Smoking Behavior Research Articles

Transdiagnostic Risk Factors for Reasons for Smoking: Evaluating the Concurrent Role of Distress Tolerance and Anxiety Sensitivity.

Although rates of cigarette smoking have declined in the US, many individuals report experiencing significant barriers to quitting smoking, including poor mental health. Two prominent affective vulnerability factors that independently underlie both smoking behavior and processes and mental health include distress tolerance and anxiety sensitivity. However, limited work has examined the concurrent role of these factors on motivational reasons for smoking. The current study is a secondary analysis of baseline data from a nationally recruited sample of individuals (N = 156; Mage = 29.74, SD = 7.72; 69.2% female) interested in participating in a digitally delivered intervention for comorbid smoking and low distress tolerance. Two-step hierarchical linear regression was used to examine the unique role of self-reported distress tolerance and anxiety sensitivity in relation to reasons for smoking (i.e., habitual, negative affect reduction, addictive, pleasurable/relaxation, stimulation, and sensorimotor manipulation). Results indicated that lower levels of distress tolerance and greater levels of anxiety sensitivity were associated with greater sensorimotor manipulation reasons for smoking. Only distress tolerance was related to addictive, negative affect reduction, and stimulation reasons for smoking, whereas only anxiety sensitivity was related to habitual reasons for smoking. The current findings suggest that there is an explanatory utility for unique and multi-risk effects for distress tolerance and anxiety sensitivity for understanding smoking motives.

Assessing the Need for Additional Evacuation Measures in Deep Underground Stations

Underground railroad stations face evacuation challenges owing to the rapid spread of smoke and extended escape routes during fires. Evacuation in deeply underground domestic railroad stations relies solely on stairways, with no legal standards for additional evacuation methods. In contrast, international standards such as NFPA 130 and Japan’s Fire Protection Engineering Association (JAFPE) recommend using evacuation elevators as a supplementary means of evacuation. This study analyzed smoke behavior in deep underground railroad stations through fire simulations at the Soongsil University and Guryong station. It also examined additional evacuation measures to enhance evacuation safety through evacuation simulations. The results show that during a fire, smoke spread follows the same path as the passenger evacuation routes because of the chimney effect. Even with smoke control and ventilation systems in operation, smoke follows the same evacuation routes, such as stairways or escalators. Therefore, the study concluded that evacuation elevators should be installed as an additional means to improve evacuation efficiency, and placed in smoke-protected evacuation routes. The study also found that combining evacuation stairways and elevators significantly enhances the evacuation efficiency.

Associations Among Experiences With Racial Discrimination, Religion/Spirituality, and Cigarette Smoking Among African American Adults: The Jackson Heart Study.

African American adults exhibit disproportionately high rates of tobacco-related diseases and associated death. Experiences with racial discrimination contribute to health disparities among African Americans, but more research is needed to understand associations between perceived discrimination and tobacco use as well as potential protective factors. This study examined associations between perceived racial discrimination and cigarette smoking, as well as religion and spirituality as moderators of any associations. Cross-sectional data were drawn from the Jackson Heart Study, a study of cardiovascular disease risk factors among African American adults in Jackson, MS. Measures included perceived everyday discrimination and major life events discrimination that was attributed to race. Participants also reported religious attendance, prayer, spirituality, and whether they prayed in response to discriminatory experiences. Logistic regression models tested associations between perceived racial discrimination and cigarette smoking status, and interactions between religiosity/spirituality and discrimination in predicting smoking status. A total of 2,972 participants were included in the analysis (62.7% female, mean age 55.1 years). Thirteen percent reported currently smoking cigarettes. Everyday racial discrimination was associated with a higher likelihood of current smoking (p = .01). The association between lifetime racial discrimination and current smoking status was weaker for those who reported prayer as a reaction compared to those who did not report prayer as a reaction (adjusted odds ratio = 0.32, 95% confidence interval: 0.11 to 0.91) while adjusting for demographics and covariates. Stressful experiences with racial discrimination may create risks for health behaviors like smoking. However, prayer may act as a coping strategy to help buffer the effects of racial discrimination on smoking behavior.

Effectiveness of Video Education in Preventing Electric Smoking Behavior in Students

Electronic cigarettes have experienced very rapid development, recently many people have been seen using electronic cigarettes, In Indonesia, as many as 2.1 million who use electronic cigarettes are students. Control of electronic cigarettes is carried out by providing education to change the knowledge and attitudes of adolescents. In the digital era, innovation is possible in delivering messages for prevention through audiovisual media such as short videos. This study aims to determine the effectiveness of video media on knowledge, attitudes and actions of electronic smoking behavior in adolescents at SMK Istiqomah Muhammadiyah 4 Samarinda. This study was conducted using an Experimental research method with a pre and post design approach. This study involved two research groups, namely the experimental group and the control group. Data were obtained using a questionnaire on knowledge, attitudes and actions of electronic smoking. The research sample was 234 students. The sampling technique that will be used in this study is Simple Random Sampling. Statistical Wilcoxon Signed Rank Test. The results of the study were that after education using video there was an increase in knowledge of 5 points and attitudes of 2 points. The results of the statistical test showed that there was an effect of video education on knowledge and attitudes with a P Value of 0.000. The conclusion of this study is that video education about the dangers of electronic cigarettes can increase knowledge and attitudes towards preventing electronic smoking behavior.

Examining the impact of health insurance and socioeconomic factors on children’s hospitalization in Indonesia: an empirical analysis

ABSTRACT The purpose of this research is to examine the impact of different types of healthcare and insurance on the health of Indonesian youth. The study employs logistic regression, a statistical method used to analyze relationships between variables and predict outcomes. Data were collected through an Indonesia’s National Socio-Economic Survey, which gathers information from individuals within a household. The findings reveal that Indonesia’s National Health Insurance (with or without subsidies) reduces the likelihood of children being hospitalized. Families enrolled in the program, often from low- to middle-income backgrounds with limited access to healthcare, benefit significantly from this initiative, which provides affordable and essential health services. This program allows these families to access healthcare that would otherwise be unaffordable. However, private and employer-sponsored insurance did not reduce hospitalization rates, likely because families in these plans already benefit from better overall health, nutrition and access to health-promoting activities. In contrast, children without insurance are more likely to be hospitalized due to their location and economic and financial constraints. Other determinant factors affecting children’s health included age, sex, parent’s education, smoking behavior and house location. The results showed that older children were generally healthier, children of well-educated and non-smoking parents were less likely to be hospitalized and those living in urban areas had a higher likelihood of hospitalization than those in rural areas. This study highlights the importance of expanding access to health insurance and promoting parental education and non-smoking behavior to improve children’s overall health. Failing to address these issues could create challenges for the future, given that the current young generation will eventually become the nation’s leaders.

Sensors for Smoking Detection in Epidemiological Research: Scoping Review.

The use of wearable sensors is being explored as a challenging way to accurately identify smoking behaviors by measuring physiological and environmental factors in real-life settings. Although they hold potential benefits for aiding smoking cessation, no single wearable device currently achieves high accuracy in detecting smoking events. Furthermore, it is crucial to emphasize that this area of study is dynamic and requires ongoing updates. This scoping review aims to map the scientific literature for identifying the main sensors developed or used for tobacco smoke detection, with a specific focus on wearable sensors, as well as describe their key features and categorize them by type. According to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) protocol, an electronic search was conducted on the PubMed, MEDLINE, and Web of Science databases, using the following keywords: ("biosensors" OR "biosensor" OR "sensors" OR "sensor" OR "wearable") AND ("smoking" OR "smoke"). Among a total of 37 studies included in this scoping review published between 2012 and March 2024, 16 described sensors based on wearable bands, 15 described multisensory systems, and 6 described other strategies to detect tobacco smoke exposure. Included studies provided details about the design or application of wearable sensors based on an elastic band to detect different aspects of tobacco smoke exposure (eg, arm, wrist, and finger movements, and lighting events). Some studies proposed a system composed of different sensor modalities (eg, Personal Automatic Cigarette Tracker [PACT], PACT 2.0, and AutoSense). Our scoping review has revealed both the obstacles and opportunities linked to wearable devices, offering valuable insights for future research initiatives. Tackling the recognized challenges and delving into potential avenues for enhancement could elevate wearable devices into even more effective tools for aiding smoking cessation. In this context, continuous research is essential to fine-tune and optimize these devices, guaranteeing their practicality and reliability in real-world applications.

Natural language processing realises the potential of electronic health records: identifying risk factors for disease progression and major adverse limb events in intermittent claudication

Abstract Background/Introduction Peripheral Arterial Disease (PAD) is a common pathology, affecting 4.5% of the UK population. Symptomatic PAD manifests as intermittent claudication (IC). Predictors of IC progression to Chronic-Limb-Threatening Ischaemia (CLTI) and complications including Major Adverse Limb Events (MALE), such as smoking history and diabetes, have been described previously in resource-intensive cohort studies. Novel Natural Language Processing (NLP) approaches transform routinely collected, unstructured health records into datasets for real-world analysis of PAD. Purpose This study leverages NLP based interrogation of electronic health records to efficiently identify risk factors for disease progression and MALE in patients presenting with IC. Methods A retrospective cohort study of patients with PAD at a large, tertiary vascular referral centre identified using the SNOMED terms of IC in the Medcat-NLP-AI toolkit. Demographics, Index of Multiple Deprivation (IMD), and indicators of disease progression, and revascularisation and amputation (MALE) were analysed using Kaplan-Meier survival and Cox Proportional-Hazards analysis. Results 5,027 patients (Mean age 73.7(61.8-85.6), Males 66.1% (n=2,781) were identified. Self-reported population ethnicity was 4.72% Asian, 15.5% Black, 79.7% White. All-cause mortality was 19.5% (n=979) after 10 years of follow-up, with 5.85% of patients progressing to CLTI (n=294). 2.32% of Asian patients, 5.78% of Black patients and 5.04% of White patients progressed to CLTI, respectively. 5.09% of Asian patients, 8.99% of Black patients, and 7.36% of White patients underwent amputation. Multivariate analysis of risk factors for progression to CLTI, demonstrated that diabetes (HR 2.36, 95%CI: 1.22 - 4.48, p = .01) and smoking history (HR 1.76, 95%CI: 1.19 - 2.59, p = .004) independently predicted progression. No risk factors for MALE reached significance. Conclusions Diabetes and smoking behaviour are well-described in the literature as risk factors for progression to CLTI. This study demonstrates the utility of NLP as a resource efficient, validated, methodological tool. Disparities in MALE may exist between patients within a universal healthcare system, although our sample size was insufficient to demonstrate statistical significance. A larger, multicentre analysis is warranted. NLP represents a valuable tool for efficiently identifying and analysing risk factors for PAD progression and holds potential to refine management algorithms.KM curves of CLTI-free survival (DM)

Factors Influencing Tobacco Use in Chinese Teenagers

The Report on Chinese Adolescent Tobacco Use 2023 announces a year-on-year decline in the prevalence of smoking in Chinese teenagers. Nevertheless, the hazards of tobacco products to the physical and mental health of this population remain a concerning issue. This study is an encapsulation of factors influencing the smoking behavior of Chinese adolescents based on a review of relevant literature. Personal characteristics such as gender, age, psychological traits, lifestyle, and perceptions of tobacco use, along with environmental factors like the family environment, circle of friends, and school climate, can all potentially influence a teenager's smoking behavior. A thorough examination of these factors can provide implications for advancing the regulation of teenager tobacco use and improving the work on adolescent health protection.

Smoking cessation after acute myocardial infarction: a Swiss-wide cohort study

Abstract Background Smoking is a major cardiovascular risk factor and of great importance in terms of both primary and secondary prevention. The present study aims to identify patient characteristics associated with smoking cessation within 1 year after acute myocardial infarction (AMI) to inform physician-patient interactions, secondary prevention measures, and public health planning. Methods ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) patients enrolled between 2012 and 2022 in the AMIS Plus registry who were active smokers at the time of the index event were included. At the 1-year follow-up, patients were questioned about their smoking behaviour via telephone interview and were further classified into those who had quit (stoppers) or continued (continuers) smoking. Patient characteristics were collected at the time of the index event and at follow-up and then compared using descriptive statistics. Results From a total of 4523 patients with AMI, 4242 (93.8%) provided information regarding their smoking status at a median follow-up of 395 days (interquartile range 370 to 469) after the index event. Of 1691 (39.9%) active smokers at the time of AMI, 861 (50.9%) reported quitting whereas 830 (49.1%) were still smoking at the 1-year follow-up. Stoppers were younger (57 vs. 58 years, p<0.001), more likely to be male (82.8% vs. 77.7%, p=0.008) and have presented with STEMI (77.0% vs. 71.0%, p=0.005), and less likely to have had a previous AMI (6.6% vs. 13.3%, p<0.001) than continuers. Smoking cessation was more common in patients with a more severe AMI characterised by a greater extent of myocardial injury (in-hospital median peak creatine kinase level 1291 IU/L vs. 1101 IU/L, p=0.012), at least one in-hospital complication (13.9% vs. 9.9%, p=0.01), and participation in a rehabilitation programme (83.7% vs. 68.8%, p<0.001). Stoppers more frequently implemented other favourable lifestyle changes, such as dietary changes (56.2% vs. 45.2%, p<0.001) and increased physical activity (54.6% vs. 37.7%, p<0.001) than continuers. Self-reported weight gain was more prevalent among those who quit smoking (44.0% vs. 19.7%, p<0.001). Conclusions In Switzerland, half of the patients with AMI who were active smokers at the time of AMI, reported to have stopped smoking 1 year after the index event. Smoking cessation was associated with participation in a rehabilitation programme and occurred more often in patients with larger AMI sizes, higher in-hospital complication rates and more frequent implementation of other favourable lifestyle changes after AMI. The significant weight gain after smoking cessation seems to represent a major issue that should specifically be addressed.

Social norms and social opportunities: a qualitative study of influences on tobacco use among urban adolescent girls in Ghana

BackgroundTobacco use is a global public health threat and a leading preventable cause of death in the world. While cigarette use among youth has been decreasing in high-income countries, low- and middle-income countries have contrastingly high rates of adolescent smoking. In Ghana, smoking prevalence is lower than in other parts of the African continent and more common among men than women; however the gender gap in tobacco use among adolescents has narrowed, with shisha use among girls recently surpassing boys. These trends toward increased relative use among adolescent girls are a cause for concern and highlight the need for interventions to prevent and/or reduce tobacco use in this population.MethodsWe conducted in-depth interviews with girls aged 13–20 (n = 148) and their parents (n = 7) in Ghana’s largest two cities – Accra and Kumasi, to explore the physical, social, and psychological context underlying smoking perceptions and behavior.ResultsWe identified 11 key insights into influences on smoking behavior, organized into the broader themes of perceptions of smoking, environmental factors, and internal factors. Findings underscore that perceptions around smoking are very much driven by girls’ social world, which is generally small and parent-centric for non-smokers at younger ages but can start to expand as girls get farther along in school or leave school entirely. After what may have been a sheltered adolescence, many older girls in Ghana look for ways to express their independence in decision-making and a few may use their developing agency to rationalize limited or infrequent tobacco use if they perceive the benefits to them outweigh the potential consequences.ConclusionsOur findings highlight strong social influences on girls’ perceptions, exposure to opportunities, and decision-making in ways that can often be protective against smoking, particularly at younger ages, but may also leave girls unprepared to manage challenging situations later in life. Understanding this context in Ghana will be important for any future programming aiming to prevent smoking initiation among adolescents.

Identity in the context of physical activity and smoking: A scoping review among adults aged 45+

Abstract Background Identity (i.e., self-perceptions of oneself) plays an important role in health behaviors such as physical activity (PA) and smoking. This review offers a comprehensive synthesis and comparison of how PA- and smoking-related identity is associated with PA and smoking behavior in adults aged 45+. It further synthesizes and compares identity terminology and measurement tools used to capture identity concerning smoking cessation and PA among adults aged 45+. Where applicable, the role of personal, PA-, and smoking-related characteristics were considered. Methods A thorough search across 11 databases, updated in May 2023, yielded 5801 unique publications. Ensuing careful screening procedures, 45 peer-reviewed empirical studies were systematically reviewed. Experts in the field contributed to validate and structure the narrative. Results The review reveals a complex, enduring connection between identity and behavior in both PA and smoking domains, encompassing processes like identity formation, maintenance, change, and loss. In essence, identities linked to PA and abstaining from smoking emerged as pivotal for promoting active lifestyles and successful smoking cessation. Many parallels but also distinctions emerged within this association, alongside variations in the terminology and measurement tools pertaining to identity. Factors such as gender, age, and behavioral history emerged as influential in shaping identities related to smoking and PA. Conclusions Despite variances, findings suggest that the relationship between identity and behavior, including associated processes, may not fundamentally differ between health-promoting and health-compromising behaviors. There is however need for more unified identity definitions and measurement tools. We propose avenues for future research, including exploring causality between identity and behavior to facilitate the development of identity-related smoking cessation and PA-promotion interventions. Key messages • Identities associated with physical activity and refraining from smoking are associated with a physically active lifestyle and successful smoking cessation. • Despite differences, the relationship between identity and behavior may not fundamentally vary between health-promoting and health-compromising behaviors.

Quitting with pride: Differences in smoking behaviour across sexual identity groups in Ireland

Abstract Background As smoking prevalence reduces, smoking inequalities across population groups is emerging as a key challenge. Despite recognition of specific needs among members of the Lesbian, Gay, Bisexual, Transexual Plus (LGBT+) community, differences in smoking across sexual identity groups is uncharted in Ireland and the community is not represented in tobacco policy agenda setting. This study aimed to measure and compare the prevalence of smoking, quitting intention and quitting behaviour across sexual identify groups in Ireland. Methods Secondary analysis of the 2023 “Healthy Ireland” cross sectional survey of health status was conducted (n = 7,411). For the first time, this survey included a question on self-reported sexual identify, along with standard questions on smoking prevalence, quitting intention and quitting behaviour. Prevalence of smoking, quitting intention and quitting behaviour were calculated with 95% Confidence Intervals (CI) and compared across groups with Chi Square tests. Results In total, 2.3% (95% CI 2.0-2.7%) of respondents reported an LGB+ identity. Compared to those reporting straight identity, LGB+ respondents reported higher smoking prevalence (17.6% versus 21.4% respectively); intention to quit was similar across groups, however, LBG+ respondents also reported a higher prevalence of making at least one quit attempt in the previous 12 months (51.3% versus 78.0% respectively, p < 0.0001). Conclusions While this study highlighted tobacco-use as a health challenge for the LGB+ community in Ireland, it also identified an opportunity for tailored stop smoking approaches to support quit success. As a consequence, an innovative Fulbright-sponsored policy dialogue was convened between leaders in tobacco control, LGBT+ community leaders, health services and academia across Ireland and the USA to explore solutions, underlining the important role equity stratifiers and population surveillance play in agenda setting for public health. Key messages • Including sexual identity in the national population health survey enabled tobacco-use needs across sexual identity groups in Ireland delineated for the first time. • Equity-stratified population health surveillance informed a policy dialogue to better represent needs of LGBT+ community in public health agenda setting.

Mind the gap: from real-world policies to health impact assessment modelling

Abstract When conducting health impact assessments (HIA), researchers often face the challenges of trying to align as closely as possible with policy scenarios. This phase concerns the translation of real-world policies into estimates usable in models. Most of the time, researchers need to address a policy-impact gap between what is needed by the policymakers and what is believed to be reliable data fitted for the model. These mismatches can stem from differences in how exposure and outcomes are studied compared to the policy plan. By looking at a case study of the planned Belgian policy to reduce tobacco selling points, challenges during the pre-modelling phase were identified. The question of what an effect size should be and its importance in the HIA process were considered fundamental for the analysis. In particular, literature on exposure to tobacco sales points differed in outcomes, as it would target proximity to someone’s home, while the policy itself focuses on the reduction of points of sale of a specific store type. Similarly, smoking behaviour can be measured in various ways, such as initiation, cessation, relapse rates, or overall smoking prevalence. The policies’ effect on these various outcomes differed significantly. In this presentation, the discussion will focus on the alignment of the existing literature with the specific details outlined in the policy. We will explore the challenges that arose when existing research criteria and assumptions did not fully match the policy, taking the new Belgian tobacco plan as an example. Lastly, we will highlight the opportunity to set up monitoring systems to evaluate tobacco interventions to extract reliable estimates for HIA and strengthen evidence-based tobacco policies in the future.

7.P. Skills building seminar: Using health impact assessment for assessing tobacco control policies

Abstract Tobacco use is the largest contributor to premature death and preventable disease in Europe. Despite decreasing tobacco use in recent years, the European Commission estimates that the number of smokers in Europe is 26% in the population, and 29% among 15-24 year olds. This persistent public health risk is amenable to policy, but targeted and effective strategies are needed. Health impact assessment (HIA) methods can aid decision-makers in exploring the consequences of policy actions on select outcomes, providing a platform for informed, evidence-based policy design. Routine data collection on risk factors including smoking and tobacco use behaviour is common and available in Europe. Analysing and valorising these data can provide a better picture of vulnerable and target groups for which tobacco use is a persistent problem, or where the attributable disease burden is particularly high. These data can form the basis for robust projections and the application of HIA methods. In addition, a number of policy strategies exist for tobacco control including changes in packaging, taxation, labelling, ingredients, creation of smoke-free environments, and restrictions on advertising. These policies have a common goal in improving tobacco control, but may lead to differential effects across age groups, populations, and different measures of tobacco use. It is thus necessary to use robust tools to understand these effects and better coordinate and plan policy. HIA methods, each with their own strengths and limitations, have been applied successfully to estimate the impact of different tobacco control measures. Novel methodologies that make use of available data, computational power, and provide a low-cost way to explore policy interventions can be an essential tool to policy planning and in particular to tackle the intractable areas of tobacco control. This skills building workshop will present two key approaches, each with their own strengths and weaknesses, that have been applied in HIA studies on tobacco control - i.e., a static approach based on the calculation of potential impact fraction, and a dynamic approach based on microsimulation models. Furthermore, the workshop will demonstrate, using two real-life examples, how policy measures can be translated into effect size estimates - which is one of the most crucial steps in any HIA. By providing a step-by-step presentation of how HIA has been applied in practice, attendees will gain unique insights in the different ways by which HIA can be used to gain insights into the relative impact of policy strategies for tobacco control. Key messages • Tobacco use remains the largest contributor to preventable disease burden in Europe; a key area for analysing policies using health impact assessment. • Attendees will gain unique insights in the different ways by which HIA can be used to gain insights into the relative impact of policy strategies for tobacco control.

Tobacco Smoking Functional Networks: A Whole-Brain Connectome Analysis in 24,539 Individuals.

Nicotine addiction, a multifaceted neuropsychiatric disorder, profoundly impacts brain functions through interactions with neural pathways. Despite its significance, the impact of tobacco smoking on the whole-brain functional connectome remains largely unexplored. We conducted a whole-brain analysis on 24,539 adults aged 40 and above from the UK Biobank cohort. Subjects were categorized into individuals who use nicotine and who do not use nicotine based on current and chronic tobacco smoking information. Functional connectivity was assessed using resting-state functional magnetic resonance imaging (rfMRI). We employed a network analysis method to assess the systematic effects of tobacco smoking on brain connectome by identifying subnetworks that show nicotine-use-related differences. Our analyses revealed two nicotine-use-related subnetworks with distinct network structure (permutation p-value < 0.001). In the first network, there is a significant decrease in resting-state functional connectivity (rsFC) between the basal ganglia regions (e.g., nucleus accumbens) and 73% of the remaining brain regions, emphasizing the central hub role of basal ganglia in addictive smoking behaviors. Additionally, a data-driven subnetwork mainly involving regions from frontal and occipital lobes, showed reduced rsFC among individuals who use nicotine. The results suggest significant alterations in the communication and coordination among the basal ganglia and the broader network of brain regions. The observed changes in rsFC indicate a widespread disruption in the connectivity patterns associated with nicotine use. This study identifies rsFC subnetworks related to chronic nicotine use through whole-brain connectome analysis. The findings confirm that widespread alterations in rsFC are centered around hub nodes within the basal ganglia, including bilateral nucleus accumbens, putamen, caudate, and globus pallidus. In addition, our analysis found a clique-forming subnetwork vulnerable to tobacco smoking consisting of regions from the visual, dorsal/ventral attention, and frontoparietal networks.

Understanding compliance with smoke-free environments: a realist review

Abstract Background Local governments increasingly implement outdoor smoke-free environments to decrease adolescent smoking and denormalize smoking behavior. Recent research indicates that compliance with smoke-free outdoor spaces is often lacking. We examined compliance with outdoor smoke-free environments and examined the mechanisms that affect compliance in different contexts. Methods We performed a realist review, an exploratory approach that synthesizes existing evidence into a program theory that links elements of compliance with outdoor smoke-free environments with specific mechanisms and outcomes. A search was performed in PubMed, Web of Science, Embase, and PsycINFO, resulting in 25 relevant English language articles. Preliminary results Our analysis showed that the kind of enforcement (voluntary or enforcement with sanction options etc.) influences smokers’ compliance. Additionally, how implementation of the smoke-free environment was done (with supporting signs, size of the environment, attention for smoking cessation etc.) also influenced smokers’ compliance. For instance, with the implementation of an outdoor smoke-free environment (context), smokers get used to non-smoking. They are reminded they can quit smoking at any time (mechanism), leading to more compliance (outcome). If however, their social environment continues smoking (context), they are more inclined to keep smoking (mechanism), which leads to less compliance (outcome). Conclusions Compliance of smokers with smoke-free outdoor environments is influenced by the type of enforcement and the type of outdoor smoke-free environment. These mechanisms are important to understand so that policymakers may consider smokers’ reactions and are better able to anticipate upon them. Key messages • Type of enforcement and type of implementation influence compliance with smoke-free outdoor environments. • This realist review helps policymakers consider smokers’ reactions while implementing smoke-free environments.

The role of interoception in lifestyle factors: a systematic review

Abstract Interoception, the perception of the internal state of the body, has been shown to play an important role in various conditions. A clear overview of the relationship between interoception and lifestyle factors has to the best of our knowledge not yet been presented. This systematic review aims to provide insight into the current state of evidence about the role of interoception in lifestyle factors. A protocol for this systematic review was registered in PROSPERO (CRD42023465957). A systematic search conducted in PubMed, Embase, and Web of Science databases included terms such as interoception (accuracy, attention, awareness, sensitivity, or sensibility), as well as lifestyle factors (alcohol consumption, cognitive leisure and relaxation activities, eating behavior, exercise, sleep, or smoking). Studies written in English, using qualitative data, including adults, using at least one measure of interoception, and using at least on measure of a lifestyle factor were included. The review included 68 studies, in which 47 measures of interoceptive accuracy and 34 measures of interoceptive attention were identified. Six studies quantified interoceptive awareness (e.g., the interaction between interoceptive accuracy and attention). 12 studies focused on alcohol consumption, 22 studies on cognitive leisure and relaxation activities, 19 studies on eating behavior, 9 studies on exercise, 4 studies on sleep, and 5 studies on smoking. Generally, cognitive leisure and relaxation activities, eating behavior, and fasting showed positive relations with interoception. Conflicting evidence on the relation between exercise and some interoceptive domains, and moderate evidence on the positive relation with other interoceptive domains was found. Greater sleep difficulties were related to enhanced interoception scores and alcohol consumption was negatively related with interoception, while results on the relation between interoception and smoking behavior showed varying results. Key messages • Some lifestyle factors positively influence interoception and vice versa, while for other factors the results are varying or conflicting. • The role of interoceptive skills in lifestyle factors is important for lifestyle and health management.

Exploring non-smokers’ attitudes toward e-smoking: results from the Minerva Project Europe

Abstract Background In the shifting paradigm of tobacco use, the attitudes of non-smokers toward e-cigarettes are crucial for public health planning, as in the literature it has been suggested that non-smokers who use e-cigarettes could be more prone to switch to tobacco. This multi-center study investigates the interplay between traditional smoking and the potential benefits of transitioning to e-smoking, through a comprehensive examination of smoking behaviors, dietary, and lifestyle practices. Methods MINERVA (My changINg lifEstyles, our Research, and eVeryone’s heAlth) is an ongoing prospective international cohort study aimed at investigating the association between smoking habits and dietary and lifestyle habits among the study participants. The secondary objective pertains to the assessment of subjects’ willingness to try e-cigarettes. We implemented an univariable logistic regression analysis on a dataset comprising 2367 nonsmokers to identify factors influencing their willingness to smoke e-cigarettes. Results Employment significantly predicted willingness, with employed non-smokers showing a higher likelihood to consider e-smoking (OR 2.5, p = 0.002). Household dynamics, specifically the presence of children, also affected the decision, indicating a protective effect against adopting e-smoking (OR 1.26, p &amp;lt; 0.001). Lifestyle choices, particularly fitness and dietary habits, played a discernible role. Surprisingly, age inversely correlated with the willingness to try e-smoking, as younger non-smokers were more likely to consider it (OR 0.97 per year increase, p &amp;lt; 0.001), suggesting that this openness could increase their risk of future tobacco use, which carries important public health consequences. Conclusions The study’s outcomes underscore the impact of socio-economic and lifestyle factors on non-smokers’ openness to e-cigarettes. These insights are pivotal for devising culturally competent educational campaigns and regulatory policies. Key messages • In the shifting paradigm of tobacco use, the attitudes of non-smokers toward e-cigarettes are crucial for public health planning. • By thoroughly analyzing smoking habits, diet, and lifestyle choices, the Minerva Project research aims to shed light on the complex dynamics between health behaviors and smoking.

A Case for a Maternal Culturally Tailored Smoking Cessation Research Agenda

Background/Objectives: Despite national efforts, smoking rates during pregnancy remain high among certain demographics, particularly American Indian/Alaska Native and younger women. This study examines the causal link between maternal smoking, maternal and fetal mortality, and social determinants of health, highlighting disparities faced by Black, Indigenous, and People of Color (BIPOC) and American Indian/Alaskan Native (AIAN) pregnant persons. Methods: Data from various sources, including national reports and committee findings, were analyzed to assess trends in maternal smoking, mortality rates, and associated factors. While smoking rates among all groups have declined, disparities persist. Young women, BIPOC, and American Indian/Alaska Native women, and those with lower educational attainment, have higher smoking rates. Black women exhibit significantly higher maternal mortality rates, often linked to cardiac/coronary conditions. Stress, exacerbated by social determinants of health like poverty and housing insecurity, emerges as a key factor driving smoking behavior, particularly among African Americans. The leading causes of pregnancy-related deaths vary by race and ethnicity, with preventability noted in 80% of cases. Perinatal exposure to cigarette smoking is also identified as a leading cause of poor infant health outcomes, emphasizing the importance of addressing smoking behavior during and after pregnancy. Results: This report advocates for a comprehensive approach to reducing maternal and fetal mortality rates, with a focus on adapting existing smoking cessation programs to adopt culturally tailored agendas in order to address social and political determinants of health as well as behavioral drivers of tobacco use among pregnant persons.

Unraveling the Effects of Economic Growth and Unemployment on Tobacco Use: A Panel Data Approach.

The economic situation is recognized as a significant factor influencing tobacco consumption. Accordingly, this research aims to investigate the relationship between economic growth, unemployment, and tobacco use. This investigation employs data from 1985 to 2019 to elucidate the relationship between economic growth, unemployment, and tobacco consumption in a select group of OECD countries. Employing Pedroni and Johansen-Fisher Panel Co-Integration Tests, we assess the co-integrating relationships. Furthermore, FMOLS and DOLS techniques are applied, complemented by the Dumitrescu Hurlin Panel Causality Test. FMOLS and DOLS results suggest that a 1% increase in GDP leads to a 6.46% and 7.29% rise in tobacco consumption, respectively, while GDP squared results in a 0.39% and 0.43% decrease. However, both tests failed to establish a significant relationship between tobacco consumption and unemployment. Cointegration was confirmed by Johansen-Fisher and Pedroni tests. Dumitrescu-Hurlin causality tests revealed direction of granger causality from economic growth to tobacco consumption, but not with unemployment. Tobacco consumption declined across all countries studied. Economic growth shows a positive association, while GDP squared has a negative association, indicating an inverted U-shaped relationship. No significant relationship was found with unemployment in the employed tests. In addition to the measures implemented by countries to reduce tobacco consumption, economic factors also exert a significant relation with smoking behavior. The available results suggests that economic growth initially associated with increase in tobacco consumption but reduction in later stages indicating a long-term inverse relationship between economic growth and tobacco use.