included if they reported primary data and were published between January 2017 and March 2024 in English; the population was adults/young people (16 yr+) imprisoned or formerly imprisoned, in prisons with comprehensive smoke-free policies; and at least one of the following was reported: pre-release intention to smoke, vape or remain abstinent post-release; smoking/vaping behaviour post-release and factors influencing smoking/vaping behaviour; attempts to quit again following post-release smoking/vaping relapse. Nine studies met our criteria. The evidence base is small and mainly from the USA or Australia. Evidence continues to suggest that most people resume smoking after leaving a smoke-free prison. No new interventions have been successful in reducing relapse rates. No studies report on vaping post-release, although two studies report on perceived factors affecting smoking relapse post-release from prisons allowing vaping. Given very high rates of relapse, there remains a significant need to better understand what approaches are feasible and acceptable for reducing return to smoking post-release. This review updates the limited evidence on smoking behaviours after leaving a smoke-free prison.

PS-P08-7: HYPERTENSION AND ITS CORRELATES AMONG PREGNANT WOMEN CONSUMING TOBACCO IN INDIA: FINDINGS FROM THE NATIONAL FAMILY HEALTH SURVEY-4

Background: Hypertension or high blood pressure during pregnancy has significant implications on maternal and perinatal morbidity and mortality. Tobacco use amplifies this burden and increases the risk of hypertensive disorders along with adverse birth outcomes. The current study aimed to evaluate the joint risk at the population level of tobacco use and hypertension among pregnant women in India. Methodology: Data of 32428 currently pregnant women aged 15 to 49 years were obtained from the National Family Health Survey NFHS4 to estimate bivariate i.e. tobacco user vs non-user and binomial logistic regression analysis in order to get odds ratios of having hypertension. The analysis included sociodemographic variables such as the respondents age, type of residence, wealth index, and education status. Results: The prevalence of hypertension among pregnant tobacco users 7.5% was significantly higher than that of non-users 6.1%. The odds of having hypertension were 1.17 95% CI 1.02 to 1.35 times among tobacco users than non-users and increased with age p less than 0.001 and in rural areas p 0.02. However, it varied inversely with education status p more than 0.05; NS and wealth quintile p 0.01. Conclusion: The present study identifies the higher co-existence of hypertension among tobacco-using pregnant women and highlights the need for tobacco control/cessation and hypertension prevention and management during pregnancy considering socio-demographic disparities.

Prevalence of Job Stress and Drug Use in Nurses Working in Teaching Hospitals in Bandar Abbas

Background: Stress, as the most common issue in human life, has become one of the characteristics of modern life. Nurses, due to the challenging nature of their profession, are constantly exposed to stress. According to studies, job stress is related to smoking. This study aimed to investigate the prevalence of drug use and its relationship with job stress in nurses in Bandar Abbas. Materials and Methods: This study was a descriptive-analytical survey. The statistical population included all nurses working in hospitals affiliated to Hormozgan University of Medical Sciences in 2018 with a sample size of 488 people. Data collection tools included a demographic characteristics questionnaire, the active and inactive drug use questionnaire, and the Osipow Job Stress questionnaire. SPSS version 19.0 was used for data analysis. Results: The mean score of job stress was 179.16±31.55 in men and 177.44±24.39 in women. According to the Mann-Whitney test, there was a significant difference between the levels of tobacco use and levels of marriage in terms of stress scores (P=0.001). There was a significant inverse correlation between age and stress (P=0.001). Conclusion: The results of the present study showed that nurses, due to their stressful job, can be constantly exposed to high-risk behaviors to address these stresses and conflicts; therefore, policymakers should develop well-written programs to address these pressures.

Relationship between tobacco use, alcohol consumption and non-communicable diseases among women in India: evidence from National Family Health Survey-2015-16

BackgroundBased on an increased prevalence of diabetes, asthma and hypertension among women in reproductive age, understanding the risk factors of non-communicable diseases (NCDs) is crucial to inform policy and program interventions to address the problem. In this study, we empirically assessed the associations of behavioural factors such as alcohol consumption and tobacco use and a variety of socioeconomic characteristics with prevalence of NCDs in adult women.MethodsThe data were derived from the National Family Health Survey conducted in 2015–16. The effective sample size for the present paper was 699,686 women aged 15–49 years in India. Descriptive statistics along with bivariate analysis were conducted to find the preliminary results. Additionally, multivariable logistic regression analysis was conducted to find the relationship between NCDs and behavioural factors such as alcohol consumption and tobacco use. Moreover, population attributable risk was estimated in the present study.ResultsIt was revealed that 15.9% of women had any of the NCDs. A proportion of 0.8% of women smoked tobacco whereas 5.5% of women consumed smokeless tobacco. Also, a proportion of 1.2% of women consumed alcohol in the current study. The odds of having NCDs among women who smoked tobacco, consumed smokeless tobacco and consume alcohol were 16, 8 and 20% significantly higher than the odds of having NCDs among women who did not smoke tobacco, consume smokeless tobacco and consume alcohol respectively. The population attributable risk of having NCDs was 1.8% (p < 0.001) for women who smoked, 0.8% (p < 0.001) for women who consumed smokeless tobacco and 2.2% (p < 0.001) for women who consumed alcohol. Besides, the odds of having NCDs among overweight and obese women were 2.25 and 3.60 times greater than the odds of having NCDs among women who were underweight.ConclusionThe findings revealed that smoking and using smokeless tobacco and alcohol consumption were risk factors of NCDs in women. The findings also alarm the focus of maternal and child health programs on NCDs’ risk factors like maternal obesity, due to their adverse health consequences on their children too. Also, the coexistence of higher levels of tobacco use and alcohol consumption requires different strategies to address the vulnerability of women towards NCDs, including screening and early detection of NCDs especially among those who smoke or chew tobacco and consume alcohol.

Assessment of sociodemographic indicators of Tobacco expenditure: an application of the censored regression model

ABSTRACT Background The high level of tobacco use in Turkey and across the world, causes a high number of health problems. This study explores the indicators of tobacco expenditure of households, the smallest unit of a society. In this context, the sociodemographic factors affecting household tobacco use were examined, and recommendations are made to reduce tobacco product impact in terms of users and those who are exposed to smoke. Methods This study uses the dataset acquired from the Household Budget Survey. The factors affecting household expenditure on tobacco products were evaluated using the Tobit model. Results Gender, age, educational status, marital status, income level, and social variables were found to be effective indicators of tobacco product expenditure. Conclusion The study aims to bring the following issues to the attention of decision-makers and policymakers: Priority should be given to tobacco control programs, particularly for young, single, male, and lowly educated individuals; raise tobacco taxes in a way that does not adversely affect the financial situation of low-income smokers who use such products; and encourage the implementation of evidence-based smoking cessation methods.

Campus administrator perceptions of the effectiveness of tobacco-free policies in California universities

Background: In response to high levels of tobacco use among university students, the University of California (UC) and California State University (CSU) systems adopted tobacco-free policies in recent years. While few existing studies capture student response to these policies, there is no research that captures campus administrator perceptions on the effectiveness of these policies. This study was conducted to understand campus administrator perceptions of student compliance to tobacco-free policies in California universities.Methods: This was a qualitative study to understand campus administrator perceptions of student compliance to the tobacco-free policies on select California universities. Data collection took place between March-May 2018 and included key informant (KI) interviews and a focus group (FG) with campus administrators from selected universities. Content analysis using Atlas.ti software was conducted to interpret results.Results: Nine campus administrators participated in KI interviews and four further participated in a FG. Overall analysis of the results indicated that all administrators believe tobacco-free policies on their respective campuses are effective in reducing student tobacco use. Additionally, some administrators believed punitive methods were needed, while others felt creation of a cultural norm would be most effective, and all administrators believed smoking cessation programs were helpful resources to ensure policy compliance. Participants further agreed stronger implementation strategies relating to communicating policy provisions are needed to ensure student understanding of policy.Conclusions: Administrators perceive that tobacco-free policies are effective in reducing tobacco use among university students. It is recommended that additional strategies are utilized to increase student awareness of the policy.

The mental health of university students during the COVID-19 pandemic: An online survey in the UK.

Higher education students’ mental health has been a growing concern in recent years even before the COVID-19 pandemic. The stresses and restrictions associated with the pandemic have put university students at greater risk of developing mental health issues, which may significantly impair their academic success, social interactions and their future career and personal opportunities. This paper aimed to understand the mental health status of University students at an early stage in the pandemic and to investigate factors associated with higher levels of distress. An online survey including demographics, lifestyle/living situations, brief mental well-being history, questions relating to COVID-19 and standardised measures of depression, anxiety, resilience and quality of life was completed by 1173 students at one University in the North of England. We found high levels of anxiety and depression, with more than 50% experiencing levels above the clinical cut offs, and females scoring significantly higher than males. The survey also suggested relatively low levels of resilience which we attribute to restrictions and isolation which reduced the opportunities to engage in helpful coping strategies and activities rather than enduring personality characteristics. Higher levels of distress were associated with lower levels of exercising, higher levels of tobacco use, and a number of life events associated with the pandemic and lockdown, such as cancelled events, worsening in personal relationships and financial concerns. We discuss the importance of longer-term monitoring and mental health support for university students.

Comparison of tobacco use in a university town and a nearby urban area in China by intensive analysis of wastewater over one year period

Understanding smoking patterns in the population is essential for formulating public health and tobacco control policies. Wastewater-based epidemiology (WBE) is a valuable complementary approach to conventional survey methods to measure tobacco use, providing non-invasive information in an objective and cost-effective manner. This study estimates tobacco use in an urban population at daily resolution and in a university town at weekly resolution in China. Wastewater samples were collected daily in an urban catchment (n = 279) and every week from a university town located within 13 km of the urban catchment (n = 43) in 2017–2018. The tobacco-related biomarkers, cotinine and hydroxycotinine, and nicotine were analyzed via direct injection liquid chromatography tandem mass spectrometry (LC-MS/MS). Per capita daily tobacco use was back-estimated based on cotinine in wastewater. Over the year of sampling, we observed an increasing trend in tobacco use in the urban catchment that corroborated with sales statistics in 2017–2018. Tobacco use in the urban area was estimated to be 1.16 cigarettes/person aged 15+/day, while it was estimated to be 0.60 cigarettes/person aged 15+/day in the university town. The level of tobacco use in the university town remained stable over the year in contrast to the urban area. The difference of tobacco use in the two catchments may be attributed to their demographic differences. Furthermore, the Tobacco-Free Campus Policy would be a possible reason for the lower level of tobacco use in the university town.

Oral Cavity and Oropharyngeal Cancer Disparities in Alabama and the United States: A Review

IntroductionIn the United States, an estimated 53,000 people developed new cases of oral cavity and pharyngeal cancers (OPC) in 2019, and an estimated 10,860 deaths were associated with OPC. While oral cavity and pharyngeal cancers affect people of all ages, races, ethnicities, and genders, many recent epidemiological studies of OPC have identified significant disparities in OPC incidence and mortality rates among differing populations. There are 2 main etiologic factors that lead to the development of OPC. The first is by modifiable risk behaviors, and the second is infection by the human papillomavirus (HPV). Studies have shown that HPV not only causes cervical and anal cancers, but also causes a subset of head and neck squamous cell carcinomas (HNSCC). MethodsOPC prevalence, mortality, incidence based on gender, race, and anatomical location published by the Surveillance, Epidemiology, and End Results Program (SEER) and the Alabama Statewide Cancer Registry from 1980 to 2016 were examined. ResultsOral cancer is more common in men than women, among those with a history of tobacco or heavy alcohol use, and individuals infected with HPV. Current trends show that OC and OP cancer incidence are decreasing in African-American males, and that overall incidence rates are highest in White males. Furthermore, incidence rates in Blacks have been decreasing from 1980 from a rate of 16.82 per 100,000 to 8.64 per 100,000 in 2016. In contrast, incidence rates have been relatively unchanged for the White population in the same time period, a decrease from 12.98 to 12.64 per 100,000.According to SEER data of OC and OP cancers, mortality rates in 1980, per 100,000, are 6.97 in Blacks and 3.87 in Whites. However, over the course of the past few decades, data show a dramatic improvement in the mortality rates in Blacks from 6.97 to 2.63 per 100,000 in 2016, and slight improvement in mortality rate in Whites from 3.87 to 2.60 per 100,000 in 2016. One study published in 2009 suggested that better survival outcomes in White OP cancer patients were associated with better-prognosis HPV-positive tumors, which are rarer in the Black population.Interestingly, while overall mortality rates are similar for the White and Black populations with OC and OP cancers in 2016, there is still a significant disparity when looking at the 5-year survival rates. In the period of 1978-1980, the 5-year survival percentage for the White population with OPC is 55.4% vs. 34.9% in the Black population with OPC. In the period of 2009-2015, the 5-year survival rate for the White population with OPC is 70.3% vs. 50.9% in the Black population with OPC. In Alabama, incidence rates for OC and OP cancers have remained stable from 2005 to 2014 with rates from 13.1 to 12.9 per 100,000. Compared to overall incidence rates in the United States from 2010-2015, incidence rates in Alabama were higher for Black males, White males, and females. Mortality rates were also worse for the same patient populations in Alabama as compared to the United States. The higher incidence rates in Alabama may be associated with higher levels of tobacco use in the state as compared to the rest of the country.

Tobacco Use Among 1 310 716 Women of Reproductive age (15-49 Years) in 42 Low- and Middle-Income Countries: Secondary Data Analysis From the 2010-2016 Demographic and Health Surveys.

IntroductionTobacco use among women, especially during pregnancy is a public health concern. There is a need to understand the diverse nature of their tobacco consumption across the globe.MethodsWe used Demographic and Health Surveys (DHS) data collected between 2010 and 2016 from 42 low- and middle-income countries (LMICs) to estimate the prevalence of smoking, smokeless tobacco, and dual use among pregnant and non-pregnant women of reproductive age (15–49 y). We compared tobacco use between both groups adjusted for age, type of residence, education and combined wealth index, and a subgroup analysis for the South-East Asia Region (SEAR) as the tobacco use in SEAR among women is far more diverse than in other regions primarily due to the popularity of smokeless tobacco use in this region.ResultsBased on the data of 1 310 716 women in 42 LMICs, the prevalence of smoking was 0.69%(95%CI: 0.51–0.90) among pregnant women and 1.09%(95%CI: 0.81–1.42) among non-pregnant women. The prevalence of smokeless tobacco use was 0.56%(95%CI: 0.33–0.84) among pregnant women and 0.78%(95%CI: 0.35–1.37) among non-pregnant women. The relative risk ratios(RRR) for smoking (0.85; 95%CI: 0.67–1.09) and smokeless tobacco use (0.81; 95%CI:0.67–1.00) were not-significantly lower among pregnant women than non-pregnant women and education and wealth index had an inverse relationship with both forms of tobacco. In SEAR, among pregnant women, the prevalence of smoking and smokeless tobacco use was 1.81% and 0.45%, respectively. However, pregnant women were 7%(RRR 1.07; 95%CI:1.02–1.12) more likely to use smokeless tobacco than non-pregnant women.ConclusionDespite the added risk of foetal harm during pregnancy, there is no evidence that the tobacco consumption between pregnant and non-pregnant women differ in 42 LMICs. A significantly higher use of smokeless tobacco among pregnant women in SEAR is of particular concern and warrants further investigation.ImplicationsTobacco use among women in low- and middle-income countries (LMICs) is lower than high-income countries (HICs), but this may be because LMICs are earlier in the epidemiological transition of tobacco use. If ignored as a public health issue and the tobacco industry continues to market its products to women, the level of tobacco use may rise as it did in HICs. Also, despite low prevalence rates and with no evidence that these differ among pregnant and non-pregnant women, is concerning as tobacco consumption in any form during pregnancy is associated with poor birth outcomes. This suggests a need for raising awareness about the harms of tobacco use among women in LMICs, especially during pregnancy. There is a need to develop preventive and cessation interventions to decrease tobacco use (smoking and smokeless) among women who are from low socio-economic status and less educated, as they bear the greatest burden of tobacco use.

The Impact of Psychiatric Disorder Diagnosis on Motivation to Quit and Stage of Change Among Patients at a Hospital-Based Outpatient Smoking Cessation Clinic

Objective Smoking is among the greatest international public health concerns, causing excessive levels of preventable premature death, disability, and economic costs. The prevalence of tobacco use among people with psychiatric disorders (PDs) remains persistently high relative to the general population, highlighting the need to improve smoking cessation (SC) strategies in this group. We aimed to assess the associations between having a PD and baseline motivation to quit (MtQ) smoking and Prochaska’s stage of change (SoC), two clinically important metrics linked to SC outcomes. Methods: This retrospective chart review included patients who completed a baseline visit at a hospital-based outpatient SC clinic (N = 896). Multivariate hierarchical logistic and linear regression models were developed to assess variables associated with MtQ (importance and confidence in quitting) and SoC, primarily PD category (externalizing, internalizing, externalizing/internalizing, psychotic or no PD) and secondarily, demographics, physical health history, and tobacco use/dependence metrics. Results: The variables negatively associated with MtQ were female sex (p = .011), older age (p = .038), deriving income from social assistance (p < .001), and age at smoking initiation (p = .005), whereas ≥ 1 quit attempt in the past year predicted higher MtQ (p < .0001). Being in the preparative/action SoC (versus the pre-contemplative/contemplative) was associated with income from social assistance (OR 0.39, p = .001), more daily cigarettes smoked (OR 0.98, p = .005) and ≥ 1 past-year quit attempt (OR 1.69, p = .013). Conclusions: Having a PD was not associated with either MtQ or SoC. Deriving income from social assistance predicted lower MtQ and SoC. Having made ≥ 1 quit attempt in the past year was associated with higher MtQ and SoC. Our study suggests that people with PDs are as motivated to quit smoking and ready for change as people without PDs, and smoking cessation efforts should be amplified in this group to address the disproportionately high level of tobacco use, especially because having at least one quit attempt may enhance MtQ and SoC.

Tobacco content in video on demand services in low- and middle-income countries

Abstract Background There is clear evidence that exposure to tobacco is linked to smoking uptake. The economic and social burden of diseases associated with smoking is particularly high in low-and middle-income countries, where smoking uptake is high and exposure to tobacco use and branded content is widespread. Streamed content exhibits consistently higher levels of tobacco content than broadcast media and these levels have increased. The prevalence of smoking and tobacco content in video-on-demand (VOD) services is troubling given their popularity with youth audiences and the ease with which content can be accessed by children. This is because barriers to youth consumption that exist for film or broadcast media, including content gatekeepers, are absent. Methods The most popular VOD series from 10 low- and middle-income countries (Bangladesh, Brazil, China, India, Indonesia, Mexico, Pakistan, Philippines, Ukraine and Vietnam) were identified based on demand expressions and coded for individual depictions of tobacco. 18 series were analysed, representing a mix of international content in several languages. 111 episodes, totalling 81.4 hours of coded content, were analysed for tobacco depictions and characterisation of smoking characters. Results Tobacco content was prevalent and particularly prominent in non-English language series, where readily identifiable “stars” frequently partook in smoking. Cigarettes dominated tobacco imagery, with other forms (pipes and electronic nicotine delivery systems) rarely appearing. Notably, there were several incidents featuring well-known brands. Given that access to VOD services is difficult to moderate, youth audiences can easily access programming featuring high levels of tobacco use by identifiable characters, played by well-known actors. A lack of control regarding consumption of streamed content means that it is extremely important for content producers like Netflix and Amazon to ensure VOD content is suitable for youth audiences. Key messages Tobacco content in video-on demand services is increasing. Tobacco exposure is linked to smoking uptake.

Patterns of Tobacco Use and Related Protective Factors Among Somali Youth in the United States.

Anti-smoking norms and educational aspirations are established tobacco prevention targets for general United States (U.S.) adolescent populations but protective factors remain poorly characterized for Somali-American youth. Here we describe patterns of past 30-day tobacco use and associated protective factors among eighth, ninth, and eleventh grade Somali adolescent respondents (n = 2009) to the 2016 Minnesota Student Survey using multivariate logistic regressions. E-cigarette (5.7%) and hookah (5.0%) use were most prevalent. Male youth reported higher levels of tobacco use across products. Adjusted odds ratios showed that internal developmental assets (e.g., e-cigarettes aOR 0.37, 95% CI 0.37, 0.79) and parental anti-smoking norms (e.g., e-cigarettes aOR 0.19, 95% CI 0.09, 0.38) protected against use of all tobacco products. E-cigarettes and hookah are prevalent among U.S. Somali youth, highlighting the need for prevention efforts that address emerging tobacco products and leverage protective factors such as internal assets and parental anti-smoking norms.

SMOKING PREVALENCE AND AWARENESS OF THE DETRIMENT OF TOBACCO SMOKING AMONG STUDENTS IN MEDICAL UNIVERSITY

Introduction. A high level of tobacco use among medical workers is registered in Russia. The adherence to this bad habit can undermine the medical professionals’ authority and reduce the effectiveness of the preventive work with the population. The goal of this research was to determine the smoking prevalence among medical students, their level of awareness of health risks, and attitudes of smokers to this bad habit. Material and methods. The survey concerning the prevalence and attitudes towards smoking was conducted among the students of the medical faculty of the Sechenov University. Students were asked about biographical data, health status at the time of the survey, attitudes towards healthy lifestyles and smoking, the respondents’ awareness of the detriment of tobacco smoking, attitudes to the anti-smoking campaign. A separate block of questions was addressed to smokers (smoking experience, smoking intensity, reasons for initiation). Results. Of the 531 respondents, 18.0% were smokers at the time of the survey, 9.4% were former smokers, 72.5% never smoked. 59.6% of smokers had low smoking intensity. 3.2% of smokers had high smoking intensity. Smoking experience in both sex groups averaged 4.56 years. The main reasons for students’ initiation to smoking were curiosity (27.8%), the influence of the closest active smoking environment (21.5%), as well as existing problems in the family and the educational process (16.7%). Most of the students were informed about the negative effects of smoking and 82.7% of current smokers planned to give up smoking. 94% of smokers believed they to need professional help to stop smoking. Discussion. The prevalence of smoking among students at Sechenov University is comparable to the data of the Global Survey of Medical Students. Conclusions. Smoking is still common among medical students. The training of future health care workers in knowledge and skills to stop smoking should be carried out within an additional curriculum in a medical university.

Effectiveness of a telephone-based intervention for smoking cessation in patients with severe mental disorders: study protocol for a randomized controlled trial

BackgroundUp to 75% of inpatients with mental disorders smoke, and their life expectancy is decreased by up to 25 years compared to the general population. Hospitalized patients without monitoring after discharge quickly return to prehospitalization levels of tobacco use. The aim of the 061 QuitMental study is to assess the effectiveness of a multicomponent and motivational telephone-based intervention to stop smoking through a quitline addressed to smokers discharged from mental health hospital wards.MethodsA pragmatic randomized controlled trial, single blinded, will include 2:1 allocation to the intervention group (IG) and the control group (CG). The IG will receive telephone assistance to quit smoking (including psychological and psychoeducational support, and pharmacological treatment advice if required) proactively for 12 months, and the CG will receive only brief advice after discharge. The sample size, calculated with an expected difference of 15 points on smoking abstinence between groups (IG, 20% and CG, 5%), α = 0.05, β = 0.10, and 20% loss, will be 334 participants (IG) and 176 participants (CG). Participants are adult smokers discharged from psychiatric units of five acute hospitals.Measurements include dependent variables (self-reported 7-day point prevalence smoking abstinence (carbon monoxide verified), duration of abstinence, number of quit attempts, motivation, and self-efficacy to quit) and independent variables (age, sex, and psychiatric diagnoses). In data analysis, IG and CG data will be compared at 48 h and 1, 6, and 12 months post discharge. Multivariate logistic regression (odds ratio; 95% confidence interval) of dependent variables adjusted for potential confounding variables will be performed. The number needed to treat to achieve one abstinence outcome will be calculated. We will compare the abstinence rate of enrolled patients between groups.DiscussionThis trial evaluates an innovative format of a quitline for smokers with severe mental disorders regardless of their motivation to quit. If effective, the pragmatic nature of the study will permit transfer to routine clinical practice in the National Health System.Trial registrationClinicalTrials.gov, NCT03230955. Registered on 24 July 2017.

Early Predictors of Trajectories of Tobacco Use Level from Adolescence to Young Adulthood: A 16-Year Follow-Up of the TEMPO Cohort Study (1999–2015)

Purpose: Individual and family characteristics early on in life are associated with adolescent smoking; however, their role with regard to long-term tobacco smoking trajectories into young adulthood is not well-known, which is what we set out to study using data from a longitudinal community-based cohort. Methods: We used data from 2,025 youths in France (12–26 years at baseline, 16 years of follow-up), participating in the longitudinal TEMPO cohort study. First, we modeled smoking trajectories from adolescence onwards using Group-Based Trajectory Modeling, by using the declared consumption of cigarettes at different ages. Second, among trajectories of smokers, associations with individual and family characteristics in childhood and adolescence were studied using multinomial logistic regression. Results: We observed 5 smoking trajectories: non-smokers (62.3%), 3 groups of persistent smokers with different levels of tobacco use (low, intermediate, high), and a group characterized by high-level smoking followed by cessation. Among participants who were lifetime smokers (n = 763), the trajectory of tobacco use was associated with early substance use initiation, academic attainment, grade retention, and parental smoking. Early tobacco and cannabis use initiation predicted high-level tobacco use, whether it persisted (OR 2.29, 95% CI 1.23–4.28) or not (OR 2.99, 95% CI 1.59–5.63). Grade retention and parental smoking predicted persistent smoking of intermediate (respectively OR 1.53, 95% CI 1.03–1.92; OR 1.74, 95% CI 1.03–2.92) or high level use (respectively OR 1.74, 95% CI 1.07–2.85; OR 1.70, 95% CI 0.91–3.18). Poor academic attainment predicted all 3 smoking trajectories, especially persistent high-level smoking (no high school degree: OR 5.29, 95% CI 1.65–16.97, vocational degree: OR 1.94, 95% CI 0.99–3.80). Conclusions: Tobacco smoking trajectories from adolescence to adulthood are associated with early substance use initiation, parental smoking, and academic difficulties.

Associations Between Multiple Forms of Discrimination and Tobacco Use Among People Living With HIV: The Mediating Role of Avoidance Coping.

People living with HIV (PLWH) have higher levels of tobacco use compared with the general population, increasing their risk of morbidity and mortality. PLWH also face potential chronic stressors related to the stigma and discrimination associated with HIV and other characteristics (eg, race and sexual orientation). These experiences may be associated with harmful health behaviors, such as tobacco use. The purpose of the current study is to explore the psychosocial context of tobacco use in PLWH, examining avoidance coping as a mediator in the relationship between multiple forms of discrimination and tobacco use. Participants included 202 PLWH recruited from an HIV primary care clinic in Birmingham, AL, between 2013 and 2015. Participants responded to parallel items assessing experiences of discrimination related to HIV status, race, and sexual orientation, as well as items assessing avoidance coping. Data on current tobacco use were obtained from participants' clinic records. Mediation models for each form of discrimination (HIV, race and sexual orientation) adjusting for demographic variables and the other forms of discrimination were evaluated. The indirect effect of HIV-related discrimination on likelihood of tobacco use through avoidance coping was significant, suggesting that avoidance coping mediates the association between HIV-related discrimination and tobacco use. However, the indirect effects of the other forms of discrimination were not significant. Given the disparity in tobacco use in PLWH, behavioral scientists and interventionists should consider including content specific to coping with experiences of discrimination in tobacco prevention and cessation programs for PLWH.

Parental Smoking Cessation: Impacting Children's Tobacco Smoke Exposure in the Home.

There is no safe or risk-free level of tobacco use or tobacco smoke exposure. In this randomized controlled trial, we tested a tobacco control intervention in families and specifically evaluated a tailored cessation intervention for the parents and/or caregivers (Ps/Cs) who were smokers while their children were simultaneously enrolled in tobacco prevention. Ps/Cs and children were recruited from 14 elementary schools across rural and urban settings. Approximately one-fourth (24.3%; n = 110) of the total Ps/Cs enrolled in the randomized controlled trial (n = 453) were smokers, predominantly women (80.9%), with a mean age of 37.7 years. (SD 12.2); 62.7% were African American, 44% had less than a high school education, and 58% earned <$20 000 annually. P/C smokers were offered a tailored cessation intervention in years 1 and 2. Self-report smoking status and saliva cotinine were obtained at baseline, the end of treatment (EOT) and/or year 2, and in the year 4 follow-up. Ps/Cs in the intervention group showed a larger increase in self-reported smoking abstinence over time (EOT: 6.5% [SE = 5.7%]; year 4: 40.6% [SE = 5.7%]) than the control group (EOT: 0.0% [SE = 6.5%]; year 4: 13.2% [SE = 6.4%]; F = 4.82; P = .0306). For cotinine, the intervention group showed a decrease from baseline (239.9 [SE = 1.3]) to EOT 99.3 [SE = 1.4]) and then maintenance through year 4 (109.6 [SE = 1.4]), whereas the control group showed increases from baseline (221.1 [SE = 1.4]) to EOT (239.0 [SE = 1.4]) to year 4 (325.8 [SE = 14]; F = 5.72; P = .0039). This study provides evidence that tailored cessation offered to Ps/Cs in their children's schools during their children's enrollment in tobacco prevention may contribute to more robust success in P/C cessation and a reduction of tobacco smoke exposure in children.

Does Tobacco Use Differ by Metropolitan Status Among Young Adults Males Ages 18-34?

Purpose: With conflicting findings for the relationship between tobacco use and metropolitan status, the purpose of this study is to assess whether smoking cigarettes and chewing tobacco differs by metropolitan status for young adult males in the general population. Methods: This cross-sectional analysis uses 2016 Behavioral Risk Factor Surveillance System (BRFSS) data for N=935 males ages 18 to 34 in Florida, Michigan, New York, and Washington. Ordered logistic regression was performed for combined state data to assess patterns in relationships between tobacco use (none vs chewing tobacco only vs smoking cigarettes only vs both) and metropolitan status while controlling health-related, demographic, and socioeconomic factors and state. Results: Across states, about one-fourth of young adult males reported tobacco use (26%), with about one-fifth for smoking cigarettes only (18%), and very few for chewing tobacco only (6%) or both chewing and smoking cigarettes (3%). In this study, roughly one-third lived in urban (27%), suburban (41%) or rural (32%) areas. The results of adjusted analysis indicated that each successive level of tobacco use was moderately related to living in a suburban or rural area and moderately- to highly-related to moderate and excessive alcohol use. Conclusion: The results of this study indicate that successive use of chewing tobacco and smoking cigarettes in young adult males in the general population is related to living in suburban or rural areas and to moderate and excessive alcohol use. In primary care, providers may expect up to one-fourth of young adult males to smoke cigarettes or chew and half to use alcohol. Because these are moderately to high-related, providers should continue to screen for tobacco and alcohol use in all young adult males, especially those living in suburban or rural communities. Clinicians should provide education and resources for tobacco cessation and substance abuse programs as necessary.

Tobacco Use and Smoke Exposure in Children: New Trends, Harm, and Strategies to Improve Health Outcomes.

Every day in the USA, approximately 4000 adolescents begin smoking and the adolescent brain is particularly susceptible to nicotine addiction. We present current pediatric trends on tobacco use and exposures, various new products used by adolescents, the adverse biological and behavioral effects of tobacco use and exposures, and tobacco control strategies to eliminate tobacco-related illnesses and deaths in the pediatric population. Twelve-20% of women continue to smoke during pregnancy. New research reveals cognitive differences and behavior-control disorders are seen in elementary school children from prenatal and postnatal exposures. Traditional cigarette smoking has decreased in adolescents; novel and appealing tobacco products have captured their attention, particularly electronic cigarettes, and rates double and often triple from middle to high school. Children with asthma and those living in multi-housing units have higher rates of secondhand smoke exposure than non-asthmatics and children living in single-home dwellings. There is no "safe or risk-free" level of tobacco use or exposure. Tobacco use and exposure in childhood and adolescence must be decreased using evidenced-based strategies to improve child health.