Smoking-related Health Research Articles

Prevalence of smoking among secondary school male students in Jeddah, Saudi Arabia: a survey study

BackgroundThis study was conducted to examine the prevalence of smoking and the smoking habits among male secondary school students in Jeddah, Kingdom of Saudi Arabia and to assess their knowledge and attitudes towards smoking.MethodsA cross-sectional study was conducted in Jeddah, using a two-stage cluster sample that randomly selected four schools from 85 public secondary schools for males. Data were obtained through a self-administered questionnaire containing questions on personal background, smoking behavior, knowledge, and behavior and attitudes towards smoking. A total of 695 students responded to the questionnaires with an 87.4% response rate.ResultsThe age range of this student sample was 16–22 years. Two hundred fifty-eight (37%) of the study group were current smokers. The most common reasons given for smoking were personal choice (50.8%) and the peer pressure from smoker friends (32.8%). Many students researched the smoking hazards (68.1%), but only 47.6% knew about the bad effects of passive smoking. Two thirds of the smoking students wanted to quit smoking (63.2%), especially if suitable help was available, and 75.1% tried to quit. A third of the smoking students (36.8%) found it difficult to stop smoking in no-smoking areas.ConclusionA well-planned integrated antismoking campaign is urgently required, especially among students and teachers. Our study revealed that smoking prevalence was high, which will lead to future high smoking-related health problems if proper preventive measures are not taken accordingly.

Smokers’ Knowledge About Smoking-Related Health Problems in Lebanon

The relationship between smokers’ knowledge about smoking related health problems and the motivation to quit smoking in a sample of Lebanese smokers was evaluated. The first group of smokers was composed of hospitalized subjects for a cardiologic or a respiratory health problem (n = 42). The second group was composed of smokers who have not suffered from any smoking-related health problem (n = 69). A positive correlation was found between the Richmond test score and the knowledge level about smoking related health problems (r = .302; p = .0013).

A comprehensive examination of hookah smoking in college students: Use patterns and contexts, social norms and attitudes, harm perception, psychological correlates and co-occurring substance use

The practice of waterpipe smoking (hookah) has rapidly increased in popularity among young adults yet burgeoning research suggests that its use is associated with nicotine dependence and other negative smoking-related health consequences. Moreover, descriptive studies indicate that consumers may hold the belief that hookah smoking is safer than smoking cigarettes. The current study extended previous work by conducting a comprehensive assessment of patterns and contexts of hookah use, psychological correlates of use, co-occurring substance use as well as social norms and health perceptions surrounding the practice. Participants were 143 ethnically diverse undergraduate students at a large urban US university. Approximately half of the sample (48%) reported life-time use of hookah and 22% reported use within the past 30days. Relative to cigarette smoking, hookah smoking was associated with less perceived harm and addiction potential and higher social approval. Participants who reported life-time hookah use, as compared to those who did not, perceived less associated harm, had a greater number of friends who had tried and approved of hookah, were more likely to use cigarettes, marijuana, and alcohol and in higher frequencies and quantities and were at higher risk for problem tobacco and alcohol use. Among participants who were not current smokers, those with hookah experience were more likely to endorse intent to try a cigarette soon. Hookah users did not differ from non-users on measures of trait anxiety, depression and impulsivity though they were more likely to drink alcohol for coping, social and enhancement purposes than non-users. Implications are discussed for public health initiatives to educate young adults about the potential consequences of hookah smoking.

Pictorial Health Warnings on Cigarette Packages in Qatar: Preimplementation Awareness and Perceptions of Ever-Smokers Versus Never-Smokers

Studies have demonstrated that pictorial health warnings (PHWs) on cigarette packages were significantly associated with increased awareness of smoking-related health hazards and behavior change. A new legislation on PHWs was recently endorsed and PHWs have recently been introduced in Qatar. This study aims to evaluate the general public's awareness, beliefs, and perceptions on antitobacco PHW labels on cigarette packs prior to the implementation of the new regulation. A cross-sectional survey using a pretested 23-item questionnaire was conducted among randomly approached adults in Qatar. Data were analyzed using IBM SPSS(®) version 19. Demographic characteristics and other outcomes of interest were compared using chi-square or Fisher's exact tests. A total of 500 participants (59% male) responded to the survey. Most notably, ever-smokers did not significantly differ from never-smokers on awareness of PHW. About one third of the respondents had no idea about any specific text warning messages on tobacco products sold and nearly 45% of them did not know what a PHW was. Furthermore, a substantial proportion (more than 20%) of the respondents in both groups did not believe that introducing PHWs will enhance smoking behavior change. Nonsmokers generally tended to have more positive attitudes than smokers toward perceived impact of PHWs. These findings suggest the needs for increased awareness about the value of PHWs and call for further research to determine the effectiveness of PHW labels on cigarette packages in Qatar and greater Middle Eastern region, where legislations on PHWs are still at infancy.

Perioperative Smoking Behavior of Chinese Surgical Patients

Surveys suggest that, consistent with a high smoking prevalence, Chinese smokers in the general population report little interest in quitting. In other cultures, surgery is a powerful teachable moment for smoking cessation, increasing the rate of spontaneous quitting. We determined the perioperative tobacco use behavior of Chinese patients scheduled for elective surgery who smoke cigarettes and factors associated with both preoperative intent to abstain and self-reported smoking behavior at 30 days postoperatively. Specifically, we tested the hypothesis that perception of the health risks of smoking would be independently associated with both preoperative intent to abstain and self-reported abstinence at 30 days postoperatively. Patients ≥18 years of age scheduled for elective noncardiovascular surgery at Peking Union Medical College Hospital in Beijing, China, were assessed preoperatively and up to 30 days postoperatively for factors associated with smoking behavior, including indices measuring knowledge of smoking-related health risks. Of the 227 patients surveyed at baseline, most (164, 72%) intended to remain abstinent after hospital discharge. For the 204 patients contacted at 30 days postoperatively, 126 (62%) self-reported abstinence. In multivariate analysis, factors associated with preoperative intent to abstain after surgery included older age, self-efficacy for abstaining, and undergoing major surgery; factors associated with abstinence included older age, self-efficacy, major surgery, and preoperative intent to abstain. Higher perception of benefits from quitting was associated with intent, but not abstinence. Knowledge of the health risks caused by smoking was not found to be associated with either intent or abstinence, so that the hypothesis was not supported. Both intent to quit and self-efficacy for maintaining abstinence appear to be much higher in Chinese surgical patients than in prior surveys of the general Chinese population, and the majority of surgical patients maintained abstinence for at least 30 days. These findings suggest that surgery can serve as a powerful teachable moment for smoking cessation in China.

Smoking-related disease risk, area deprivation and health behaviours

Smokers and ex-smokers are at risk of many chronic diseases. However, never smokers and never smokers exposed to environmental tobacco smoke (ETS) are also at risk. Additionally, smoking behaviours and their associated disease risk are socially patterned and positively associated with health inequalities. However, other lifestyle choices also contribute to health inequalities. We aim to assess the contribution of other lifestyle behaviours pertaining to alcohol, physical inactivity and weight to smoking-related disease risk across (i) the socioeconomic spectrum and (ii) smoking status. Smoking-related disease risk is modelled using probit analysis. The results are used to predict disease risk across the socioeconomic dimension and smoking status for a set of healthy and unhealthy behaviours using the administratively linked Scottish Health Surveys and Scottish Morbidity Records. The results confirm the deprivation gradient in disease risk regardless of smoking status group. Imposition of healthy (unhealthy) lifestyle behaviours decreases (increases) the predicted risk across the deprivation distribution regardless of smoking status providing evidence of the multifaceted health behavioural determinants of disease risk across the deprivation distribution. The results are of policy interest as they suggest that to reduce inequalities in smoking-related diseases, interventions reducing both smoking and other unhealthy behaviours are required.

Impact of Tobacco-Control Legislation

Oncology nurses should be aware of smoking-related public health legislation and tobacco use prevention resources as well as increase their knowledge of psycho-education materials, medications, and products available to aid smoking cessation. Smoking is the leading cause of preventable death; one out of five deaths in the United States is attributed to smoking. Each day, almost 4,000 Americans younger than age 18 try their first cigarette, and 1,000 of those youths will become regular smokers. In 2009, House Resolution 1256: The Family Smoking Prevention and Tobacco Control Act gave the U.S. Food and Drug Administration the authority to regulate tobacco products with emphasis placed on prevention of the use by youth through graphic health warnings. Most states and many countries have enacted bans on smoking in all enclosed public places; however, some still allow smoking in adult-specific venues, such as bars, and some have not enacted any general statewide ban on smoking in any nongovernment-owned spaces. Oncology nurses can be instrumental in advocating for tobacco control legislation as well as providing and supporting services focused on smoking cessation and the prevention of tobacco use.

Serum osteopontin in giant cell arteritis: A biomarker associated with sistemic inflammatory response and relapsing course

Quality-adjusted life-years (QALYs) use a single number to provide an assessment of the overall health burden of diseases associated both with mortality and morbidity. This study examined the trend and geographic variation of the burden of smoking by calculating smoking-related QALYs lost from 1993 to 2008 for the US adults and individual states.Population health-related quality of life scores were estimated from the 1993 to 2008 Behavioral Risk Factor Surveillance System. The smoking-related QALYs lost are the sum of QALYs lost due to morbidity and future QALYs lost in expected life years due to premature deaths (mortality).From 1993 to 2008, the percent of US adults who smoked declined from 22.7% to 18.5%, but the smoking-related QALYs lost were relatively stable at 0.0438 QALYs lost per population. Although smoking contributed more QALYs lost for men (0.0535) than for women (0.0339), smoking-related QALYs lost decreased by 2.5% for men but increased by 12.6% for women. Kentucky, Oklahoma, Mississippi, West Virginia, and Tennessee had the most smoking-related QALYs lost wheras Utah, California, Connecticut, Minnesota, and Hawaii had the least QALYs lost. The state tobacco tax rate was strongly and negatively associated with both the percent smoked (r = −0.60) and QALYs lost (r = −0.54), as well as the percentage change in both.This analysis quantified the overall burden of smoking for the nation and individual states from 1993 to 2008. Such data might assist in providing specified quantitative targets for the Healthy People 2020 smoking-related health objectives and for tracking changes on a yearly basis.

Statement of Retraction: Ortendahl M, Näsman P. “Quitting smoking is perceived to have an effect on somatic health among pregnant and non-pregnant women”

The Editors and Publisher would like to inform the readers the following article has been retracted from publication in The Journal of Maternal-Fetal & Neonatal Medicine:Ortendahl M, Näsman P. Quitting smoking is perceived to have an effect on somatic health among pregnant and non-pregnant women. J Matern Fetal Neonatal Med. 2008;21:239–246. (doi:10.1080/14767050801924829).This article has been found to reproduce content to a high degree of similarity, without appropriate attribution or acknowledgement by the authors, from the following original article:Ortendahl M, Näsman P. Perception of Smoking-Related Health Consequences among Pregnant and Non-Pregnant Women. Am J Addict. 2007;16:521--527. (doi:10.1080/10550490701643088)The text in the manuscript published in The Journal of Maternal-Fetal & Neonatal Medicine was found to be almost word-for-word identical to the text published in the American Journal of Addictions. The data presented in all 4 tables is also essentially the same, but just presented in a different layout.The authors have been fully co-operative with our investigations and agree with the Editors and Publisher on this course of action to correct the redundancy in the literature record.The journal’s policy in this respect is clear: The Journal of Maternal-Fetal & Neonatal Medicine considers all manuscripts on the strict condition that they have been submitted only to The Journal of Maternal-Fetal & Neonatal Medicine, that they have not been published already, nor are they under consideration for publication or in press elsewhere.The Journal of Maternal-Fetal & Neonatal Medicine published this article in good faith, and on the basis of signed statements made by the corresponding author regarding the originality of their work. The article is withdrawn from all print and electronic editions.Gian Carlo Di Renzo and Dev Maulik(Editors-in-Chief)Anna Treadway(Head of Journals Publishing, Informa Healthcare)

Health outcomes associated with long-term regular cannabis and tobacco smoking

This study aimed to identify patterns of health concerns associated with long-term use of cannabis and tobacco individually, as well as in combination. We recruited 350 adults aged 40 or over who smoked cannabis but not tobacco (cannabis-only group, n=59), smoked both cannabis and tobacco (cannabis/tobacco group, n=88), smoked tobacco but not cannabis (tobacco-only group, n=80), or used neither substance (control group, n=123). Participants completed a survey addressing substance use, diagnosed medical conditions, health concerns relating to smoking cannabis/tobacco, and general health (measured using the Physical Health Questionnaire and the Short Form 36). Several significant differences were found among the four groups. With regard to diagnosed medical conditions, the three smoking groups reported significantly higher rates of emphysema than did the control group (ps<.001). However, all members of the cannabis-only group diagnosed with emphysema were former regular tobacco smokers. Total general health scores, general health subscales, and items addressing smoking-related health concerns also revealed several significant group differences, and these tended to show worse outcomes for the two tobacco smoking groups. Findings suggest that using tobacco on its own and mixing it with cannabis may lead to worse physical health outcomes than using cannabis alone.

Prevalence of smoking among male secondary school students in Jeddah, Saudi Arabia

Objectives:This study was conducted to examine the prevalence of smoking and habits of smoking among male secondary school students in Jeddah, Kingdom of Saudi Arabia (KSA) and to assess their knowledge and attitudes toward it.Materials and Methods:A cross-sectional study was conducted in Jeddah, using a two-stage cluster sampling, randomly selecting 4 out of 85 government male secondary schools. Data were obtained through a self-administered questionnaire eliciting responses to questions on personal background, smoking behavior, knowledge, behavior, and attitude toward smoking. A total of 695 students responded to the questionnaires with 87.4% response rate.Results:Of the studied group, 258 (37%) currently smoked, and of these, 83.7% had started smoking at the age of 14 years or less. The most common reason for smoking was the influence of family, especially the presence of someone at home who smoked (65, 9%) and friends who smoked (42.5%). Many of the students search for information on the risks of smoking (66.3%), and only (45.3%) knew about the bad effects of passive smoking on others. Two-third of the students who smoked wanted to quit smoking (63.2%), especially if suitable help was offered, whereas (60.9%) had tried to quit. While 50% of students smoked for recreation and entertainment, and (33.6%) had difficulty avoiding smoking in no smoking areas.Conclusion:A well-planned integrated antismoking campaign is urgently required, especially among students and teachers. The study revealed that the prevalence of smoking was high. This will contribute to an increase in smoking-related health problems in the future if proper preventive measures are not taken.

Cigarette Warning Label Policy Alternatives and Smoking-Related Health Disparities

Pictorial health warning labels on cigarette packaging have been proposed for the U.S., but their potential influences among populations that suffer tobacco-related health disparities are unknown. To evaluate pictorial health warning labels, including moderation of their influences by health literacy and race. From July 2011 to January 2012, field experiments were conducted with 981 adult smokers who were randomized to control (i.e., text-only labels, n=207) and experimental conditions (i.e., pictorial labels, n=774). The experimental condition systematically varied health warning label stimuli by health topic and image type. Linear mixed effects (LME) models estimated the influence of health warning label characteristics and participant characteristics on label ratings. Data were analyzed from January 2012 to April 2012. Compared to text-only warning labels, pictorial warning labels were rated as more personally relevant (5.7 vs 6.8, p<0.001) and effective (5.4 vs 6.8, p<0.001), and as more credible, but only among participants with low health literacy (7.6 vs 8.2, p<0.001). Within the experimental condition, pictorial health warning labels with graphic imagery had significantly higher ratings of credibility, personal relevance, and effectiveness than imagery of human suffering and symbolic imagery. Significant interactions indicated that labels with graphic imagery produced minimal differences in ratings across racial groups and levels of health literacy, whereas other imagery produced greater group differences. Pictorial health warning labels with graphic images have the most-pronounced short-term impacts on adult smokers, including smokers from groups that have in the past been hard to reach.

Awareness and impact of New York City's graphic point-of-sale tobacco health warning signs

BackgroundTo increase knowledge of smoking-related health risks and provide smoking cessation information at the point of sale, in 2009, New York City required the posting of graphic point-of-sale tobacco health...

Sex specific trajectories in cigarette smoking behaviors among students participating in the Unplugged school-based randomized control trial for substance use prevention

ObjectivesUnderstanding the developmental pathways and sex differences in cigarette smoking behaviors in adolescents has the potential to positively impact substance abuse prevention and to reduce smoking-related health problems. Using data from the Unplugged school-based prevention trial, we investigated different patterns of smoking behavior development among secondary school students in the Czech Republic. MethodsGrowth mixture modeling was used to examine different trajectories in cigarette smoking behaviors among male and female students (N=1874 6th graders; 50.4% male, mean age 11.8years at baseline) participating in the Unplugged school-based randomized control trial for substance use prevention. ResultsA two-class model characterized cigarette use as a function of sex and Unplugged intervention status. More rapid cigarette use increases were observed in females (OR=1.17, p=0.01 in both rapid/moderate and slow smoking escalator classes) as compared to males. Further, in both classes, more rapid increases in smoking were observed for the control group as compared to the intervention group (OR=1.22, p<0.01 slow escalators; OR=1.54, p=0.08 rapid/moderate escalators). There was no difference in sex distribution when comparing the two classes (OR=1.02, p=0.98). ConclusionsThis study adds to a growing literature on developmental and sex differences in cigarette use among adolescents. This research supports additional multi-year prevention strategies aimed at adolescent females and early treatment programs for adolescent smokers to prevent increasing cigarette use with age.

Smoking Prevalence, Willingness to Quit and Factors Influencing Smoking Cessation among University Students in a Western Nigerian State

Background: In order to increase the proportion of successful attempts to quit smoking, it is important to understand the characteristics of smokers who successfully quit smoking. This study seeks to find out the smoking prevalence, the level of willingness to quit and factors influencing smoking cessation among university students in a western Nigerian state.Methodology: This study was a descriptive cross-sectional study carried out among young adults in tertiary institutions. A sample size of 300 was determined using Fishers formula while multi stage sampling technique was used to select respondents. The questionnaire was semi-structured, pretested and self administered. Analysis was done using Epi-Info version 3.4.1. Frequency tables and cross-tabulations were generated with a statistical significance p-value pre-determined at less than 0.05. Results: The number of respondents that ever smoked was 66 (22% of the total number of respondents) out of which 25 (38%) have ceased smoking while 41 (62%) currently smoke. Those willing to quit out of the 41 that currently smoke are 16 (39%) while 25 (61.0%) were not willing to quit. Of the respondents that ever smoked, the main location of smoking was parties/clubs (50%), while friends (53%) were found to be the main influence to smoke. Willingness to quit smoking was expressed by 16 (39.0%) of current smokers. Among respondents that ever smoked, 55(83.3%) attempted to quit out of which 41(74.5%) did as a result of health problems. Factors that positively affected smoking cessation were older age group of 26-30 (100%), belief that smoking can lead to premature death (47.1%) and never being asked to quit smoking (68.4%) with statistically significant p values. Conclusion: Influence of friends and going to parties/clubs are major factors contributing to smoking habit. Diagnosis of health problems play a major role in attempts to quit smoking while belief that smoking can lead to premature death is a major factor influencing smoking cessation. Being asked to quit smoking without a good understanding of the attendant health hazards does not contribute positively to successful smoking cessation. Peer education in schools emphasizing knowledge of the health implications of smoking as well as early diagnosis of smoking related health problems will go a long way in encouraging smoking cessation.

Association Between Genetic Variants on Chromosome 15q25 Locus and Objective Measures of Tobacco Exposure

BackgroundTwo single-nucleotide polymorphisms, rs1051730 and rs16969968, located within the nicotinic acetylcholine receptor gene cluster on chromosome 15q25 locus, are associated with heaviness of smoking, risk for lung cancer, and other smoking-related health outcomes. Previous studies have typically relied on self-reported smoking behavior, which may not fully capture interindividual variation in tobacco exposure.MethodsWe investigated the association of rs1051730 and rs16969968 genotype (referred to as rs1051730–rs16969968, because these are in perfect linkage disequilibrium and interchangeable) with both self-reported daily cigarette consumption and biochemically measured plasma or serum cotinine levels among cigarette smokers. Summary estimates and descriptive statistical data for 12 364 subjects were obtained from six independent studies, and 2932 smokers were included in the analyses. Linear regression was used to calculate the per-allele association of rs1051730–rs16969968 genotype with cigarette consumption and cotinine levels in current smokers for each study. Meta-analysis of per-allele associations was conducted using a random effects method. The likely resulting association between genotype and lung cancer risk was assessed using published data on the association between cotinine levels and lung cancer risk. All statistical tests were two-sided.ResultsPooled per-allele associations showed that current smokers with one or two copies of the rs1051730–rs16969968 risk allele had increased self-reported cigarette consumption (mean increase in unadjusted number of cigarettes per day per allele = 1.0 cigarette, 95% confidence interval [CI] = 0.57 to 1.43 cigarettes, P = 5.22 × 10−6) and cotinine levels (mean increase in unadjusted cotinine levels per allele = 138.72 nmol/L, 95% CI = 97.91 to 179.53 nmol/L, P = 2.71 × 10−11). The increase in cotinine levels indicated an increased risk of lung cancer with each additional copy of the rs1051730–rs16969968 risk allele (per-allele odds ratio = 1.31, 95% CI = 1.21 to 1.42).ConclusionsOur data show a stronger association of rs1051730–rs16969968 genotype with objective measures of tobacco exposure compared with self-reported cigarette consumption. The association of these variants with lung cancer risk is likely to be mediated largely, if not wholly, via tobacco exposure.

Effects of D-cycloserine on cue-induced craving and cigarette smoking among concurrent cocaine- and nicotine-dependent volunteers

Rates of cigarette smoking are 3- to 4-fold greater among those with cocaine-dependence, and compared to non-users, cocaine users are at greater risk of incurring smoking-related negative health effects and death. The current study examined D-cycloserine's (0 or 50mg once weekly) effects on 1) extinction of cue-induced craving for cigarettes, 2) cigarette smoking in conjunction with cognitive–behavioral therapy, and 3) safety and tolerability in cocaine-dependent smokers. This was a double-blind, placebo-controlled, between groups, outpatient study. Participants (N=29) were concurrent cocaine- and nicotine-dependent volunteers seeking treatment for their cigarette smoking. Study visits were 3 times per week for 4 consecutive weeks. At each visit, participants received cognitive–behavioral therapy for smoking, were exposed to smoking cues. A subset of participants (N=22) returned for 6-month follow-up visits. While craving decreased, no significant effects of D-cycloserine treatment were observed. Likewise, significant decreases in smoking were observed at study days 6 (p<0.002) and 12 (p<0.0001) relative to baseline, although no participants achieved complete abstinence. However, there was no effect of D-cycloserine on cigarette smoking during treatment or at 6-mos follow-up. The treatment was safe and tolerable, with nearly 90% of treatment sessions attended based on an intent-to-treat analysis. While no effects of D-cycloserine on craving or smoking were observed in the current study, the results do suggest that smoking treatment is well accepted and may be effective for cocaine-dependent individuals.

Physician advice for smoking cessation in primary care: time for a paradigm shift?

General practitioners are often exhorted to routinely counsel patients who smoke about quitting in light of current evidence-based medicine (EBM) guidelines suggesting that such brief interventions provide an easy and effective way of increasing quit rates. Drawing on semi-structured interviews conducted with 25 smokers and 10 general practitioners (GPs) in British Columbia, Canada, this article explores smokers’ and GPs’ perspectives on smoking cessation interventions in primary care settings. Study findings indicate that both patients and GPs believe smoking is best broached when it is patient-initiated or raised in the context of smoking-related health issues, and there was a broader consensus that the role of doctors is to provide education and information rather than coercing smokers to quit. However, smokers wanted further recognition of the difficulties of quitting smoking and many questioned the competence of GPs to deal with addiction-related issues. Similar barriers to smoking cessation were raised by smokers and GPs – primarily inadequate time and resources. Based on these findings, we argue that the assumption that primary care consultations provide an important venue for encouraging smokers to quit deserves reconsideration based on the complexity of this issue, the circumstances in which most GPs practice, and the danger of alienating smokers. Questions are raised about whether current EBM guidelines are an adequate tool for guiding individual clinical interactions between GPs and smokers.

일부지역 치위생과 학생들의 흡연 실태와 자아존중감과의 관계

Objectives : This study was performed to understand smoking condition and to investigate the relations among knowledge regarding smoking and oral hygiene, awareness of anti-smoking policy, and self-esteem, to provide fundamental basis, developing programs for smoking prevention and anti-smoking. Methods : From September 7, 2010 to September 16, 2010, questionaire survey was conducted for 566 female university students studying dental hygienics at a local district in Jeollanam-do. Collected data was analyzed by Chi-square test, t-test, one way ANOVA, Scheffe multiple range test, Perason's correlation test, and stepwise multiple regression test. Results : 1. Smoking condition of study subjects on general characteristics showed 17.1%, where 14.0% of previous smoking history, and 68.9% of currently nonsmoker. 2. Analysis on the knowledge related to smoking and oral hygiene, awareness of anti-smoking policy, and self esteem on the general characteristics of study subjects have shown better awareness of anti-smoking policy in non-alcoholics. Significant difference was found in knowledge about smoking and awareness of anti-smoking policy according to current resident status, but no difference found in self-esteem. Higher academic grade was related to higher awareness of anti-smoking policy and better ics. aalcell. Better health, but no diffeoral hygiene were related to better awareness of anti-smoking policy, and bewhich were statistically significant. Favorable interpersonal self-estehip was related to better awareness of anti-smoking policy. 3. Analysis on knowledge regarding smoking related health and oral hygiene, awareness of anti-smoking policy, and self-esteem showed higher level of anti-smoking knowledge in non-smoking group(60.44) compared to currently smoking group or group with previous history of smoking, and better awareness of anti-smoking policy in non-smoking group(53.54) than other groups, which was statistically significant. 4. Correlation analysis among smoking related knowledge, awareness of anti-smoking policy, and self-esteem has found relatively high correlation between smoking related knowledge and awareness of anti-smoking policy, which was statistically significant(r=0.481, p<0.001). 5. Among factors influencing awareness of anti-smoking policy, higher level of smoking related knowledge and satisfaction to specialty was related to higher awareness of anti-smoking policy which was lower in current smoker than past smoker, and higher academic grade was related to higher awareness of anti-smoking policy. Conclusions : Following results emphasize the need to establish a novel curriculum by which effective programs for smoking prevention and education of anti-smoking specialist could be provided as well as promoting coaching anti-smoking activity.

Can pictorial warning labels on cigarette packages address smoking-related health disparities? Field experiments in Mexico to assess pictorial warning label content.

The objective of this study was to determine the most effective content of pictorial health warning labels (HWLs) and whether educational attainment moderates these effects. Field experiments were conducted with 529 adult smokers and 530 young adults (258 nonsmokers; 271 smokers). Participants reported responses to different pictorial HWLs printed on cigarette packages. One experiment involved manipulating textual form (testimonial narrative vs. didactic) and the other involved manipulating image type (diseased organs vs. human suffering). Tests of mean ratings and rankings indicated that pictorial HWLs with didactic textual forms had equivalent or significantly higher credibility, relevance, and impact than pictorial HWLs with testimonial forms. Results from mixed-effects models confirmed these results. However, responses differed by participant educational attainment: didactic forms were consistently rated higher than testimonials among participants with higher education, whereas the difference between didactic and testimonial narrative forms was weaker or not statistically significant among participants with lower education. In the second experiment, with textual content held constant, greater credibility, relevance, and impact was found for graphic imagery of diseased organs than imagery of human suffering. Pictorial HWLs with didactic textual forms seem to work better than those with testimonial narratives. Future research should determine which pictorial HWL content has the greatest real-world impact among consumers from disadvantaged groups, including assessment of how HWL content should change to maintain its impact as tobacco control environments strengthen and consumer awareness of smoking-related risks increases.