Smoking Prevention Research Articles

Impact of Smoking on Adolescents Development

This research investigates how smoking affects cognitive development in adolescents, emphasizing both the short-term and long-term consequences of nicotine on the brain. The research highlights the significant disruption caused by nicotine to critical brain regions such as the prefrontal cortex and hippocampus, which are essential for decision-making, impulse control, and memory retention. The incidence of smoking among adolescents, particularly the rise in e-cigarette use, is attributed to targeted marketing, affordability, and accessibility. These factors exacerbate the psychological and academic challenges faced by adolescents, linking smoking to issues such as depression, anxiety, and poor academic performance. The paper emphasizes the necessity of comprehensive educational programs, parental and community involvement, and stricter regulations to curb the use of tobacco products among young people. Future research directions include establishing a causal relationship between smoking and cognitive development, conducting longitudinal studies, and integrating mental health support with smoking prevention programs. By addressing these areas, the study aims to inform public health policies and promote healthier lifestyles among adolescents.

Risk Perception and Knowledge Following a Social Game-Based Tobacco Prevention Program for Adolescents: Pilot Randomized Comparative Trial.

Adolescence is a critical developmental stage that is particularly vulnerable to the initiation of tobacco use. Despite the well-documented health risks associated with tobacco use, it remains prevalent among adolescents. Games for health are a promising strategy for tobacco prevention, using experiential and social learning theories to enhance engagement and improve behavior change. This pilot study aims to (1) compare the social game-based program Storm-Heroes to a nonsocial program regarding adolescents' personal and social experiences and (2) examine how these experiences predict higher tobacco knowledge and perceived risks of vaping and conventional tobacco use. In a cluster-randomized comparative design, 4 after-school sites (N=79 adolescents) were recruited in person and randomized in a single-blinded format to 1 of 2 interventions: the social game Storm-Heroes (44/79, 56%) or the nonsocial program A Smoking Prevention Interactive Experience (ASPIRE; 35/79, 44%). A study team member supervised both interventions. Data were collected at baseline, immediate follow-up, and a 1.5-month follow-up (45/74, 61% retained). Repeated measures mixed effects models were conducted. A total of 45 participants continued until the 1.5-month follow-up. Participants in the Strom-Heroes group were more likely to increase their perceived risk of vaping (B=0.40; P<.001), perceived risk of conventional tobacco use (B=0.35; P=.046), and tobacco knowledge (B=1.63; P<.001) than those in the control condition. The usability level of the program was related to a higher perceived risk of vaping (B=0.16; P=.003) and conventional tobacco use (B=0.16; P=.02) by follow-up. Attention to the program was also related to higher perceived risk of vaping (B=0.12; P=.002) and conventional tobacco use (B=0.14; P<.001). Distraction was not related to either perceived risk of vaping (P=.15) or perceived risk of conventional tobacco use (P=.71). In contrast, both more attention (B=0.60; P<.001) and less distraction (B=-0.37; P<.001) were related to higher tobacco knowledge. The increased perceived risk of vaping and conventional tobacco among Storm-Heroes participants aligns with the program's goals of improving participants' awareness of the risks associated with tobacco use and their tobacco knowledge. However, distraction weakened the effect of the program on tobacco knowledge, indicating that emphasis needs to be placed on minimizing distraction for better outcomes. With the results of this study, researchers can work to advance the current version of Storm-Heroes and amplify engagement in the program to improve its potential for preventing adolescents' initiation of tobacco use. ClinicalTrials.gov NCT02703597; https://clinicaltrials.gov/study/NCT02703597.

Tobacco, respiratory diseases, cardiovascular risk, and cancer: Classical approaches and new alternatives

Smoking tobacco is the main preventable aetiological factor of mortality worldwide, with a significant impact on respiratory and cardiovascular diseases and cancer. Smoking cessation and prevention must be prioritized in health care and legislative initiatives to reduce mortality and associated complications. To date, pharmacological treatments and behavioural therapies, along with community strategies, have been shown to be the most effective methods, especially when used in combination with a coordinated approach. However, their efficacy remains suboptimal and diminishes over time due to the high frequency of relapse. Data from the survey on alcohol and other drugs in Spain (EDADES) of the Spanish National Health System showed that the percentage of smokers has hardly decreased in recent decades and that many smokers do not intend to give up smoking, even those who have already suffered from some complications. In this context, the development of new products such as electronic cigarettes and heated tobacco may have some application in the population. The FDA recognition of risk-modifying products, the British Health System reports on electronic cigarettes, and the recommendations of the American College of Cardiology expert consensus on smoking cessation, among others, indicates the need to consider updating the multifactorial and multidisciplinary approach of smoking and its consequences.

Study on smoke sealing effectiveness of the air curtain in exit bifurcated tunnel fires

The feasibility of using a smoke prevention air curtain in the exit bifurcated tunnel was investigated through 1:10 scale model experiments. The results indicated that the jet velocity and heat release rate (HRR) significantly influenced the smoke sealing effectiveness of the air curtain. However, once the jet velocity reached a certain extent, the longitudinal fire location had a relatively limited effect on the smoke sealing effectiveness. Subsequently, numerical simulations were conducted to investigate the influence of the HRR, jet velocity, longitudinal velocity, and bifurcation angle on the smoke sealing efficiency of the air curtain. The simulations were based on the evacuation strategy of bifurcated tunnel under longitudinal ventilation, assuming no smoke backflow upstream of the fire. The findings revealed that the smoke sealing efficiency was positively correlated with the jet velocity, negatively correlated with the HRR and longitudinal velocity, and somewhat increased with the increase of bifurcation angle. Additionally, a prediction model was proposed for determining the optimal air curtain jet velocity in the bifurcated tunnel. This model was developed using dimensional analysis principles and taking into account various influencing factors, which can provide valuable insights for designing smoke control measures and enhancing safety in bifurcated tunnel fires.

Efficacy of digital interventions for smoking prevention among children: a systematic review

Abstract Background Smoking remains a leading preventable cause of morbidity and mortality globally, with initiation often occurring in childhood. Early smoking onset is linked to increased difficulty in quitting and higher risk of long-term health complications. Traditional prevention strategies have not fully succeeded in curbing youth smoking rates, highlighting the need for innovative approaches. Digital interventions (DI), such as gamified education, social media campaigns, and virtual reality, offer a novel avenue for engagement and education. This systematic review aims to assess the efficacy of DI in preventing smoking, and improving knowledge and awareness about smoking damages, among children. This review is part of the PRIN project, whose goal is to evaluate the effectiveness of a DI aimed at school-aged children, intended to increase knowledge about the negative effects of smoking and prevent its use. Methods On the 18th of March 2024, PubMed, Scopus, and PsycINFO were surfed for trials and observational studies evaluating DI for smoking prevention among children aged 6-12 years. Study quality will be evaluated using the Cochrane Risk of Bias Tool and New Castle-Ottawa scale. The protocol has been registered in PROSPERO. Results From 3,081 initially identified articles, 328 papers were removed because duplicate. The screening process is ongoing. Conclusions DI are a promising tool for engaging young populations through platforms they are familiar with and receptive to. By leveraging the high penetration of digital technology in the daily lives of children, these interventions have the potential to deliver smoking prevention messages in a compelling and interactive manner. Understanding the effectiveness of DI in smoking prevention can significantly contribute to public health by providing viable alternatives to traditional methods and potentially reducing future smoking-related health burdens. Key messages • Evaluating digital strategies for smoking prevention among children could offer vital alternatives to traditional methods, potentially reducing long-term health risks. • Digital interventions (DI) offer promising new ways to engage young audiences on smoking prevention using familiar platforms, potentially reshaping public health approaches.

Digital interventions to prevent smoking habit among children. Is there evidence?

Abstract Smoking remains one of the foremost preventable causes of death and disease on a global scale, with its roots often traced back to early childhood. The habit typically begins at a young age, setting a pattern that becomes increasingly difficult to break over time. This enduring issue highlights the critical need for effective preventive measures. Traditional approaches to curbing smoking among the youth-such as public health campaigns, school-based education, and legislative measures like age restrictions on tobacco purchases-have had limited success. In this context, digital interventions (DIs) have begun to emerge as a promising new frontier for tobacco prevention. Leveraging the pervasive influence of technology in young people’s lives, these interventions include gamified educational programs, which transform learning about the dangers of smoking into interactive and engaging activities; social media campaigns, which can spread powerful anti-smoking messages quickly and broadly; and virtual reality experiences, which immerse users in scenarios that vividly illustrate the impact of smoking on health. These digital strategies not only offer fresh avenues for conveying important health information but also engage young audiences in a medium they find relatable and compelling. In this context, the presentation will discuss results of a systematic review aims to assess the efficacy of DI in preventing smoking, and improving knowledge and awareness about smoking damages, among children. This review is part of the PRIN project, titled: “Leo&amp;Giulia standing for public health”, whose goal is to evaluate the effectiveness of a DI aimed at school-aged children, intended to increase knowledge about the negative effects of smoking and prevent its use. Grasping the impact of DI in smoking prevention can greatly benefit public health by offering practical alternatives.

Tobacco Free Advent Calendar: Evaluating innovative strategies in Public Health digital campaigns

Abstract Introduction Two editions, 2022 and 2023, of the Tobacco Free Advent Calendar (TFAC) built a large network of Organizations, Universities, Institutions, individual experts and medical students across Europe, coordinated by ENSPNext (European Network for Smoking and Tobacco Prevention Youth Group), to advocate for Youth and for Public Health. This study has 2 objectives: 1. Monitor the performance of TFAC 2023 vs TFAC 2022 for 31 days 2. Evaluate improvements in reach and engagement made for TFAC 2023. Methods For 24 days, TFAC 2023 featured thematic messages, embedded fact sheets, quizzes, videos and call-to-action buttons. New content was accessible daily starting on the first day of advent, ending on Christmas. TFAC was available in English and Armenian. AI was used to assist for various tasks and challenges during development and research. Comparative and Time Series Analysis were conducted in Excel and IBM SPSS26. Results TFAC 2023 was accessed 3764 times (8.8% increase), the doors were opened 1506 times (3.9% decrease), Call to action buttons were clicked 261 times (169% increase). For english version a strong variation in reach was observed, but not in engagement which remained relatively constant. In Armenian version both reach and engagement varied in 2023 vs 2022. A seasonal component was identified for both versions, particularly an increase at weekends and a decrease on weekdays. Similar to 2022, the reach and engagement were higher at the start and lower as time passed, although in 2023 the reach and engagement remained higher and more constant over time. Completion rates of interactive materials ranged between 21.4% to 100% in the English version and from 7.1% to 100% in the Armenian version. No interactive material remained unanswered. Conclusions Decrease of translations didn’t lower the reach and engagement of TFAC. Engagement with TFAC 2023 was higher, possibly due to the implication of students organizations and collaboration with influencers. Key messages • Targeted dissemination increased the reach and engagement of TFAC 2023 versus TFAC 2022. • Members of the target group should be recruited for being members in the projects affecting them to increase engagement and impact of the campaign.

Assessing the contribution of smoking to the disease burden in Belgium, 2013-2020

Abstract Tobacco use remains a challenge given its substantial role in contributing to disability and premature death globally. Understanding its impact on population health, as an attributable burden, can help monitor progress on the effectiveness of tobacco policies. In this study, we used the Comparative Risk Assessment (CRA) method to estimate the share of the disease burden due to smoking in Belgium from 2013 to 2020. Population attributable fractions (PAF) were computed for risk-outcome pairs by age, sex, and region in Belgium for 2013-2020. Exposure estimates were extracted from a time series of the Belgian Health Interview Survey. Dose-response curves or relative risk estimates were drawn from the Global Burden of Disease Study 2019. In Belgium, smoking-related deaths decreased from 12,851 deaths (PAF=11%) in 2013 to 9,413 deaths (PAF=7%) in 2020. Deaths among men (2013: PAF=18%, n = 9859; 2020: PAF=11%, n = 7041) were three times higher than among women (2013: PAF=5%, n = 2991; 2020: PAF=3%, n = 2341). Over time, larynx cancer (2013: PAF=72%, n = 185; 2020: PAF=63%, n = 125), trachea, bronchus, and lung cancer (2013: PAF=60%, n = 4,899; 2020: PAF=60%, n = 3,682), other pharyngeal and oropharyngeal cancers (2013: PAF=47%, n = 118; 2020: PAF=40%, n = 100), mouth cancer (2013: PAF=37%, n = 172; 2020: PAF=30%, n = 122), and aortic aneurysm (2013: PAF=40%, n = 268; 2020: PAF=33%, n = 209) emerged as the primary contributors to smoking-related deaths in Belgium. While the ranking of contributing causes stayed mostly consistent in both genders over the years, cervical cancer (2013: PAF=23%, n = 53; 2020: PAF=21%, n = 64) ranked fourth instead of mouth cancer (2013: PAF=22%, n = 28; 2020: PAF=14%, n = 15) among women. Despite decreasing trends over time, smoking remains a significant contributor to cancer deaths in Belgium, particularly among men. Results from this study can help inform the development of strategies for smoking prevention and reinforce the need for continued efforts in prevention initiatives. Key messages • Cancers are the primary cause of smoking-related deaths in Belgium, with a decline in the death toll over time. • Understanding the role of smoking on population health as an attributable burden can improve health monitoring.

TOBACCO CONSUMPTION DYNAMICS BEFORE AND AFTER THE COVID-19 PANDEMIC

In 2022, 2,453 residents were surveyed (men - 1137, women - 1316) aged from 15 to 86 years (average age - 43,0 ± 16,4 years). There were 58,9% city dwellers, 41,1% villagers. The GATS technique was used. The results of the 2022 survey were compared with 2019. Mathematical and statistical processing included descriptive statistics and calculation of the χ2 distribution. Over the past three years, the share of smokers has not changed (19,0% in 2022 vs 19,9% in 2019). At the same time, there were significantly more women smoking (7,4% vs 5,4%), and fewer men smoking (32,4% vs 36,7%). The number of smokers has significantly increased in the age group 65+, among women, as well as among persons aged 45-64 years. In 2022, smokers made fewer attempts to quit smoking. The number of users of electronic nicotine delivery systems increased (7.1% vs 5.4%), especially among men (9.5% vs 6.0%); a noticeable increase was observed in the 45-64 age group (2.8% vs 0.9%). During the COVID-19 pandemic, the proportion of smokers of both sexes in the older age group has increased significantly. The number of users of electronic nicotine delivery systems has increased. Many indicators of assistance to the population in quitting tobacco use and prevention of smoking among the adult population have worsened.

Evaluating the Impact of School-Based Smoking Prevention Interventions on Students' Physical Activity Intentions, Perceived Social Expectations, and Self-Efficacy

This study evaluates the impact of school-based smoking prevention interventions on students' physical activity intentions, perceived social expectations, and self-efficacy. With increasing rates of adolescent smoking and its associated health risks, school-based interventions have been widely promoted as effective strategies to prevent smoking initiation. However, little research has been conducted in Pakistan to assess their broader effects on health behaviors. This study addresses this gap by analyzing data from 240 school students in Lahore, Pakistan, using a structured questionnaire. The respondents were approached while visiting at their schools. The data was obtained using simple random sampling technique from one of the Lahore based elite private school. The findings reveal significant positive relationships between the interventions and all three outcome variables. Smoking prevention programs had the strongest effect on physical activity intentions (β = 0.4441), followed by perceived social expectations (β = 0.3359) and self-efficacy (β = 0.3089). These results suggest that these interventions not only reduce smoking tendencies but also encourage broader health-promoting behaviors among students. By promoting positive social expectations, self-efficacy, and physical activity, these interventions can create a lasting impact on adolescent health. Future research should focus on the long-term sustainability of these outcomes and their potential application to other health areas.

Translation and cross-cultural adaptation of the Telemedicine Satisfaction Questionnaire for use in Brazil.

To translate, cross-culturally adapt to Brazilian Portuguese, and evaluate the reliability of the Telemedicine Satisfaction Questionnaire (TSQ). This cross-sectional study involved patients from the Smoking Prevention and Cessation Center (PrevFumo) who participated in at least four of the eight scheduled remote meetings with the PrevFumo psychologist in 2020, 2021, or 2022. Participants were contacted by telephone and asked to answer the 14 questions of the TSQ three times at intervals of 7 or 10 days. We assessed 53 patients (73.3% women). The mean age was 49.7 ± 10.2 years. The mean smoking history was 35.32 ± 24.8 pack-years. Of the 53 patients evaluated, 30.2% had completed high school or had some higher education, and 32.1% were classified as socioeconomic class B2 (A being the highest and E being the lowest). Forty-nine (92.5%) of the patients attended all eight meetings. The TSQ with only three answer options showed high reliability, with approximately 90% agreement after three applications. Patients were satisfied with telemedicine. The TSQ is rapidly applied, is easy to complete, and showed high reliability in our patient sample. Patients declared that they were satisfied with their telemedicine experience.

Sex-related inequalities in current cigarette smoking among adolescents in Africa

IntroductionRisky behaviours, including tobacco use, are highly prevalent among adolescents worldwide. Although these behaviours are largely influenced by various sociodemographic factors, including sex, there is a paucity of regionally representative literature on the sex-related inequalities in cigarette smoking among adolescents in Africa. This study examined the sex-based disparities in current cigarette smoking among adolescents aged 13–15 years in Africa.MethodsThe present study employed a secondary analysis of nationally representative data on 45 African countries obtained from the Global Youth Tobacco Survey, accessible through the World Health Organization (WHO) Global Health Observatory. We used the online version of the WHO Health Equity Assessment Toolkit (HEAT) to generate the results.ResultsThe prevalence of current cigarette smoking among the adolescents surveyed ranged from 1.6% in Eritrea to 10.4% in Mali among the low-income countries, from 1.3% in Tanzania to 13.1% in Mauritania among the lower-middle-income countries, from 5.2% in Gabon to 15.3% in Mauritius among the upper-middle-income countries, and 14.7% in Seychelles, the only high-income country in the study. The absolute summary measure (D) showed diverse sex-related disparities in the burden of current cigarette smoking among adolescents across the sub-regions. In all countries surveyed, the prevalence of cigarette smoking was higher among male adolescents compared to females, except in Liberia and Mozambique, where female adolescents bore a more significant burden than their male counterparts. Furthermore, male adolescents were more burdened with high cigarette smoking prevalence than females in low-income countries such as Mali, Madagascar, Guinea, Burkina Faso, and The Gambia, where such disparities were most pronounced. Meanwhile, we found less disparity in the burden of cigarette smoking between male and female adolescents in most of the lower and upper-middle-income countries surveyed.ConclusionThis study sheds light on the sex-based inequalities in the prevalence of current cigarette smoking among adolescents in Africa. In contrast to female adolescents, male adolescents bear a greater burden of current cigarette smoking. The burden of cigarette smoking is most pronounced in low-income countries such as Mali, Madagascar, Guinea, Burkina Faso, and The Gambia. Conversely, in most of the lower and upper-middle-income countries surveyed, the burdens of current cigarette smoking among male and female adolescents were found to be less disparate. Consequently, cigarette smoking prevention programmes and strategies must be implemented in all African nations. There is also the need to intensify interventions aimed at altering the smoking behaviour of male adolescents. Policymakers can develop and implement evidence-based interventions to address the burden of cigarette smoking among the adolescents. Finally, existing policies and programmes addressing adolescents' cigarette smoking should be re-assessed and strengthened to achieve their objectives.

Smoking prevalence among adults in China Mainland and their age of smoking initiation during adolescence: a national cross-sectional study

ObjectivesThis study aims to calculate the national prevalence of smoking among Chinese adults and to describe the hazard of smoking initiation by age during their adolescence, as well as the...

Greenwashed Cigarette Ad Text and Imagery Produce Inaccurate Harm, Addictiveness, and Nicotine Content Perceptions: Results from a Randomized Online Experiment.

The tobacco industry has a long history of circumventing regulations to present their products, inaccurately, as less harmful. Greenwashing (portraying a product as natural/eco-friendly) is increasingly used by tobacco companies and may mislead consumers to believe that certain cigarettes are less harmful than others. This study assesses the effect of some common greenwashing tactics on consumer product perceptions. We conducted an online experiment with 1,504 participants ages 18-29, randomized to view a cigarette ad manipulated for presence/absence of a combination of 4 different greenwashing techniques: greenwashed ad text, greenwashed ad imagery, recycled paper ad background, and image of greenwashed cigarette pack. Participants rated perceived absolute harm, relative harm to other cigarettes, absolute addictiveness, relative addictiveness, and relative nicotine content. Participants who viewed ads containing greenwashed text were more likely to have inaccurate perceptions about absolute harm (AOR=1.72), relative harm (AOR=3.92), relative addictiveness (AOR=2.93) and nicotine content (AOR=2.08). Participants who viewed ads containing greenwashed imagery were more likely to have inaccurate perceptions of relative harm (AOR=1.55), absolute addictiveness (AOR=1.72), relative addictiveness (AOR=1.60) and nicotine content (AOR=1.48). Forty-two percent of those who saw an ad with all greenwashed features believed the product was less harmful than other cigarettes vs. 2% of those who saw an ad without greenwashed features. We found greenwashed text and imagery produced inaccurate risk perceptions. More active U.S. Food & Drug Administration (FDA) enforcement against such greenwashing and new FDA rulemaking to prohibit unnecessary imagery in tobacco advertising and establish plain packaging requirements would help protect consumers and public health. These findings provide evidence that greenwashing tactics used by the tobacco industry increase inaccurate product risk perceptions. These tactics could be a way for the industry to make implicit modified risk claims, despite applicable U.S. Family Smoking Prevention and Tobacco Control Act prohibitions. Findings from this study support the need for prohibitions on these tactics, and the potential for such prohibitions to help protect public health.

Lessons for cannabinoid regulation from electronic nicotine delivery system product regulation.

Cannabis legalization continues to spread, with 38 states permitting the use of medical marijuana, 22 states permitting recreational use, and growing political momentum for federal legalization. The last time the Food and Drug Administration (FDA) was tasked with regulating a new product occurred with 2009's Family Smoking Prevention and Tobacco Control Act, which created the Center for Tobacco Products (CTP). Thus, the time is ripe to review the history of CTP with particular attention to difficulties the nascent center faced in regulating novel products such as e-cigarettes or electronic nicotine delivery systems (ENDS). Specifically, FDA has struggled with defining its scope of authority, determining which review pathway(s) to utilize, and promulgating timely and transparent product standards for marketing authorization-all of which offer lessons for improving cannabis product oversight and enforcement.

Polygenic risk scores for nicotine use and family history of smoking are associated with smoking behaviour

IntroductionFormal genetics studies show that smoking is influenced by genetic factors; exploring this on the molecular level can offer deeper insight into the etiology of smoking behaviours. MethodsSummary statistics from the latest wave of the GWAS and Sequencing Consortium of Alcohol and Nicotine (GSCAN) were used to calculate polygenic risk scores (PRS) in a sample of ~2200 individuals who smoke/individuals who never smoked. The associations of smoking status with PRS for Smoking Initiation (i.e., Lifetime Smoking; SI-PRS), and Fagerström Test for Nicotine Dependence (FTND) score with PRS for Cigarettes per Day (CpD-PRS) were examined, as were distinct/additive effects of parental smoking on smoking status. ResultsSI-PRS explained 10.56% of variance (Nagelkerke-R2) in smoking status (p=6.45x10−30). In individuals who smoke, CpD-PRS was associated with FTND score (R2=5.03%, p=1.88x10–12). Parental smoking alone explained R2=3.06% (p=2.43×10−12) of smoking status, and 0.96% when added to the most informative SI-PRS model (total R²=11.52%). ConclusionThese results show the potential utility of molecular genetic data for research investigating smoking prevention. The fact that PRS explains more variance than family history highlights progress from formal to molecular genetics; the partial overlap and increased predictive value when using both suggests the importance of combining these approaches.

Understandability of passive smoking prevention leaflets in Japan

PurposeThere are few studies in Japan evaluating informational materials about passive smoking prevention with respect to health literacy. This study applied a range of health literacy assessment tools to assess the understandability of public-sector leaflets about passive smoking prevention.MethodsWe collected 26 anti-passive smoking leaflets published online by Japanese prefectural governments. We used three internationally recognized health literacy assessment tools to evaluate their understandability: the Clear Communication Index (CCI), the Suitability Assessment of Materials (SAM), and the Patient Education Materials Assessment Tool (PEMAT, further divided into scales for understandability and actionability).ResultsAlthough none of the assessed materials met the CCI's scoring threshold for “easy to understand,” the highest-scoring leaflet, which received a top-two ranking in three of the four scales (excluding the PEMAT understandability scale), was characterized by its conciseness and its easy-to-understand structure, including the use of checklists and flowcharts to engage reader interest. There was a significant correlation between CCI and SAM, and between SAM and the PEMAT understandability scale. However, the PEMAT actionability scale did not significantly associate with the other assessment scales.ConclusionsThe understandability of written informational materials about passive smoking prevention in Japan could be improved by referring to multiple assessment scales.

Attitudes toward smoking cessation according to smoking status among dentists in the Aichi Dental Association in Japan.

The prevalence of smoking, including heated tobacco products (HTPs), among Japanese dentists was reported to be 16.5%, significantly higher than that among Japanese physicians and United States dentists. However, large-scale studies on smoking cessation implementation based on dentists' smoking status and perceptions since the introduction of HTPs are lacking. Therefore, we aimed to investigate and assess dentists' attitudes toward smoking, including HTP use and smoking cessation, according to smoking status. A self-administered questionnaire comprising six major items was mailed to 3883 dentists who were members of the Aichi Dental Association in August 2019. The primary outcome was smoking cessation status. The secondary outcome was the impact of smoking on intervention for smoking cessation. This study was reported using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Among the 1317 (42%) dentists analyzed, men were more positive toward smoking than women. Current and former smokers were more positive about smoking than never smokers/users, regardless of the tobacco product type. Additionally, the current smoker group using conventional cigarettes was less likely to ask for their patients' smoking status than the never smoker group. Furthermore, the current smoker (OR=2.0; 95% CI: 1.3-3.1 vs never smoker) and HTP user (OR=1.9; 95% CI: 1.2-3.1 vs never user) groups were less likely to engage in smoking cessation than the never smoker/user groups, regardless of the tobacco product type. Since the smoking status of dentists affects the implementation of smoking cessation interventions, it is crucial to encourage them to quit using all tobacco products to promote smoking cessation interventions in dental practice. Additionally, providing proper smoking prevention education to dentists is an important task.

Evaluation of a medical student-delivered smoking prevention program utilizing a face-aging mobile app for secondary schools in Germany: The Education Against Tobacco cluster-randomized controlled trial

BackgroundTo reduce smoking uptake in adolescents, the medical students' network Education Against Tobacco (EAT) has developed a school-based intervention involving a face-aging mobile app (Smokerface). MethodsA two-arm cluster-randomized controlled trial was conducted, evaluating the 2016 EAT intervention, which employed the mobile app Smokerface and which was delivered by medical students. Schools were randomized to intervention or control group. Surveys were conducted at baseline (pre-intervention) and at 9, 16, and 24 months post-intervention via paper & pencil questionnaires. The primary outcome was the difference in within-group changes in smoking prevalence between intervention and control group at 24 months. ResultsOverall, 144 German secondary schools comprising 11,286 pupils participated in the baseline survey, of which 100 schools participated in the baseline and at least one of the follow-up surveys, yielding 7437 pupils in the analysis sample. After 24 months, smoking prevalence was numerically lower in the intervention group compared to control group (12.9 % vs. 14.3 %); however, between-group differences in change in smoking prevalence between baseline and 24-months follow-up (OR=0.83, 95 %-CI: 0.64–1.09) were not statistically significant (p = 0.176). Intention to start smoking among baseline non-smokers declined non-significantly in the intervention group (p = 0.064), and remained essentially unchanged in the control group, but between-group differences in changes at the 24-months follow-up (OR=0.88, 0.64–1.21) were not statistically significant (p = 0.417). ConclusionWhile a trend towards beneficial effects of the intervention regarding smoking prevalence as well as intention to start smoking among baseline non-smokers was observed, our smoking prevention trial demonstrated no significant effect of the intervention.

Mobile Phone–Based Personalized and Interactive Augmented Reality Pictorial Health Warnings for Enhancing a Brief Advice Model for Smoking Cessation: Pilot Randomized Controlled Trial

Background Augmented reality (AR) is a novel modality for promoting smoking cessation (SC). AR-visualized adverse consequences for education and smoking prevention have only been evaluated in nonsmokers in previous studies. Objective To assess the feasibility and preliminary effectiveness for SC of AR pictorial health warnings (PHWs) on cigarette packs. Methods We conducted a pilot randomized controlled trial in adult daily smokers in communities in Hong Kong. All participants received AWARD (ask, warn, advise, referral, do-it-again) model–guided SC advice, a warning leaflet, and referral to SC services at baseline. Interactive, chat-based SC support comprising regular messages and real-time support was provided to all participants via instant messaging apps (eg, WhatsApp) for 3 months after randomization. Participants in the intervention group additionally received 6 links to the AR PHWs showing the worsening health status of various organs caused by smoking. The level of the AR PHWs was adjustable to smoking behaviors (ie, smoking duration or daily cigarette consumption) to increase interaction. Participants could swipe, drag, or rotate the 3D PHWs to reinforce their impression of the health consequences of smoking. The primary outcome was self-reported past 7-day point-prevalence abstinence (PPA) at 3 months. The acceptability of the AR intervention was assessed by the proportion of participants who had viewed AR PHWs during the intervention. Participants who viewed AR PHWs further evaluated the perceived effect of the AR PHWs on a scale of 0 (not helpful at all) to 10 (very helpful). Intention to treat was used, and the risk ratio (RR) of the intervention effect was estimated by Poisson regression. Results From April to November 2021, 80 participants were recruited and randomly assigned to intervention (n=40) and control (n=40) groups. Most participants were male (66/80, 83%) and planned to quit beyond 30 days or were undecided (65/80, 81%). The intervention group had a higher but nonsignificant 7-day PPA (7/40, 18% vs 5/40, 13%; RR 1.40, 95% CI 0.48-4.07) and quit attempts (15/40, 38% vs 11/40, 28%; RR 1.36, 95% CI 0.71-2.60) at 3 months than the control group. In the intervention group, 17 of 40 (43%) participants viewed the AR PHWs. The AR PHWs had modest effects on knowledge of the adverse consequences of smoking on personal health (mean score 3.94, SD 3.52), reducing the frequency of buying cigarettes (mean score 3.29, SD 3.08), increasing the perceived importance of quitting (mean score 3.88, SD 3.50), and making the PHWs more disgusting (mean score 3.41, SD 3.08) and horrible (mean score 3.38, SD 3.05). The 3-month self-reported 7-day PPA was higher in those who ever (vs never) viewed the AR PHWs (5/17, 29% vs 2/23, 9%). Conclusions The mobile-based interactive AR PHWs were feasible, and the effectiveness on smoking abstinence warrants further testing. Trial Registration ClinicalTrials.gov NCT04830072; https://clinicaltrials.gov/study/NCT04830072