Tobacco smoking is still one of the most important avoidable risk factors for early morbidity and mortality. Smokers lose roughly one decade of life, whereas the cessation of smoking leads to an increase in the quality of life and years of life. In Germany the life expectation is disproportionately low in view of the well-developed social security system and the number of heathy years is reduced in the younger generations. An essential reason is considered to be the previous focus on curative instead of preventive medicine, among others caused by the lack of a superordinate strategy for prevention. In the past measures for individual prevention were shown to be less effective than measures for behavioral prevention, such as tobacco tax and smoking bans. The cessation of smoking is an essential component of secondary prevention but is currently insufficiently promoted and implemented by those responsible in the healthcare system and is additionally poorly funded. New products containing nicotine are infiltrating the market, which among other things are unsuitable for smoking cessation due to the high potential for dependency and the cardiovascular and pulmonary risk profiles. Additional measures, such as the limitation of the influence by the tobacco industry, the implementation of the "Strategy for a tobacco-free Germany 2040" and the complete remuneration of costs for tobacco cessation are necessary in the future to fulfil the minimum standard for prevention, to sustainably reduce the foreseeable cost explosion in the healthcare system and to enable a sustainable society.

Secondhand smoke (SHS) constitutes a significant health risk for children. This study examined whether knowledge of SHS harms to children and concern about setting examples for children and are associated with intentions to quit among adults who smoke in Japan, a country where child health and parental role as models for their children are highly valued. Data came from respondents of the 2021 ITC Japan Wave 4 Survey who smoked cigarettes at least weekly (n = 2586). Weighted logistic regression analyzed whether respondents' knowledge of SHS harms to children (Knowledge Index), concern that one's smoking would influence children to smoke (Influence Index), and support for banning smoking in cars with children (Policy Index) were associated with intentions to quit. 39.3% of respondents intended to quit smoking. 85.5% of all respondents supported a law to ban smoking in cars with children. The Influence Index was most strongly associated with quit intentions (OR = 2.21, 95% CI = 1.94, 2.53), and this association was stronger for respondents living with children at home than for respondents who did not (interaction p=.039). Greater knowledge of SHS harms (OR = 1.39, 1.27, 1.54) and support for banning smoking in cars with children (OR = 1.39, 1.27, 1.54) were also associated with quit intentions, but that association was no different among those who lived with children. Both knowledge about SHS health harms on children and concerns that one's smoking would influence children to smoke were significantly related to quit intentions. This suggests that interventions to increase awareness among adults who smoke may reduce children's exposure through increased quitting, especially among those with children. The very high support among those who smoke for a law to ban smoking in cars with children suggests that this is a feasible policy option in Japan.

Approximately 5000 child deaths are attributed to secondhand smoke exposure (SHSe) annually, which is three times the number of childhood cancers combined. Infants, medically fragile infants, are highly vulnerable to the harmful effects of SHSe, including respiratory infections and sudden infant death syndrome. While having a home smoking ban may mitigate these risks, implementation remains a challenge for many families. Our primary aim was to explore the familial and sociocultural factors associated with smoking-ban initiation and maintenance in households with medically fragile infants. Qualitative interviews were conducted with 20 mothers participating in a behavioral intervention from 2015 to 2016 aimed at reducing SHSe in infants discharged from a large urban, children's hospital in Houston, Texas. Interviews explored family structure, cultural influences, social networks, and smoking history. Thematic analysis was used to identify key themes. Three primary themes emerged: 1) Household structure and power dynamics - mothers in multigenerational homes often lacked authority to enforce smoking bans, especially when the primary authority figure was a smoker; 2) Sole responsibility - mothers felt burdened as the only advocates for SHSe reduction, often without support from other household members; and 3) Variable level of support for SHS bans - while emotional and logistical support was common during infants' hospital stays, this support rarely extended to smoking-related behavior change. Participants felt these factors significantly influenced smoking-ban initiation and sustainability. Findings underscore the need to move beyond individual-level interventions and engage the broader household context. Intervention sessions should include all household members - particularly individuals who smoke - and incorporate collaborative care models that offer behavioral counseling, pharmacological aids (e.g. nicotine replacement therapy), and real-time feedback technologies. Tailoring interventions to reflect household power structures and support systems may enhance their effectiveness in reducing SHSe and protecting medically vulnerable infants.

Exposure to cigarette smoke is one of the environmental risk factors that is still widely found and has a significant impact on the health of the respiratory system, especially the upper respiratory tract. The irritants and toxic substances in cigarette smoke can trigger mucosal inflammation, interfere with the defenses of the airways, and increase susceptibility to various upper airway disorders. This study aims to systematically analyze the relationship between cigarette smoke exposure and upper airway disorders based on available scientific evidence. The method used is Systematic Literature Review (SLR) with reference to the PRISMA 2020 guidelines. Literature searches were conducted through PubMed, ScienceDirect, Google Scholar, and Garuda databases. Articles were selected based on inclusion and exclusion criteria, resulting in 26 articles that were analyzed narrative-synthesis. The results showed that most studies reported a meaningful association between exposure to cigarette smoke, both in active and passive smokers, and an increased risk of upper respiratory tract disorders such as rhinitis, sinusitis, recurrent upper respiratory tract infections, pharyngitis, and laryngitis. Higher risks are found in passive smokers, especially children, as well as in individuals with long-term, high-intensity exposure. The conclusion of this study confirms that exposure to cigarette smoke is an important and preventable risk factor for upper respiratory tract disorders. Therefore, it is necessary to strengthen the policy of non-smoking areas, public education, as well as promotive and preventive efforts in health services to reduce the impact of exposure to cigarette smoke on the health of the upper respiratory tract.

This study evaluated the effectiveness of smoke-free legislation in reducing indoor air pollutants, specifically PM<sub>2.5</sub>, NO₂, and TVOC, in recreational facilities in Korea. A quasi-experimental before-and-after study was conducted in selected indoor venues, with pollutant levels compared pre- and post-designation of non-smoking areas. Monitoring was performed in three billiard halls and three screen golf ranges in Seoul. PM<sub>2.5</sub>, NO₂, and TVOC were measured using a Grimm 1.108 aerosol spectrometer (Germany), MEZUS-210/ANA-2 and Teledyne M200E (Korea/USA), and a Sibata MP-Σ30 sampler (Japan). Sampling occurred during operating hours, and results were analyzed using non-parametric tests against Korean standards. After implementation, PM<sub>2.5</sub> decreased from 42.8 to 18.6 μg/m³, and NO₂ from 148.3 to 57.9 μg/m³, though reductions were not statistically significant. TVOC showed the clearest improvement, falling significantly from 29.2 to 18.4 ppb (p < 0.01). Smoke-free policies substantially reduced indoor pollutants, particularly TVOC, in recreational facilities. While PM<sub>2.5</sub> and NO₂ declines were less consistent, the results highlight both the benefits of smoke-free laws and the need for complementary interventions such as improved ventilation and continuous monitoring.

INTRODUCTIONSecondhand smoke (SHS) exposure poses health risks to pregnant women, with spousal smoking identified as the primary source of SHS exposure among Chinese pregnant women. This study examines smoking cessation intention and its associated factors among smoking husbands during their wives' pregnancy.METHODSThis was a cross-sectional study in Shanghai from April 2021 to December 2024, enrolling all registered pregnant women and their cohabiting smoking husbands in Jinshan District, Shanghai (n=1754 couples). Separate structured questionnaires were administered to collect demographic data and smoking-related behaviors. Double data entry was performed using EpiData 3.1, with SPSS 26.0 employed for statistical analyses.RESULTSAmong the participants, 47.4% of the smoking husbands expressed a willingness to quit smoking. The results of the univariate analysis indicate that a husband's willingness to quit smoking is associated with several factors, including his age, health status, and the surrounding environment (p<0.05). Multivariable logistic regression analysis revealed that husbands' willingness to quit smoking was significantly associated with several factors. Specifically, compared to husbands younger than 25 years old, those older than 35 years were less willing to quit smoking (adjusted odds ratio, AOR=0.52; 95% CI: 0.38–0.70). Additionally, husbands in poor health were less likely to quit than those in good health (AOR=0.65; 95% CI: 0.50–0.93). Furthermore, husbands with higher levels of education were less likely to quit than those with lower levels (AOR=0.62; 95% CI: 0.46–0.82). When comparing smoking habits, husbands who smoked ≥11 cigarettes per day were less willing to quit than those who smoked ≤5 cigarettes daily (AOR=0.56; 95% CI: 0.42–0.75).CONCLUSIONSSmoking cessation intentions among husbands are influenced by multidimensional interactions of individual characteristics (age, health status), smoking behavior patterns (intensity, duration), and family and social environments (smoking bans, peer influence). Future research should elucidate the mechanisms underlying the interactions among these variables.

This research aims to increase public legal literacy towards the Ranperda of Non-Smoking Areas (KTR) through university service programs in the city of Medan. The approach used is qualitative descriptive with the subject of people living or active in the target area of the Ranperda KTR. Data was collected through training and workshops on legal rights, obligations, and sanctions, pre- and post-training questionnaires, and participatory observation to assess community response and participation. The results of the study show that legal literacy training has proven to be effective in increasing public understanding of the Ranperda KTR, increasing awareness of legal compliance, and encouraging active participation in supervision and implementation of regulations. Based on these findings, it is recommended that legal literacy programs be carried out routinely with interactive methods, supported by local governments through socialization and public facilities that facilitate compliance with the KTR. This research shows that educational and participatory-based community service is an effective strategy to strengthen legal compliance while creating a healthier environment.

Spain implemented an extensive outdoor smoking ban during the COVID-19 pandemic in 2020. We examined support for this restriction during and beyond the pandemic among people who currently and formerly smoked. Cross-sectional study. The 2021 ITC EUREST-PLUS Spain Survey used a multistage sampling to obtain a representative sample of people who currently or formerly smoked (n=1006). We estimated prevalence ratios (PRs) to examine associations with ban support during and after the pandemic. Analyses accounted for the complex sampling design and were weighted to ensure representativeness. Most people who currently (79.2%) and formerly smoked (94.6%) supported the outdoor smoking ban when a safe interpersonal distance could not be maintained during the pandemic. Support for a permanent ban remained substantial (61.4% and 87.2%, respectively). Those who currently smoke were more likely to support bans during and after the pandemic if they had smoke-free homes (PR=1.11; PR=1.29, respectively), understood secondhand smoke harms to health (PR=1.40; PR=1.65), had tried to quit (PR=1.14; PR=1.30) and self-reported as healthy (PR=1.40; PR=1.47). Those who formerly smoked were more likely to support bans during the pandemic if they had smoke-free homes (PR=1.08) and did not self-report as healthy (PR=0.95); and after the pandemic if they had quit smoking for ≥6 months (PR=1.23) and used alternative tobacco products (PR=1.17). Most people who currently or formerly smoked in Spain supported the outdoor smoking ban during and after the COVID-19 pandemic. This high acceptance suggests that the pandemic may have created an opportunity to strengthen tobacco control.

Robust evidence demonstrates that tobacco use acts as a causal and, therefore, modifiable risk factor for the development of type 2 diabetes mellitus (T2DM). However, its specific population-level impact in Mexico has not yet been quantified. This study aimed to estimate the population attributable fraction (PAF) of T2DM associated with tobacco use among Mexican adults, utilizing data from the 2021 National Health and Nutrition Survey (ENSANUT). A nested case-control analysis was conducted within the complex sampling design of the ENSANUT. Adults aged 20 years or older were included. Cases were defined as individuals with a self-reported medical diagnosed T2DM diagnosis; controls were individuals without T2DM. Exposure status was categorized as current person who smokes, former person who smokes, and never person who smokes. A logistic regression model was employed, adjusting for key covariates including age, sex, socioeconomic status, and comorbidities. The PAF was subsequently calculated using the Miettinen formula. The adjusted PAF for T2DM attributable to smoking was 10.1% (95% CI: 4.07-14.97). This finding suggests that approximately one in eight T2DM cases could be prevented through the elimination of tobacco use. The association was more pronounced among men and individuals with a history of heavy tobacco use. The estimated PAF for T2DM due to tobacco use underscores the significant contribution of policies established within the WHO Framework Convention on Tobacco Control to the prevention of chronic diseases. The implementation and strengthening of such policies, including increased tobacco taxes, comprehensive smoking bans in public places, on-package warnings, and advertising prohibitions, would prove highly beneficial. These findings show a strong population-level association between tobacco use and T2DM, but causality cannot be established. Future longitudinal studies in Mexico are needed to confirm these results.

Dual use of electronic and combustible cigarettes among adolescents is an emerging public health concern, particularly in countries experiencing rapid shifts in tobacco and nicotine product availability. This study examined the prevalence and correlates of ever and current dual use among adolescents aged 13-15 in Saudi Arabia. We analysed data from the 2022 Saudi Arabia Global Youth Tobacco Survey (GYTS), a nationally representative, school-based cross-sectional survey. Ever dual use was defined as having ever tried both cigarettes and e-cigarettes, while current dual use was defined as past 30-day use of both products. We used survey-weighted logistic regression to examine predictors of dual use. In the 2022 GYTS, 12.6% of adolescents had ever smoked cigarettes and 14.4% had ever used e-cigarettes; 2.9% and 5.4% were current users, respectively. Among 5,436 adolescents aged 13-15, 5.3% (95% CI: 4.3-6.4) reported ever dual use and 1.4% (95% CI: 1.1-1.9) reported current dual use. Ever dual use was associated with being aged 15 compared to 13years (AOR = 1.82, 95% CI: 1.14-2.91, p = 0.013), having ≥ 50 SAR weekly spending money compared to none (AOR = 1.60, 95% CI: 1.04-2.45, p = 0.032), having at least one parent who smoked vs none (AOR = 1.64, 95% CI: 1.18-2.28, p = 0.004), having close friends who smoked vs none (AOR = 5.01, 95% CI: 3.62-6.92, p < 0.001), being offered free nicotine products vs not offered (AOR = 2.96, 95% CI: 2.30-3.81, p < 0.001), and perceiving quitting nicotine as difficult vs not difficult (AOR = 1.85, 95% CI: 1.41-2.43, p < 0.001). Supporting both indoor and outdoor smoking bans vs not supporting bans (AOR = 0.40, 95% CI: 0.29-0.55, p < 0.001) and perceiving tobacco as less attractive vs more attractive (AOR = 0.63, 95% CI: 0.43-0.94, p = 0.023) were protective. Similar correlates were found for current dual use, notably having close friends who smoked vs none (AOR = 8.61, 95% CI: 4.21-17.61, p < 0.001) and being offered free nicotine products vs not offered (AOR = 2.82, 95% CI: 1.59-5.01, p = 0.001). Dual use among Saudi adolescents appears to be influenced by peer dynamics, product availability, and permissive social norms. Caution is warranted in interpreting associations due to potential reverse-causal explanations. These findings highlight the urgent need for tailored prevention and stronger policy enforcement.

Introduction: Voluntary bans on smoking inside the home reduce exposure to secondhand smoke, prevent smoking uptake, and support cessation. In Hungary, limited data are available on the temporal changes and correlates of smoke-free household rules. Objective: To examine the prevalence, temporal trend, and sociodemographic correlates of voluntary bans on traditional tobacco smoking inside the home. Method: We conducted a secondary analysis of data from two surveys in 2009 and one in 2022. The unit of analysis was the household. We applied Z-tests, Cochran–Armitage trend tests, and binomial logistic regression with calculation of average marginal effects (AMEs). Results: The proportion of households with a complete ban on smoking inside the home increased in Hungary from 60.6% in 2009 to 75.1% in 2022 (h = 0.3; p<0.01). Nevertheless, in 2022, 25.2% (95% CI: 22.5–28.0%) of children under the age of 18 still lived in households where smoking inside the home was allowed. Financial difficulties (AME ≈ –0.09 to –0.01) and the presence of a smoker in the household (AME ≈ –0.42 to –0.30) had a negative association in all models. The presence of a child under 18 years slightly increased the likelihood of a complete ban (AME ≈ 0.02 to 0.10). Discussion: Although there has been improvement, minors are still not adequately protected from indoor tobacco smoke in all Hungarian households. Conclusion: Our findings highlight the need for targeted health communication and intervention programmes, particularly among disadvantaged households with children and at least one smoker. Orv Hetil. 2025; 166(46): 1818–1826.

Studies on public support for tobacco control laws inform implementation strategies. We assessed public support for the Control of Smoking Products for Public Health Act 2024(Act 852). An online survey was conducted among 1000 adult Malaysians using the Global Adult Tobacco Survey questionnaire. Support for laws under Act 852; smoke-free environments, advertising, promotion, and sponsorship; tobacco packaging and labeling, sales restrictions, etc., cover conventional cigarettes and nicotine products, was measured on a five-point Likert scale. Support was compared between individuals who smoke tobacco and use nicotine products and those who do not use these products. The mean age was 38.7 years (SD=11.5), 60% were Malays, 49.4% were private employees, and 48.5% were educated to a bachelor's/higher degree. The respondents showed a high (>80%) level of public support for all laws. The highest support was for a ban on sales to minors (91.6%), a smoking ban in various public spaces (91.5%), and prohibiting sales via vending machines and places closer to higher education institutes (90.9%). Support was significantly higher among those who do not smoke and use nicotine products. Higher age and education, higher knowledge of the harms of smoking, and smoke-free policy at home were associated with higher support; current tobacco/nicotine product use and exposure to tobacco advertisements were associated with lower support. A strong public support for Act 852 that covers both tobacco and nicotine products augurs well for their strict implementation to achieve Malaysia's tobacco endgame of reducing smoking prevalence to <5% by 2040.

Despite a slight global decline in tobacco use in 2022, tobacco consumption still poses severe health risks across all age groups, thus underscoring the necessity for targeted tobacco control policies. This study employs an age-stratified analytical framework, examining adolescents, adults and the elderly. For adolescents, smoke-free campus policies and the regulation of tobacco purchase channels have proven effective, albeit with existing rural-urban disparities; tobacco tax hikes exert minimal influence, and social media anti-smoking campaigns require optimization. In the case of adults, tobacco taxation (which has a more pronounced impact on low-income groups) and public place smoking bans yield positive results, while smoking cessation services call for enhanced accessibility and integration with medical insurance. For the elderly, community-based interventions and nicotine replacement therapy (NRT) hold promise, yet rural areas suffer from resource shortages and low NRT utilization. Additionally, tobacco control policies for adults also indirectly benefit adolescents. This paper provides empirical evidence to inform the formulation of age-adapted tobacco control strategies.

Despite global progress in the field of tobacco control, rates of cessation intentions remain low in low- and middle-income countries (LMICs), including Türkiye. It is imperative to comprehend the multifaceted factors that influence individuals’ intentions to quit smoking to formulate efficacious tobacco control strategies. This community-based cross-sectional study explored sociodemographic and psychosocial factors as predictors of intention to quit tobacco smoking among adults in Türkiye. Intention to quit was assessed using a three-stage model: non-contemplation, undecided, and contemplation. Multinomial logistic regression was employed to analyze the associations between the intention stage and various predictors, including perceived financial hardship, social factors, and motives. Tobacco users’ quit intentions varied by sociodemographic and psychosocial factors. Financial hardship (AOR = 3.62; 95% CI: 1.44, 9.08) and difficulty with smoking bans (AOR = 2.88; 95% CI: 1.35, 6.15) increased the likelihood of being undecided. Primary (AOR = 0.29; 95% CI: 0.10, 0.81) and high school education (AOR = 0.24; 95% CI: 0.11, 0.56), as well as initiation due to emulation (AOR = 0.43; 95% CI: 0.21, 0.90), were linked to lower likelihood of contemplation. Conversely, adverse life events (AOR = 2.57; 95% CI: 1.14, 5.80) and enjoyment (AOR = 2.15; 95% CI: 1.15, 4.02) increased contemplation, while peer influence predicted significantly lower odds of being in the contemplation stage (AOR = 0.44; 95% CI: 0.22, 0.90). This study underlines the sociodemographic and psychological determinants of tobacco use among adults in Türkiye. Public health interventions should prioritize the groups with low health literacy, limited resources, and strong social and peer influences.

Smoking is a detrimental habit that contributes significantly to public health problems. To address this issue, the East Kutai Regency Government issued Regional Regulation Number 08 of 2017 concerning No-Smoking Areas. One of the designated KTR pillars is SMAN 2 North Sangatta, which plays a strategic role in reducing the high prevalence of smoking among adolescents. This study aims to analyze the influence of communication, resources, bureaucratic structure, and attitudes on the implementation of the KTR regulation. The research applied an analytical survey with a cross-sectional design involving 422 respondents from the academic community of SMAN 2 North Sangatta, selected through consecutive sampling. Data were collected through questionnaires and analyzed using chi-square and logistic regression tests. The findings revealed a significant relationship between communication and the implementation of the Smoke-Free Area regulation (p&lt;0.001), as well as between resources and implementation (p&lt;0.001). Conversely, bureaucratic structure showed no significant relationship (p=0.779)while attitudes demonstrated a positive influence. Logistic regression analysis confirmed that communication and resources were the most influential factors in ensuring effective implementation (p= 0.000&lt;0.05). In conclusion, strengthening communication and optimizing resource allocation are essential to improving compliance with KTR policies in schools.

Public transportation is very important for the mobility of Indonesian society and is used by millions of people every day, there is still a big problem related to smoking. Many regulations, implementation and law enforcement are still difficult. This study uses a normative legal research method with a legislative approach, a conceptual approach, and a comparative approach. Data collection is carried out through tracing primary, secondary and tensier legal materials and literature studies. In addition, this study develops a model of harmonization of laws and regulations for law enforcement of smoking bans on public transportation through an integrated regulatory framework approach to consumer protection, health and transportation regulations. It aims to identify weaknesses in the regulatory and law enforcement system, and to formulate more effective strategies to protect the rights of public transportation consumers to a smoke-free environment, so that it can provide more optimal protection for the health and safety of public transportation users in Indonesia.

BackgroundDrastic life events, such as a cancer diagnosis, do not necessarily lead to a reduction in unhealthy and dysfunctional behaviors like smoking. Continued smoking among cancer survivors significantly increases the risk of recurrence and worsens treatment outcomes. While evidence-based smoking cessation treatments have demonstrated their effectiveness in acute cancer care, their impact among long-term cancer survivors remains limited, and overall quit rates remain low. To cessation outcome and improve long-term support strategies, it is essential to better understand the experiences, attitudes, and perceived barriers of both current and former smoking cancer survivors.Materials and MethodsThis qualitative study included semi-structured interviews with six cancer survivors (50% female), aged 34 to 81 years, with different cancer types (breast, skin, lung, urinary bladder cancer, and GIST). At the time of the interview, three participants were still smoking, two had quit at the time of their diagnosis, and one had quit beforehand. All had completed cancer treatment at least four years prior without relapse. Interviews were transcribed verbatim and analyzed using qualitative content analysis, applying an inductive approach to identify recurring themes and categorize the data using computer-assisted analysis software.ResultsFour main categories emerged from the interviews: (1) motivations for quitting, (2) perceived barriers, (3) facilitators of cessation, and (4) contextual influences.Key motives for continued smoking after a cancer diagnosis included managing nicotine cravings and stress, experiencing pleasure and boredom relief, and a perceived lack of negative health consequences. Some participants reported smoking to cope with treatment-related discomfort. A general lack of knowledge regarding the link between smoking and cancer contributed to low motivation to quit and limited risk awareness. Participants who had successfully quit cited improvements in health and well-being as primary reasons for cessation, alongside external factors such as financial savings and the aversion to cigarette odor. Medical advice and support from healthcare providers were mentioned frequently – both as motivating factors and, in cases where such support was absent or discouraging, as barriers.Barriers to quitting included a persistent smoking environment, negative emotions during cessation attempts, poor timing related to the cancer experience, and previous failed quit attempts.Conversely, facilitators of cessation included external regulations (eg, smoking bans, legal restrictions), a tobacco-free environment, strong internal motivation, individual coping strategies for withdrawal symptoms and craving, medical recommendations, and support from family or peers.Discussion/ConclusionThe results highlight the need for a better adaptation of smoking cessation interventions to the specific needs of cancer survivors. This has significant implications for oncology professionals and healthcare providers in cancer care. The inconsistency in smoking cessation advice from healthcare providers, ranging from discouragement to strong encouragement, points to the necessity of re-evaluating current policies and establishing more standardized communication within oncology settings. Cancer survivors require improved education about the health risks associated with continued smoking, as well as information about available cessation aids and pharmacological support options. The “teachable moment” following a cancer diagnosis presents an opportunity to integrate smoking cessation support into routine oncological care. Practical strategies for cancer survivors who wish to quit include the development of alternative behaviors, effective stress management techniques, and further enhancement of legal restrictions to promote a smoke-free environment. Such measures would not only support individual cessation efforts but also contribute to broader public health goals, protecting cancer survivors and the general population from smoking-related harm. The insights from this study provide a foundation for the development of more tailored cessation interventions for cancer survivors.

Government of Himachal Pradesh imposed smoke ban in 2009 with convincing decline in smoking prevalence among young adults. Thereafter, government wanted to assess the impact of smoke ban considering its effective implementation. The objectives of this study were to assess reduction in acute myocardial infraction (AMI) and stroke hospital admissions in two districts (Shimla and Kangra) of Himachal Pradesh after smoke ban on July 1, 2009. A secondary data-based retrospective study using Poisson regression-based interrupted time series (ITS) modeling was carried out from January 2007 to December 2011. Monthly AMI and stroke hospital admission data were collected from January 2007 to December 2011 from two tertiary care hospitals. In district Kangra, admission data for study period 2007 (January to November) were not available, so ITS analysis was done from 2008 to 2011 for the said district. Risk ratio was calculated as exp (regression estimate) with a 95.0% confidence interval (CI) to assess effect. In both districts, smoke ban showed no effect (Shimla: 1.03; 95% CI: 0.85-1.25, Kangra: 0.97; 95% CI: 0.74-1.28) in terms of AMI admissions, even across gender and age groups. In Kangra district, smoke ban showed a protective effect on stroke admissions but with wide confidence intervals (0.21; 95% CI: 0.07-0.59). However, in Shimla district, it showed significant positive effect on an increase in stroke admissions (1.06; 95.0% CI: 1.03-1.75). Smoke ban showed no impact on AMI and stroke monthly hospital admissions in both districts, except in Kangra for stroke.

Abstract Background In many vocational and secondary schools, smoking is still considered as normal behavior. To change this norm, the project “Here We Are” aimed to denormalize (e-)tobacco product consumption. Methods Based on a detailed literature review, three workshops with students, and advisory board consultations, a denormalizing intervention was developed and implemented at three schools (e.g., relocating smoking areas away from school entrances, removing contradictory elements such as ashtrays in non-smoking areas, improving signage, and enhancing the appeal of non-smoking areas with sunshades, lounge chairs, as well as board an outdoor games). To evaluate the effectiveness of the intervention, 14-20-year-old-students filled in standardized online questionnaires on smoking regulations, perceived norms, attitudes, and behaviors (N = 673) before, during and after the intervention. We also conducted pre-post-observations of students’ smoking behaviors during school days and semi-structured interviews (N = 54). Results The new regulations were well received, students’ knowledge about local smoking regulations increased and the perception of (e-)tobacco use as “normal” declined (even five months after the intervention). The importance the change communication, the attractiveness of smoke-free zones relative to smoking areas, and the consistent enforcement of rules were identified as critical factors for the sustainable intervention success. Other key factors for success include adherence to the rules by school staff (teachers, cafeteria employees), students’ understanding of the new regulations, the timing of implementation (avoiding mid-school year), and the involvement of facility and technical services. Conclusions The findings suggest that re-designing school areas with adolescents can promote the denormalization of smoking. Challenges and opportunities as well as current work on the multiplication and continued development of the intervention will be discussed. Key messages • Co-designing school areas can promote the denormalization of (e-)tobacco product consumption. • Success factors comprise attractive smokefree zones, change communication, and rule enforcement.

Abstract Background In Finland, other than tobacco flavours have been prohibited in nicotine-containing and nicotine-free e-cigarettes since 2016, combined with other strict regulations such as retail licensing, distance sales ban, taxation, advertising and display ban and inclusion to smoking bans. Around 2021, new attractive “vapes” that partially circumvent these regulations became available. We examine the use of flavoured e-cigarettes among Finnish youth. Methods Biennial National School Health Promotion study data from years 2015-2023 with students on 8th-9th grades in comprehensive schools (N = 390004), 1st-2nd year in general upper secondary schools (N = 210150) and 1st-2nd year in vocational institutions (N = 122334) was utilized. Changes in tobacco-flavoured and other-flavoured (e.g., fruit) e-cigarette use were assessed with cross-tabulations and logistic regression models adjusted for age, gender, school type, smoking and snus use. Results Overall, daily e-cigarette use declined between 2015-2021 but increased between 2021-2023 both among girls and boys. In 2023, 5% of girls and 6% of boys used e-cigarettes daily. Use of tobacco-flavoured e-cigarettes was consistently less common than use of e-cigarettes with other flavours. Compared to 2017, when data was available for all e-cigarette flavours, current use of tobacco-flavoured e-cigarette became less likely in 2019 (OR 0.75, 95% CI 0.72-0.78) and remained on similar level in 2021 (OR 0.74; 0.71-0.78), but became more likely in 2023 (OR 1.60; 1.53-1.66). Current use of other than tobacco flavours became less likely in 2019 (OR 0.73; 0.71-0.75) and in 2021 (0.53; 0.51-0.55), but became more likely in 2023 (OR 2.26; 2.19-2.32). Conclusions Comprehensive e-cigarette regulations were associated with reduced e-cigarette use among youth, but the use increased when new products targeting regulatory loopholes became available. The increase was driven by use of other than tobacco flavours. Key messages • Regulation of flavours and other attractive elements in e-cigarettes is essential to prevent use among youth. • Yet, regulations need to be future proofed for new product developments.