Reduce Tobacco Use Research Articles

Substance use prevention during adolescence: Study protocol for a large-scale cluster randomized trial of Botvin High School LifeSkills Training

BackgroundConcerns about the rise in adolescent vaping and cannabis use suggest the need for effective substance use prevention programs. Botvin LifeSkills Training (LST) has a strong evidence base at the middle school level for preventing or reducing tobacco use and related problems. A high school (grades 9–10) version of the LST program was also developed and shows promising initial evidence for reducing tobacco use in a single pilot study. However, the high school version of LST has not been sufficiently tested in an experimental trial, despite being widely implemented in high schools across the U.S. This paper outlines the study protocol for a large-scale cluster randomized trial of Botvin High School LST, with objectives of documenting the design of prospective research and promoting transparency. MethodsA total of 60 high schools in Colorado and Ohio were randomized to the 10-session, teacher-led intervention group (n = 33 schools) or business-as-usual control group (n = 27 schools). Across two cohorts of schools, 9th-grade students complete self-report surveys at pretest, immediate posttest, 1-year follow-up, and 21-month follow-up. Primary outcomes are tobacco (nicotine) use and cannabis use. Secondary outcomes are alcohol use, illicit drug use, psychosocial behaviors (e.g., violence and mental health), and academic achievement. Intent-to-treat analyses will use multilevel modeling to estimate intervention effects across assessment points. ConclusionThis independent evaluation will help to determine whether the intervention is appropriate for large-scale adoption. This trial is preregistered with the Open Science Framework (https://osf.io/dnz5q/).

Tobacco Use and Cessation Counseling among Dental Professionals in Saudi Arabia.

The study aimed to assess the prevalence of tobacco use among dental professionals and their attitudes and behaviors about tobacco cessation counseling in Saudi Arabia. A total of 359 male and female dental professionals participated in this cross-sectional study. A pretested self-administered questionnaire was administered among study participants by visiting dental hospitals and clinics in Saudi Arabia. In the study, 15.9% of the participants were current tobacco users and 50.4% had a tobacco user at home or the workplace. Most participants reported that tobacco use is associated with bad breath (88.9%), oral cancer (88.3%), dryness of the mouth (80.8%), and bad taste (79.9%). Most participants asked patients about their tobacco habits (86.6%), mentioned tobacco habits in patient records (71.3%), and explained the benefits of quitting tobacco (79.9%). Less than half the sample (47.1%) referred patients to tobacco quitting services/programs. Male gender (Adjusted odds ratio (AOR) 5.50, 95% CI 2.48−12.23, p < 0.001), having a tobacco user at home/the workplace (AOR 3.18, 95% CI 1.57−6.45, p 0.001), and believing that tobacco cessation counseling was a waste of time (AOR 2.32, 95% CI 1.13−4.76, p 0.021) were associated with significantly increased odds of tobacco use among dental professionals. The study concluded that tobacco use was common among dental professionals despite their awareness of the adverse effects of tobacco. Reduction in tobacco use and promotion of counseling skills among dental professionals should be achieved through public health measures.

Addressing tobacco use in the context of complex social needs: A new conceptual framework and approach to address smoking cessation in community health centers.

This article presents a new conceptual framework "Connection to Health for Smokers" (CTHS), its application to address smoking cessation, and its acceptability in community health centers (CHCs). CTHS, an online interactive patient educational tool comprehensively implements the "5 A's" (ask, advise, assess, assist, and arrange) within the context of patients' social and behavioral health needs. Semi-structured interviews were conducted with five health educators (nurses) who administered CTHS with 62 patients to evaluate the acceptability of the program. Thematic analyses were conducted with interview transcripts. CHC health educators viewed CTHS has enhanced patient-centered communication, was able to identify patients' needs beyond tobacco use, and individualize action planning to integrate social and behavioral health needs. CTHS received enthusiasm from CHC health educators as a helpful tool to address tobacco use among their patients. Comprehensive on-site smoking cessation programs at CHCs that provide a structured evidence-based approach informed by an understanding of each patient's coexisting social and behavioral health needs may play an important role in reducing tobacco use disparities in the United States. CTHS offers a new promising framework to comprehensively integrate the 5A's within the context of social and behavioral determinants of health for smoking cessation.

The smoke-free home study: study protocol for a cluster randomized controlled trial of a smoke-free home intervention in permanent supportive housing

BackgroundFormerly chronically homeless adults who live in permanent supportive housing (PSH) have high prevalence of smoking. It is uncommon to find smoke-free policies in PSH because of the concern that such policies contradict PSH’s harm reduction framework and could increase homelessness should residents lose their housing because of the policy. However, in the absence of such policies, non-smoking PSH residents face the harmful effects of secondhand smoke exposure while residents who smoke see increased risks from high rates of smoking throughout their residence. Our pilot work highlighted the feasibility and acceptability of an intervention designed to promote voluntary adoption of a smoke-free home. Here we report a protocol for a cluster randomized controlled trial of the smoke-free home intervention for formerly chronically homeless residents in PSH.MethodsThe smoke-free home intervention provides face-to-face counseling and instruction to PSH residents on how to adopt a smoke-free home and offers training for PSH staff on how to refer residents to tobacco cessation services. We will randomize 20 PSH sites in the San Francisco Bay Area to either the intervention or wait-list control arms. We will enroll 400 PSH residents who smoke cigarettes in their housing unit and 120 PSH staff who work at the sites. At baseline, three- and six-months follow-up, we will ask residents to report their tobacco use and cessation behaviors and adoption of smoke-free homes. We will ask staff to answer questions on their knowledge, attitudes, practices, and barriers related to supporting residents’ smoking cessation. The primary outcome for PSH residents is adoption of smoke-free homes for 90 days or more at six-months follow-up, and the secondary outcome is point prevalence tobacco abstinence. The primary outcome for PSH staff is change in Smoking Knowledge Attitudes Practices survey score.DiscussionVoluntary adoption of smoke-free homes is a promising approach for reducing exposure to secondhand smoke and reducing tobacco use among a population facing high rates of tobacco-related disease, and is aligned with PSH’s harm reduction framework. Findings from this study have the potential to inform adoption of tobacco control policies among vulnerable populations most at risk for smoking-related harms.Trial registrationThis study was registered with the U.S. National Institute of Health Clinical Trials register on April 22, 2021: NCT04855357.

Efficacy of Motivational Interviewing and Brief Interventions on tobacco use among healthy adults: A systematic review of randomized controlled trials

Objective. To assess the effectiveness of a brief intervention and motivational interviewing in reducing the use of different tobacco-related products in adults Methods. For this systematic review, PubMed, Web of Science, and PsychINFO databases were electronically searched for randomized controlled trials on the effect of a brief intervention and / or motivational interview on tobacco reduction among healthy adults published between January 1, 2011 to January 1, 2021. Data from eligible studies were extracted and analyzed. CONSORT guidelines were used to assess the quality of the studies by two reviewers for the included studies. The titles and abstracts of the search results were screened and reviewed by two independent reviewers for eligibility criteria per the inclusion and exclusion criteria. Cochrane review criteria were used to assess the risk of bias in included studies. Results. A total of 12 studies were included in the final data extraction of 1406 studies. The brief intervention and motivational interviewing showed varied effects on tobacco use reduction among adults at different follow-ups. Seven of the 12 studies (58.3%) reported a beneficial impact on reducing tobacco use. Pieces of evidence on biochemical estimation on tobacco reduction are limited compared to self-reports, and varied results on quitting and tobacco cessation with different follow-ups. Conclusion. The current evidence supports the effectiveness of a brief intervention and motivational interviewing to quit tobacco use. Still, it suggests using more biochemical markers as outcome measures to reach an intervention-specific decision. While more initiatives to train nurses in providing non-pharmacological nursing interventions, including brief interventions, are recommended to help people quit smoking.

Surveillance of tobacco use among young adolescents: trends and predictors across three years in Sousse, Tunisia

BackgroundIn developed countries, there was an overall decrease in tobacco use over the last decades. In Tunisia, a national strategy to reduce tobacco use was set up since 2008. However, this strategy was rarely evaluated. The objective of the current study was to examine the trends in tobacco use among the middle schoolchildren of the governorate of Sousse (Tunisia) between 2014 and 2016 and to determine predictors of its experimentation.MethodsThree cross-sectional studies were conducted in 2014, 2015 and 2016 school years among middle schoolchildren randomly selected from the governorate of Sousse-Tunisia. The required sample size for each study was 760 participants. Each year, the same procedure was used to recruit pupils from the same middle schools. The same pre-established and pre-tested questionnaire was self-administered anonymously to participants in their classrooms.ResultsLifetime tobacco use rose from 11% in 2014 to 17.3% in 2016 (p = 0.001). Across the 3 years of survey, predictors of lifetime tobacco use were: The male sex (OR, 95% CI: 4.4 [3.2-6.1]), age above 13 (OR, 95% CI: 2.3 [1.7-3.1]), lifetime illicit substances use (OR, 95% CI: 3.9 [1.1- 13.8), lifetime inhalant products use (OR, 95% CI: 2.2 [1.2-4.3]), tobacco use among the father (OR, 95% CI: 2.2 [1.2-4.3]), tobacco use among siblings (OR, 95% CI: 1.7 [1.2-2.4]) and current anxiety symptoms (OR, 95% CI: 1.8 [1.4-2.4]).ConclusionLifetime tobacco use is in expansion among the young adolescents of Sousse. The current national tobacco prevention program should be strengthened and expanded to cover other substances use issues with emphasis on secondhand smoking and mental health problems.

Measuring the impact of state and local Tobacco 21 policies in the United States: A longitudinal study of youth and young adults ages 15-21.

Tobacco 21 (T21) policies, which prohibit tobacco sales to individuals under 21, aim to reduce youth tobacco use by limiting youth access to these products. Little, however, is known about the longitudinal effect of T21 policies on youth tobacco use behaviors at the national level. Participants aged 15-21 years from a longitudinal study conducted between May 2014 and May 2019 (n = 13,990) were matched to geocoded T21 policies. Generalized linear mixed models examined the association of direct and bordering T21 policy exposure and cigarette and e-cigarette use and intention to use, accounting for individual characteristics. Controlling for sociodemographic and psychosocial covariates, there were statistically significant positive associations between T21 exposure and e-cigarette use (OR = 1.45 [1.03,2.06], p < .003) and intention to use e-cigarettes (OR = 1.54 [1.05,2.26], p < .027). We found no association between T21 policy exposure and cigarette use or intention to use cigarettes. Furthermore, exposure to T21 policies did not significantly modify the relationship between age and either cigarette outcome. This is the first longitudinal study to evaluate state and local T21 policies at the national level. Our analyses demonstrate that existing T21 policies are not sufficient to reduce youth tobacco use and intentions to use, and suggest that T21 policies need to be a part of a comprehensive tobacco policy landscape. Our findings suggest further research is warranted on state and local T21 policy enforcement and implementation, including how T21 may differentially impact cigarette and e-cigarette use, and may have implications for the federal T21 policy. This research evaluates state and local T21 policies in the United States longitudinally, finding that T21 policies are not sufficient to stem e-cigarette use among adolescents and young adults. These findings support further policy action and suggest that local and state T21 policies are not sufficient to reduce tobacco use and rather, need to be part of a broader, more comprehensive set of tobacco control policies. Further research on enforcement and implementation challenges of T21 policies and the impacts of the new federal T21 policy is warranted.

Prospective prediction of substances use among a cohort of Tunisian adolescents

Abstract Background The risk of substances use increases during adolescence. In Sousse (Tunisia), an upward trend of these risk behaviors has been observed during the last years among young adolescents. Among older adolescents, the trend of their use is unknown. Objectives To determine the incidences and the most influencing factors on substances use among high school students in Sousse between 2018 and 2019. Methods A prospective longitudinal study was conducted among a cohort of high school students from Sousse. The same pre-tested questionnaire served to collect data in 2018 and 2019 from the same participants in their classes and in the presence of pre-trained investigators. Results A total of 404 high school students have participated in the study. Their median age was of 17 (IIQ: 15.8-17.6) years. Girls represented 66.8% of participants. The incidence rates of lifetime tobacco use, alcohol consumption, lifetime inhalants use and lifetime illicit substances use between 2018 and 2019 were 13%, 3.5%, 1.8% and 2 .9% respectively. Lifetime tobacco use was the main predictor of inhalants experimentation. This latter was the main predictor of becoming a user of e-cigarettes while alcohol consumption was the most influencing factor on cannabis experimentation among high school students. On the other hand, illicit substances use among friends predicted e-cigarette use, alcohol consumption, and cannabis experimentation among participants. Conclusions The existing prevention programs aiming at reducing tobacco use and substances use in the schools of Tunisia should be reinforced and integrate a comprehensive and multi-sectoral prevention program. The implementation of a national observatory of substances use would ensure the continuous improvement of this program. Key messages • There is an upward trend on using substances among the adolescents of Sousse, Tunisia. • Tobacco experimentation and alcohol consumption are the gateway to later substances experimentation among the adolescents of Sousse, Tunisia.

Who Are the Local Policy Innovators? Cluster Analysis of Municipal Tobacco Control Policies in Massachusetts.

Tobacco use is a leading cause of preventable death, yet it is challenging to establish public policy to reduce tobacco use. Massachusetts has been a national leader in tobacco control, and its policy-making patterns can be informative to the country. To identify factors associated with the adoption of tobacco policy within 351 Massachusetts municipalities. We obtained the 2019 Massachusetts municipality-level tobacco control policy information from Massachusetts' Tobacco Automated Fact Sheet Information system and compiled it with data from American Community Survey, Massachusetts Municipal Association, and Massachusetts state government's Web sites. We used k -means clustering method to identify statistical clustering patterns and hotspot analysis (Getis-Ord Gi*) and Local Indicators of Spatial Association to identify geographic clustering patterns. We then performed multinomial logistic regression to identify factors associated with policy clusters. Massachusetts. Three hundred fifty-one municipalities in Massachusetts. Policy clusters-groups of municipalities with similar tobacco control policy behaviors. Based on the k -means analyses, we identified 3 clusters in Massachusetts municipal tobacco control policy behaviors: 54% (N = 191) of municipalities were "Policy Leaders" with a high adoption rate of the 6 tobacco control policies; 18% (N = 63) were "Peer-Influenced Actors" focused on tobacco purchase restrictions for individuals younger than 21 years; and 28% (N = 97) were "Policy Non-Actors," with no tobacco control policies in place. Policy Leaders were geographically clustered in larger cities and the MetroWest region. Policy Non-Actors were clustered in rural areas of Western and Central Massachusetts. Larger municipal population size, higher municipal tax income, and higher percentages of residents voting Democratic were associated with higher policy adoption activities. Local variation in the adoption of tobacco policies may exacerbate inequities in tobacco use and population health. Opportunities remain to implement additional tobacco control regulations at the local level to promote public health.

Deadly declines and diversity – understanding the variations in regional Aboriginal and Torres Strait Islander smoking prevalence

Deadly declines and diversity – understanding the variations in regional Aboriginal and Torres Strait Islander smoking prevalence

A longitudinal analysis of MPOWER implementation, 2008-2018

Background In 2008, the World Health Organization (WHO) introduced MPOWER-a package of evidence-based, high-impact policy measures to help countries reduce tobacco use. These measures align with selected articles within the World Health Organization’s Framework Convention on Tobacco Control (FCTC), a global public health treaty to prevent and reduce tobacco use. Methods Observational longitudinal study involving 195 countries that submitted biannual national reports between 2008 and 2018. To report changes in MPOWER scores, countries were assessed using a validated checklist of the seven MPOWER indicators and a maximum possible unweighted composite score of 34 points. Covariate analysis was conducted among selected health, sociopolitical, and economic indicators. Results 176 out of 195 countries improved their MPOWER scores between 2008 and 2018, with two achieving full implementation (Brazil and Turkey). Twenty-three (23) countries representing 11.2% of the global population recorded an MPOWER scoring increase of at least 10 points between 2008 and 2018. The overall mean 10-year scoring increase was 5.1 points or a relative improvement of 27.1%. In 2018, 20 countries representing 10.4% of the global population excelled in MPOWER implementation by receiving a total composite score of at least 30 of 34 possible points. The MPOWER elements with the highest degree of implementation in 2018 include Warn (package), Protect (smoking ban) and Enforce (ad ban). Several covariates were positively associated with higher levels of MPOWER implementation, including cigarette affordability, the existence of national tobacco control objectives, the human development index score, the national corruption index score, national literacy rates and the political regime index score. Conclusions MPOWER implementation increased markedly between 2008 and 2018 in all seven WHO regions and countries representing all four World Bank income classifications. However, only two countries achieved full implementation by 2018. More work is needed to improve MPOWER implementation. Countries with low-income levels, compromised human development, reduced literacy rates, higher rates of corruption, and autocratic political regimes appear to struggle more with MPOWER implementation.

Chatbots for Smoking Cessation: Scoping Review.

BackgroundDespite significant progress in reducing tobacco use over the past 2 decades, tobacco still kills over 8 million people every year. Digital interventions, such as text messaging, have been found to help people quit smoking. Chatbots, or conversational agents, are new digital tools that mimic instantaneous human conversation and therefore could extend the effectiveness of text messaging.ObjectiveThis scoping review aims to assess the extent of research in the chatbot literature for smoking cessation and provide recommendations for future research in this area.MethodsRelevant studies were identified through searches conducted in Embase, MEDLINE, APA PsycINFO, Google Scholar, and Scopus, as well as additional searches on JMIR, Cochrane Library, Lancet Digital Health, and Digital Medicine. Studies were considered if they were conducted with tobacco smokers, were conducted between 2000 and 2021, were available in English, and included a chatbot intervention.ResultsOf 323 studies identified, 10 studies were included in the review (3 framework articles, 1 study protocol, 2 pilot studies, 2 trials, and 2 randomized controlled trials). Most studies noted some benefits related to smoking cessation and participant engagement; however, outcome measures varied considerably. The quality of the studies overall was low, with methodological issues and low follow-up rates.ConclusionsMore research is needed to make a firm conclusion about the efficacy of chatbots for smoking cessation. Researchers need to provide more in-depth descriptions of chatbot functionality, mode of delivery, and theoretical underpinnings. Consistency in language and terminology would also assist in reviews of what approaches work across the field.

Prevalence of smoking and smokeless tobacco use during breastfeeding: A cross-sectional secondary data analysis based on 0.32 million sample women in 78 low-income and middle-income countries.

SummaryBackgroundSmoking and smokeless tobacco use during the postpartum period is well studied in high-income countries, whereas low-income and middle-income countries (LMICs) lack evidence.MethodsIn this cross-sectional study we used data from the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted in 78 LMICs between January 2010 and December 2019 to study tobacco use among 0.32 million sample lactating women. Age-standardized prevalence of smoking and smokeless tobacco use was estimated and presented with a 95% Confidence Interval (CI) for 78 LMICs. Pooled estimates overall and by WHO regions were obtained using random-effects meta-analyses. Country-level and community-level variance to understand contextual factors was also quantified using multilevel modelling.FindingsPooled prevalence of any tobacco use among breastfeeding women in LMICs was 3.61% (95% CI 3.53–3.70); with the lowest prevalence in regions of the Americas (1.44%, 1.26–1.63) and the highest in the Southeast Asia region (6.13%, 6.0–6.27). The pooled prevalence of tobacco smoking was reported to be 1.16% (1.11–1.21), with the highest prevalence in the Eastern Mediterranean region (4.27%, 3.88–4.67) and the lowest in the African region (0.81%, 0.76–0.86). The pooled prevalence of smokeless tobacco use was reported to be 2.56% (2.49–2.63), with the highest prevalence in the Southeast Asia region (4.92%, 4.80–5.04). Illiterate and poor women in LMICs bore the enormous burden of tobacco use.InterpretationThe prevalence of smoking and smokeless tobacco use among lactating women in LMICs varied considerably across different WHO regions. Considering the cross-sectional design of the study, caution is required while interpreting the results. To improve mothers' and children's health and nutrition outcomes and reduce health inequalities in LMICs, reducing tobacco use through evidence-based interventions is critical.FundingNone.

Food insecurity, social needs, and smoking status among patients in a county hospital system

Tobacco use in the U.S. is increasingly concentrated among populations with socioeconomic disadvantages such as food insecurity. Building on prior studies showing that food insecurity increases odds of cigarette smoking, the current study sought to examine how food insecurity and other social needs, particularly financial strain, transportation barriers, and housing/utility insecurity, were associated with smoking status among adult patients seen in a county hospital system. We analyzed data from the electronic health record of patients from The MetroHealth System (Cleveland, Ohio, USA), covering a two-year period since implementation of social determinants of health assessments (2019–2021; N = 45,151 patients). Logistic regression analyses were used to examine associations with smoking status. Compared to the overall smoking prevalence (21 %), smoking was higher among patients screening for transportation barriers (41 %), financial strain (39 %), food insecurity (34 %), and housing/utility insecurity (27 %). Each of these social needs was independently associated with increased odds of current smoking (all p < 0.05). Smoking prevalence increased sequentially as the number of social needs increased; with each addition of a social need, there was a dose-response association with higher odds of current smoking (adjusted ORs ranged from 1.56 to 3.76, all p < 0.001), and current smoking specifically among ever smoking patients (adjusted ORs ranged from 1.39 to 3.01, all p < 0.001). There was substantial overlap among several social needs and smoking status. Alongside improving access to evidence-based cessation treatments and services, the findings raise the possibility that addressing social needs might reduce barriers to quitting and thereby reduce tobacco use disparities.

Patterns of tobacco use in low and middle income countries by tobacco product and sociodemographic characteristics: nationally representative survey data from 82 countries

ObjectivesTo determine the prevalence and frequency of using any tobacco product and each of a detailed set of tobacco products, how tobacco use and use frequency vary across countries, world...

Cross-Sectional Associations of Self-Reported Social/Emotional Support and Life Satisfaction with Smoking and Vaping Status in Adults.

This study aimed to examine the cross-sectional association of self-reported social/emotional support and life satisfaction with smoking/vaping status in US adults. The study included 47,163 adult participants who self-reported social/emotional support, life satisfaction, and smoking/vaping status in the 2016 and 2017 BRFSS national survey data. We used multivariable weighted logistic regression models to measure the cross-sectional association of self-reported social/emotional support and life satisfaction with smoking/vaping status. Compared to never users, dual users and exclusive smokers were more likely to have low life satisfaction, with an adjusted odds ratio (aOR) = 1.770 (95% confidence interval [CI]: 1.135, 2.760) and an aOR = 1.452 (95% CI: 1.121, 1.880) respectively, especially for the age group 18–34. Exclusive cigarette smokers were more likely to have low life satisfaction compared to ex-smokers (aOR = 1.416, 95% CI: 1.095, 1.831). Exclusive cigarette smokers were more likely to have low social/emotional support (aOR = 1.193, 95% CI: 1.030, 1.381) than never users, especially those aged 65 and above. In addition, exclusive cigarette smokers were more likely to have low social/emotional support than ex-smokers, with an aOR = 1.279 (95% CI: 1.097, 1.492), which is more pronounced among the age group 18–34, as well as 65 and above. Our results suggest that life satisfaction and social/emotional support may play important roles in smoking and vaping, which should be incorporated into behavioral interventions to reduce tobacco use.

Income and cigarette price responsiveness: evidence from Vietnam

BackgroundVietnam has an ad valorem tobacco excise structure, with the tax base being factory gate price, making the excise susceptible to tax avoidance and less effective in reducing tobacco use....

The Fish Oil to Reduce Tobacco Use iN Expectant mothers (FORTUNE) feasibility trial

Three small clinical trials have suggested that supplementation with n-3 long-chain polyunsaturated fatty acids (eicosapentaenoic acid and docosahexaenoic acid) found in fish oils may reduce nicotine cravings and at higher doses reduce cigarette consumption. Pregnant women who smoke have fewer pharmacologic options to aid them with smoking cessation. Although n-3 long-chain polyunsaturated fatty acid supplementation has been studied in pregnancy, few studies have evaluated doses of ≥4 g per day, and no previous studies have selectively enrolled pregnant women who smoke. High-dose n-3 long-chain polyunsaturated fatty acids may aid cessation but could be poorly tolerated in pregnant women who smoke because of gastrointestinal side effects. We conducted a feasibility trial to determine the tolerability of high-dose n-3 long-chain polyunsaturated fatty acid supplementation in pregnant women who smoked. We hypothesized that n-3 long-chain polyunsaturated fatty acid doses of 4.2 g a day would be well-tolerated relative to an olive oil placebo. We assessed red blood cell phospholipid membrane concentrations at baseline and end of therapy (4 weeks) and piloted outcomes for a future efficacy trial of n-3 long-chain polyunsaturated fatty acid supplementation for smoking cessation in pregnancy. We recruited 28 pregnant women between the gestational ages of 6 and 36 weeks who reported daily cigarette smoking and were motivated to quit to participate in a double-blind placebo-controlled randomized feasibility trial of 4.2 g per day of n-3 long-chain polyunsaturated fatty acid supplementation. Participants reported cigarettes per day, completed the Fagerström Test for Cigarette Dependence, and provided blood, urine, and exhaled CO samples. We used repeated-measures analysis of variance to pilot analyses of changes in cigarettes per day and Fagerström Test for Cigarette Dependence scores. At baseline, red blood cell membrane eicosapentaenoic acid concentrations were negatively correlated with cigarettes per day (r=-0.44; P=.04). By 4 weeks, circulating n-3 long-chain polyunsaturated fatty acid levels increased by 18% in the n-3 long-chain polyunsaturated fatty acid supplementation arm vs a decrease of 3% in the placebo arm. Occurrence of gastrointestinal side effects such as burping, heartburn, diarrhea, abdominal pain, or nausea did not differ statistically between study arms. At 4 weeks, participants allocated to the n-3 long-chain polyunsaturated fatty acids arm reported a median of 3 cigarettes per day (interquartile range, 1-8) vs 7 cigarettes per day (interquartile range, 1-14) in the placebo arm, which was not statistically significant (P=.99). Participants allocated to the n-3 long-chain polyunsaturated fatty acids arm had a decrease of 1 (interquartile range, 0-1) on the Fagerström Test for Cigarette Dependence score vs 0 (interquartile range, 0-0) for placebo (P=.46). High-dose n-3 long-chain polyunsaturated fatty acids may be tolerated in pregnant women who smoke; however, there was a high level of participant dropout, with more participants allocated to the fish oil arm becoming lost to follow-up. These results will inform the design of a future large-scale randomized controlled trial to test the impact of fish oil supplements on smoking cessation in pregnancy.

Ngaaminya (find, be able to see): summary of key findings from the Which Way? project.

Ngaaminya (find, be able to see): summary of key findings from the Which Way? project.

"It Depends on Where You Are and What Job You Do": Differences in Tobacco Use across Career Fields in the United States Air Force.

While tobacco use within the military is often discussed as being homogenously part of U.S. military culture, literature from civilian populations highlights that tobacco use varies by career field (e.g., “white collar” vs. “blue collar”). The objective of this qualitative study was to compare tobacco use by career fields in the U.S. Air Force. Airmen, Military Training Instructors, and Technical Training Instructors participated in 22 focus groups across five major Air Force Technical Training bases. Focus groups were conducted in-person using semi-structured interview guides and were audio-recorded. A conventional content-coding approach was used to code transcripts. Participants described substantial variation across the careers, which was attributed to social norms and the nature of jobs. Individuals in careers that spend most of their time outside were more likely to permit tobacco use. Conversely, tobacco use was seen as stigmatized in medical fields. Additionally, smokeless tobacco was identified as popular in certain careers because it could be used covertly on the job. Findings suggest that a one-size-fits-all approach to reducing tobacco use through policies and programs may not reflect the realities of military tobacco use. These findings may provide insights into other branches of the U.S. military with similar career fields.