Youth Smoking Initiation Research Articles

Impact of regulatory tightening of the Hungarian tobacco retail market on availability, access and cigarette smoking prevalence of adolescents

IntroductionPolicies that reduce tobacco retail density to decrease tobacco use among the youth are critical for the tobacco endgame. This paper reviews a Hungarian tobacco regulatory measure, which, since 2013,...

The validity of self-rated alcohol susceptibility in predicting alcohol use in early adolescents in Latin America.

The measurement of substance use susceptibility was first conceived as part of the preparatory stage that precedes youth smoking initiation and is defined as the lack of a firm commitment not to smoke in the future. Despite being a consistent and validated predictor of smoking initiation, there has been little research on whether susceptibility can predict alcohol use. This study assessed the validity of an adapted alcohol susceptibility measure to predict alcohol consumption among early adolescent students in Argentina and Mexico who had not previously consumed alcohol. A school-based longitudinal study was conducted among first-year students in 33 secondary schools in Argentina and 57 in Mexico. The baseline sample included 1504 never-drinker adolescents in Argentina and 5264 in Mexico, of whom 1055 and 3540, respectively, completed a follow-up survey one and a half years later. Logistic regression with school as a random effect was used to estimate the adjusted odds ratios for the transitions from never-drinker to ever-drinker, current drinker, and binge drinker. At baseline, 34% and 23.6% of adolescent never-users in Argentina and Mexico, respectively, were susceptible to alcohol. After controlling for other known predictors of alcohol use initiation, alcohol susceptibility was positively associated with ever-drinking (OR = 3.23, 95% CI 2.38-4.36 in Argentina, OR = 1.73, 95% CI 1.43-2.10 in Mexico), current drinking (OR = 2.41, 95% CI 1.71-3.4 in Argentina, OR = 1.77, 95% CI 1.37-2.28 in Mexico), and binge drinking (OR = 2.27, 95% CI 1.78-2.91 in Argentina, OR = 1.89, 95% CI 1.32-1.99 in Mexico). The susceptibility measure adapted for use with alcohol appears valid for identifying individuals or groups at risk of drinking initiation and problematic drinking among early adolescents in Argentina and Mexico.

Content analysis of tobacco imagery in popular music Videos, 2018–2021

Exposure to tobacco imagery in movies and television has been identified as a key factor to youth smoking initiation (Davis, 2008; Bennett et al., 2020). This study aims to investigate the prevalence of tobacco imagery in popular music videos from 2018 to 2021. The weekly top 10 songs of 2018–2021 were identified usingBillboard Chartscategories (Hot 100, Hot R&B/Hip-Hop, Country, Rock & Alternative, Dance/Electronic, Pop Airplay). Content analyses of the top music videos using the Thumbs up Thumbs Down methodology were conducted to identify tobacco depictions on screen. The sample consisted of 1,008 music videos across four years; 196 of which contained tobacco imagery (19.4%). Between 2018 and 2021, the proportion of videos with tobacco imagery ranged between 12.8% and 23.0% of the total year sample. Tobacco incidences almost doubled from 280 occurrences in 2018 to 522 occurrences in 2020, but decreased by over half to 290 occurrences in 2021. Tobacco incidences varied by year and genre, with Hot 100 being the top offending genre in 2018 with 40.0% of videos containing tobacco imagery while Hot R&B/Hip-Hop was the top offending genre from 2019 to 2021 (52.7%, 52.5%, and 23.9% respectively). Cigarettes were most pervasive in 2019 (70.1% of total tobacco incidences), 2020 (45.6%), and 2021 (64.1%) music videos. Pipes were the most pervasive product in 2018 music videos (39.6%). Given the reach and frequency of exposure to music videos among young people, reducing tobacco imagery in popular music videos may prevent tobacco use among young people.

Near majority of adults favor R ratings for films with smoking

Near majority of adults favor R ratings for films with smoking

E-cigarette regulation: Is it time for a new Framework Convention on Tobacco Control?

E-cigarette regulation: Is it time for a new Framework Convention on Tobacco Control?

Expectations as a Factor of Tobacco Smoking Initiation in Youth

Introduction: Disappointing statistics of the World Health Organization on the growing number of new smokers, including those choosing electronic nicotine delivery systems, requires studies of both social factors and intrinsic subjective motivation to start smoking, where the main role is played by expectations of young people. The article discusses expectations of youth from smoking initiation and those from regular cigarette smoking. It also describes reported expectations and concomitant factors that preceded the initiation of smoking. Objective: To study the impact of expectations of young adults on smoking initiation. Materials and methods: An online survey of young people was conducted in January – May 2021 in the city of Khimki, Moscow Region, using Google Forms. All respondents were regular smokers (n = 360, 17–24 years of age; confidence level: 5 %, confidence interval: 95 %; criterion sampling). The study of youth expectations was retrospective and accurate enough in assessing subjective expectations from smoking initiation. Nonparametric statistics (Spearman’s rank correlation) was used for data analysis. Results: The main reason for initiation of tobacco smoking is a social factor confirming expectations of “feeling like an adult” (78.3 %) in young smokers with the support of friends, where smoking in the company of peers prevails over other occasions of tobacco use (76.6 %). Smoking among young people with little experience is attributed to social dependence, and, above all, social expectations. Consequently, 30.0 % of young adults have a significant potential for quitting smoking. A high social significance of the peers’ perception of the fact of starting smoking as a way to emphasize the overcoming of negative physical expectations was also confirmed. Positive expectations from smoking, such as relaxation and emancipation, significantly exceed negative ones (discomfort and malaise). Conclusions: Expectations have proved to be a determining factor in initiation of tobacco smoking among young people, which requires a change in the social component of smoking prevention techniques by bringing it to the level of the national idea of a healthy lifestyle (activity and longevity).

Do demographic and socioeconomic characteristics underpin differences in youth smoking initiation across Canadian provinces? Evidence from the Canadian Community Health Survey (2015-2018).

Youth initiation may drive differences in smoking prevalence across Canadian provinces. Provincial differences in initiation relate to tobacco control strategies and public health funding, but have also been attributed to population characteristics. We test this hypothesis by examining the extent to which seven characteristics-immigration, language, family structure, education, income, home ownership and at-school status-explain differences in initiation across provinces. We used data from 16 897 youth aged 12 to 17 years in the Canadian Community Health Survey collected from 2015 to 2018. To examine the proportion of provincial differences explained by population characteristics, we compared average marginal effects (AMEs) from partially and fully adjusted models regressing "having ever initiated" on province and other characteristics. We also tested interactions to examine differences in the association between population characteristics and initiation across provinces. Initiation varied from 4% in British Columbia to 10% in Quebec. Being born in Canada, speaking French, not living in a two-parent household, being in the lowest household income quintile, having parents without postsecondary education, living in rented accommodation and not being in school were each associated with initiation. Taking these results into consideration, the AME of residing in another province compared with Quebec was attenuated by between 3% and 9%. Family structure and household income were more strongly associated with initiation in the Atlantic region and Manitoba, but not in Quebec. Differences in initiation between Quebec and other provinces are unlikely to be substantially explained by their demographic or socioeconomic composition. Reprioritizing tobacco control and public health funding are likely key in attaining the "tobacco endgame" across provinces.

Smoking Frequency of Nursing Students and the Extent to Which They Are Affected by the Warning Labels on Cigarette Packs

Background: Determining the smoking frequency of young people and their exposure to cigarette pack warnings is important in terms of developing new policies for smoking cessation. Objectives: This study was conducted to determine the smoking frequency of nursing students, their nicotine dependence, the extent to which they were affected by textual/graphic warning labels on cigarette packs, and the factors affecting them. Methods: The research is cross-sectional type. According to the sample calculation formula in cases where the universe is known, the universe was accepted as 855, the sample was calculated with 95% confidence interval and 0.05 error, and the number of people to be sampled was found to be 195. A total of 240 people were selected for the study, considering that there may be data losses. The students to be sampled were determined by the stratified sampling method. The data were collected via the survey created by the researchers and the Fagerstrom Test for Nicotine Dependence (FTND). Chi-squared test were used for statistical analysis. Results: The average age of the students was 20.95 ± 1.70. 22.5% of the participants smoked. 68.5% of students had a low addiction level, while 57.1% were affected by warnings on a cigarette packs. It was observed that the effect of textual warnings on the cigarette packs did not differ by gender. Graphics showing a person in intensive care and a dead person's foot in the morgue evoked higher levels of negative affect on women than on men. When the written warnings on the cigarette package and some variables are compared; It was found that there was a statistically significant difference between smoking status, presence of smokers in the family, level of smoking addiction and smoking status. No statistically significant difference was found when being affected by written warnings and gender were compared. Conclusion: In order to prevent early youth smoking initiation, preventive studies should be carried out on young people from childhood. Particularly male students should be observed more carefully. Nurses; should develop strategies that can be effective in smoking-related youth and conduct qualitative research on them.

Commentary: Electronic Nicotine Delivery Systems: Seeing Through the Clouds.

Commentary: Electronic Nicotine Delivery Systems: Seeing Through the Clouds.

A Comprehensive Program to Reduce Tobacco-related Cancers Through Actions by a National Cancer Institute-designated Cancer Center.

Tobacco use accounts for 30% of all cancer-related deaths worldwide and 20% in the US, despite effective, evidence-based interventions for reducing tobacco use and tobacco-related cancers and deaths. In 2012, to reduce the burden of tobacco-related cancer and associated population-level risks across Texas, The University of Texas MD Anderson Cancer Center initiated the EndTobacco® program to promote statewide cancer control activities. We created evidence-based initiatives, established selection criteria, and implemented actions involving policy, education, and tobacco treatment services. As a result, EndTobacco has supported, educated, and convened local and state coalitions in policymaking; provided tobacco treatment education to health professionals; implemented Texas' only certified tobacco treatment training program; and led an initiative to enhance the tobacco-free culture of the state's publicly funded university system. Supported by commitments from MD Anderson, we developed and implemented evidence-based actions for tobacco control tailored to the center's mission, values, expertise, resources, and partnerships. By 2021, the adult smoking rate in Texas dropped from 19.2% (2014) to 13.2%. Contributors to this drop include state tobacco control policies, programs and services from multiple agencies and associations, and EndTobacco activities that complement the statewide effort to prevent youth smoking initiation and increase quit attempts among youth and adults.

Cigarette Price Increases, Advertising Ban, and Pictorial Warnings as Determinants of Youth Smoking Initiation in Poland.

Europe's Beating Cancer Plan aims to create a "Tobacco-Free Generation" by 2040. To generate meaningful public health policy to achieve this target, we must understand more clearly the determinants of youth smoking initiation. We examine the determinants of cigarette-smoking initiation in Poland using survival analysis techniques and data from four youth smoking surveys: the 2003, 2009, and 2016 Global Youth Tobacco Surveys (GYTS) and the 2019 PolNicoYouth survey (number of person-period observations N = 164 807). Split-population duration models are employed. The hazard of smoking initiation is modeled as a function of cigarette prices, nonprice tobacco-control measures, and socioeconomic variables. Our study finds a negative and significant relationship between cigarette prices and the hazard of smoking initiation in all models (hazard ratio from 0.86 to 0.91). Lower hazards of smoking initiation were also associated with a comprehensive advertising ban (hazard ratio from 0.69 to 0.70) and with the introduction of pictorial warnings (hazard ratio from 0.65 to 0.68). This study concludes that cigarette price increases, such as from higher cigarette excise taxes, could further significantly reduce cigarette youth smoking initiation in Poland. Removing promotional and advertising elements from cigarette packs and making the health warning more noticeable through plain packaging laws would further accelerate the reduction in smoking initiation. The European Union is currently formally reconsidering the Tobacco Tax Directive. This makes this analysis of the impact of cigarette prices on youth smoking initiation both timely and germane. As ever more countries implement standardized cigarette packaging, findings here provide support for this measure that removes advertising elements from the packs and makes the health warning more noticeable.

Cigarette price increases, advertising ban, and pictorial warnings as determinants of youth smoking initiation in Poland

Cigarette price increases, advertising ban, and pictorial warnings as determinants of youth smoking initiation in Poland

Social norms as a predictor of smoking uptake among youth: a systematic review, meta-analysis and meta-regression of prospective cohort studies.

Social norms towards smoking are a key concept in tobacco control policy and research. However, the influence and strength of different types of social norms on youth smoking uptake is unclear. This study aimed to examine, quantify and compare evidence of the longitudinal associations between different types of social norms towards smoking and youth smoking uptake (initiation and escalation). Systematic review searching four databases (MEDLINE, EMBASE, PsycInfo, CINAHL) from January 1998 to October 2020. Evidence synthesis via narrative review, meta-analysis pooling unadjusted associations (initiation only, due to heterogeneity in escalation outcomes) and meta-regression comparing effect sizes by norm type and study characteristics. Studies included observational prospective cohort studies using survey methodology with youth aged ≤24years. Measurements included longitudinal associations between descriptive norms (perceived smoking behaviour) and injunctive norms (perceived approval/disapproval of smoking) among social network(s) and subsequent smoking initiation or escalation. Thirty articles were identified. In the narrative review, smoking initiation (but not escalation) was consistently predicted by two norms: parental and close friend smoking. Associations between smoking uptake and other descriptive norms (smoking among siblings, family/household, partner, peers, adults) and all injunctive norms (perceived approval of smoking among parents, siblings, close friends/peers, partner, teachers, people important to you, the public) were less consistent or inconclusive. In the meta-analysis pooling unadjusted associations, 17 articles were included (n=27 767). Smoking initiation was predicted by the following descriptive norms: smoking among parents [Odds Ratio (OR)=1.88, 95% Confidence Interval (CI)=1.56-2.28], close friends (OR=2.53, 95% CI=1.99-3.23), siblings (OR=2.44, 95% CI=1.93-3.08), family/household (OR=1.55, 95% CI=1.36-1.76) and adults (OR=1.34, 95% CI=1.02-1.75), but not peers (OR=1.14, 95% CI=0.92-1.42). Smoking initiation was also predicted by two injunctive norms, perceived approval of smoking among parents (OR=1.74, 95% CI=1.27-2.38) and the public (OR=4.57, 95% CI=3.21-6.49), but not close friends/peers (OR=2.36, 95% CI=0.86-6.53) or people important to the individual (OR=1.24, 95% CI=0.98-1.58). In this systematic review (narrative and meta-analysis), descriptive norms of parents' and close friends' smoking behaviour appeared to be consistent predictors of youth smoking initiation, more so than the descriptive norms of more distal social networks and injunctive norms.

Association of Coming Out as Lesbian, Gay, and Bisexual+ and Risk of Cigarette Smoking in a Nationally Representative Sample of Youth and Young Adults

Coming out as lesbian, gay, bisexual, or other identities besides heterosexual (LGB+) may represent a susceptible period for cigarette smoking initiation in youth and young adults. To assess whether young people who change their sexual identity have higher risk of cigarette smoking initiation and current smoking compared with those with consistent sexual identities. This cohort study used data from the nationally representative Population Assessment of Tobacco and Health study (wave 1, 2013-2014; wave 2, 2014-2015; wave 3, 2015-2016; wave 4, 2016-2018). Youth and young adults aged 14 to 29 years who were never smokers at wave 1 were included in this study. Analysis began October 2018 and ended June 2020. Consistent sexual identity (consistently heterosexual, consistently LGB+) vs changing sexual identity (coming out as LGB+, other LGB+ patterns) based on 4 waves of sexual identity data. Identities were further classified by distinguishing between bisexual and lesbian, gay, and other nonheterosexual identities. Smoking initiation and current cigarette smoking at wave 4. Among 7843 individuals who never smoked at wave 1, 6991 (90.7%) reported a consistent sexual identity, and 852 (9.3%) changed sexual identity across waves. The mean (SE) baseline age of participants who reported consistent heterosexuality was 20.1 (0.8) years; consistently LGB+, 20.0 (3.7) years; coming out as LGB+, 18.0 (2.9) years, and other LGB+ pattern, 20.3 (3.8) years. A total of 14.1% (weighted) initiated smoking, and 6.3% were current smokers at wave 4. Compared with consistently heterosexual identities, coming out as LGB+ (23% vs 13%; odds ratio [OR], 1.72; 95% CI, 1.34-2.20), consistently LGB+ identities (17% vs 13%; OR, 1.45; 95% CI, 1.03-2.04), and other LGB+ patterns (17% vs 13%; OR, 1.47; 95% CI, 1.04-2.08) were positively associated with smoking initiation by wave 4. Compared with consistently heterosexual identities, ORs for smoking initiation were 2.24 (28% vs 13%; 95% CI, 1.72-2.92) for coming out as bisexual, 1.99 (23% vs 13%; 95% CI, 1.20-3.29) for consistently LGB+ with change to/from bisexual, and 2.20 (23% vs 13%; 95% CI, 1.40-3.46) for other LGB+ patterns with change to/from bisexual identity. Current smoking estimates were similar to those for smoking initiation. Compared with consistently heterosexual identities, changing sexual identity over follow-up was associated with smoking initiation and current smoking. The risk associated with changing sexual identities was concentrated among participants coming out as bisexual or reporting other changes in their identity to/from being bisexual. More research is needed on mechanisms underlying the association between changing sexual identity and smoking initiation to inform tailored prevention programs and tobacco regulations.

Associations of Flavored e-Cigarette Uptake With Subsequent Smoking Initiation and Cessation

Several states have banned sales of flavored e-cigarettes, but evidence on the association between vaping flavors and subsequent smoking initiation and cessation is limited. To evaluate whether new uptake of flavored e-cigarettes is more strongly associated with subsequent smoking initiation and cessation than uptake of unflavored e-cigarettes, separately for youths (12-17 years), emerging adults (18-24 years), and prime-age adults (25-54 years). This cohort study conducted secondary data analyses of longitudinal survey data from waves 1 to 4 of the Population Assessment of Tobacco and Health Study (collected from 2013 to 2018). The analytic sample was limited to 17 929 respondents aged 12 to 54 years at wave 1 who completed at least 3 consecutive waves of the survey and did not use e-cigarettes at baseline. Data were collected from 2013 to 2018 and analyzed in February 2020. Flavored vs unflavored e-cigarette use reported in wave 2 of the Population Assessment of Tobacco and Health Study. Binary indicators captured wave 3 smoking among 7311 youths and 4634 emerging adults who did not smoke at baseline (ie, initiation) and not smoking at wave 3 among 1503 emerging adults and 4481 prime-age adults who smoked at baseline (ie, cessation). Smoking status was based on having smoked in the past 30 days for youths and established smoking (ie, current smoking among those who smoked at least 100 cigarettes in their lifetime) for emerging and prime-age adults. The youths who did not smoke at baseline, emerging adults who smoked at baseline, and prime-age adults who smoked at baseline consisted of 51.4% to 58.0% male participants and 66.9% to 77.0% white individuals. Vaping uptake was positively associated with smoking initiation in youth (adjusted odds ratio [AOR], 6.75; 95% CI, 3.93-11.57; P < .001) and in emerging adults (AOR, 3.20; 95% CI, 1.70-6.02; P < .001). Vaping uptake was associated with cessation in adults (AOR, 1.34; 95% CI, 1.02-1.75; P = .03). Vaping nontobacco flavors was no more associated with youth smoking initiation than vaping tobacco-flavors (AOR in youth, 0.66; 95% CI, 0.16-2.76; P = .56) but was associated with increased adult smoking cessation (AOR in adults, 2.28; 95% CI, 1.04-5.01; P = .04). In this study, adults who began vaping nontobacco-flavored e-cigarettes were more likely to quit smoking than those who vaped tobacco flavors. More research is needed to establish the relationship between e-cigarette flavors and smoking and to guide related policy.

Impact of UK Tobacco Control Policies on Inequalities in Youth Smoking Uptake: A Natural Experiment Study.

IntroductionUK countries implemented smoke-free public places legislation and increased the legal age for tobacco purchase from 16 to 18 years between 2006 and 2008. We evaluated the immediate and long-term impacts of these UK policy changes on youth smoking uptake and inequalities therein.Aims and MethodsWe studied 74 960 person-years of longitudinal data from 14 992 youths (aged 11–15 years) in annual UK household surveys between 1994 and 2016. Discrete-time event history analyses examined whether changes in rates of youth smoking transitions (initiation, experimentation, and escalation to daily smoking or quitting) or their inequalities (by parental education) were associated with policy implementation. Parallel analyses examined smoke-free legislation and the change in legal age. We interpret the results as a combined effect of the two pieces of legislation as their implementation dates were too close to identify separate effects. Models were adjusted for sex, age, UK country, historical year, tobacco taxation, and e-cigarette prevalence, with multiple imputation for missing data.ResultsFor both policies, smoking initiation reduced following implementation (change in legal age odds ratio [OR]: 0.67; 95% confidence interval [CI]: 0.55 to 0.81; smoke-free legislation OR: 0.68; 95% CI: 0.56 to 0.82), while inequalities in initiation narrowed over subsequent years. The legal age change was associated with annual increases in progression from initiation to occasional smoking (OR: 1.26; 95% CI: 1.07 to 1.50) and a reduction in quitting following implementation (OR: 0.57; 95% CI: 0.35 to 0.94). Similar effects were observed for smoke-free legislation but CIs overlapped the null.ConclusionsPolicies such as these may be highly effective in preventing and reducing socioeconomic inequalities in youth smoking initiation.ImplicationsUK implementation of smoke-free legislation and an increase in the legal age for tobacco purchase from 16 to 18 years were associated with an immediate reduction in smoking initiation and a narrowing of inequalities in initiation over subsequent years. While the policies were associated with reductions in the initiation, progression to occasional smoking increased and quitting decreased following the legislation.

Analyzing big tobacco\u2019s global youth marketing strategies and factors influencing smoking initiation by Nigeria youths using the theory of triadic influence

BackgroundMajor transnational tobacco companies (TTCs) have identified Nigeria, the seventh most populous country in the world, as a market with a significant revenue potential, given its high youth population and growing gross domestic product (GDP). This research analyses tobacco industry-related strategies and activities targeting youth (aged 15 to 24 years) in Nigeria involving existing, but most importantly, future tobacco users. Nigeria is the focus of this study because the tobacco industry has viewed it as a major emerging market since the 1990s. Successful marketing in Nigeria could provide the industry with a template for similar initiatives in other emerging markets in low- and middle-income countries.MethodsThe research began with a systematic review of secondary literature to determine how the tobacco industry has targeted youth globally and factors contributing to youth smoking initiation. It then used the theory of triadic influence as a heuristic framework to categorize the various factors influencing youth smoking initiation and industry strategies related to increasing tobacco use among youths. Quotations from internal tobacco industry documents were organized into the three streams of the theory of triadic influence: biology/personality, social and cultural/environmental streams. A total of 12 interviews were conducted with 6 policymakers and governmental officials, 2 civil society organization representatives, a high school principal, a journalist and 2 researchers to investigate how the tobacco industry had targeted youth in Nigeria.ResultsThe findings indicate that TTCs have actively targeted youth in Nigeria since the 1990s, focusing on changing behaviour through the biology/personality, social and environmental/ cultural streams.ConclusionThe study suggests that Nigeria implement and vigorously enforce its 2015 National Tobacco Control Bill as well as a package of other measures to prevent tobacco companies targeting youth.

Need for Tobacco Plain Packaging in the Kingdome of Saudi Arabia: A groundbreaking Step for Smoking Control Measure.

Tobacco industry using its marketing strategy to influence smoking behavior among youth and packing is the primary factor that helped tobacco companies in their advertisement. Standardized “plain” cigarette packaging is advocated by Australia then by World health organization as a public health policy to reduce youth smoking initiation and promote smoking cessation to prevent and reduce morbidity and mortality caused by smoking. Plain packaging was in Australia’s market in December 2012, and several other countries are then implemented plain packaging after facing some legal resistance from opponents. On behalf of the Kingdom of Saudi Arabia, the minister of Health agreed upon the World Health Organization's initiative to adopt plain packaging as a tobacco control measure. In May 2019, plain packs were available in the Saudi market. Tobacco companies have challenged these public health policies. Additionally, consumers have made massive campaigns against new plain packs, claiming of taste change and quality alteration. The Decision-making of plain packaging is supported by quantitative and qualitative studies. Results are indicating that plain packaging can decrease positive perceptions of smoking and encourage to quit smoking Ministry of health, Saudi Food and Drug Agency and ministry of commerce coordinate work is essential in maintaining the policy and responding to any consumers' concerns. This can be implemented by evolving social media and web-services to raise smoker’s awareness and perception toward their tobacco use. Ensure that tobacco companies comply with international tobacco manufacturing standards. In this review report, I would like to show some evidence that supports and encourage continuing plain packaging and to recommend some solutions for consumer’s anger and claims against these new packs.

Anticipated Effects of Nicotine Reduction on Youth Smoking Initiation and Maintenance.

This commentary summarizes emerging findings on the potential impact of a nicotine reduction policy on youth and young adults. We conclude that: (1) adolescent smokers and nonsmokers alike are likely to be less sensitive to reinforcement from very low nicotine content (VLNC) cigarettes compared with adults; (2) reducing nicotine in cigarettes to 0.4 mg/g would reduce the abuse potential of cigarettes in adolescents and young adults; (3) findings to date do not support concerns that nicotine reduction leads to compensatory smoking in young smokers; and (4) if the scope of a reduced nicotine product standard were applied to all combusted tobacco products, that would likely maximize public health benefit of this policy.

The influence and interaction of exposure to pro-smoking and anti-smoking messaging on youth smoking behaviour and susceptibility.

INTRODUCTIONExposure to tobacco-related information is an important factor in youth smoking initiation. This study aims to explore the relationship between exposure to pro-smoking and anti-smoking media and adolescents’ current smoking status and susceptibility to smoking, as well as the interaction between exposure to pro-smoking and anti-smoking media information.METHODSThis cross-sectional study was conducted in 2017. We recruited 12278 students from junior, senior and vocational high schools located in Shanghai, China. The exposure of participants to tobacco promotional and control messages over the past 30 days was examined, as well as current smoking and susceptibility to never smokers’ initiation. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using complex samples procedure logistic regression, adjusting for related covariables.RESULTSThere were 89.3% and 91.5% of adolescents exposed to tobacco pro-smoking and anti-smoking messages. Exposure was more prevalent among males, suburb school and vocational school students. Exposure to pro-tobacco and antitobacco messages, separately, increased and decreased the risk of current smoking and susceptibility to never-smokers’ smoking, respectively, especially among males and junior high school students. Risk was associated with the exposure level (p-trend<0.001). Tobacco control messaging was found to mitigate the influences of tobacco promotion on the risk of both current smoking (AOR=0.64; 95% CI: 0.41–0.99) and susceptibility to smoking (AOR=0.65; 95% CI: 0.46–0.93).CONCLUSIONSExposure to tobacco-related messages was highly prevalent and associated with youth smoking and susceptibility to smoking. It is therefore important to enhance the comprehensiveness and enforcement of promotion bans. Given that tobacco control information can counter the impact of tobacco promotion information on smoking risk, the publicity and dissemination of tobacco control information should be consistently strengthened.