Regular Cigarette Research Articles

Nicotine addiction – a health problem in adolescents in a neurobiological context

Abstract Smoking is one of the leading causes of death which can be prevented in the developed countries. Smoking begins mainly in adolescence. Smoking in early adolescence is known to be associated with an increased risk of later addiction. Also the growing popularity of e-cigarettes, which attract young people with a variety of flavors, and are still little associated with harmful effects on health, unlike regular cigarettes. Exposure to nicotine in young people can affect learning, memory and attention, and lead to increased impulsivity, mood disorders and drug dependence. Nicotine and its derivatives are harmful to the human body, causing a significant increase in blood pressure, deterioration of blood supply to the vessels and acceleration of atherosclerotic processes, it has a detrimental effect on the gastric mucosa, causing gastric disorders. In addition, smoking is associated with the risk of many cancers: oral cavity, larynx, esophagus, lung, pancreas, kidney, liver and bladder. Nicotine addiction causes many health, social and financial consequences for the individual and the community as a whole. Multiple nicotine addiction risk SNPs were found in the CHRNA5/A3/B4 gene cluster, with the best reported results for the risk allele derived from the non-synonymous SNP, rs16969968, in CHRNA5. Therefore, in the problem of addiction, including nicotine addiction, it seems important to know the neurobiological factors, including genetic ones, involved in these processes. This could lead to the development of new pharmacological and behavioral treatment strategies in the future.

Awareness and Perception of Nicotine Pouches and E-Cigarettes among Dental Students in Lahore

Objective: The purpose of this study was therefore, to assess the awareness and perception of dental students regarding these products, which are rapidly being marketed in Pakistan. Methods: The study was cross-sectional, close-ended questionnaire based and helped the investigators to compare the awareness and perception of dental students regarding nicotine pouches and e-cigarettes. Students in 1st, 2nd, 3rd and final year of nine dental colleges in Lahore city were targeted to fill the questionnaire via convenience sampling and Microsoft Excel was used to analyze the results obtained. Results: More than 70% of the participants were aware of nicotine pouches and e-cigarettes. However, very few participants had ever used them. Almost 1/3rd of the participants believed that both nicotine pouches and e-cigarettes are less harmful and less addictive than regular cigarettes and can help quit smoking. Conclusion: Generally, people were better aware of e-cigarettes and considered them less harmful and less addictive compared to NPs while NPs were considered as a better alternative to help quit smoking. Keywords: Nicotine pouches, E-cigarettes, new nicotine products, awareness, perception

Smokers' Likelihood to Engage With Information and Misinformation on Twitter About the Relative Harms of e-Cigarette Use: Results From a Randomized Controlled Trial.

BackgroundInformation and misinformation on the internet about e-cigarette harms may increase smokers’ misperceptions of e-cigarettes. There is limited research on smokers’ engagement with information and misinformation about e-cigarettes on social media.ObjectiveThis study assessed smokers’ likelihood to engage with—defined as replying, retweeting, liking, and sharing—tweets that contain information and misinformation and uncertainty about the harms of e-cigarettes.MethodsWe conducted a web-based randomized controlled trial among 2400 UK and US adult smokers who did not vape in the past 30 days. Participants were randomly assigned to view four tweets in one of four conditions: (1) e-cigarettes are as harmful or more harmful than smoking, (2) e-cigarettes are completely harmless, (3) uncertainty about e-cigarette harms, or (4) control (physical activity). The outcome measure was participants’ likelihood of engaging with tweets, which comprised the sum of whether they would reply, retweet, like, and share each tweet. We fitted Poisson regression models to predict the likelihood of engagement with tweets among 974 Twitter users and 1287 non-Twitter social media users, adjusting for covariates and stratified by UK and US participants.ResultsAmong Twitter users, participants were more likely to engage with tweets in condition 1 (e-cigarettes are as harmful or more harmful than smoking) than in condition 2 (e-cigarettes are completely harmless). Among other social media users, participants were more likely to likely to engage with tweets in condition 1 than in conditions 2 and 3 (e-cigarettes are completely harmless and uncertainty about e-cigarette harms).ConclusionsTweets stating information and misinformation that e-cigarettes were as harmful or more harmful than smoking regular cigarettes may receive higher engagement than tweets indicating e-cigarettes were completely harmless.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN) 16082420; https://doi.org/10.1186/ISRCTN16082420

Exploring Tobacco and E-Cigarette Use among Queer Adults during the Early Days of the COVID-19 Pandemic.

The purpose of this narrative study is to describe the vaping and smoking characteristics of Queer people ages 18–34 before March of 2020 and to better understand how the COVID-19 pandemic has impacted those behaviors since March of 2020. In total, 31 participants were screened. Thirteen participants were screened prior to the emergence of COVID-19, and 18 were screened when study protocols transitioned to a remote setting (pre and during). Of the 27 eligible participants, a total of 25 participants completed the study. Most participants (n = 13) self-identified as male, followed by five identified as female, four self-identified as gender non-binary, and three identified as transgender. The most common sexual orientation amongst participants was gay (n = 10), with bisexual being the second-most reported. Approximately 20 Queer participants reported using cigarettes, 14 participants self-reported using electronic devices, and 11 reported using hookah. Twenty participants reported smoking ten or less, and four self-reported using 11–20 cigarettes per day. Approximately, 92% of participants (n = 23) indicate that they are using an e-cigarette and regular cigarettes, and 57% of participants (n = 12) report using one pod or cartridge per day. The three themes that emerged in this study are: (1) Queer people during COVID-19 are experiencing heightened minority stress; (2) Queer people are unfamiliar with smoking cessation; and (3) vaping and smoking are attributed to stress and anxiety. Queer participants are likely to be dual users of cigarette and vaping products. This present study provides increasing evidence that Queer people are experiencing heightened stress and anxiety and using cigarette smoking and vaping to cope during the COVID-19 pandemic.

Intention to quit smoking according to smoking preferences and perceptions of electronic cigarettes among university students in South Korea.

This study aimed to alleviate unhealthy smoking habits among university students and provide the basic data necessary for public health-oriented approaches such as developing regulations and policies on electronic cigarettes by analyzing the relationship between university students’ smoking preferences, perceptions of electronic cigarettes, and intention to quit smoking.This study involved 567 college students and conducted frequency and chi-squared analyses of the general characteristics, smoking preferences, and perceptions of electronic cigarettes. This study also performed logistic regression analysis to analyze the relationship between intention to quit smoking stratified by smoking preferences and the perceptions about electronic cigarettes. SPSS version 25.0 was used for data analysis.This study showed that electronic cigarette smokers were approximately 6.4 to 10.8 times more likely to think that electronic cigarettes positively affect smoking cessation attitude than nonsmokers. This study showed that regular cigarette smokers were approximately 1.7 to 2.2 times and other smoker 3.3 to 3.9 times more likely to think that electronic cigarettes positively affect smoking cessation attitude than nonsmokers. Those who perceived harmless to the human body, capable of reducing the frequency of smoking, and less harmful than tobacco were approximately 2.6 to 2.9, 11.6 to 12.8, and 3.3 to 3.7 times more likely have intention to quit smoking, respectively.Regular health education, advertising awareness of health hazards, and public health science-oriented approaches and policies for smoking cessation support services are needed to create awareness on electronic cigarettes among university students.

Abstract 12948: Both Electronic and Regular Cigarettes Induce Transcriptional Changes in iPS-Derived Cardiomyocytes

Introduction: Cigarette smoking is an important etiology for cardiac diseases and electronic cigarettes are increasing in popularity. In the current study, we sought to assess differential gene expression in iPS-cardiomyocytes after exposure to conventional cigarette smoke extract (CSE) and electronic cigarette extracts (ECE) utilizing direct digital mRNA detection of heart failure targeted genes. Hypothesis: Methods: Human cardiomyocytes derived from iPSCs were acutely exposed for two consecutive days with 2.5% of CSE and ECE. RNAs were isolated and NanoString analysis was used to compare gene expression between groups for 126 heart failure specific genes. NanoString mRNA raw count data were preprocessed and normalized using nSolver 4.0 Analysis SoftwareNano-string of customized target panel was run for mRNA expression of cardiomyocytes with direct exposure to CSE (N=3) and ECE (N=3) and was compared to control (N=3). At least a 1.5-fold change in gene expression with FDR adjusted p<0.05 was considered as significant. Results: Five genes were significantly differentially expressed cardiomyocytes exposed to CSE vs control (CETP, ATRLN1, ENOS, C10ORF88 and ERF). In ECE exposed cells, five genes were also significantly differentially expressed compared to control (PDK4, CAV3, PER1, MYH6 and ERF). ERF gene is a transcription factor and protooncogene involved in development, apoptosis, and the regulation of telomerase was significantly overexpressed in cells exposed to both CSE and ECE. Despite different nicotine concentrations in ECE and CSE, no significant gene differences between CSE and ECE were observed. Conclusions: ECE and CSE exposure alters transcriptional profiles in iPS-cardiomyocytes compared to controls in heart failure targeted genes. These genes are involved in transcription and circadian regulation, metabolism and contractile proteins. There were no significant differences in transcriptional profiles between ECE and CSE exposed cells.

Urinary Cotinine and Nicotine Dependence Levels in Regular Male Electronic Cigarette Users.

Found in plasma, urine, and saliva, cotinine can be used as a biomarker for nicotine in electronic cigarette (e-cig) users. Nicotine is addictive and causes dependence. Thus, it becomes a problem in smoking cessation programs. This study aimed to determine the relationship between urinary cotinine (UCot) and nicotine dependence levels in regular male e-cig users. This cross-sectional study consecutively included regular male e-cig users and nonsmokers. All subjects were interviewed and had their UCot levels measured using an enzyme-linked immunosorbent assay method. The regular e-cig users completed the Penn State Nicotine Dependence Index questionnaire. This study recruited 71 males aged 18-45 years divided into e-cig users and non-smokers group. The predominating characteristics in e-cig users are as follows: 23 males (67.6%) aged <30 years, the highest education of senior high school 25 (73.5%) and 25 (73.5%) subjects had occupation. The UCot levels among the e-cig users in the non-dependency group were lower than that of the medium-high dependency group (P = .008). The median value for UCot level in the regular e-cig users was higher than that of the non-smoker group (276.11 [58.01-284.15] ng/mL vs 5.21 [4.65-23.72] ng/mL, P < .001). Factors influencing the UCot levels of the e-cig users were age (P = .041), nicotine level of the e-cig liquid (P = .013), and the flavor of the e-cig liquid (eg, menthol or non-menthol; P = .040). UCot and nicotine dependence levels in the regular male e-cig users were significantly related. Nicotine dependence was found in 76.5% of the regular male e-cig users. The UCot levels in the e-cig users were significantly higher than in the non-smokers.

Polygenic score for cigarette smoking is associated with ever electronic-cigarette use in a college-aged sample.

Electronic cigarette use has escalated rapidly in recent years, particularly among youth. Little is known about the genetic influences on e-cigarette use. This study aimed to determine whether genetic risk for regular use of combustible cigarettes or for number of cigarettes smoked per day confers risk for ever e-cigarette use or frequency of e-cigarette use. We used data from 9541 young adults from the Spit for Science longitudinal cohort study (2011-2019). Polygenic scores (PGS) of regular combustible cigarette use (PGS-RCU) and cigarettes per day (PGS-CPD) were constructed using summary statistics from the two largest available genome-wide association study (GWAS) meta-analysis of European ancestry and East Asian ancestry of combustible cigarette use and used to test whether the PGS of RCU or CPD predicted lifetime e-cigarette use and frequency of past 30-day e-cigarette use in a diverse sample of young adults of African (AFR), Admixed American (AMR), East Asian (EAS), European (EUR), and South Asian (SAS) ancestry. The PGS-RCU was associated with lifetime e-cigarette use in the EUR sample (OR = 1.27, 95% CI = 1.19-1.36, P= 7.53 × 10-12 ), but not in the other subsamples (ps > 0.12). This association remained significant after excluding regular combustible cigarette smokers (OR = 1.21, 95% CI = 1.12-1.31, P = 3.36 × 10-6 ). There was no statistically significant association between PGS-CPD and lifetime e-cigarette use and neither the PGS-RCU nor the PGS-CPD were associated with frequency of e-cigarette use in the past 30 days in any of the subsamples. Genetic factors associated with regular combustible cigarette use appear to be associated with ever e-cigarette use in young adults. We did not find evidence for shared genetic factors influencing heaviness of use of combustible cigarettes and current e-cigarette use frequency.

Conjoint Developmental Trajectories of Adolescent E-cigarette and Combustible Cigarette Use.

In this study, we sought to identify which adolescents progress to regular electronic cigarette (e-cigarette) use (without cigarette smoking), which adolescents become dual users of both types of cigarettes, and how dual use develops across time. Adolescents (N = 1808) from public high schools outside Philadelphia, Pennsylvania, completed in-classroom surveys at wave 1 (fall 2016, beginning of ninth grade) and at 6-month intervals for the following 36 months (fall 2019, beginning of 12th grade). A sequential processes growth mixture model identified 4 conjoint latent classes: later, rapid e-cigarette uptake (class 1: n = 230); no use of e-cigarettes or combustible cigarettes (class 2: n = 1141); earlier, steady e-cigarette uptake (class 3: n = 265); and dual use of e-cigarettes and combustible cigarettes (class 4: n = 204). Using a rich set of potential risk factors, multinomial logistic regression assessed the likelihood of belonging to each conjoint class compared with the comparison class (dual use). Adolescents in the dual use class were characterized by a greater number and severity of e-cigarette and combustible cigarette risk factors. Adolescents in the 2 e-cigarettes-only classes were characterized by either e-cigarette-specific risk factors (earlier onset) or no risk factors (later onset). The no use class had an absence of risk factors for e-cigarette and cigarette use. This study provides new prospective evidence for distinct patterns and profiles of adolescents who progress to current e-cigarette use, including adolescents who were initially cigarette smokers. The findings have implications for prevention intervention timing, tobacco product focus, content, and the adolescent subgroups to target.

Nicotine-free electronic-cigarettes for smoking cessation: Occasional reinforcement during extinction

Two experiments were conducted to examine whether using e-cigarettes with occasional use of regular cigarettes prevented relapse after extinction. In Experiment 1 (ABAC with a multiple-baseline design), six short-term smokers who wanted to stop smoking were asked to use e-cigarettes and were allowed to smoke 20 % of the usual number of regular cigarettes per day during the partial reinforcement period. Experiment 1 demonstrated that using e-cigarettes reduced the amount of smoking even after extinction. In Experiment 2 (ABAB design), which involved a single long-time smoker and partial reinforcement, the participant was unable to maintain low rates of smoking after the experiment. However, the excessive smoking (regular cigarettes > 15 per day) observed before the experiment was prevented. This study suggested that a partial reinforcement procedure (occasionally smoking cigarettes) prevented relapse after extinction without hardship in some smokers.

Investigation of the content of carbonyl compounds and specific nitrosamines of tobacco in cigarette smoke and in the aerosol of the tobacco heating system

Investigation of some toxic compounds concentrations in aerosol of new class of tobacco products - tobacco heating systems and comparing their levels with regular cigarettes aerosol is an important step in understanding whether these products are low-risk, as some manufacturers claim. Three popular in Russia cigarette brands, reference cigarette 3R4F and new heated tobacco products (HTP) were tested for levels of emissions of some harmful and potentially harmful constituents (HPHC). Aerosols of these products were collected under the ISO intense smoking regime and quantified for levels of N'-nitrosonornicotine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone, acrolein, acetaldehyde, formaldehyde. Levels of above mentioned HPHCs were measured by the high-performance liquid chromatography / mass spectrometry (HPLC/MS-MS). The results demonstrate that highest levels of measured HPHCs are obtained for reference cigarette 3R4F. As for popular in Russia cigarette brands their levels vary greatly and for some compounds can be very close to levels of 3R4F aerosol. Levels of all measured HPHCs in aerosol of HTP were significantly lower compared to all cigarettes. This can be explained by specific mechanism of HTPs aerosol formation without pyrolytic and pyrosynthetic reactions which are typical to all combustive tobacco products due to their high temperature of the process.

Quantification and cytotoxicity of degradation products (chloropropanols) in sucralose containing e-liquids with propylene glycol and glycerol as base

Electronic cigarettes (e-cigarettes) have gained increasing popularity in recent years, mostly because they are supposed to be less harmful than regular cigarettes. Therefore, it is highly imperative to investigate possible noxious effects to protect the consumers. E-liquids consist of propylene glycol, glycerol, aroma compounds and sweeteners. One of these sweeteners is a chlorinated version of sucrose, namely sucralose. The aim of this work was to investigate degradation products of sucralose in the presence of propylene glycol and glycerol at different temperatures of commercially available e-cigarettes. Chemical analysis and biological tests were simultaneously performed on e-liquid aerosol condensates. The results of the chemical analysis, which was executed by employing GC‐MS/GC-FID, demonstrated high amounts of various chloropropanols. The most abundant one is extremely toxic, namely 3-chloropropane-1,2-diol, which can be detected at concentrations ranging up to 10,000 mg/kg. Furthermore, a cytotoxicity investigation of the condensates was performed on HUVEC/Tert2 cells in which metabolic activity was determined by means of resazurin assay. The cellular metabolic activity significantly decreased by treatment with e-liquid aerosol condensate. Due to the results of this study, we advise against the use of sucralose as sweetener in e-liquids.

News framing of e-cigarettes: A cross-national study of the US, UK, and Korea

ABSTRACT This study explores the growing news coverage of e-cigarettes regarding, (a) how the arguments regarding e-cigarettes are presented in the print news media in the United States (US), United Kingdom (UK), and Korea; (b) which arguments were under-represented; and (c) to what extent scientific research shapes the arguments. Results suggest that the most salient argument in the US and UK was that e-cigarettes are less harmful (or “safer”) than regular cigarettes. Although both US and UK news recognized e-cigarettes as a smoking cessation tool, US news framed e-cigarettes from a negative viewpoint. In Korean news, the dominant argument concerned e-cigarette ingredients. The public health frame competed against economic frames in Korean media coverage. With the exception of epidemiological data, scientific studies received very little media coverage in all three countries. Reports of scientific uncertainty were correlated with the level of controversy on e-cigarette issues, and limitations of scientific studies were described to highlight such controversy. Lastly, we discussed issues that were neglected in the news regarding e-cigarettes in all three countries.

Psychosocial Impact of COVID-19 Pandemic in Libya: A Cross-Sectional Study.

Background: Since the outbreak of COVID-19 were announced in Wuhan, China, the virus has spread in most countries. After one year of restrictive measures applied by governments, it is unclear how this prolonged social distancing has affected the mental health of individuals in Libya. Therefore, the present study aims to assess the levels of perceived stress, depression, sleep disturbance, and self-efficacy associated with the pandemic in Libya and their association with the demographic factors.Methods: A cross-sectional study was conducted between October 10 and November 10, 2020 in 21 cities in Libya using an online survey. The survey collected socio-demographic variables and other important psychological variables using valid scales: namely, the Perceived Stress scale, the PROMIS Depression scale, the PROMIS Sleep Disturbance scale, and self-efficacy 6-item scale. Additionally, data were collected regarding eating and smoking habits, housing and living situations, and the preparedness of the public to manage the upcoming waves of the pandemic.Results: The questionnaire was accessed 746 times, and a total of 683 completed questionnaires were analyzed (response rate of 91.6%), with ages ranging from 18 to 94 years (Mean ± SD = 27.09 ± 10.57). Among the respondents, 58.4% were females and 77% were from the age group 18–29 years. The perceived stress, depression, and sleep disturbance symptoms were high in overall population. For stress, 52.7 and 17.1% of respondents reported moderate and high stress, and for sleep quality 28.8 and 8.1% reported moderate and high sleep disturbance, respectively. For depression, the overall median score was 20 (out of 40). The perceived stress, depression, and sleep disturbance were more prevalent among females and the younger age groups (18–29 years old). The overall self-efficacy median total score was 6.67 (out of 10), with a significantly higher median total score for males than females (7 vs. 6.33, p = 0.001). About 14.5% of the respondents were regular cigarette smokers, and most of them (79.8%) described their smoking habits during the previous month as more than typical. In addition, the reported eating habits of almost half of the respondents (43%) had changed, with about one-third (29.6%) reporting that their eating habits had become less healthy during the pandemic.Conclusion: The findings of this research suggest increased levels of stress, depression, and sleep disturbances as well as COVID-19-related fear during the pandemic, especially among young females. This alarming finding urgently calls for safe and low-barrier interventions to help mentally burdened individuals. This study makes a significant contribution in providing essential data on the psychological and social impacts on the Libyan population due to the COVID-19 pandemic.

Exposure of heat-not-burn tobacco effect on the quality of air and expiratory plume

The increasing interest to avoid the consumption of regular tobacco has lead in the development of several types of devices to decrease the effects of this practice on active and bystanders. In this work, the impact of the use of new heat-not-burn (HnB) devices has been evaluated and compared with that of regular cigarettes and electronic cigarettes (e-cigs). Portable monitoring devices were employed for CO, CO2, particulate matter (PM) and volatile organic compounds (VOCs) to evaluate the quality of indoor air and expiratory plume of both, active and passive, users during these practices. It can be noticed that the levels of VOCs in active HnB smokers expiratory air are five times lower in particular cases than those provided by regular tobacco and three times lower than those obtained for e-cigs, while the contribution of particulate matter to air pollution decreases between 200 and 600 times regarding the values obtained for e-cig vaping and regular tobacco smoking. The level of contaminants as CO decreases significantly in both, active and passive HnB smokers, in comparison with active and passive regular tobacco smokers, due to the absence of organic material combustion.Regarding passive HnB smokers, the exposure to HnB smoke do not increases the level of VOCs in ambient air nor in expiratory plume, remaining at the basal levels, being three times lower than values obtained to an exposure to regular tobacco smoke and two times lower than exposure to e-cigs vapours. On the other hand, the use of HnB devices decreases the concentration of PM in bystanders around thirty five times in relation with values obtained for passive regular tobacco smokers. Concerning the nicotine content delivered by HnB tobacco, data shown that HnB tobacco provides values from 0.5 to 1.7 mg of nicotine to the mainstream, being these values similar to those found in conventional tobacco.

Slim cigarette smoking in Urban China: Who are the early adopters and why?

Sales data in China indicate that slim cigarette consumption has increased dramatically over the last few years. This study examined who smoked slim cigarettes and the reasons for adopting these new products. A survey of an online panel from 19 Chinese cities was conducted from October 2018 to April 2019 with 20,055 members aged 16 and older. Among the 31.7% [95% confidence interval (CI) = 30.1–33.4] of panel members who reported currently smoking, 37.7% (95% CI = 34.8–40.5) smoked slim cigarettes. Among smokers, women were significantly more likely to smoke slim cigarettes than men [56.5% (95% CI = 50.8–62.2) vs. 35.5% (95% CI = 32.8–38.1)]. Smokers with a bachelor’s degree were more likely to smoke slim cigarettes than those without [41.3% (95% CI = 38.1–44.4) vs. 33.1% (95% CI = 30.0–36.1)]. Most slim cigarette smokers were dual smokers [77.7% (95% CI = 75.3–80.1)], smoking both regular and slim cigarettes. Among dual smokers, 97.5% (95% CI = 96.7–98.3) started smoking regular cigarettes before slim cigarettes. Of the many reasons given for smoking slim cigarettes, 37.0% (95% CI = 34.3–39.7) directly related to harm reduction with another 10.1% (95% CI = 8.4–11.7) reporting their reason as wanting “to reduce consumption of regular cigarettes,” a plausible indication of harm reduction. These findings suggest strong interest in harm reduction among the current Chinese smoking population and that the popularity of slim cigarettes is likely to increase, with the more educated as the early adopters. Given the absence of any evidence that these products actually reduce harm, it is urgent that the public health community be on high alert in order to avoid repeating the sad history of low-tar cigarettes, when a supposed harm-reduction product misled the field of tobacco control.

A quality improvement project to improve the physical health of people with intellectual disability &amp; severe mental illness in a forensic inpatient ward

AimsReview physical health risk factors of service users Co-produce personalised care plans for service users Improve health knowledge and confidence in self-management of health problems Support reduction in risk by improving physical activity levels and supporting healthy dietary choices.BackgroundPeople with intellectual disability have poorer physical health outcomes than those without intellectual disability; there is higher prevalence of obesity, constipation and diabetes in this group of the population, and consistent evidence of premature mortality. Excess mortality in persons with severe mental illness has also been established.Empowering patients to take an active role in their care, is good practice and encouraged as part of the NHS Long Term Plan.Quality Improvement methodology was used to design and deliver a multi-disciplinary team (MDT) intervention, on a forensic mental health ward for persons with intellectual disability, to improve physical health in this patient group.MethodCardiovascular risk was assessed for 13 patients on a low secure forensic mental health ward. Measures of weight, BMI, blood pressure, resting heart rate, smoking status &amp; status regarding prescription of psychotropic medications were collected.Together with individual comorbidities and activity levels, a personalised care plan was co-produced by MDT members and patients. Motivational interviewing techniques were adapted to support patients to set personal goals.Education sessions were designed in 'easy-read' format and delivered by MDT members in a group format. Focus groups were held with service users and with staff members to explore barriers to change. Based on these, specific ideas to increase physical activity and support healthy dietary changes were introduced.The Patient Activation Measure (PAM) questionnaire was modified and used to assess confidence and knowledge in preventing or reducing health problems, and maintaining changes.ResultCardiovascular risk and activity levels were assessed for 13 inpatients. 85% of patients had a BMI in the overweight or obese range. 62% were regular cigarette smokers. 92% were prescribed psychotropic medications. On review of 2 months of opportunities for activity, all patients were categorised as 'inactive'. Patients engaged to varying degrees to co-produce personalised care plans and to engage in group education and physical activity. Of these patients, all showed improvement in measures of Patient Activation and activity level.ConclusionAn individualised approach is required in exploring physical health problems, considering modifiable risk factors and addressing barriers to change. Co-production, and active participation of MDT members in role-modelling 'healthy habits' was positively reported by patients to facilitate self-management.

Smokers’ support for the ban on sale of slim cigarettes in six European countries: findings from the EUREST-PLUS ITC Europe surveys

Background: Efforts to regulate tobacco products and reduce consumption in the European Union (EU) include the European Tobacco Products Directive (TPD), which went into force in May 2016. Despite the initial discussion to include a ban on sale of slim cigarettes, it was excluded in the final TPD. The main goal of this study was to examine support for a ban on slim cigarettes among smokers in six European Countries. Methods: Data from the 2018 (Wave 2) International Tobacco Control Policy Evaluation Project 6 European Country (ITC 6E) EUREST-PLUS project survey, a cross sectional study of adult smokers (n=5592) from Germany, Greece, Hungary, Poland, Romania, and Spain, was analysed. Descriptive statistics were used to estimate support for a ban on slim cigarettes by sociodemographic characteristics and smoking behaviors. Logistic regression analysis was used to examine factors associated with support for a ban on slim cigarettes and perceptions of harm. Results: Support for a ban on slims varied across countries, with highest support in Romania (33.8%), and lowest in Greece (18.0%). Female smokers (OR=0.77; 95%CI=0.66-0.90, daily smokers (OR=0.59; 95%CI=0.42-0.83), menthol smokers (OR=0.56; 95%CI=0.36-0.87), and smokers who did not have plans to quit within next six months (OR=0.45; 95%CI=0.36-0.57) had significantly lower odds of supporting a ban on slim cigarettes. Overall, 20% of smokers perceived slim cigarettes as less harmful than regular cigarettes. Conclusions: Support for a ban of slim cigarettes was relatively low among smokers, while misperceptions that slim cigarettes are less harmful is high, particularly among countries where slim cigarette use is more prevalent. Findings support a ban on slim cigarettes to reduce misperceptions around slim cigarettes being less harmful.

Prospective estimation of the age of initiation of cigarettes among young adults (18-24 years old): Findings from the Population Assessment of Tobacco and Health (PATH) waves 1-4 (2013-2017).

To prospectively estimate the age of cigarette initiation among young adults (18-24 years old) who were never cigarette users at their first wave of adult study participation overall, by sex, and by race/ethnicity given recent increases in cigarette initiation occurring in young adulthood. Secondary analyses were conducted using the PATH restricted-use adult datasets among young adult never users of cigarettes in waves 1-3 (2013-2016) with outcomes followed-up in waves 2-4 (2014-2017). Interval censoring survival methods were used to estimate the age of initiation of (i) ever, (ii) past 30-day, and (iii) fairly regular cigarette use. Among never cigarette users when they first entered the adult study, interval censoring Cox proportional hazard models were used to explore differences in the estimated age of initiation of the three cigarette use outcomes by sex and by race/ethnicity, controlling for the effect of previous e-cigarette use and the total number of other tobacco products ever used (0-5 products) before cigarette initiation outcomes. Among the young adults who were never cigarette users at their first wave of adult participation, the highest increase in cigarette initiation occurred between 18 and 19 years old. By age 21, 10.6% (95% CI: 9.5-11.7) initiated ever cigarette use, 7.7% (95% CI: 6.1-8.1) initiated past 30-day of cigarette use, and 1.9% (95% CI: 1.4-2.5) initiated fairly regular cigarette use. After controlling for other tobacco products: (a) males were 83% more likely to initiate past 30-day cigarette use at earlier ages than females; (b) Hispanic and Non-Hispanic Black young adults had increased risk to initiate past 30-day cigarette use at earlier ages than Non-Hispanic White young adults (62% and 34%, respectively). The substantial amount of cigarette initiation among young adults reinforces the need for prevention strategies among this population. Although, interventions are needed for all young adult populations, strategies should target 18-21-year-olds, with potentially differential prevention targets by sex and by race/ethnicity.

Fresher with flavour: young women smokers\u2019 constructions and experiences of menthol capsule cigarettes and regular cigarettes

BackgroundFlavour capsule cigarettes are one of the fastest growing segments of the tobacco market, and there is evidence that Australian young people are increasingly using menthol flavoured capsule cigarettes. This qualitative research examines how young women construct and experience menthol flavour capsule cigarettes as part of their smoking practices, and explores the perceived differences between menthol capsule cigarettes and regular cigarettes. Semi-structured face-to-face in-depth interviews were conducted with 41 Australian young women smokers, using a constructivist grounded theory approach.ResultsFindings reveal that the perceived fresh and improved taste of menthol and the ability to customise the smoking process positively contributed to young women’s experiences of smoking menthol capsule cigarettes. In particular, menthol capsule flavour cigarettes were constructed by the young women as “fresh”, “light” and “minty”, and “popping” the menthol capsule allowed the young women to personalise their smoking experience.ConclusionThese results indicate that specific public health campaigns and legislation should be developed to counter the powerfully alluring effects and the innovative appeal of menthol capsule cigarettes.