Smoking Initiation Rates Research Articles

The Role of Digital Media and Peer Influence on Adolescent Smoking Behavior: A Critical Analysis of Intervention Strategies

This study is an attempt to explore perceptions and attitudes toward smoking amongst adolescents, where the main objective of the research is to explore the factors that help in understanding how their views and behavior are shaped. This study garnered data through questionnaires given to adolescents between the ages of 10-20, representing varied walks of life. The results bring out intricate interplays of social, psychological, and environmental factors that shape adolescent perceptions. Peer pressure, media representation, and familial attitudes emerge as potent determinant factors. The research therefore stresses the implementation of focused educational programs and policies aimed at dispelling myths in order to reduce smoking initiation rates during this period. Recommendations for further research and intervention are discussed here, which would form the foundation of comprehensive anti-smoking strategies relevant for this most vulnerable age group.

Trends in smoking initiation and cessation over a century in two Australian cohorts

Background Historical data on smoking can enhance our comprehension of the effectiveness of past tobacco control policies and play a key role in developing targeted public health interventions. This study was undertaken to assess trends in smoking initiation and cessation in Australia for the period 1910–2005. Methods Rates of smoking initiation and cessation were calculated for participants in two population-based cohorts, the Busselton Health Study and the Tasmanian Longitudinal Health Study. The effects of time trends, gender and age group were evaluated. Results Of the 29,971 participants, 56.8% ever smoked. In males, over the period 1910–1999, the rate of smoking initiation in young adolescents remained high with a peak in the 1970s; in older adolescents it peaked in the 1940s and then declined; in young adults it showed a steady decline. In females, the rate of smoking initiation in young adolescents rose sharply in the 1960s and peaked in the 1970s, in older adolescents it increased throughout the period, and in young adults it declined after 1970. In the period 1930–2005, 27.3% of 9,605 people aged 36–50 years who smoked ceased smoking. Rates of cessation in this age group increased throughout but decreased in males after 1990 and plateaued around 2000 in females. Conclusion Our findings show substantial variation in the efficacy of tobacco control policies across age groups, with a notable lack of success among the younger population.

PREVALENCE OF SMOKING IN INSTITUTIONALISED ADOLESCENT ORPHANS OF PATNA, BIHAR

Background: Smoking is a significant public health concern with detrimental effects on overall well-being. Vulnerable populations, such as institutionalized adolescent orphans, may face unique challenges that contribute to higher rates of smoking initiation and maintenance. This study aimed to investigate the prevalence of smoking among institutionalized adolescent orphans in Patna, Bihar, and identify associated factors. Methods: A cross-sectional study was conducted among institutionalized adolescent orphans aged 13-18 years in Patna, Bihar. A structured questionnaire was administered to collect data on smoking behavior, demographics, initiation age, frequency of smoking, duration, reasons for smoking, exposure to tobacco advertising, knowledge about the harmful effects of smoking, and previous attempts to quit. Data were analyzed using descriptive statistics and subgroup analyses. Results: A total of 250 institutionalized adolescent orphans participated in the study. The overall prevalence of smoking was found to be 17%. Male participants exhibited a higher prevalence of smoking (22%) compared to females (11%). The prevalence increased with age, with the highest rates observed among the 17-18 years age group. Exposure to tobacco advertising and peer pressure were identified as influential factors associated with smoking initiation. A considerable proportion of smokers reported a lack of awareness about the harmful effects of smoking. Previous attempts to quit smoking were reported by 25% of smokers. Conclusion: The study highlights a significant prevalence of smoking among institutionalized adolescent orphans in Patna, Bihar. Gender, age, exposure to tobacco advertising, peer pressure, and lack of awareness were identified as important factors associated with smoking behavior in this population. The findings emphasize the need for targeted interventions and policies addressing these factors to reduce smoking rates and improve the overall well-being of institutionalized adolescent orphans. Further research is needed to evaluate the effectiveness of specific interventions and to explore additional factors influencing smoking behavior in this context

Fifty-year forecasts of daily smoking prevalence: can Australia reach 5% by 2030?

ObjectiveTo compare 50-year forecasts of Australian tobacco smoking rates in relation to trends in smoking initiation and cessation and in relation to a national target of ≤5% adult daily prevalence...

Relating Onset of Health Conditions to Changes in Tobacco/Nicotine Use — Analyses based on the U.S. PATH Study *

1. SUMMARY Introduction Evidence is limited on how the onset of health conditions affects tobacco/nicotine use. We report analyses from adults in the U.S. PATH study relating changes in established cigarette and/or e-cigarette use between Waves 1 and 4 to onset of conditions in Waves 2 or 3. Methods Nine conditions had sufficient onsets for analysis. The main analyses adjusted for sex and age. Additional analyses excluded other tobacco/nicotine product users, controlled for more variables, restricted changes in one product to never users of the other, or restricted attention to changes occurring after onset of the condition. Results In the main analyses, onset of each condition predicted significantly increased overall e-cigarette initiation rates, with highest odds ratios (OR) for any major respiratory condition (2.86, 95% confidence interval (CI) 2.10–3.90) and cancer (2.51, 1.52–4.14). Each onset also predicted higher cigarette smoking initiation rates, but ORs were lower than for e-cigarette initiation, and only significant for any cardiovascular condition (1.65, 1.31–2.08), high blood pressure (1.34, 1.13–1.58), and any major smoking-related condition (1.35, 1.12–1.62). For quitting smoking only six conditions showed increased ORs, significant only for high cholesterol (1.29, 1.02–1.62). The additional analyses generally confirmed these patterns. Relationships with re-initiating cigarettes or becoming dual users of cigarettes and e-cigarettes were inconsistent. Onset of conditions also tended to reduce amount smoked by smokers. Conclusions While PATH is nationally representative, its sample size does not always allow precise estimates. There is concern about accuracy of statements by some older participants claiming to be Wave 1 never smokers but Wave 4 ever smokers. Nevertheless the previously unreported association between onset of the health conditions and e-cigarette initiation (which mainly occurs in Wave 1 cigarette smokers) appears real. [Contrib. Tob. Nicotine Res. 32 (2023) 1–10]

The impact of low-dose CT on smoking behavior among non-smokers, former-smokers, and smokers: A population-based screening cohort in rural China.

Lung cancer screening may provide a "teachable moment" for the smoking cessation and relapse prevention. However, the impact of lung cancer screening on smoking initiation in non-smokers has not been reported. A baseline smoking behavior survey was conducted in 2000 participants who were screened by low-dose computed tomography (LDCT) from 2014 to 2018. All participants were re-surveyed on their smoking behavior in 2019. Of these, 312 participants were excluded, leaving 1688 participants in the final analysis. The smoking initiation rate in baseline non-smokers, the relapse rate in baseline former smokers, and the abstinence rate in baseline current smokers were calculated, respectively. The associations between screening results, demographic characteristics, and smoking behavior change were analyzed using multivariable logistic regression. From 2014 to 2019, smoking prevalence significantly decreased from 52.6% to 49.1%. The prevalence of smoking initiation, relapse, and abstinence in baseline non-smokers, former, and current smokers was 16.8%, 22.9%, and 23.7%, respectively. The risk of smoking initiation in baseline non-smokers was significantly higher in those with negative screening result (adjusted OR=2.97, 95% CI: 1.27-6.94). Compared to smokers who only received baseline screening, the chance of smoking abstinence in baseline current smokers was reduced by over 80% in those who attended 5 rounds of screening (adjusted OR=0.15, 95% CI:0.08-0.27). No significant associations were found between smoking relapse and prior screening frequency, with at least one positive screening result. Age, gender, occupational exposure, income, and smoking pack years were also associated with smoking behavior changes. The overall decreased smoking prevalence indicated an overwhelming effect of "teachable moment" on "license to smoke." A tailored smoking cessation strategy should be integrated into lung cancer screening.

A Web-Based Education Program to Empower Family in Smoking Prevention among Adolescents in Indonesia: A Randomized Controlled Trial

BACKGROUND: Stronger family connections, communications, and parental respect reduce smoking initiation. Web-based computer-tailored smoking prevention programs may help decrease smoking initiation rates among adolescents. However, there is currently no conclusive evidence regarding the efficacy of a web-based, computer-tailored smoking prevention program to empower families in adolescent smoking prevention. AIM: This study aimed to investigate the effects of web-based education program to empower family, improve skill to refuse, and prevent smoking initiation among adolescent in Indonesia. METHODS: A randomized controlled trial was employed on family members in Bogor, West Java, Indonesia. The following criteria were the mother or legal guardian of children aged 10 to 14 years who are not currently smoking. Data were collected 3 times: One week before the start of the training (baseline), immediately after intervention (T1), and three months after the training concluded (T2). RESULTS: 77 participants completed the study, 37 in the intervention group and 40 in the control group. The average age in this sample of the family (mother) was 37.34 (SD:7.51) years in the intervention group and 11.75 (SD:6.81) for the control group. From baseline to follow-up, family empowerment, smoking refusal skill, and smoking intention increased 38%, 24%, and 33%, respectively. CONCLUSIONS: A web-based education program appears to be a suitable catalyst for empowering family and smoking prevention among adolescents. It should be regarded as a valuable and supportive addition to existing and future programs.

Monitoring the Increase in the U.S. Smoking Cessation Rate and Its Implication for Future Smoking Prevalence.

We calculate the U.S. adult smoking cessation rate for 2014-2019, compare it to the historical trend, and estimate the implication for future smoking prevalence. We repeated an earlier analysis, which examined the cessation rate from 1990 to 2014, extending the period to 2019. Employing National Health Interview Survey (NHIS) and National Survey on Drug Use and Health (NSDUH) data, we estimated the adult cessation rate in 6-year intervals, using weighted nonlinear least squares. We then employed a meta-regression model to test whether the cessation rate has increased beyond expectation. We used cessation rate estimates and smoking initiation rate estimates to project smoking prevalence in 2030 and eventual steady-state prevalence. The annual cessation rate increased 29% using NHIS data (from 4.2% in 2008-2013 to 5.4% in 2014-2019) and 33% with NSDUH data (4.2%-5.6%). The cessation rate increase accounts for 60% of a smoking prevalence decline in the most recent period exceeding the 1990-2013 predicted trend. The remaining 40% owes to declining smoking initiation. With current initiation and cessation rates, smoking prevalence should fall to 8.3% in 2030 and eventually reach a steady state of 3.53%. The smoking cessation rate continued to increase during 2014-2019. NHIS and NSDUH results are practically identical. The larger share (60%) of the smoking prevalence decrease, beyond expectation, attributable to the increased cessation rate is encouraging since the positive health effects of cessation occur much sooner than those derived from declining initiation. The smoking cessation rate in the United States continues to increase, accelerating the decline in smoking prevalence. This increase suggests that the Healthy People 2030 goal of 5% adult smoking prevalence, while ambitious, is attainable. Our findings can be used in simulation and statistical models that aim to predict future prevalence and population health effects due to smoking under various scenarios.

A cost-utility analysis of the impact of electronic nicotine delivery systems on health care costs and outcomes in Canada.

We determined the impact of electronic nicotine delivery systems (ENDS) on health outcomes and costs in Canada, based on their effect on smoking cessation and smoking initiation rates. We used gender-specific Markov models to estimate lifetime discounted life years, quality-adjusted life years (QALYs) and smoking-related health care costs for cohorts of males and females aged 15 to 19 years, in scenarios in which (1) ENDS are available (status quo); (2) ENDS are completely unavailable; and (3) ENDS are available for smoking cessation through health care provider prescription, in addition to currently recognized smoking cessation tools. Analysis was from the perspective of a publicly funded health care system. Outcomes are expressed per 1000 individuals and based on expected values obtained through a Monte Carlo simulation of 10 000 replications. For males aged 15 to 19 years, life years, QALYs and smoking-related health care costs were 41 553, 35 871 and CAD 79 645 964, respectively, when ENDS were available; 41 568, 35 894 and CAD 79 645 960 when ENDS were unavailable; and 41 570, 35 897 and CAD 79 605 869 when ENDS were available through prescription only. For females, life years, QALYs and smoking-related health care costs were 43 596, 37 416 and CAD 69 242 856, respectively, when ENDS were available; 43 610, 37 438 and CAD 69 085 926 when ENDS were unavailable; and 43 611, 37 438 and CAD 69 076 034 when ENDS were available through prescription only. Thus, situations in which ENDS are unavailable, or available through prescription only are dominant over the status quo. These results show that a policy change whereby ENDS were unavailable to the Canadian population or available through prescription only would likely increase population health and reduce health care costs.

Rural disparities in adolescent smoking prevalence.

Rural residence is a well-established risk factor for risk behaviors and subsequent morbidity and mortality in the United States. Smoking is the primary cause of preventable death and is more prevalent in rural America. As chronic smoking habits typically develop during adolescence, the discrepancy in smoking rates between rural and urban youth likely contributes to a significant geographic disparity in the long-term health of adults. Data were extracted from 12th-grader surveys of the US Monitoring the Future study from 1998 to 2018. The historic trends of smoking initiation, ever-regular and current-regular smoking rates of rural and urban adolescents were estimated with intercept-only time-varying effect models. Differences in prevalence between rural and urban youth were calculated for each smoking behavior. Though overall smoking prevalence continues to decline, this trend is significantly attenuated among rural adolescents compared to urban youth. The absolute difference in lifetime smoking prevalence between rural and urban youth has markedly increased from 6.9% in 1998 to 13.5% in 2018, which is among the highest in the past 20 years and is a potentially alarming upward trend. However, the absolute differences in ever-regular and current-regular smoking prevalence have shown an overall net decline, decreasing from 6.4 to 4.8%, and from 5.5 to 3.0%, respectively. This geographic disparity between rural and urban adolescents represents a potentially modifiable cause of increased morbidity and mortality in rural areas. Interventions and regulatory efforts should be tailored for rural adolescents to reduce the narrowing but persistent disparity in regular smoking.

Public health implications of vaping in the USA: the smoking and vaping simulation model

BackgroundNicotine vaping products (NVPs) are increasingly popular worldwide. They may provide public health benefits if used as a substitute for smoking, but may create public health harms if used as a gateway to smoking or to discourage smoking cessation. This paper presents the Smoking and Vaping Model (SAVM), a user-friendly model which estimates the public health implications of NVPs in the USA.MethodsSAVM adopts a cohort approach. We derive public health implications by comparing smoking- and NVP-attributable deaths and life-years lost under a No-NVP and an NVP Scenario. The No-NVP Scenario projects current, former, and never smoking rates via smoking initiation and cessation rates, with their respective mortality rates. The NVP Scenario allows for smoking- and NVP-specific mortality rates, switching from cigarette to NVP use, separate NVP and smoking initiation rates, and separate NVP and smoking cessation rates. After validating the model against recent US survey data, we present the base model with extensive sensitivity analyses.ResultsThe SAVM projects that under current patterns of US NVP use and substitution, NVP use will translate into 1.8 million premature smoking- and vaping-attributable deaths avoided and 38.9 million life-years gained between 2013 and 2060. When the NVP relative risk is set to 5%, the results are sensitive to the level of switching and smoking cessation rates and to a lesser extent smoking initiation rates. When the NVP relative risk is raised to 40%, the public health gains in terms of averted deaths and LYL are reduced by 42% in the base case, and the results become much more sensitive to variations in the base case parameters.DiscussionPolicymakers, researchers, and other public health stakeholders can apply the SAVM to estimate the potential public health impact of NVPs in their country or region using their own data sources. In developing new simulation models involving NVPs, it will be important to conduct extensive sensitivity analysis and continually update and validate with new data.ConclusionThe SAVM indicates the potential benefits of NVP use. However, given the uncertainty surrounding model parameters, extensive sensitivity analysis becomes particularly important.

Trends in age of smoking initiation among the Chinese population born between 1950 and 1997

ObjectivesSmoking prevalence has significantly increased among Chinese adolescences in the past decades. The aim of our study is to investigate the trends and changing patterns in age of smoking initiation among the Chinese population. Study designPooled data from the 2006–2015 China Health and Nutrition Survey was used for analysis. A total of 10,032 adults aged ≥18 years who were born between 1950 and 1997 were separated into five birth cohorts (1950–1959, 1960–1969, 1970–1979, 1980–1989 and 1990–1997). MethodsAge-specific (10–24 years) smoking initiation rates were calculated by gender, educational level and urbanisation. The multiple logistic models were used for estimates of changes in smoking initiation age. ResultsThe mean age of smoking initiation decreased substantially from 22.0 years (95% confidence interval [CI]: 21.2–22.7) to 17.5 years (95% CI: 16.2–19.1) over five generations. A large decrease was seen in the initiation age group of 15–24 years in the 1980s cohort (15–19 years: odds ratio [OR] = 0.57; 95% CI: 0.19–0.97; 20–24 years: OR = 0.45; 95% CI: 0.18–0.82); a significant decrease was also found in the 1990s cohort (15–19 years: OR = 0.47; 95% CI: 0.11–0.94; 20–24 years old: OR = 0.34; 95% CI: 0.14–0.85). The peak age of smoking initiation changed from 20 years old to 18 years old over the five generations. ConclusionsThe age of smoking initiation has decreased rapidly in the Chinese population in the past decades. Chinese adolescents are becoming the main target group for the tobacco marketing industry, and national legislations are urgently required.

Early Alcohol and Smoking Initiation: A Contributor to Sexual Minority Disparities in Adult Use

Lesbian, gay, and bisexual adults report higher rates of smoking and alcohol use than heterosexual peers. Prior studies have not examined whether potential disparities in early initiation among lesbian, gay, and bisexual youth may contribute to adult disparities. Data on 126,463 adults (including 8,241 lesbian, gay, and bisexual adults) were from the 2015-2017 National Survey on Drug Use and Health. Rates of reported early alcohol and smoking initiation (before age 15 years) among both lesbian/gay and bisexual adults were examined relative to same-gender heterosexual adults. Mediation analyses were used to assess whether early initiation differences contribute to disparities in adult heavy episodic drinking, alcohol use disorder, current smoking, and nicotine dependence for each subgroup. Analyses were conducted in 2018-2019. For both lesbian/gay and bisexual women, early alcohol initiation rates were elevated and explained 21%-38% of their observed disparities in adult heavy episodic drinking and alcohol use disorder. Similarly, early smoking initiation rates were elevated among both lesbian/gay and bisexual women and explained 22%-29% of their disparities in adult smoking and nicotine dependence. By contrast, no evidence was observed that early initiation mediated adult disparities for gay or bisexual men. A significant proportion of alcohol and smoking disparities among lesbian/gay and bisexual women in adulthood appear attributable to early initiation, indicating the need for enhanced early prevention efforts for these groups. Making routine adolescent screening for substance use, brief intervention, and referral to treatment more culturally sensitive to lesbian, gay, and bisexual youth may also be an important step in reducing adult disparities for lesbian, gay, and bisexual women.

Smoking prevalence and attributable deaths in Thailand: predicting outcomes of different tobacco control interventions

BackgroundDespite substantial positive impacts of Thailand’s tobacco control policies on reducing the prevalence of smoking, current trends suggest that further reductions are needed to ensure that WHO’s 2025 voluntary global target of a 30% relative reduction in tobacco use is met. In order to confirm this hypothesis, we aim to estimate the effect of tobacco control policies in Thailand on the prevalence of smoking and attributed deaths and assess the possibilities of achieving WHO’s 2025 global target. This paper addresses this knowledge gap which will contribute to policy control measures on tobacco control. Results of this study can help guide policy makers in implementing further interventions to reduce the prevalence of smoking in Thailand.MethodA Markov chain model was developed to examine the effect of tobacco control policies, such as accessibility restrictions for youths, increased tobacco taxes and promotion of smoking cessation programs, from 2015 to 2025. Outcomes included smoking prevalence and the number of smoking-attributable deaths. Due to the very low prevalence of female smokers in 2014, this study applied the model to estimate the smoking prevalence and attributable mortality among males only.ResultsGiven that the baseline prevalence of smoking in 2010 was 41.7% in males, the target of a 30% relative reduction requires that the prevalence be reduced to 29.2% by 2025. Under a baseline scenario where smoking initiation and cessation rates among males are attained by 2015, smoking prevalence rates will reduce to 37.8% in 2025. The combined tobacco control policies would further reduce the prevalence to 33.7% in 2025 and 89,600 deaths would be averted.ConclusionCurrent tobacco control policies will substantially reduce the smoking prevalence and smoking-attributable deaths. The combined interventions can reduce the smoking prevalence by 19% relative to the 2010 level. These projected reductions are insufficient to achieve the committed target of a 30% relative reduction in smoking by 2025. Increased efforts to control tobacco use will be essential for reducing the burden of non-communicable diseases in Thailand.

Trends in smoking initiation in Europe over 40 years: A retrospective cohort study.

BackgroundTobacco consumption is the largest avoidable health risk. Understanding changes of smoking over time and across populations is crucial to implementing health policies. We evaluated trends in smoking initiation between 1970 and 2009 in random samples of European populations.MethodsWe pooled data from six multicentre studies involved in the Ageing Lungs in European Cohorts consortium, including overall 119,104 subjects from 17 countries (range of median ages across studies: 33–52 years). We estimated retrospectively trends in the rates of smoking initiation (uptake of regular smoking) by age group, and tested birth cohort effects using Age-Period-Cohort (APC) modelling. We stratified all analyses by sex and region (North, East, South, West Europe).ResultsSmoking initiation during late adolescence (16–20 years) declined for both sexes and in all regions (except for South Europe, where decline levelled off after 1990). By the late 2000s, rates of initiation during late adolescence were still high (40–80 per 1000/year) in East, South, and West Europe compared to North Europe (20 per 1000/year). Smoking initiation rates during early adolescence (11–15 years) showed a marked increase after 1990 in all regions (except for North European males) but especially in West Europe, where they reached 40 per 1000/year around 2005. APC models supported birth cohort effects in the youngest cohorts.ConclusionSmoking initiation is still unacceptably high among European adolescents, and increasing rates among those aged 15 or less deserve attention. Reducing initiation in adolescents is fundamental, since youngsters are particularly vulnerable to nicotine addiction and tobacco adverse effects.

Rationale, design and conduct of a school-based anti\u2013smoking intervention: the \u201cPEPITES\u201d cluster randomized trial

BackgroundIn France smoking initiation rates amongst 11 to 16 year-olds are worryingly high. Several studies show that early initiation to psycho-active substances is a strong predictor of tobacco addiction. Decreasing the age at which tobacco use starts represents a key challenge for reducing tobacco usage. Implementing an intervention trial using educational workshops based on the Theory of Planned Behavior (TPB) and covering the 4 years of secondary school could be effective.Methods“PEPITES” is an interventional research, using a cluster randomized design. It will allow assessing the effectiveness of interventions both in reducing the tobacco initiation rate and the regular smoking rate of secondary school pupils. We will also evaluate the process of the implementation of the study and thus will help to the transferability of the intervention.A partnership convention was signed between the JDB Foundation and the National Education authority which designated 6 secondary state schools for the PEPITES trial.The 6 schools were randomly allocated to 3 groups of 2 clusters each: 1 control group, 2 different intervention groups with 2 workshops per year during 4 years; In one of this group the 2 last workshops will be dedicated to measure the loss of taste due to tobacco smoking. In each school, all pupils in year 1 with a signed parental authorization (744 pupils) have been included in the trial. The interventions targets one of the variables of the TPB and the reinforcement of psycho-social competencies. We estimated that we could detect a reduction of increase ≥5.5 and 8% respectively in the 2 principal outcomes (risk α of 5%, and β of 80%).DiscussionCarrying out a randomized prevention trial in the school environment raises specific problems which it seems useful to detail for other educational actors who would like to perform a similar study.This discussion concerns the acceptation and cooperation of the National Education partners, the risks of contamination, the information given to parents and pupils and their consent, and the representativeness of the schools involved.Trial registrationISRCTN85812512. Registered 15 May 2018 by BioMed Central. (retrospectively registered).

Projecting the effects of tobacco control policies in the USA through microsimulation: a study protocol

IntroductionSmoking remains the leading cause of preventable death in the USA but can be reduced through policy interventions. Computational models of smoking can provide estimates of the projected impact of...

International Approaches to Tobacco Use Cessation Programming and Prevention Interventions among Indigenous Adolescents and Young Adults

This article reviews evidence-based smoking cessation and prevention programs for Indigenous youth and young adults in Australia, Canada, New Zealand, and the USA. A systematic review using PubMed and PsycINFO search engines was conducted to identify randomized controlled trials (RCTs) and quasi-experimental studies focusing on Indigenous youth and young adults. Beyond two Cochrane reviews (2012) of smoking cessation and prevention programs for Indigenous youth and young adults, we located only two additional studies post Cochrane review. Combined results from the articles in the Cochrane reviews and the more recent studies suggest that recruitment of young Indigenous populations is challenging. Only one study with the smoking cessation program using mobile phone text messaging among the Maori was shown effective. Additional evidence-based programs are essential for Indigenous youth and young adults to reduce smoking initiation and prevalence rates. Further evaluations of commercial tobacco use prevention and cessation programs are needed to bridge the gap between tobacco-related health disparities in Indigenous and non-Indigenous populations. Additionally, qualitative research is encouraged to further understand the barriers to recruitment.

Association Between The Real Cost Media Campaign and Smoking Initiation Among Youths - United States, 2014-2016.

In the United States, approximately 900,000 youths smoke their first cigarette each year (1). Health communication interventions are evidence-based strategies for preventing the initiation of tobacco use, promoting and facilitating cessation, and changing beliefs and attitudes about tobacco use (2,3). This report describes the association between the Food and Drug Administration's (FDA's) first national tobacco public education campaign, The Real Cost, and rates of smoking initiation among youths in the United States from 2014 to 2016. A nationally representative cohort study of youths (N = 5,185) was conducted during November 2013-March 2016. Results from a discrete-time survival model indicate that, among youths who reported never having smoked a cigarette in the baseline survey, the odds of reporting smoking initiation at follow-up were lower among youths with frequent exposure to campaign advertisements than among those with little or no exposure (adjusted odds ratio [aOR]=0.70, 95% confidence interval [CI]=0.55-0.91). Based on the results of the model, The Real Cost is associated with an estimated 348,398 U.S. youths aged 11-18 years who did not initiate smoking during February 2014-March 2016. Sustained youth-focused tobacco education campaigns, such as The Real Cost, can help speed progress toward preventing tobacco use among youths in the United States.

Projecting the future smoking prevalence in Norway.

Background : Norway has achieved a noteworthy reduction in smoking prevalence over the past forty years. In 2015, 13% of Norwegians aged 13–74 smoked daily and a further 9% smoked occasionally. One of the objectives of the Norwegian 2013–16 national strategy for tobacco control is to achieve a reduction in the daily smoking prevalence to < 10% by 2016. This paper aims to estimate how long it will take for Norway to achieve the 10% smoking prevalence. Methods : A dynamic forecasting model using smoking prevalence data from national survey data on the prevalence of current, former and never smokers in the Norwegian population from 1985 to 2012 was used to estimate future smoking prevalence in the Norwegian population based on a continuation of current patterns in smoking cessation and initiation rates. Results : The result suggests that Norway’s smoking prevalence among men and women will continue to decline if current trends of smoking initiation and cessation continue. Our model predicts, based on figures for 1985–2012, that the prevalence of current daily and occasional smoking among men and women will not fall below the 10% mark until 2029 for men and 2026 for women, if current trends continue. Conclusion : Smoking is likely to remain an important public health issue in Norway for many years. New strategies are needed to accelerate the decline in smoking in Norway.