Tobacco Control Research Articles

Conceptions of Freedom in the Regulation of Junk Food and Tobacco

This paper examines the regulatory disparities between the junk food and tobacco industries in the UK, focusing on the underlying conceptions of freedom that shape public policy. While both industries contribute significantly to public health challenges, tobacco is subject to far stricter regulations. Through an analysis of parliamentary debates within the House of Commons, the paper explores the application of positive and negative freedom in discussions of junk food and tobacco. I find that the presence of addiction in tobacco discourse is used to apply a positive conception of freedom, leading to more stringent regulations. Conversely, junk food discussions emphasise individual choice, aligning with a negative conception of freedom and resulting in softer regulatory approaches. This paper argues that these differing narratives on freedom contribute to the observed regulatory differences and suggests that emphasising the addictive nature of junk food could shift regulatory perspectives.

Exploring In-School Adolescent Smoking Behaviors: A Comparative Study of Rural and Urban Contexts in Anambra, Nigeria

The use of tobacco among adolescents is a big public health issue in low- and middle-income countries of the world including Nigeria. The aim of this study was to compare prevalence and determinants of tobacco use among in-school adolescents’ resident in urban and rural secondary schools in Anambra State. A cross-sectional analytical design was observed using multi stage random sampling to sample 360 students from some selected schools. A pretested, semi structured questionnaire adapted from the Global School Health Survey (GSHS) was used to collect data. The data was analyzed by descriptive and inferential statistics. Similar prevalence of tobacco use was found in both the urban (6.3%) and in the rural (6.5%) sites, without significance in either (p=1.000). Participation in protective factors including health education programs in which participants are educated on smoking dangers and sexually transmitted diseases (STDs) in particular was associated with non-smoking behavior significantly more in urban areas. On the other hand, being urban adolescents who reported tobacco use showed significantly association with risk factors such as poor school environment and bullying. Consequently, no difference in rates of tobacco use occur between urban and rural adolescents, despite differences in protective and risk factors. Recommendations aimed at strengthening health education, and improving school environments and reducing bullying are suggested to reduce adolescent smoking in these settings. Effective tobacco control of Nigerian adolescents requires targeting of public health interventions on the basis of the socio-cultural context.

Do-it-yourself flavored capsule cigarettes: Exploiting potential regulatory loopholes?

Capsule cigarettes allow users to crush liquid-filled capsules to release flavors into cigarettes' filters. New devices are emerging across the globe that allow people who smoke to circumvent tobacco flavor restrictions via injectable capsules. This study examined TikTok videos marketing flavored capsule injector devices. TikTok videos (n = 832) posted worldwide between July 6, 2021, and December 28, 2023, that used hashtags #injectorflavor, #flavourclickball, #flavorball, and #injectorballcigarette were collected using a TikTok application programing interface. A codebook was developed using a systematic iterative approach, identifying six codes: flavor capsules, promotes flavors (i.e., fruit, mint or menthol flavors, non-alcoholic drinks, alcoholic drinks), demonstrates how to use or refill large injector devices, demonstrates how to use small convenient devices, includes music (any or English-language). Two independent coders annotated all videos. Overall, 88.3% (n=735) of the videos displayed flavor capsules and had been viewed more than 72 million times. Half (51.6%) of the videos demonstrated how to use large box-shaped devices to inject capsules into the filter of a cigarette, and 15.0% of the videos showed how to do this with smaller, more convenient devices. Flavors including fruit (35.5%), menthol/mint (27.8%), non-alcoholic drinks (21.9%), and alcoholic drinks (11.6%) were used to promote these capsules. Most videos (85.6%) were uploaded by sellers on "TikTok shop." TikTok accounts are promoting injectable capsule devices that circumvent flavored tobacco sales restrictions. Policy makers, tobacco control advocates, and public health practitioners should be aware of such marketing to inform regulation and develop prevention strategies. Our findings identified an emerging product that can encourage circumvention of flavor restriction policies. Regulators, policy makers, public health practitioners, researchers, and advocates should be aware of such products to inform regulation and develop prevention strategies. Given the potential for these products to reduce the intended effects of flavored tobacco sales restrictions, policy makers must be poised to address materials that consumers use to create their own flavored tobacco products, including flavor capsules designed to be inserted into cigarettes.

Prevalence and patterns of tobacco use among young adults in India - does perceived stress play a role?

Background: Tobacco use among young people is a public health concern. Perceived stress among young adults as a determinant for tobacco use has not been extensively explored previously in India. Methods: A cross-sectional study was conducted among young adults aged 18-30 years across India. Data was collected using a self-administered, web-based, online questionnaire, on sociodemographic characteristics, tobacco use and its pattern, and the levels of perceived stress using the Perceived Stress Scale (PSS-10). Results: The prevalence of tobacco use in our study sample was 25.7% and the mean age at initiation of tobacco use was 20.71 years. Though tobacco use was significantly associated with male gender [aOR=2.26 (1.16-4.38), p=0.01], current alcohol consumption [aOR=13.73 (6.72-28.04), p=0.00] and having known smokers among family and friends [aOR=3.13 (1.39-7.04), p=0.01], there was no association between levels of perceived stress and tobacco use. Cigarettes/beedis were the most commonly used tobacco product, 27.58% of respondents reported using tobacco products daily or for more than half the days of the week and 48.27% of respondents started using tobacco out of curiosity. Seventy percent of users used tobacco during specific events like social gatherings and vacations while 57.47% used tobacco while meeting specific colleagues/ friends. Conclusions: We found no association between perceived stress and tobacco use. However, current use of alcohol and having knowledge about smokers among family and friends significantly determined tobacco use among our study population. This necessitates more holistic approaches towards behaviour change efforts for tobacco control.

7.P. Skills building seminar: Using health impact assessment for assessing tobacco control policies

Abstract Tobacco use is the largest contributor to premature death and preventable disease in Europe. Despite decreasing tobacco use in recent years, the European Commission estimates that the number of smokers in Europe is 26% in the population, and 29% among 15-24 year olds. This persistent public health risk is amenable to policy, but targeted and effective strategies are needed. Health impact assessment (HIA) methods can aid decision-makers in exploring the consequences of policy actions on select outcomes, providing a platform for informed, evidence-based policy design. Routine data collection on risk factors including smoking and tobacco use behaviour is common and available in Europe. Analysing and valorising these data can provide a better picture of vulnerable and target groups for which tobacco use is a persistent problem, or where the attributable disease burden is particularly high. These data can form the basis for robust projections and the application of HIA methods. In addition, a number of policy strategies exist for tobacco control including changes in packaging, taxation, labelling, ingredients, creation of smoke-free environments, and restrictions on advertising. These policies have a common goal in improving tobacco control, but may lead to differential effects across age groups, populations, and different measures of tobacco use. It is thus necessary to use robust tools to understand these effects and better coordinate and plan policy. HIA methods, each with their own strengths and limitations, have been applied successfully to estimate the impact of different tobacco control measures. Novel methodologies that make use of available data, computational power, and provide a low-cost way to explore policy interventions can be an essential tool to policy planning and in particular to tackle the intractable areas of tobacco control. This skills building workshop will present two key approaches, each with their own strengths and weaknesses, that have been applied in HIA studies on tobacco control - i.e., a static approach based on the calculation of potential impact fraction, and a dynamic approach based on microsimulation models. Furthermore, the workshop will demonstrate, using two real-life examples, how policy measures can be translated into effect size estimates - which is one of the most crucial steps in any HIA. By providing a step-by-step presentation of how HIA has been applied in practice, attendees will gain unique insights in the different ways by which HIA can be used to gain insights into the relative impact of policy strategies for tobacco control. Key messages • Tobacco use remains the largest contributor to preventable disease burden in Europe; a key area for analysing policies using health impact assessment. • Attendees will gain unique insights in the different ways by which HIA can be used to gain insights into the relative impact of policy strategies for tobacco control.

An Overview of Tobacco Control Policies in China

The tobacco epidemic is a global public health concern as the toxic substances in tobacco pose a severe threat to human health. In response to this issue, countries around the world have adopted various strategies to control tobacco use. The Chinese government began to pay attention to the health hazards of smoking in the 1970s and joined the international community in tobacco control endeavors by becoming a signatory of the World Health Organization Framework Convention on Tobacco Control in the early 21st century. It has further intensified its tobacco control measures in recent years with its “Healthy China” strategy. This article gives an overview of tobacco control policies released by the Chinese government over the years, with a separate analysis of the provisions on smoking control stipulated in the Health China Action Plan (2019-2030). Also discussed are the outcomes of those policies and the challenges China faces in tobacco control, as well as the lessons China can learn from international experiences in this regard.

How do industry and other actors undermine tobacco control policies post-adoption? A scoping review

Abstract Background Over recent decades, many countries have strengthened their tobacco control policies. To be effective, full implementation is needed. Tobacco industry interference is widely recognised as a key barrier to tobacco control progress and evidence-based models like the policy dystopia model (PDM) list industry strategies, focusing on those avoiding and undermining policy adoption. While prior research highlighted industry activities post-adoption, these have not been captured systematically. This review aimed to map the efforts of industry, front groups and other actors to undermine the implementation of policies, including marketing, packaging, smokefree and flavour measures. Methods We searched six literature databases, relevant bibliographies and grey literature, and consulted experts. We included articles describing one or more attempts to undermine adopted policies, including marketing, packaging, smokefree and flavour. The PDM served as starting point for coding; additional strategies were identified inductively. Strategies were charted against aims and policies. Results Several aims and strategies were identified which were similar across policies. Following policy adoption efforts to 1) overturn and 2) weaken measures, and 3) delay implementation continued. Legal strategies were utilised and there were attempts to influence stakeholders. In addition, tobacco industry and other actors sought to 4) undermine policy effectiveness by creating confusion, circumventing policies, and noncompliance, and 5) use implementation as an opportunity to enhance industry reputation. Conclusions Interference from tobacco industry and other actors threatens effective tobacco control policy implementation. The public health community must continue to monitor, expose and counter industry conduct after policy adoption. More research is needed to enhance our understanding of how industry interferes in policy implementation, and how this can be pre-empted and countered. Key messages • The interference from tobacco industry and other actors following policy adoption threatens effective tobacco control, and needs to be monitored, exposed and countered by the public health community. • Policymakers and civil servants need to be wary of efforts to undermine tobacco control policies and act to ensure effective policy implementation.

Quitting with pride: Differences in smoking behaviour across sexual identity groups in Ireland

Abstract Background As smoking prevalence reduces, smoking inequalities across population groups is emerging as a key challenge. Despite recognition of specific needs among members of the Lesbian, Gay, Bisexual, Transexual Plus (LGBT+) community, differences in smoking across sexual identity groups is uncharted in Ireland and the community is not represented in tobacco policy agenda setting. This study aimed to measure and compare the prevalence of smoking, quitting intention and quitting behaviour across sexual identify groups in Ireland. Methods Secondary analysis of the 2023 “Healthy Ireland” cross sectional survey of health status was conducted (n = 7,411). For the first time, this survey included a question on self-reported sexual identify, along with standard questions on smoking prevalence, quitting intention and quitting behaviour. Prevalence of smoking, quitting intention and quitting behaviour were calculated with 95% Confidence Intervals (CI) and compared across groups with Chi Square tests. Results In total, 2.3% (95% CI 2.0-2.7%) of respondents reported an LGB+ identity. Compared to those reporting straight identity, LGB+ respondents reported higher smoking prevalence (17.6% versus 21.4% respectively); intention to quit was similar across groups, however, LBG+ respondents also reported a higher prevalence of making at least one quit attempt in the previous 12 months (51.3% versus 78.0% respectively, p < 0.0001). Conclusions While this study highlighted tobacco-use as a health challenge for the LGB+ community in Ireland, it also identified an opportunity for tailored stop smoking approaches to support quit success. As a consequence, an innovative Fulbright-sponsored policy dialogue was convened between leaders in tobacco control, LGBT+ community leaders, health services and academia across Ireland and the USA to explore solutions, underlining the important role equity stratifiers and population surveillance play in agenda setting for public health. Key messages • Including sexual identity in the national population health survey enabled tobacco-use needs across sexual identity groups in Ireland delineated for the first time. • Equity-stratified population health surveillance informed a policy dialogue to better represent needs of LGBT+ community in public health agenda setting.

International survey of young adults’ opinions on tobacco endgame measures & e-cigarette regulations

Abstract In the last decade, while tobacco consumption has decreased, there has been a significant rise in e-cigarette usage particularly among young people. Tobacco-free generations and other endgame strategies are being considered in several countries, moving from tobacco control towards ending the tobacco epidemic. This online survey of 18-34-year-olds evaluated opinions on potential endgame measures and e-cigarette regulations, to generate evidence to inform policy decisions. The survey was developed with input from the World Federation of Public Health Associations and Tobacco-Free Ireland, asking participants about support (yes/no) for 20 endgame measures in 4 domains and attitudes towards e-cigarettes. Utilising convenience sampling, the survey was distributed through international networks. Of 295 responses in 34 countries, 72% were never smokers and 56% were never e-cigarette users. 31% were aware of tobacco endgame. 68% supported increasing tobacco purchasing age to 21. 70% supported restricting tobacco sales to a limited number of licenced shops. 73% supported reducing nicotine content in cigarettes. 74% supported tobacco companies having to pay for health costs from smoking. 73% would like to see tobacco-free generation legislation in their country, but only 31% expected it would be successful. Regarding e-cigarettes, they were judged as more desirable than cigarettes mostly due to different flavours and visual appearance (both 74%). They were perceived to be an important health risk (82%) and as or more addictive than cigarettes (78%). 65% believed overall harms from e-cigarettes outweigh benefits for society. 86% felt they should be subjected to the same advertising restrictions as cigarettes and 66% supported increasing their cost. There was strong support for various tobacco endgame measures and tobacco-free generation legislation in this 18-34-year-old cohort. The majority recognised health risks of e-cigarettes and favoured stricter regulation of these products. Key messages • An international survey of 295 young adults in 34 countries demonstrated strong support for various tobacco endgame measures including tobacco-free generation legislation. • For e-cigarettes, there was wide acknowledgement of addictiveness and health risk, and support for increased education and warnings, lower nicotine content and reduced advertising and availability.

DYNAMO-HIA: A health impact assessment tool fit for quantifying tobacco control policy

Abstract DYNAMO-HIA is a generic, publicly-available and easy to use software tool for health impact assessments of changes in health risk-factors such as obesity, air pollution, processed meat consumption, physical activity, alcohol taxation, or smoking. The tool uses a graphic use interface, does not require programming skills, and has comparatively modest data requirements. Health outcomes that can be investigated are mortality, life expectancy, healthy-life expectancy, disability and prevalence of various chronic disease such as chronic obstructive pulmonary disease (COPD), cancer, or coronary heart diseases. DYNAMO-HIA can in principle be used for any tobacco control policy or ordinance-e.g. price increases or pictorial health warning labels-that target changes in smoking prevalence or smoking initiation/quitting rates. Past applications of DYNAMO-HIA for tobacco control policy included country studies for Belgium, Mongolia, or Korea and several comparative country studies. In this presentation we will give a general overview into the use of DYNAMO-HIA and show-case a recently published study. This study quantified the reduction in COPD burden that would occur in Italy, England and Sweden over 40 years if tobacco prices were increased by 5%, 10% and 20% over current local prices.

The impact of the tobacco law on tobacco-related hospitalizations in Portugal - a natural experiment

Abstract Introduction Tobacco is responsible for approximately 8 million deaths annually worldwide, with 1.2 million resulting from passive exposure to smoke, as reported by the WHO. Comprehensive tobacco control policies have been enacted across Europe, yet their impacts are seldom assessed. This study evaluates the effects of the anti-tobacco legislation enacted in Portugal in 2007 on tobacco-related hospitalizations between 2002 and 2018. Methods Data from all in-patient admissions in public hospitals throughout the 2002-2018 period were utilized. A quasi-experimental interrupted time series design was employed, treating 2008 as an exogenous shock. The dependent variables include the municipality-based incidence of hospitalizations by year for tobacco-related diseases, namely, Acute Myocardial Infarction, stroke, lower respiratory tract infections, chronic obstructive pulmonary disease, and asthma. The analysis was adjusted for the percentage of women, the percentage of individuals aged over 65, and purchasing power in the municipality. Time trend graphs for each variable were generated, followed by an adjustment using the Poisson regression model to forecast their trends. A comparison was conducted between observed post-law implementation data and projected values from the regression model to ascertain the percentage difference between the two. Expected Results The 2007 tobacco law led to significant reductions in tobacco-related disease incidence, with the most notable effects immediately post-implementation. The impact varies across age groups, with younger individuals (30-49 years) showing a sharper decrease. The effect diminished over time, as indicated by negative coefficients in time:law interactions, such as -0.03. Conclusions The anti-tobacco laws implemented in Portugal have effectively decreased hospitalizations related to tobacco use, suggesting potential increases in life expectancy and reduction in health system burden. Key messages • Public health policies are crucial for the long-term improvement of people’s health. • Non-exposure to tobacco can bring health gains on several levels.

Calculating potential impact fractions to assess the impact of tobacco control policies

Abstract This presentation will provide a straightforward and accessible method for evaluating the effectiveness of various tobacco control policies in reducing the smoking-associated disease burden. To estimate numbers and proportions of potentially avoidable disease cases under different policy intervention scenarios (such as cigarette tax/price increases, comprehensive marketing ban, and plain packaging), this approach entails the calculation of age- and sex-specific potential impact fractions, representing the percentage change in disease risk following changes in exposure to smoking. The approach can account for lag and latency periods between reductions in smoking prevalence and declines in disease excess risks. The future disease burden is estimated by combining data on the incidence or mortality of the disease of interest, published effect sizes of tobacco control policies, and national smoking prevalence data. Intervention scenarios are compared against a status quo scenario that assumes the continuation of recent smoking trends. The presentation will outline the approach, using the example of smoking-associated cancer, and discuss model assumptions, required data, and sensitivity analyses. This straightforward modelling framework enables the comparison of different health policy measures’ impacts, providing valuable insights for policymakers and public health officials regarding the potential public health impact of tobacco control policy measures.

Sailing along the global tobacco supply chain: public health insights of innovative database project

Abstract Background Tobacco control commonly focuses on reducing tobacco demand rather than tobacco supply. This paper presents findings from a major four-year project on the tobacco supply chain. Transnational Tobacco and Leaf Companies (TTLCs) and other tobacco supply chain companies argue that provision of livelihoods, exports and corporate social responsibility (CSR) exonerates tobacco. Our objective was to consider these claims. Methods This paper presents the results of three studies: a literature review and two analyses of data from the innovative Tobacco Supply Chain Database (TSCD). Study 1: A scoping review of academic literature (n = 124 papers) reviewing how the tobacco supply chain embeds the tobacco industry as a development actor. Study 2: The statistical association between countries hosting TTLC subsidiaries (TSCD) and TTLC interference in health policy (Global Tobacco Industry Interference Index) was analysed (n = 76 countries). Study 3: Document and website analysis of TSCD non-TTLC tobacco supply chain companies comparing descriptions of CSR and tobacco supply chain involvement (n = 80 companies). Results Study 1: Although there are instances of advantages of involvement in the tobacco supply chain, TTLCs tends to be associated with declines in tobacco workers’ income, equality, quality of life (cultural and health and wellbeing) and nations’ environment and economy. Study 2: Countries that hosted more TTLCs had more policy interference (farming subsidiaries p=.046, tobacco product manufacturing subsidiaries p=.008). Study 3: Non-TTLC companies often lack transparency regarding their connection to tobacco. For example, 68% linked to CSR activity on their homepage whereas only 16% linked to involvement in the tobacco supply chain. Conclusions Tobacco supply chain involvement is detrimental to public health, the environment and governance. Countries and companies should seek to extricate themselves from the tobacco supply chain. Key messages • Tobacco supply chain involvement weakens public health governance despite CSR activities. Lack of transparency on supply chain involvement by companies is thus a concern. • The new Tobacco Supply Chain Database illuminates previously hidden areas of the tobacco supply chain: the location of tobacco industry subsidiaries and presence of independent companies.

Legal perspectives on climate change and inequalities

Abstract In many areas of public health policy, litigation has delivered significant, long-lasting impacts. Examples include tobacco control, increasing access to treatments for HIV, and addressing air pollution and climate change. Litigation is an established part of public health’s advocacy toolbox in national courts, and increasingly in international courts and tribunals. In responding to climate change, in addition to potential policy and law reform, climate change litigation creates opportunities for public scrutiny and debate by raising awareness of inaction or harm caused by governments or private sector polluters, and sparking wider community mobilisation for climate action. Where climate change litigation is based on human rights claims, credible science-based evidence of the health and other human rights impacts of climate change is essential. Public health professionals are increasingly involved in assembling and presenting such evidence, often focusing on vulnerable populations. However, the multiple intersecting identities of vulnerable populations have not been sufficiently explored. For example, how does intersectional disadvantage influence the ways in which evidence of the impact of climate change is assembled and assessed? How are these issues addressed in the courts? Examples include older women (KlimaSeniorinnen v. Switzerland), young people, from both the global South and global North, in urban or remote areas, or with different pre-existing health conditions (Sacchi et al. v. Argentina et al), and Indigenous people, including women and children (Daniel Billy and others v. Australia; Teitiota and others v. New Zealand). Multiple identities can compound vulnerability. For example, young people may be more vulnerable both due to their physical immaturity and due to eco-anxiety and other mental health impacts. This presentation will explore these issues, and the critical role of public health professionals in legal action to address climate change.

Prevalence of Oral Potentially Malignant Lesions, Tobacco use, and Effect of Cessation Strategies among Solid Waste Management workers in Northern India: a pre-post intervention study

BackgroundIndia bears the highest global burden of oral cancer, despite having an operational tobacco cessation framework. Occupational groups like solid waste management personnel face significant health challenges due to prevalent tobacco use, leading to oral potentially malignant lesions and oral cancer. Enhanced tobacco control strategies are essential for these groups.MethodsA pre-post interventional, community-based study enrolled 1200 municipal workers in Varanasi, India, from July 2022 to August 2023. 858 tobacco users underwent screening and were randomly assigned to one of three interventions: Very Brief Advice, Individual Behavioral Counseling, or Group Behavioral Therapy. Follow-up was conducted one year after the baseline interventions Effectiveness was measured by nicotine dependence reduction using the Fagerstrom Test for Nicotine Dependence (FTND) scores and cessation rates defined as at least 6-month abstinence. Appropriate statistical tests assessed the burden of tobacco use, oral potentially malignant lesions, and pre-post differences in FTND scores within and between groups. A p-value of < 0.05 was considered statistically significant.ResultsMunicipal workers exhibited a high prevalence (71.5%) of smokeless tobacco (SLT) use. One-third (32.9%) of the participants screened positive for oral potentially malignant lesions and oral cancer. Leukoplakia was the most common lesion. Screened positivity correlated with significant nicotine dependence. Among 494 follow-up participants, 47.1% reported a significant reduction in nicotine dependence across all intervention groups. Quade’s ANCOVA indicated significant differences in post-test FTND scores, with individual behavioral counselling showing the greatest reduction. However, no cessation was achieved in any group despite the significant decline in dependence.ConclusionSolid waste management personnel in Varanasi show heightened SLT use and associated oral potentially malignant lesions. The persistent tobacco use in these high-risk occupational populations undermines government tobacco control efforts and highlights the need for robust policy and implementation strategies. The study demonstrated a significant reduction in nicotine dependence following interventions, though tobacco cessation was not achieved. More frequent interventions and addressing quitting barriers—such as cultural norms, lack of awareness, easy accessibility, and adverse working conditions—are crucial. Developing a tailored workplace model to tackle tobacco use in occupational settings may facilitate cessation.Clinical trial registration numberTrial registration Clinical Trials Registry India CTRI/2020/07/026479. Date of registration 10/07/2020.

Tobacco control policies discussed on social media: a scoping review

ObjectiveTo describe the scope of published literature about tobacco-related policy discussions from social media data and discuss implications for tobacco control policy and future research.Data sourcesPubMed, Medline, CINAHL and Web...

Exposure to e-cigarette and heated tobacco product advertisements via digital, traditional media, and points-of-sale: An examination of associations with use intentions and perceived risk among adults in Armenia and Georgia.

E-cigarette and heated tobacco product (HTP) marketing often leverages digital media and points-of-sale (POS) and advertises risk reduction, including in Armenia and Georgia where male cigarette use rates are high. Using 2022 survey data from Armenian and Georgian adults (n=1468, mean age=42.92 years, 51.4% female; and past-month use of e-cigarettes 3.2%, HTPs 2.7%, and cigarettes 31.6%), multivariable linear regression examined 4 outcomes - e-cigarette and HTP use intentions and perceived risk (1=not at all, to 7=extremely) - in relation to past-month e-cigarette or HTP advertisement exposure via digital media, traditional media, and POS, controlling for covariates (country, age, gender, education level, relationship status, children, past-month cigarette and e-cigarette/HTP use). E-cigarette and HTP use intentions were low (mean score=1.47, SD=1.39 each), while perceived risk was high (mean score=5.83, SD=1.6, and mean score=5.87, SD=1.56, respectively). Past-month exposure to e-cigarette and HTP advertisements, respectively, were 12.9% and 11.2% via digital media, 6.1% and 4.8% traditional media, and 22.5% and 21.1% POS. For e-cigarettes, ad exposure via digital media was associated with greater use intentions (β=0.24; 95% CI: 0.03-0.44), ad exposure via traditional media (β= -0.32; 95% CI: -0.55 - -0.09) and POS (β= -0.30; 95% CI: -0.60 - -0.004) was associated with lower risk perceptions. For HTPs, ad exposure via digital media (β=0.35; 95% CI: 0.14-0.56) and POS (β=0.21; 95% CI: 0.04-3.63) was associated with greater use intentions, and ad exposure at POS was associated with lower risk perceptions (β= -0.23; 95% CI: -0.42 - -0.03). Tobacco control efforts should monitor and regulate e-cigarette and HTP marketing, particularly via digital media which may effectively promote use, and via POS which may target and influence risk perceptions.

Use of E-Cigarette, Traditional Cigarettes, and C-Reactive Protein: The Cross Cohort Collaboration

This cross-sectional study included 18,797 participants from six longitudinal cohorts (CARDIA, FHS Gen III, HCHS/SOL, MESA, MiHeart, and REGARDS). 5,806 of them were with high-sensitivity C-reactive protein (hs-CRP) measurements. We found that among exclusive electronic cigarette (EC) use was associated with significantly lower high-sensitivity C-reactive protein (hs-CRP) levels compared to exclusive combustible cigarette use, suggesting a potentially lower inflammatory burden. hs-CRP levels in dual users and former smokers currently using EC were comparable to those observed in exclusive cigarette smokers. In contrast, individuals who exclusively used ECs showed no significant difference in hs-CRP levels compared to never smokers. These findings have important implications for tobacco regulation, public health, and clinical practice, highlighting the need for continued monitoring of EC-related health impacts.

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.

The impact of specific health warning messages on Chinese young people's perception of smoking risks and quitting intentions.

Although a substantial body of research has analyzed the effectiveness of cigarette package warning labels in tobacco control, the very general health warnings messages (HWMs) on cigarette packaging in China have shown limited effectiveness in deterring youth from smoking. Therefore, this study investigates the impact of specific and more detailed warning text messages on Chinese young people's risk perception of smoking and their intention to quit. We employed a randomized survey experiment to examine the impact of specific text-based warning labels on Chinese young people's risk perception of smoking and intention to quit. The total effective sample size was 1064 participants. The subjects were divided into three groups: the first group served as the control group, which was shown the existing cigarette package warning labels; the second group was shown cigarette package warning labels related to cardiovascular, digestive, and respiratory diseases; and the third group was shown cigarette package warning labels related to sexual dysfunction. The respiratory disease-related warnings significantly increased young people's awareness of smoking-related respiratory risks (p<0.01). The impact of warning labels for the three common diseases on enhancing young people's overall risk perception of smoking (p<0.05) and their intention to quit exhibited only weak statistical significance (p<0.05). In contrast, warning labels related to sexual dysfunction significantly increased young people's risk perception of smoking (p<0.001) and their intention to quit (p<0.001), with a much higher level of statistical significance compared to those related to the other three common diseases. Detailed descriptions of the risks associated with all four diseases were positively correlated with awareness of smoking-related harm and the intention to quit. However, warnings related to sexual dysfunction had a greater level of statistical significance compared to those related to the other three common diseases. This stronger significance may be attributed to young people's heightened concern about sexual dysfunction.