Tobacco Control Programs Research Articles

Age-period-cohort analysis of smoking prevalence trends among career military personnel in South Korea.

This study evaluated smoking trends among career military personnel in South Korea. After a tobacco tax increase in 2015, the tobacco control program for career military personnel expanded significantly. This study explores long-term smoking trends among career military personnel through age-period-cohort (APC) analysis within the context of targeted tobacco control policies. This secondary data analysis utilized data from 12052 individuals aged 19--54 years, identified as career military personnel in the Korea Community Health Survey (KCHS) from 2008 to 2022. APC analysis with the intrinsic estimator (IE) method was conducted to address multicollinearity and accurately assess the contributions of age, period, and birth cohort to smoking prevalence. Smoking prevalence significantly decreased among career military personnel, from 46.2% in 2008 to 34.1% in 2022. The highest prevalence of smoking was initially observed in the age group of 22-24 years. Although overall prevalence declined, a slight increase was observed in the age group of mid-30s to early 40s, suggesting that smoking behavior varied across age groups. A significant decrease occurred between 2014 and 2016, with individuals born in the 1970s exhibiting the highest smoking prevalence, and those born after 1980 demonstrating a notably lower smoking prevalence. Although smoking prevalence has declined, the distinct age, period, and cohort characteristics of career military personnel necessitate tailored tobacco control policies that consider the various aspects of military life.

Banning tobacco products sales to adolescents in the Gulf Cooperation Council countries

Background: Tobacco use poses a challenge to public health in the Gulf Cooperation Council countries. Although restricting access to tobacco can reduce consumption among adolescents, there is limited knowledge of how to implement the tobacco sales ban policy in the sub-region. Aim: To assess implementation of the ban on tobacco products sales to adolescents in the Gulf Cooperation Council countries as recommended in the WHO Framework Convention on Tobacco Control. Methods: We used the school-based, self-reported, cross-sectional survey data collected by the Global Youth Tobacco Survey 2013–2018 among 13–15-year-old students from 5 of the 6 Gulf Cooperation Council countries. We analysed the pattern of implementation of the 4 provisions of the WHO Framework Convention on Tobacco Control that address the banning of tobacco products sales to adolescents. Results: Implementation of key provisions related to the banning of tobacco products sales to adolescents varied among the countries. Bahrain, Qatar and United Arab Emirates implemented the 4 provisions, while Kuwait and Oman implemented only one. More than 50% of the adolescents who tried to purchase cigarettes were not refused. Conclusion: The GCC countries should consistently implement and enforce the policy on banning tobacco products sales to adolescents as part of their tobacco control programmes. Programmes should seek to engage and educate merchants and adolescents on the health implications of tobacco use and the need to enforce compliance.

Assessment of national tobacco control program (NTCP) initiative on tobacco cessation among transgenders in Puducherry – A quasi-experimental study

ABSTRACT Aim: This study aims to evaluate the impact of the National Tobacco Control Program initiative on the attitudes toward tobacco use and tobacco dependency among transgender individuals in Puducherry. Materials and Methods: A Quasi-experimental design was used to examine the effectiveness of the intervention. The study involved 52 transgender individuals from the SCOHD organization in Puducherry. The intervention included two awareness sessions, the Distribution of IEC materials during each session, and recreational activities for the participants. Changes in attitude toward tobacco use were measured using the Intention to Quit Tobacco questionnaire, while tobacco dependency among participants was assessed using the Fagerstrom Nicotine Dependency Scale (FNDS). Measurements were taken at baseline and third month to track the evolution of attitudes and dependency. Results: The program resulted in significant shifts in attitude and nicotine dependency among transgender individuals. This program indicated a positive trend, with an increase in individuals progressing to the contemplation and preparation stages, suggesting a growing willingness to reduce or quit tobacco use. The Fagerstrom Nicotine Dependency Scale showed a decrease in nicotine dependency over three months. Conclusion: The NTCP awareness sessions and follow-ups had a noticeable impact on altering attitudes toward tobacco use and reducing nicotine dependency among transgender individuals in Puducherry.

Prevalence of Tobacco Consumption and Its Economic Burden among Adult Males (≥18 Years) Residing in an Urban Area of Raipur, Chhattisgarh, India.

Introduction: Globally, besides being the second largest consumer of tobacco, India is also the second largest tobacco producer. There are very few studies that give data on economic burden of tobacco consumption. We estimated the prevalence of tobacco consumption along with monthly expenditure for the same among adult males. Methodology: A community-based cross-sectional study was conducted among males aged ≥18 years residing in an urban area of Raipur city. Simple random sampling technique was applied and a total of 292 adult males participated in the study. Analysis was done on Statistical software package (STATA) software version 12. Results: The mean age [standard deviation (SD)] was 41 (13) years. The prevalence of tobacco consumption (smoke and/or smokeless) was 73.6%, where use of smokeless tobacco was 60.6% and use of smoke tobacco was 33.6%. Beedi was the most common type of smoke used (11%), followed by a mix of cigarette and beedi (10.4%). Among occasional smokers, mean (SD) number of days of occasional smoking in a month was 7.8 (5.1) whereas among smokeless tobacco users, nearly 83% use them daily with 2-5 times in a day (66%). Nearly 67% of them had seen someone smoking and/or chewing tobacco in public places in the last 7 days. Mean [interquartile range (IQR)] monthly expenditure on tobacco products among study participants was INR 367 (0-355). Mean (IQR) monthly expenditure on smoking tobacco products and smokeless tobacco products was INR 244 (0-150) and INR 123 (0-225), respectively. Conclusion: This study gives insight to both consumer prospects about how much money they are spending on something that is going to harm in future (health problems due to tobacco use) and also to the policymakers of tobacco control programs to implement stringent rules on tobacco sale.

Smartphones: A Catalyst for Tobacco Control Training in India

The tobacco crisis confronting low- and middle-income countries (LMICs) requires scale-up of effective tobacco control programs, such as Tobacco Free Teachers-Tobacco Free Society (TFT-TFS). We previously demonstrated the efficacy of TFT-TFS in increasing tobacco use cessation among teachers and schools’ adoption of tobacco control policies in Bihar, India. To scale TFT-TFS, we are now pioneering a smartphone-based mobile learning strategy to train principals (or their designees) in Madhya Pradesh to implement and monitor TFT-TFS in schools. Research underscores the transformative potential of mobile learning: a flexible, scalable, and cost-effective alternative to in-person training methods. Our study is a unique opportunity to test a training approach that could have implications for wider and more efficient delivery of other public health programs. The strategic use of gamification and digital storytelling enhances the TFT-TFS mobile training app. Gamification mechanics—including points, leaderboards, and digital badging—foster a dynamic learning environment to enhance learning outcomes. This approach propels continuous participant engagement toward understanding and implementation of TFT-TFS’s six monthly themes and four program components. The TFT-TFS smartphone training program weaves in elements of Indian culture, notably the symbolic use of colors and kites. The Indian kite festival celebrates communal harmony through healthy competition. Similarly, the app employs the idea of school kites, which are divided into six blank segments corresponding to the TFT-TFS monthly themes. Participants navigate each module, engaging with animated videos, digital assessments, and interactive activities. Upon a principal’s successful completion of each monthly theme’s program components, the school’s kite receives a new color, unlocking the subsequent theme. The TFT-TFS smartphone training showcases a unique interactive mobile learning application that integrates gamification and tests how to scale up an effective tobacco control program in schools in India and other LMICs. The TFT-TFS smartphone-based training app may also have relevance to other public health-related training efforts in resource-constrained areas.

Is unassisted smoking cessation choice and success associated with high mental stress? Evidence from six cities in China.

Unassisted smoking cessation (USC) is a method of quitting smoking driven by self-determination without the support of professional cessation assistance. This approach may contribute to a potential decrease in overall smoking prevalence within a population. However, the factors potentially influencing smokers' choice of USC and their success remain unclear. This study examined the associations between mental stress and USC choice and success. Between June and September 2016, a cross-sectional multistage sampling design was used to interview subjects from six selected cities in China. A standardized questionnaire was used to obtain information on sociodemographic characteristics, USC choice, and success. Mental stress was measured by the Chinese version of the Perceived Stress Scale (CPSS). Multivariate logistic regression models were used to examine the association between mental stress, USC choice, and success, with adjustments for relevant covariates. Among 1647 smokers who had attempted or had quit, 91.6% (95% CI: 90.9-97.5) reported that they had done so without assistance, and 42.1% (95% CI: 32.4-61.3) of them achieved abstinence. While mental stress was not significantly associated with USC success (χ2=2.02, p=0.1547), smokers experiencing high levels of mental stress were 0.34 times less likely (95% CI: 0.23-0.50) to attempt USC compared to those with low levels of mental stress. Moreover, a significant negative linear association was observed between varying levels of mental stress and the prevalence of USC use (R2=0.910, p<0.001). The study findings should help to understand USC and its role in reducing smoking prevalence in the Chinese population. These findings can inform future tobacco control programs and policies in China. Government and social agencies should prioritize understanding smokers' preferences for USC and providing USC services to promote success within the population.

Abstract A159: Data-driven strategies to develop materials to improve tobacco cessation services for Asian-American populations of Los Angeles County

Abstract BACKGROUND: Tobacco cessation stands as a pressing public health priority for cancer prevention, yet minority populations, including Asian Americans, encounter significant hurdles in quitting smoking. The Los Angeles County Tobacco Control and Prevention Program and the City of Hope Cessation Learning Collaborative join forces to tackle organization-level and individual-level barriers hindering the delivery, accessibility, utilization, and compliance of tobacco cessation interventions across diverse populations in Los Angeles County. Survey data gathered from healthcare providers and community members play a pivotal role in shaping the development and implementation of targeted tobacco cessation interventions. OBJECTIVES: To pinpoint gaps in tobacco cessation services for Asian/Asian American communities and develop tailored resources to address these deficiencies. METHODS: Data collection utilized: 1) Key Informant Interviews to delineate successes, barriers, and strategies in smoking cessation services for Asian/Asian American communities, 2) surveys with providers and healthcare staff serving these communities to identify critical factors contributing to challenges and barriers in providing cessation services, and 3) surveys with individuals within these communities to evaluate smoking history, tobacco product usage, access to cessation services, and barriers encountered. Collaborative partnerships with Community-Based Organizations (CBOs) serving Asian American communities were formed to conduct provider surveys. Findings from all surveys and interviews informed the development of culturally sensitive tobacco cessation training for healthcare providers. Behavioral mapping techniques and survey/interview findings guided the creation of a culturally appropriate capacity-building toolkit and tipsheets with recommendations to support tobacco cessation service implementation. RESULTS: Data collection comprised 5 Key Informant Interviews, 260 Surveys with Asian Serving Providers &amp; Staff, and 1,070 Adult Tobacco Cessation Surveys among Asian/Asian American populations. Utilizing these findings, trainings were conducted, and resources developed for providers from 18 CBOs at Monthly Learning Collaborative Meetings. System-level findings informed the development of a capacity-building toolkit and tipsheets with recommendations to enhance tobacco cessation efforts in Asian American communities. CONCLUSIONS: Data-driven strategies are pivotal in tobacco cessation care. Through collaboration with CBOs and targeted interventions, tools can be fashioned to address culturally specific barriers to tobacco services. This learning collaborative initiative serves as a robust blueprint for developing data-driven strategies for equitable tobacco cessation services. Citation Format: Sophia Yeung, Alexis Garden, Brenda Gascon, Lauren D'Souza, Gaole Song, Jonjon Macalintal, Kimlin Ashing, Cary Presant, Gladis Chavez-Sosa, Cindy Song, Jonathan Tandoc, Jazmine Guillen, Lori Fischbach. Data-driven strategies to develop materials to improve tobacco cessation services for Asian-American populations of Los Angeles County [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A159.

Return on investment of tobacco control measures: a systematic review protocol.

The objective of this systematic review will be to estimate the return on investment (ROI) and social return on investment (SROI) on tobacco control measures. Tobacco consumption has been proven to be associated with a huge epidemiological, humanistic, and economic burden. National and international organizations are making concerted efforts to control tobacco use. However, currently, there are no conclusive estimates of the ROI and SROI of such programs and policies. This review will include all studies that evaluate the ROI or SROI on tobacco control programs and policies on tobacco users and probable tobacco users globally. This review will follow the JBI methodology for systematic reviews of economic evidence. Databases to be searched will include Embase (Ovid), MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Health Economic Evaluation Database (HEED), National Health Service Economic Evaluation Database (NHS EED), CEA Registry, LILACS, Science Direct, Web of Science, EconLit, and Google Advanced Search. Gray literature will also be searched for in non-academic databases, including the websites of various civil societies and non-governmental organizations involved in tobacco control. Two independent reviewers will screen titles/abstracts, and later full-text studies. Critical appraisal will be conducted using the JBI checklist for economic evaluations and the SROI Quality Framework. Data will be extracted and synthesized using JBI data extraction forms and synthesis tools. The MPOWER framework will be considered for data synthesis across all selected studies using narrative synthesis, tables, and figures. PROSPERO CRD42023391591.

Indian Buffet process factor model for counterfactual analysis

This article proposes a factor model-based counterfactual analysis. We explicitly estimate the underlying factor structure of the outcome variables and estimate the counterfactual values of the unit subject to an intervention. With the help of the non-parametric Bayesian Indian Buffet Process prior, our approach is capable of exploring heterogeneous factor exposures, and the number of latent factors is endogenously determined in the estimation process. The flexible Markov Chain Monte Carlo algorithm utilizes the maximal intervention-free information provided by the data, whereas the original synthetic control only uses pre-intervention data. The counterfactual values are estimated by simulating from the posterior predictive distribution so that we can integrate out any parameter estimation uncertainty. We also calculate the posterior predictive upper- and lower-quantile bounds for inference. The two applications, namely California’s Tobacco Control Program and the West German Reunification, demonstrate the usefulness of our approach compared to the synthetic control method and the elastic net model. The Monte Carlo simulation study also shows the robustness of our approach with respect to nonlinear dynamics in the underlying factor process.

A realist evaluation of the implementation of a national tobacco control program and policy in India.

There is a growing interest in studying and unpacking implementation of policies and programmes as it provides an opportunity to reduce the policy translation time lag taken for research findings to translate to policies and get implemented and understand why policies may fail. Realist evaluation is a theory-driven approach that embraces complexity and helps to identify the mechanisms generating the observed policy outcomes in given context. We aimed to study facilitators and barriers while implementing the Cigarettes and Other Tobacco Products Act, 2003 (COTPA) a comprehensive national tobacco control policy, and the National Tobacco Control Programme (NTCP), 2008 using realist evaluation. We developed an initial program theory (IPT) based on a realist literature review of tobacco control policies in Low- and Middle-Income Countries (LMICs). Three diverse states -Kerala, West Bengal, and Arunachal Pradesh- with varying degree of implementation of tobacco control law and program were chosen as case studies. Within the three selected states, we conducted in-depth interviews with 48 state and district-level stakeholders and undertook non-participant observations to refine the IPT. Following this, we organized two regional consultations covering stakeholders from 20 Indian states for a second iteration to further refine the program theory. A total of 300 Intervention-Context-Actor-Mechanism-Outcome (ICAMO) configurations were developed from the interview data, which were later synthesized into state-specific narrative program theories for Kerala, West Bengal and Arunachal Pradesh. We identified five mechanisms: collective action, felt accountability, individual motivation, fear, and prioritization that were (or were not) triggered leading to diverse implementation outcomes. We identified facilitators and barriers to implementing the COTPA and the NTCP, which have important research and practical implications for furthering the implementation of these policies as well as implementation research in India. In the future, researchers could build on the refined program theory proposed in this study to develop a middle-range theory to explain tobacco control policy implementation in India and other LMICs.

Implementation and Evaluation of a Multi-level, Place-Based Tobacco Prevention and Control Program at a Minority-Serving Institution in Texas.

Multi-level, place-based interventions have proven effective at promoting a range of health behaviors, including tobacco control and discouraging the uptake of tobacco products. This paper describes the implementation and impact of a 3-year, multi-level tobacco prevention and control program at a community-college minority-serving institution (MSI) on the Texas Gulf Coast within the context of a broader multi-sector, cross-functional health coalition. The intervention studied included a tobacco-free policy, a large-scale communication campaign highlighting parts of the intervention and prevention and cessation resources. The intervention was bolstered by the support of a community-led Steering Committee and tobacco control experts. Results from the first 3years of implementation show that tobacco-free policies were largely supported by community members, awareness of the policy increased over time, and tobacco prevention and cessation resources were successfully embedded into campus norms. This multi-component approach shows how a community college was able to effectively reach students and staff on their campus to increase awareness of both the campus tobacco-free policy and the availability of tobacco prevention and cessation resources. Additionally, it also offers lessons for future tobacco prevention and control work in higher education.

Tobacco use and its associated factors among students of medical college at tertiary care center of Eastern Nepal.

Despite declining smoking prevalence globally, South Asia faces a rising burden. In Nepal, existing tobacco control laws haven't curbed use, with 28.9% of young adults engaging in tobacco use. This study investigates tobacco use and associated factors among medical, dental, and nursing students at a Nepalese tertiary care center. We aimed to assess tobacco use prevalence and identify factors associated with it among future healthcare professionals, considering their distinct roles in tobacco control. Medical students can contribute through clinical counseling and public health advocacy, dental students through oral health education, and nursing students through patient education and community outreach. A cross-sectional study involving 427 medical, dental, and nursing students was conducted. Data was collected using online questionnaires distributed via email and social media. Descriptive statistics and Chi-square tests were used for analysis. The study found that 45% of participants were aged 22-25, with females comprising the majority (53.2%). Nearly half (49.2%) belonged to the medical faculty, and 24.4% were in their first year. Furthermore, among those who smoke, 53% reported smoking less than 5 cigarettes daily. The analysis revealed significant associations between smoking with age (p = 0.01), year of study (p = 0.001), parental smoking history (p = 0.001), and having friends who smoke (p = 0.001). Our findings highlight the moderate prevalence of cigarette smoking among medical students, with family and friends emerging as major influences. Stress relief was a common reason, particularly among young females and first-year students. These results emphasize the urgent need for comprehensive tobacco control programs within medical institutions to equip future healthcare professionals to effectively address smoking issues.

Global policy scan of commercial combustible tobacco product retailing regulations by WHO region

Background/aimsRegulatory schemes for tobacco retailing help restrict the supply and availability of smoked tobacco products. Tobacco retailer density and the proximity of tobacco outlets to youth spaces, such as schools,...

Exposure to second-hand smoke and risk of lung cancer among Iranian population: A multicenter case-control study.

Despite the implementation of the WHO Framework Convention on Tobacco Control (FCTC) program in Iran, the regulation of second-hand smoke (SHS) exposure-an often-overlooked hazard-, still requires improvement. We employed a multi-center case-control study to investigate the association between exposure to secondhand smoke (SHS) from various tobacco products (cigarettes, water-pipes, pipes, and chopogh), opium use, and the risk of lung cancer. We included 627 lung cancer cases and 3477 controls. Exposure to SHS tobacco and SHS opium was collected through a questionnaire. We used mixed-model logistic regressions to estimate odds ratios (ORs) and 95% confidence intervals (CI). Among the overall population exposed to second-hand tobacco smoke (SHTS), the odds ratio (OR) compared to those never exposed was 1.35 (95% CI: 1.08-1.71). Never smokers who were ever exposed to second-hand tobacco smoke (SHTS) had 1.69-fold risk of lung cancer compared to those who were never exposed (95% CI: 1.13-2.52). Exposure to SHTS between 2-3 per day (OR = 2.27, 95% CI: 1.13-4.53) and more than three hours per day (OR = 2.29, 95% CI: 1.20-4.37) can increase the risk of lung cancer compared with the no exposure group (P-trend <0.01). We did not observe any association between exposure to second-hand opium smoke (SHOS) and the risk of lung cancer, either in the overall population or among never-smokers. Our study estimates the impact of second-hand tobacco smoke (SHTS) on lung cancer risk in both the overall population and never-smokers. Additional studies are required to evaluate the association between exposure to second-hand smoke from opium and other type of tobacco, including water-pipe and the risk of lung cancer.

Prevalence of tobacco smoking and related factors in people aged 15 years and above in Beijing, 2014-2021

Objective: To evaluate the effect of the implementation of Beijing Smoking Control Regulation in 2015 on the smoking prevalence in people aged ≥15 years in Beijing during 2014-2021, and explore factors associated with tobacco use behavior in local population. Methods Using a pooled cross-sectional design, data from Beijing Adult Tobacco Survey in 2014, 2016, 2019 and 2021 (4 surveys) were combined into one dataset. The 4 surveys used same multistage cluster sampling procedure. After complex survey weighting, multiple logistic regression models were constructed to analyze factors influencing smoking status. Results: A total of 8 484, 9 372, 8 534 and 10 551 respondents were included in the surveys in 2014, 2016, 2019 and 2021, respectively. The smoking prevalence rate was 23.4%, 22.3%, 20.3% and 19.9%, respectively, in Beijing residents aged ≥15 years, exhibiting a linear declining trend (P=0.010). Factors associated with current smoking in men were age 25-44 years (OR=2.22, 95%CI: 1.68-2.95) and 45-64 years, (OR=2.64, 95%CI: 2.06-3.39), educational level of high school (OR=0.69, 95%CI: 0.49-0.95) and undergraduate and above (OR=0.46, 95%CI: 0.33-0.63), and awareness of smoking causing stroke (OR=0.71, 95%CI: 0.61-0.81), and awareness of smoking causing lung cancer (OR=0.53, 95%CI: 0.42-0.66), the differences were significant (all P<0.05). After controlling interfering factors, the current smoking prevalence in men in 2019 (OR=0.73, 95%CI: 0.63-0.87, P<0.001) and 2021 (OR=0.72, 95%CI: 0.61-0.88, P<0.001) were significantly lower than that in 2014. Factors associated with current smoking in women were living alone (OR=1.80, 95%CI: 1.33-2.44), educational level of undergraduate and above (OR=0.43, 95%CI: 0.27-0.69), other occupations except doctor and teacher (OR=8.54, 95%CI: 2.80-26.02) or being retired/unemployed (OR=9.39, 95%CI: 3.19-27.65), and awareness of smoking causing cardiovascular events (OR=0.58, 95%CI: 0.39-0.84), and awareness of smoking causing lung cancer (OR=0.54, 95%CI: 0.35-0.83), the differences were significant (all P<0.05). No significant change in smoking status in women was found in 4 surveys. Conclusions: The smoking prevalence rate in men in Beijing has declined since the implementation of Beijing Smoking Control Regulation 5 years, indicating the effectiveness of legislative approach in tobacco control. Socio-demographic factors and the awareness level of tobacco harm could influence smoking status. Future tobacco control programs should target the people with lower education level, young men, women living alone, and those with occupations other than teachers/doctors or the unemployed/retired and include more comprehensive health education.

Interest in Online Tobacco Cessation Services During the COVID-19 Pandemic in India- insights from Google Trends

Abstract Background: With concerns about higher mortality and morbidity attributed to COVID-19 infection among tobacco users, the pandemic has been an opportune time to further our efforts towards tobacco cessation. The present study thus aims to assess the interest in tobacco cessation services during the pandemic. Materials and Methods: An ecological study was done using data from Google Trends for five years. The trends depicting the interest in internet search terms like “Quit-tobacco” and “Quitline” were retrieved and compared over the study period and with the Global Adult Tobacco Survey-India (GATS-II) data estimates (2016–17). The results were reported using descriptive statistics and line graphs. Results: Between 2017 and 21, the search interest regarding quitting tobacco depicted the highest peak corresponding to the second wave of the COVID-19 pandemic. There were significant geographical disparities in the Google searches made across India. As per GATS-II, only 0.2% of the smokers had used a Quitline, corresponding to a smaller peak in Google Trends. Interest in “Quitline” compared to “quit tobacco” was in a ratio of 1:11, and the gap increased further during the pandemic by 1:12. Conclusions: We observed an increasing interest in the searches related to “Quit-tobacco” like terms during the pandemic but an increasing gap in the interest around the “Quitline” searches. The present study hypothesizes that the pandemic increased concerns regarding tobacco, leading to a higher interest in tobacco cessation services, thus calling for a proactive approach to propagate ‘Quitline’ through generous advocacy to have efficient tobacco control per the National Tobacco Control Program.

Evaluation of a Regional Tobacco Control Program (Greater Manchester's Making Smoking History) on Quitting and Smoking in England 2014-2022: A Time-Series Analysis.

This study aimed to assess the impact of Greater Manchester's Making Smoking History program-a region-wide smoking cessation programs launched in January 2018-on key smoking and quitting outcomes. Data were from a nationally representative monthly survey, 2014-2022 (n = 171 281). We used interrupted time-series analyses (Autoregressive Integrated Moving Average [ARIMA] and generalized additive models [GAM]) to examine regional differences between Greater Manchester and the rest of England, before and during the program's first five years. Outcomes were rates of quit attempts and overall quits among smokers, quit success rates among smokers who tried to quit (preregistered outcomes), and current smoking prevalence among adults (unregistered outcome). Results showed mixed effects of the program on quitting. Primary ARIMA models showed comparative reductions in quit success rates (change in quarterly difference between regions = -11.03%; 95% CI -18.96; -3.11) and overall quit rates in Greater Manchester compared with the rest of England (-2.56%; 95% CI -4.95; -0.18), and no significant change in the difference in the quit attempt rate (+2.95%; 95% CI -11.64; 17.54). These results were not consistently observed across sensitivity analyses or GAM analyses. Exploratory ARIMA models consistently showed smoking prevalence in Greater Manchester declined more quickly than in the rest of England following the initiation of the program (-2.14%; 95% CI -4.02; -0.27). The first five years of Greater Manchester's Making Smoking History program did not appear to be associated with substantial increases in quitting activity. However, exploratory analyses showed a significant reduction in the regional smoking rate, over and above changes in the rest of England over the same period. Taken together, these results show a relative decline in smoking prevalence in Greater Manchester but equivocal data on quitting, introducing some uncertainty. It is possible the program has reduced smoking prevalence in the absence of any substantial change in quitting activity by changing norms around smoking and reducing uptake, or by reducing the rate of late relapse. It is also possible that an undetected effect on quitting outcomes has still contributed to the program's impact on reducing prevalence to some degree. It will be important to evaluate the overall impact of the program over a longer timeframe.

Youth empowerment in tobacco control: community-based participatory research in rural Indonesia

PurposeThis paper describes the planning and implementation program of Remaja Berdaya Sehat Tanpa Rokok (JayaStar) or Empower Youth Healthy without Smoking (EYHWS). This is a pilot tobacco control program for smoking behavior with a community-based participatory research (CBPR) approach in a rural area of Indonesia.Design/methodology/approachThis research used the participatory rural appraisal (PRA) method. The paper would describe three stages of the JayaStar program that started from diagnosis, planning action and taking action. Participants in this research were all youths aged 17–25 years including as many as 33 people. The key informants were the village head, the hamlet head, the hamlet head’s wife, the youth leader, health promotion officers at the Pleret Health Center and the Health Promotion Section of the Bantul Health Office.FindingsThe determinants of the youth empowerment process are divided into (1) predisposing factors, (2) group structure and (3) group climate. It has an important role in the success of the youth empowerment process in smoking behavior control. The implementation of the JayaStar program consisted of (1) outbound, and training with the theme of increasing self-potential; (2) training on the impact of cigarettes/vapors on the health of youths; (3) discussion and practice of making health campaign videos; (4) parenting program with the theme of the important role of parents in creating a healthy and superior young generation; (5) declaration and inauguration of JayaStar volunteers.Originality/valueThis research is an example of a successful community-based youth project that resulted in a demonstrable positive outcome. It demonstrates the importance of good relations between stakeholders. The JayaStar movement could be a potential model for youth empowerment projects to control smoking behavior among future generations in Indonesia.

Understanding ethnic inequities associated with tobacco use in Aotearoa New Zealand: a quantitative analysis.

Despite the inclusion of both individual interventions and population-based measures in the Aotearoa New Zealand (Aotearoa NZ) Tobacco Control Programme, the gap between Māori, Pacific peoples and European/Asian/Other (EAO) populations in tobacco use has not decreased significantly. Tobacco control interventions that focus on individual behaviour change have produced little impact towards reducing tobacco smoking inequities for Māori and Pacific peoples in Aotearoa NZ. Using data from the New Zealand Health Survey (NZHS), this research investigates the impact of the wider determinants of health and individual-level factors on inequities in tobacco use between Māori, Pacific peoples and EAO. A conceptual framework was developed to support the theoretical positioning of this research and to inform data categorization, framing, discourse, analyses and interpretation. We conducted hierarchical regression to examine the effect of factors from each domain on ethnic inequities in tobacco use. We found that socioeconomic factors accounted for a significant amount of the disparity in adults currently smoking between Māori and Pacific peoples and EAO. Our results suggest that socioeconomic factors may be a more effective target of intervention than individual behaviours for reducing tobacco-related inequities. Addressing the broader determinants of health through comprehensive cross-agency cooperation to reduce ethnic inequities in tobacco use in Aotearoa NZ is likely to be more effective than individual behaviour change approaches.

Interactive assistance via eHealth for small- and medium-sized enterprises’ employer and health care manager teams on tobacco control (eSMART-TC): A cluster randomized hybrid type II trial (N-EQUITY2101/J-SUPPORT2102).

10606 Background: Organizational commitment and consistent leadership are crucial to facilitate implementation of workplace wellness programs. We aimed to investigate whether interactive assistance for SME managers to implement tobacco control programs (compared with usual practice) would increase 6-month abstinence rates in tobacco-smoking employees. Methods: This hybrid type II cluster randomized effectiveness implementation trial was done in Japan. SMEs in the intervention group received interactive assistance to employers and health managers for 6 months by supporting employees through campaigns, tailored ongoing facilitation, and ensuring executive engagement and support, aiming to promote utilization of reimbursed smoking cessation treatments and implement smoke-free workplaces. SMEs in the control group received feedback on the results of the baseline survey and information on smoking cessation measures. Stratified randomization was used to allocate SMEs to either group. The primary outcome was salivary cotinine-validated 7-day point-prevalence abstinence rate at 6 months, and the key secondary outcome was the adoption score of the two recommended measures (promote smoking cessation standard treatment visits, and smoke-free policy) at each SME at 6 months (range: 0–2). Other secondary outcomes included implementation and process outcomes (e.g., proportion of smoking cessation treatment use). Results: Between July 1, 2021, and May 16, 2022, 38 SMEs enrolled. Twenty SMEs were randomly assigned to the intervention group and 18 SMEs to the control group. Among 2,929 employees enrolled, 2,556 responded the baseline survey (response rate: 87.3%; men 65.0%; mean age 44.8 years) and 713 of them (27.9%) indicated being a current smoker in the baseline. Then 176 (6.9%) were omitted because of missing primary outcome data (mainly owing to not responding, turnover, resignation, or retirement); therefore, 537 participants (21.0%) were included in the intention-to-treat based analyses of the primary outcome. At 6 months, the validated 7-day point-prevalence abstinence rate in the intervention group was significantly higher than that in the control group (11.2% vs 4.6%; difference = 6.6%, 95% confidence interval: 2.2%–11.1%, p=0.004). Regarding the analysis for key secondary outcomes, all randomized SMEs were included. At 6 months, adoption score of the two recommended measures was also significantly higher than that in the control group (1.5 vs 1.1; difference = 0.4, 95% confidence interval: 0.01–0.86, p=0.047). Conclusions: Interactive support for SME managers to implement tobacco control measures (compared with usual practice) can accelerate the implementation of evidence-based smoking cessation measures and significantly increase 6-month abstinence rates. Clinical trial information: UMIN000044526.