Smoking Addiction Research Articles

Examination of the impacts of e-cigarettes smoking on the tobacco non-smokers

Significance and Aim: The effects of cigarettes smoking on both smokers and non-smoker have been an issue of global public health concern. This led to the emergence of e-cigarettes as an alternative to help smokers in their smoking quitting journey. However, it has remained unclear on the public health costs this has on the non-smokers. The ILR Review is developed to examine the public health the use of e-cigarettes have on non-smokers. Methods: The ILR sourced data from four databases Scopus, Medline, CINAHL, and Google Scholar. This was through a keyword search process using the ‘e-cigarettes’ or ‘vaping’ AND ‘addiction’ AND ‘non-smokers’ AND ‘effects OR ‘consequences, search phrases. The search protocol was replicated for all the databases. The findings from the search process were Scopus (419), Medline (283), CINAHL (311), and Google Scholar (321). The ILR applied inclusion and exclusion criteria and the GRADE model to assess the quality of the articles. Consequently, only 23 articles remained for analysis and inclusion in the ILR findings. Finally, the articles were screed through the EQUATOR PRISMA tool and extracted in readiness for analysis. Findings and Analysis: The results demonstrate that the use of e-cigarettes has two leading public health implications on non-smokers, namely (i) the risk of new addictions and (ii) the risk of health-related illnesses. The findings affirm that the ease of accessing the e-cigarettes, the marketing craze, and the low cost of acquiring them has exposed a rising number of young people to its new addiction. The addiction could at times progress into tobacco smoking addiction. Secondly, the findings indicate that second hand smoke exposure, also known as passive smoking exposes the public to increased lung cancer, lung diseases and COPD illnesses. Conclusion: The ILR concludes that e-cigarettes have far-reaching public health concerns on non-smokers. This necessitates the need for increased restrictions and control on the e-cigarettes access and availability. This is in addition to enacting strict regulations on smoking areas and freedom.

Perceived Effects, Motor Dexterity, Cognitive and Affective Functioning Between Smokers and Non-Smokers among Selected College Students

Background/Aim: Smoking addiction is a pervasive and high risk behavior linked with complex and damaging effects to a person’s biology, behaviors, psychological well-being and cultural influence. Chronic smoking is also associated with increased risk of exposure to neurodegenerative diseases and cigarette smoking poorly affects both cognitive and affective functioning of the smokers. The perceived effects of smoking are often generalized by society such that it is viewed in extremes. This means that the societal perceptions are either smoking serves as a “relaxing mechanism”, hence, making it as acceptable as any normal habit or that, conversely, smoking is gravely dangerous to one’s health when considered as a vice. This research focused on the causal comparative ex post facto of smoking and its perceived effects to the psychological functioning among smokers and non-smokers. Methods: O’ Connor Finger Dexterity Test, Abstract Reasoning Test and Affective Functioning Assessment Test were used as bases of data comparison between the two groups. Result/Conclusion: The test results indicate that there is a significant difference between the cognitive functioning and affective functioning among the smokers in comparison with non-smokers.

Sigara İçen ve İçmeyen Yetişkinlerin Ekspiryum Havasındaki Karbonmonoksit Düzeylerinin Bağımlılık Puanları ile İlişkisinin Değerlendirilmesi

Objectıve: Smoking; along with psychological factors and habits, it causes addiction in people. The level of smoking addiction is determined in clinical practices with the Fagerström Test for Nicotine Dependence (FTND). CO level measurement in expiratory air is frequently used today as a biomarker in the diagnosis, treatment and follow-up stages of addiction. In this study, it was aimed to evaluate the relationship between CO levels and FTND of smokers. Materials and Methods: The questionnaire was applied to smokers and healthy volunteers coming to the Selcuk University Faculty of Medicine Family Practice Clinic. 68 smoker patients and 60 non-smoker volunteers were included. Patients' sociodemographic characteristics, age of starting smoking, CO levels in expiratory air and FTND scores were recorded. The relationship between FTND scores and CO levels in expiratory air was investigated. Chi-square test was used to examine the comparison of categorical data. P value p<0,05 was considered statistically significant. Results: The mean age of the individuals included in the scope of the study was 53.0±6.9 and 39.1% of them were women, 60.9% of them were men. There was a statistically significant difference was found between the participants' gender, age, occupational characteristics and marital status and smoking status. FNBT score of smokers was found to be 5.00 ± 2.44 points. The average number of cigarettes smoked/year was 31.00±17.87 years, the average number of cigarettes smoked per day was 20.00±8.76 and the average age to start smoking was 18.00±4.82. There was a positive correlation between the CO results and FTND scores (p≤0.001). There was a negative correlation between the CO results and FEV1/FVC scores(p≤0.001). Conclusıon: Among the scales that measure nicotine addiction level, FTND is the most used one in smoking cessation clinics today. In our study, there was a positive correlation between CO levels and FTND scores, which was found statistically significant. Measuring CO during patient follow-up is both an objective criterion for evaluating smoking cessation and enhances patient compliance. Therefore, CO levels can also be used as a guiding factor in determining the severity of cigarette addiction. Keywords: Addiction, Carbonmonoxide, Smoking.

Patterns of Smoking and Alcoholic Addiction in In-Patients with Schizophrenia: Medical and Sociological Study

Objective: the comorbidity of schizophrenia and tobacco and alcohol addiction modifies the clinical manifestations of both diseases, impairs compliance, increases the risk of aggressive behavior and contributes to the criminalization of patients. In order to study the characteristics of tobacco smoking and alcohol consumption by patients with schizophrenia, we conducted a medical and sociological study of the specified contingent.Patients and methods: 104 in-patients with diagnosis of schizophrenia admitted to psychiatric hospital were interviewed in February 2020. All patients participating in the study have reached the age of 18. The research program is presented by the “Questionnaire for the study of smoking and alcoholic behavior in patients with mental disorders”. Evaluation of smoking status included K. Fagerström’s test, A. Leonov’s test “Why do I smoke?” To determine the motivation to smoke, smoking index was calculated to determine the risk of developing COPD, and the AUDIT test was used to assess alcohol consumption. Statistical processing of the results of the questionnaire survey was using the SPSS-17 software. The prevalence of smoking among patients with schizophrenia is high (56.8%). Most (86.4%) of them are heavy (66.1%) and hardcore (20.3%) smokers. A high degree of dependence was revealed, the smoking experience averages 27.6 years, and the number of cigarettes smoked per day ranges from 10–20 and even up to 60 pieces. The patients are characterized by early onset of smoking (15.2 years) and the prevalence of high (47.5%) and medium (18.6%) degrees of nicotine addiction. The prevalence of alcohol consumption among patients with schizophrenia is very high (36.5%). Most (73.7%) patients consume alcohol either regularly (31.6%) or habitually (42.1%). Every fifth (21.2%) stopped drinking alcohol due to poor health.Conclusions: high prevalence of smoking and alcoholic addiction in patients with schizophrenia increases the medico–social significance of this comorbidity.

Relationship between "nomophobia" and material addiction "cigarette" and factors affecting them.

Since technological devices used for communication affect communication between people, nomophobia is a disorder of a new age. In this study, we discuss the relationship between nomophobia and smoking addiction and the factors affecting them. The Demographic Information Form and Nomophobia Scale (NMP-Q), ıf they were smoking we applied The Fagerström Test for Nicotine Dependence (FTND) Scales were directed among students (n=641) at Süleyman Demirel University studying Medicine, Dental, Nursing and Physiotherapy departments in the 1st and 4th grades. Mann-Whitney U, Kruskal-Wallis test to compare the scores of the variables with more groups. Correlation analysis was performed between the NMP-Q and Fagerström Test for Nicotine Dependence Scale scores by Spearman correlation. Bonferroni test applied as Post Hoc test for multiple comparisons of groups. In our study, 267 (42.6%) of participants who had nomophobia refuse to be dependent and smartphone addiction level was found to be 99.69 for all students. Responses were received from 73.2% (n=469) female and 26.8% (n=172) male participants. There is no significant difference between smokers in terms of factors in nomophobia (P>.05). The total score of the questionnaire (P<.01*) by gender and averages scores of women were higher in all mentioned sub-dimensions and total scores. In our study, there was no correlation between nomophobia and cigarette addiction because of the low number of smokers participating in our survey. Therefore, new conflicts with wider audiences are needed to examine the relationship between these two addictions.

Waterpipe smoking, internet addiction and depression: A public health problem trio?

Waterpipe smoking and Internet addiction may result in a new public health problem globally. This study aimed to explore waterpipe use among a large group of adolescents and its association with Internet use, mental health, primarily depression and their demographic characteristics. Using a stratified random sampling method, 2054 tertiary school students aged 14-18years were recruited in 2019. Demographical information and use of tobacco products (eg, waterpipe) were explored and compared with severity of Internet addiction and mental status. A total of 288 (14.0%) adolescents had ever used waterpipe. Multivariate logistic regression analyses suggested that being male (OR=2.55 and 95% CI=1.98-3.30; P=.0001), being depressed (OR=1.62 and 95% CI=1.24-2.11) and excessive Internet use (OR=1.94 and 95% CI=1.50-2.52; P=.0001) were significantly associated with waterpipe use. Family income and parents' educational status showed no relationship with waterpipe smoking. We suggest that adolescents who are depressed and who use the Internet excessively are at an increased risk for waterpipe use, independent of income and parenteral education.

Status and associated factors of campus bullying among students with left-behind experience in universities in the Yangtze River Delta

Objective To understand campus bullying among college students with left-behind experiences from universities in the Yangtze River Delta region and to provide information for mental health development of those college students. Methods In the Yangtze River Delta, 8 universities were selected to conduct investigations on 2 426 undergraduates in terms of left-behind ex- periexe, health-related information and campus bullying. The results were analyzed by χ 2 test and Logistic regression analysis. Results The incidence rate of bullying among college students in universities in the Yangtze River Delta is 41.71%, among which the number of students who have suffered physical, language, relationship, and sexual bullying is 13.07%, 36.73%, 22.79%, and 21.19%, respectively. The proportion of boys who suffered bullying was 39.31%, and that of girls was 44.27%, the difference was statistically significant (χ 2 =6.12, P <0.05). The proportion of left-behind college students in physical, language, relationship and total bullying was higher than that of non-left-behind college students, and the differences were statistically significant ( P <0.01). Logistic regression analysis showed that male, relationship with parents and left - behind experiences were negatively with campus bullying ( P <0.05), and urban and rural, smoking, drinking, gaming addiction and left-behind college students were positively correlated with campus bullying ( P <0.05)); Parental relationship was negatively correlated with non-left-behind college students with campus bullying ( P <0.05), and smoking, drinking, and gaming addiction were positively correlated with non-left-behind college students’ campus bullying ( P <0.05). Conclusion Campus bullying is more common among college students with left-behind experiences in the Yangtze River Delta region. Measures should be taken to carry out targeted interventions in various aspects. 【摘要】 目的 了解长三角地区高校有留守经历大学生校园欺凌状况及影响因素, 为高校留守经历大学生心理健康发展 提供帮助。 方法 在长三角地区选取8所高校的2 426名大学生进行是否留守经历、健康相关及校园欺凌等方面的问卷 调查, 并对结果进行；χ 2 检验、Logistic回归分析等。 结果 长三角地区高校大学生遭受欺凌的发生报告率为41.71%, 其中 遭受身体、语言、关系、性欺凌的学生分别占13.07%, 36.73%, 22.79%, 21.19%。男生遭受欺凌的比例为39.31%, 女生为 44.27%, 差异有统计学意义(U6.12,P<0.05)。留守经历大学生身体、语言、关系及总欺凌的比例均高于非留守大学生, 差异均有统计学意义 ( P 值均<0.01)。Logistic回归分析显示, 男生、父母关系与留守经历大学生校园欺凌呈负相关 ( P 值 均<0.05), 城乡、吸烟、饮酒、游戏成瘾与留守经历大学生校园欺凌呈正相关( P 值均<0.05);父母关系与非留守经历大学生 校园欺凌呈负相关( P 值均<0.05), 吸烟、饮酒、游戏成瘾与非留守经历大学生校园欺凌呈正相关 ( P 值均<0.05)。 结论 长三角地区高校大学生遭受校园欺凌有留守经历学生的发生率高于非留守学生, 且影响因素存在差别。应采取措施进行 多方面的针对性干预。

What Motivates Smokers to Switch to ENDS? A Qualitative Study of Perceptions and Use.

Switching completely from cigarettes to electronic nicotine delivery systems (ENDS) may reduce health risks for addicted smokers. This paper provides information about perceptions and other factors that may influence smokers’ ENDS use and substitution for cigarettes. We conducted 12 online focus groups (N = 61) among smokers who had never tried using ENDS (Never Users, N = 11), currently used both cigarettes and ENDS (Dual Users, N = 21), used but discontinued ENDS (Rejectors, N = 14), and switched completely to ENDS use (Switchers, N = 15). Thematic analysis was used to interpret the transcripts. Participants described initial interest in trying ENDS in hopes of quitting smoking and because of convenience (i.e., due to rules, regulations, or social norms). Risk perceptions and higher prices relative to cigarettes were reported as disadvantages of ENDS that discouraged initiation. Dual Users and Rejectors reported product problems (e.g., products breaking) and dissatisfaction (i.e., inability to satisfy cravings for cigarettes) as factors that lowered their substitutability for cigarettes or led to discontinuing ENDS use. Switchers indicated that satisfaction, lack of product problems, and perceived safety facilitated successfully switching from cigarette smoking to exclusive ENDS use. However, Switchers reported trying many products before they found ones that satisfied their needs. We recommend that policymakers consider the potential impact of tobacco control policies on smokers’ motivation and ability to switch completely from cigarettes to ENDS.

The CHRNA5 polymorphism (rs16969968) and its association with waterpipe smoking addiction among Jordanians

Waterpipe smoking is a form of tobacco use that causes nicotine/tobacco dependence and has become a global health problem. In this study, the association of rs16969968 SNP in the CHRNA5 gene with waterpipe dependence was investigated. A total of 386 men and women who used a waterpipe to smoke tobacco were recruited and divided into less dependent and more dependent smokers based on their score on the Lebanon Waterpipe Dependence Scale (LWDS). Results showed a significant difference in the distribution of GG, GA, and AA genotypes by waterpipe dependence status (p < .001). The more dependent group showed a higher frequency of the AA genotype than the less dependent smokers’ group (38% vs. 23%, respectively). In addition, the more dependent smokers exhibited more A allele than less dependent smokers (53% vs. 37% respectively, p < .001). In conclusion, there is an association between the rs16969968 SNP and waterpipe dependence as assessed by the LWDS.

On line ‘Diabetes and Smoking’ Survey: results and com¬ments

Cigarette smoking increases the risk of micro and macrovascular complications among subjects with diabetes. Smoking is also associated with both beta-cell function deterioration and insulin resistance. In the modern approach to the management of the global cardiovascular risk of the diabetic patient, cigarette smoking needs the same attention as other major factors (glycaemia, blood pressure and cholesterol). The prevalence of smokers, according to the AMD 2020 Annals, is 16,9% among type 2 diabetic patients and 25,9% among type 1 diabetic patients. These rather high percentages, in line with the overall population data, suggest the need of a greater and more effective engagement by diabetes team to discouraging smoking. The ‘Diabetes and Smoking’ Survey was designed by the ‘Diabetes and Addictions’ AMD-SID Lazio Working Group in order to analyze the perception that diabetologists have of smoking, to explore their specific knowledge of the smoking treatment, to highlight the interventions adopted to discourage smoking and to identify critical issues in clinical practice. The Survey has shown, first of all, the need to sensitize diabetologists to the topic of smoking: not everyone believes that smoking is addictive and not everyone adequately investigates it in anamnesis and includes it in medical records. The Survey also identified specific knowledge required on treatments for cigarette smoking addiction: diabetologists know little about drugs for smoking treatment, have false beliefs about new devices for smoking (electronic cigarettes and heated tobacco) and are little or not in contact with Anti-Smoking Centers. Currently, the intervention strategy preferred by diabetologists is to inform patients about smoking related damage, an approach of proven low efficacy (knowledge is not enough to change behaviors). Psychologists are rarely part of the diabetes Team, but even when this happens, they are not involved in the smoking addiction treatment. Finally, the Survey highlighted that the main obstacle perceived by diabetologists in the fight against smoking is the lack of a structured care process. The objective of the ‘Diabetes and Addictions’ Working Group is filling the gap between overall diabetes care (control and improvement of any micro and macrovascular risk factor) and smoking addiction treatment. KEY WORDS addiction; cessation; minimal advice; antismoking centers; structured care process.

Kicking the habit is hard: A hybrid choice model investigation into the role of addiction in smoking behavior.

Use of choice models is growing rapidly in tobacco research. These models are being used to answer key policy questions. However, certain aspects of smokers' choice behavior are not well understood. One such feature is addiction. Here, we address this issue by modeling data from a choice experiment on the US smokers. We model addiction using a latent variable. We use this latent variable to understand the relationship between choices and addiction, giving attention to nicotine levels. We find that more addicted smokers have stronger preferences for cigarettes and are unwilling to switch to e-cigarettes. Addicted smokers value nicotine in tobacco products to a much greater extent than those that are less addicted. Lastly, we forecast short-term responses to lowering nicotine levels in cigarettes. The results suggest that current nicotine-focused policies could be effective at encouraging addicted smokers to less harmful products and lead to substantial public health gains.

GAMBARAN SELF CONCEPT SISWA YANG MENGALAMI KECANDUAN MEROKOK

The purpose of this study was to determine how the self-concept of students who experience smoking addiction. The method used in this research is a qualitative method with descriptive research type. The data collection techniques used were observation, interviews. The results of the study revealed that students' self-concept of smoking arose because of the results of their interactions with the environment, where smoking among their fellow students was considered normal and even considered a stylish and cool thing, so they thought smoking was not a wrong thing. Keywords: : self concept, smoking behavior.

LC-MS/MS Method in Nicotine Metabolites Quantification

Nicotine is a ganglioplegic alkaloid, being the main component of tobacco. Some of the final metabolites of nicotine could be used to evaluate the nicotine dependency in humans using the Fagerstrom test. The test consists in cotinine quantitative determination, and evaluation of the correlation between cotinine from plasma and from urine. Cotinine quantification was performed using LC-MS/MS method both for blood and urine, in a private authorized laboratory for medical tests. Our study was conducted in two stages (1st year of study - initial assessment; and 6th year of study - final assessment) and included 62 apparently healthy subjects (77% females and 23% males) with an average age of 19�1.48 years at baseline, respectively 24�0.83 years at the final assessment. The prevalence of smoking increased significantly from 14.51% to 32.25% (p=0.01) (11% F and 3% M initially, respectively 25% F and 7% M final). The final assessment found that 21% became smokers after starting their university studies, 11% were permanent smokers throughout the 6th year study, and only 3.22% quit smoking. Percentage distribution on smoking addiction levels was at baseline: mild 11%, moderate 33%, severe 56%, and a final assessment: mild 15% (p=0.77), moderate 75% (p=0.01) and severe 10% (p=0.007). The results show a significant increase in the number of smoker girls compared to boys, a significant increase in the prevalence of moderately dependent smokers and a significant decrease in the prevalence of severely dependent smokers. LC-MS/MS can be used very well to evaluate the cotinine content in blood and urine, which could be used in Fagerstrom test in order to evaluate the nicotine addiction in young people and to find priority solutions for smoking prevention and quit smoking.

Palliative and high-intensity end-of-life care in schizophrenia patients with lung cancer: results from a French national population-based study.

Schizophrenia is marked by inequities in cancer treatment and associated with high smoking rates. Lung cancer patients with schizophrenia may thus be at risk of receiving poorer end-of-life care compared to those without mental disorder. The objective was to compare end-of-life care delivered to patients with schizophrenia and lung cancer with patients without severe mental disorder. This population-based cohort study included all patients aged 15 and older who died from their terminal lung cancer in hospital in France (2014-2016). Schizophrenia patients and controls without severe mental disorder were selected and indicators of palliative care and high-intensity end-of-life care were compared. Multivariable generalized log-linear models were performed, adjusted for sex, age, year of death, social deprivation, time between cancer diagnosis and death, metastases, comorbidity, smoking addiction and hospital category. The analysis included 633 schizophrenia patients and 66,469 controls. The schizophrenia patients died 6years earlier, had almost twice more frequently smoking addiction (38.1%), had more frequently chronic pulmonary disease (32.5%) and a shorter duration from cancer diagnosis to death. In multivariate analysis, they were found to have more and earlier palliative care (adjusted Odds Ratio 1.27 [1.03;1.56]; p = 0.04), and less high-intensity end-of-life care (e.g., chemotherapy 0.53 [0.41;0.70]; p < 0.0001; surgery 0.73 [0.59;0.90]; p < 0.01) than controls. Although the use and/or continuation of high-intensity end-of-life care is less important in schizophrenia patients with lung cancer, some findings suggest a loss of chance. Future studies should explore the expectations of patients with schizophrenia and lung cancer to define the optimal end-of-life care.

CHRNA5/CHRNA3 polymorphisms and tobacco smoking risk in a Brazilian population sample

Tobacco smoking is a major risk factor of several diseases such as lung cancer, stroke, chronic obstructive pulmonary disease and increases the susceptibility to infectious diseases. The understanding of smoking addiction requires phenotyping and genotyping studies. Variations in CHRNA5/CHRNA3 can alter receptor responses to nicotine and thus interfere with smoking behavior and risk. Therefore, this study aimed to investigate the association of CHRNA5 rs16969968 and CHRNA3 rs578776 with smoking behavior in a Brazilian population sample, comprising 449 subjects. Smoking data was obtained from a questionnaire. The polymorphisms were genotyped by Polymerase Chain Reaction (PCR). Associations were verified using logistic and linear regression analyses. We found that women with the variant AA genotype for CHRNA5 rs16969968 were at significantly increased risk of smoking, with an OR of 3.09 (95% CI: 1.09-8.76; p= 0.033). The variant TT genotype of CHRNA3 rs578776 showed protection against smoking and later smoking initiation in the overall population and in women, with an OR of 0.41 (95% CI: 0.19-0.88; p=0.022). In conclusion, CHRNA5 rs16969968 and CHRNA3 rs578776 were associated with increased risk and protective effect against smoking, respectively, in a Brazilian population sample. Gender and recessive homozygosis of the polymorphisms variants resulted in a significant effect regarding the results.

Fagerström test for nicotine dependence as an indicator in tobacco-related studies in periodontology.

Smoking is considered a risk factor for periodontitis genesis and progression. Numerous clinical studies have demonstrated the negative effect of smoking, in particular the number of cigarettes consumed (NCC), on periodontal clinical parameters. However, smoking addiction assessed by the Fagerström test for nicotine dependence (FTND) has received little attention in periodontal research. In smoking patients presenting with periodontitis, the periodontal clinical features were measured and correlated with smoking status. The ability of FTND and NCC to predict periodontitis severity was assessed and compared. Thirty-four smoking patients aged 46.5 ± 11.5 years were included. The means of NCC and FTND were 16.6 ± 5.5 and 5.2 ±1.8, respectively. NCC and FTND were correlated with each other (r=0.57, P<0.001). Patients had stage III (44.1%) or stage IV (55.9%) periodontitis and 73.5% presented a generalized extension of periodontitis. The combination of FTND and NCC in discerning disease severity (ROC curve analysis: AUC=0.746, P=0.027) was superior to each indicator separately. A discriminant score based on both indicators (D=-0.42 - 0.15 × NCC + 0.63 × FTND) derived by logistic regression showed the opposite role of the indicators and the greater relevance of FTND (P=0.031) compared to NCC (P=0.084) in the relationship. This study shows that FTND could substantially complement NCC as an indicator of smoking status in periodontal research.

Determinants of Tobacco Smoking Addiction in Rural Indonesian Communities.

Purpose To analyze the determinants of tobacco smoking addiction in rural areas. Methods A cross-sectional study was conducted on February 2020. The self-administered questionnaire (α = 0.908) and Perceived Stress Scale–10 were used as tobacco smoking determinants and the WHO ASSIST questionnaire V3.0 to determine its addiction risk. Their correlations were analyzed by Spearman's rank-order approach using the SPSS version 23.0. Results Among 75 male respondents that participated in this study, those on low, moderate, and high addiction risk were 45 (60.00%), 23 (30.67%), and 7 (9.33%), respectively, and significantly correlated with the research questionnaire that consisted three parts: 1. awareness toward the health risk; 2. social control; 3. mass media role in tobacco smoking (p=0.014, 0.004, and 0.009 respectively), but there was no significant correlation with the stress level (p=0.287). Conclusion Increased awareness toward the health risk, good social control, and mass media reporting the danger of tobacco smoking is significantly in correlation with the decreased addiction in rural areas. However, the high perceived stress has no correlation with its increase.

Prevalence of Addiction among Tuberculosis Patients

Background : India accounts for about a quarter of the global TB burden. Worldwide India is the country with the highest burden of both TB and MDR TB. Smoking and alcohol use results in sub-optimal response to anti tuberculosis treatment as well as poor prognosis Alcoholism and Nicotine abuse contribute significantly to the development and treatment course of tuberculosis in patients. Aim of the Study: To assess the Prevalence of Nicotine and Alcohol Addiction among Tuberculosis Patients and to monitor the effect of Brief Counselling Sessions for the De-addiction of Alcohol and Nicotine in the management of Tuberculosis Patients. Material & Methods: We had taken the tuberculosis patients coming to the OPD of Medicine and Respiratory Medicine Departments of DrRMLIMS, Lucknow. We used questionnaires for assessing the Nicotine Dependence and Alcohol dependence among the tuberculosis patients (Fagerstrom Tolerance Questionnaire), The Alcohol use disorders Identification Test (AUDIT). Results: Prevalence of Addiction among tuberculosis patient-54 cases out of 447 total cases (April to October). In our study, we found addiction in 45 males and 9 females, Smoking addiction was seen in 13 tuberculosis patients, alcohol addiction was found in 17 tuberculosis patients, and both smoking and alcohol addiction was seen in 24 patients. Conclusion: Nicotine and Alcohol Addiction problem in Tuberculosis patients should be effectively assessed through the nicotine addiction and AUDIT scales and Brief Cognitive Therapy should be introduced along with regular ATT for effective management of such patients.

Effectiveness of tobacco warning labels before and after implementation of the European Tobacco Products Directive-findings from the longitudinal EUREST-PLUS ITC Europe surveys.

Tobacco product packaging is a key part of marketing efforts to make tobacco use appealing. In contrast, large, prominent health warnings are intended to inform individuals about the risks of smoking. In the European Union, since May 2016, the Tobacco Products Directive 2014/40/EU (TPD2) requires tobacco product packages to carry combined health warnings consisting of a picture, a text warning and information on stop smoking services, covering 65% of the front and back of the packages. Key measures of warning label effectiveness (salience, cognitive reactions and behavioural reaction) before and after implementation of the TPD2, determinants of warning labels' effectiveness and country differences were examined in a longitudinal sample of 6011 adult smokers from Germany, Greece, Hungary, Poland, Romania and Spain (EUREST-PLUS Project) using longitudinal Generalized Estimating Equations (GEE) models. In the pooled sample, the warning labels' effectiveness increased significantly over time in terms of salience (adjusted OR = 1.18; 95% CI: 1.03-1.35), while cognitive and behavioural reactions did not show clear increases. Generally, among women, more highly educated smokers and less addicted smokers, the effectiveness of warning labels tended to be higher. We found an increase in salience, but no clear increases for cognitive and behavioural reactions to the new warning labels as required by the TPD2. While it is likely that our study underestimated the impact of the new pictorial warning labels, it provides evidence that health messages on tobacco packaging are more salient when supported by large pictures.

The past is not the future in tobacco control

In this paper we have attempted to identify missed opportunities to change the trajectory of smoking and smoking caused diseases in America over the past 100 years. Many of the missed opportunities identified are due to the actions of cigarette manufacturers who misled the public about the dangers of cigarette smoking, the addictiveness of nicotine, and the feasibility of providing lower risk alternative nicotine delivery products to addicted smokers. An important lesson learned from the past is that treating all tobacco/nicotine products as equivalently harmful is counterproductive to public health as it only serves to protect the most lethal nicotine product – cigarettes. Since 2000, the evolving marketplace of lower risk nicotine products combined with regulatory authority over tobacco products represents a new opportunity to dramatically transform the cigarette business in ways that were never imagined when the war on tobacco was raging decades ago. However, this requires embracing risk-proportionate regulation, taxation policies, and providing consumers with accurate public messaging on product relative risks. A regulatory framework based on sound science that encourages and rewards new or existing manufacturers to invest in consumer acceptable lower risk products to replace cigarettes needs to be encouraged. The past is indeed not the future in smoking control, but it may be difficult to escape the past unless a realignment of market forces and policies can be achieved.