Use Of Tobacco Products Research Articles

Prevalence and disparities in receiving medical advice to quit tobacco use in the US adult population.

Evidence suggests that advice from health care professionals (HCP) increases the likelihood of quit attempts and successful quitting of tobacco use. However, previous studies primarily focussed on cigarette smoking and did not include all forms of tobacco products. This study aimed to investigate the prevalence and disparities in receiving HCP's advice to quit tobacco use (combustible or noncombustible) in the US adult population. Using the 2022 National Health Information Survey (NHIS) data, we examined 4,424 adults who reported (i) any tobacco product use within the past 12 months and (ii) having seen an HCP within the past 12 months. The outcome variable included the receipt of advice to quit tobacco use from an HCP, and predictors included sociodemographic variables. Weighted prevalence estimates were calculated, and multivariable regression analyses were conducted. Over 38% of tobacco users who visited an HCP were advised to quit. The odds of receiving such advice were lower among Hispanics (AOR: 0.625; 95% confidence interval (CI) [0.464-0.843];p = 0.002), males (AOR: 0.767; 95% CI [0.659-0.893], p = 0.001), those above the poverty level (AOR: 0.795; 95% CI [0.641-0.987];p = 0.037), foreign-born (AOR: 0.664; 95% CI [0.496-0.888]; p = 0.006), those with a bachelor's degree or higher educational level (AOR: 0.477; 95% CI [0.349-0.653]; p < 0.001) and those aged less than 45 years (AOR: 0.404; 95% CI: [0.344-0.473]; p < 0.001). The prevalence of receiving HCP's advice to quit tobacco use remains suboptimal and disparate among sociodemographic groups. Our findings call for strategic implementation of the USPHS's recommendation on treating tobacco use and taking further actions to equip HCPs with the training and resources needed to provide appropriate advice to quit tobacco.

Pharmacokinetic analysis of nicotine and its metabolites (cotinine and trans-3'-hydroxycotinine) in male Sprague-Dawley rats following nose-only inhalation, oral gavage, and intravenous infusion of nicotine.

Nicotine is an alkaloid found in tobacco. Human exposure to nicotine primarily occurs through the use of tobacco products. To date, limited nicotine pharmacokinetic data in animals have been reported. This study exposed male Sprague-Dawley rats to vehicle (and/or air) or 4 doses of nicotine via nose-only inhalation (INH), oral gavage (PO), and intravenous (IV) infusion. Plasma, 6 tissues (brain, heart, lung, liver, kidney, and muscle), and urine were collected at multiple timepoints from 5 min to 48 h post-dose. The concentrations of nicotine, cotinine, and trans-3'-hydroxycotinine (3-OH-cotinine) were determined, and the pharmacokinetic profiles were compared among the 4 doses for each route. The results indicated that after single nicotine dose, nicotine bioavailability was 53% via PO. Across all the administration routes and doses, nicotine was quickly distributed to all 6 tissues; kidney had the highest nicotine and cotinine levels, and the lung had the highest 3-OH-cotinine levels; nicotine was metabolized extensively to cotinine and cotinine was metabolized to a lesser extent to 3-OH-cotinine; the elimination of plasma nicotine, cotinine, and 3-OH-cotinine followed first-order kinetics; plasma nicotine had a shorter half-life than cotinine or 3-OH-cotinine; the half-lives of plasma nicotine, cotinine, and 3-OH-cotinine were dose- and route-independent; and nicotine and cotinine were major urinary excretions followed by 3-OH-cotinine. Nicotine, cotinine, and 3-OH-cotinine levels in plasma, tissues, and urine exhibited dose-dependent increases. These study findings improve our understanding of the pharmacokinetics of nicotine, cotinine, and 3-OH-cotinine across different routes of exposure.

Nicotine dependence and incident psychiatric disorders: prospective evidence from US national study.

We examined the prospective associations between nicotine dependence and the likelihood of psychiatric and substance use disorders in the general adult population. Participants came from a nationally representative sample of US adults aged 18 years or older, who were interviewed 3 years apart in the National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1, 2001-2002; Wave 2, 2004-2005). The primary analyses were limited to 32,671 respondents (13,751 male (47.9% weighted); mean age of 45 years (SD = 0.18)) who were interviewed in both waves. We used multiple regression and propensity score matching (PSM) to estimate the strength of independent associations between nicotine dependence related to the use of tobacco products at Wave 1 and incident psychiatric disorders at Wave 2. Psychiatric disorders were measured with a structured interview (Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV). All analyses adjusted for multiple potential confounders, including childhood (family history of substance use disorders, parental loss, vulnerable family environment), early-adolescence (self-esteem, social deviance, conduct disorder), late-adolescence (education, personality and psychiatric disorders), adulthood (divorce, stressful life events, social deviance, quality of life, history of alcohol or other substance use disorder), and sociodemographic factors. Multiple regression analysis and PSM converged in indicating that nicotine dependence was associated with significantly increased incidence of any psychiatric disorder (OR = 1.39(95%CI:1.20;1.60)), including substance use disorders (OR = 1.91(95%CI:1.47;2.47)), and anxiety disorders (OR = 1.31(95%CI:1.06;1.62)). Population Attributable Risk Proportions were substantial, ranging from 12.5%(95%CI:8.10;17.0) for any psychiatric disorder to 33.3%(95%CI:18.7;48.0) for any other drug use disorder. Supplementary analyses also indicated significant associations between nicotine dependence and persistence of psychiatric and substance use disorders among patients having a disorder at Wave 1. In the general adult population, nicotine dependence is associated with an increased likelihood for several psychiatric and substance use disorders. Given its high prevalence, these findings have important public health implications.

Patterns of poly tobacco use among adults in the Population Assessment of Tobacco and Health (PATH) study, 2013–2017: a multistate Markov transition analysis

BackgroundA better understanding of sociodemographic transition patterns between single, dual and poly tobacco product use may help improve tobacco control policy interventions.MethodsHRs of transition between never, non-current (no past 30-day...

Youth Smoking Behavior and Policy Attitudes: A Study of High-School Students in the Maldives.

Tobacco use significantly impacts health and economic sectors. In the Maldives, 4 out of 10 men smoke daily, despite anti-tobacco policies. The Maldives Global Youth Tobacco Survey (GYTS) shows fluctuating cigarette smoking prevalence among secondary school students: 6.9% (2004), 3.8% (2007), 4.3% (2011), and 4.7% (2019). No studies have investigated smoking prevalence and attitudes toward anti-smoking policies among higher-secondary students in Addu City. This study examines smoking habits, susceptibility, and attitudes toward anti-smoking regulations to support policy development. We conducted an observational cross-sectional study using a self-administered survey based on the GYTS and the Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS), involving 335 high school students in Addu City. Variables included sociodemographic factors, ever-smokers, current smokers, age at first cigarette, smoking dependency, use of other tobacco products, smoking susceptibility, willingness to quit, and reasons to quit or not smoke. Results with p-values < 0.05 were statistically significant. 22.8% of the students had tried smoking, with 4.74% currently smoking, predominantly males. Additionally, 32.2% had tried e-cigarettes. Smoking susceptibility was 44.2%. Seven students showed smoking dependency, with a significant gender difference (75.4% boys vs 33.3% girls, p < 0.05). Among smokers, 20% wanted to quit, and 70% cited cost as a deterrent. Only 20% of smokers supported a total ban on smoking in media compared to 49.8% of non-smokers (p = 0.03). Non-smokers significantly supported anti-smoking measures (73% vs 12.5% of smokers). Cigarette smoking among high school students in Addu is below the national average, but the high number of ever-smokers and interest in smoking and e-cigarettes suggest potential future increases. Policymakers should enact stronger legislation, enforce age restrictions, raise tobacco taxes, and implement comprehensive smoking cessation programs to address tobacco use effectively.

Assessing Product Use Behavior and Exposure: Definitions and Methods

Summary In recent years, the tobacco- and/or nicotine-containing product (TNP) portfolio has expanded to include products such as e-vapor products, heated tobacco products, and nicotine pouches. Although scientific papers and regulatory requirements/recommendations related to the assessment of product use behavior and exposure to product use have been published for these novel TNPs, there is great diversity in the terminology used to characterize and assess these types of products. The aim of this paper is to define the terms and methods used for assessing product use behavior and exposure, with the objective to suggest a uniform application of terms used by scientists working in this field of research. This publication is the work product of a cross-industry work item commissioned by the Cooperation Centre for Scientific Research Relative to Tobacco (CORESTA) Product Use Behaviour and Biomarkers Subgroups.

Psychosocial and Structural Correlates of Tobacco Use Among Black Young Adults

IntroductionUS- and foreign-born Black young adults (YA) often have different cultural backgrounds and experiences that can an affect the types, extent, and response to psychosocial stressors encountered. This study examined whether psychosocial and structural stressors are similarly related to any and polytobacco (i.e., two or more tobacco products) use among sub-groups of Black YA in the U.S. MethodsCross sectional data were collected in 2023 from 445 Black YA (18-25 years) in the U.S. Stratified regression models were used to examine the association of psychosocial (mental health adversity, race-related adversity, concerns about societal issues), and structural (food insecurity, and housing insecurity) stressors with past 6 month any and polytobacco use among U.S.- and foreign-born Black YA. ResultsRace-related adversity was associated with higher odds of polytobacco use (vs. non-use) among both U.S.- (aOR=1.36, 95% CI=1.06, 1.74) and foreign-born (aOR=2.18, 95% CI=1.18, 4.03) Black YAs. Food insecurity was associated with higher odds of polytobacco use among foreign-born Black YA (aOR=1.92, 95% CI=1.13, 3.27) and any tobacco use among both U.S.- (aOR=1.36, 95% CI=1.04, 1.79) and foreign-born (aOR=1.47, 95% CI=1.01, 2.17) Black YA. However, concern about societal issues was associated with reduced odds of polytobacco use in both groups. ConclusionsIn all models, experiences of racism and discrimination (race-related adversity) was linked to higher odds of polytobacco use, while concern about societal issues was protective. However, there were nativity differences in the association of food insecurity with any and polytobacco use. Findings support the need for culturally/ethnically conscious tobacco prevention strategies that address the underlying psychosocial and structural drivers of tobacco use among Black YA subgroups.

Depression, anxiety, stress, and current e-cigarette use: Results from the Truth Longitudinal Cohort of youth and young adults (2022−2023)

ObjectiveTo examine associations between depression, anxiety, and stress, as measured by the Depression, Anxiety and Stress Scale (DASS-21) scale, with current e-cigarette use. MethodsData from the Truth Longitudinal Cohort – a nationally representative sample of youth and young adults – was collected between October 2022 to February 2023. The analytic sample was comprised of participants who provided information on e-cigarette use and the DASS-21 scale (N = 4198). Chi-square statistics were used to determine differences by current e-cigarette use across covariates and DASS-21 items. Logistic regression analyses were applied to the cross-sectional data to determine which scales predicted current e-cigarette use, adjusted for the effects of age, gender identity, race and ethnicity, parental educational attainment, perceived financial situation, and current use of alcohol, marijuana, and other tobacco use. ResultsThose who had severe/extremely severe levels of depression, anxiety, and stress had greater odds of current e-cigarette use, relative to those who had normal levels of depression, anxiety, and stress, even after adjusting for covariates. Results also demonstrated associations between age, race/ethnicity, parental education, and current use of alcohol, marijuana, and other tobacco products with current e-cigarette use. LimitationsCross-sectional analyses of self-reported data limit the ability to determine directionality of effects between depression, anxiety, stress, and current e-cigarette use. DiscussionMore severe levels of depression, anxiety, and stress were associated with a greater likelihood of current e-cigarette use. Future research is needed to evaluate changes in e-cigarette use, in response to depression, anxiety, and stress symptomatology.

Patterns of nicotine pouch use among young Australians

BackgroundDespite increasing interest in the use of nicotine pouches in Australia – where retail sale of the products is illegal – research exploring patterns of pouch use and reasons for use is lacking. Accordingly, this study explored young Australians’ experiences with nicotine pouches. MethodsAn online survey was administered to 1598 Australians aged 16–39 years (53 % women). We assessed (i) awareness and use (lifetime and past 30-day) of nicotine pouches, (ii) patterns of use (e.g., flavours and nicotine strength used), (iii) product source, and (iv) reasons for use. Regression analyses were conducted to assess socio-demographic predictors of awareness and use. ResultsJust over three-quarters (77 %) of the sample reported being aware of nicotine pouches. Lifetime use was reported by 26 % of respondents and past 30-day use by 19 %. Among those who reported past 30-day use, fruit (35 %) and menthol/mint (34 %) flavours were most commonly used. In terms of pouch source, one-third (33 %) reported obtaining the product from a tobacconist. The most common reasons for use were “they come in flavours I like” (34 %) and “to help me quit smoking” (32 %). Awareness, lifetime use, and past 30-day use of nicotine pouches were more likely among men, those who reported current use of tobacco products, and those who reported current use of e-cigarettes. ConclusionsAwareness and use of nicotine pouches among young Australians may be substantial enough to warrant the inclusion of items measuring pouch use in national surveys. Efforts should be made to better enforce existing laws regarding the sale of nicotine pouches.

Thirdhand Smoke Exposure Ignored by Pediatricians: A Cross-sectional Study.

Thirdhand smoke (THS) is defined as the harmful substances in cigarette smoke that are absorbed into objects, people, and surfaces after smoking. This study aimed to determine the level of awareness of pediatricians working in a tertiary healthcare institution about THS exposure. In this cross-sectional study, participants were asked to fill out an information form in which we questioned the participant's age, sex, occupation in the institution, the exposure of pediatric patients to cigarette smoke during daily healthcare, tobacco product use status, smoking status in their home and car, behavior in case of smoking in closed areas where smoking is prohibited, and whether they knew the term of THS. Also, the Turkish version of The Beliefs About Third-Hand Smoke was used. Eighty-one participants, with a mean age of 34.2 ± 7.6 years, were included in the study. Fifty-six (69.1%) participants said they had never used tobacco products. Participants who had never used tobacco products (P = .005), never allowed smoking in their homes (P = .017) and cars (P = .001), had heard the definition of THS before (P = .013), and thought they knew it (P = .005) had higher total scale scores. There was no significant difference between the THS awareness levels of pediatricians who questioned children's exposure to cigarette smoke in their daily practice and those who did not (P = .491). Determining the awareness levels of pediatricians about THS will be an important step in preventing THS exposure in children.

The Prevalence of Tobacco Product Use Among Students in the Faculty of Medicine at Pamukkale University and Their Views on the Smoke-Free Campus Implementation.

Tobacco use is an important risk factor for more than 20 types of cancer, especially cardiovascular and respiratory diseases, and many other health problems. Cigarettes are one of the most commonly used tobacco products in the world, and they can cause both physical and mental addiction. Adolescence is known to be the highest-risk period in terms of addiction among all age groups. As a result, smoke-free campus practices have become even more important in universities. This study investigates the prevalence of smoking among Pamukkale Medical School students and their views and behaviors regarding smoke-free campus practices. This cross-sectional study was conducted with 548 medical students at Pamukkale Universıty Faculty of Medicine during the academic year 2021-2022, between April 1-29, 2022. A face-to-face interview was conducted. Students' smoking status and their views about a smoke-free campus were assessed. In the questionnaire, the independent variables were socio-demographic characteristics, duration of staying in a smoke-free environment, smoking status in the place of residence, areas where smoking is most common, Fagerström nicotine dependence level, knowledge about smoke-free campus applications and campuses with the smokefree application. The Statistical Package for the Social Sciences version 21.0 package program was used to analyze the data. Descriptive statistics are presented with numbers and percentages for categorical variables, while the arithmetic mean and standard deviation are used for continuous variables. The chi-square test was used to compare categorical variables,and the Kolmogorov-Smirnov analysis was used to test the compatibility of data to normal distribution. The student smoking rate increased significantly as the number of semesters increased (P = .021). The smoking rate of male students was higher than that of female students (P = .001). The smoking rate of students living with their family or relatives was lower (P = .020). Smokers (14.7%) were more likely to have heard about the introduction of smoke-free zones on campus than nonsmokers (11%) (P = .280). 81.4% of students affirmed the statement, "The number of smoke-free rooms should be increased," and 84.3% responded, "I support the existence of smoke-free spaces." Nonsmoking students (90.8%) are more likely to agree that smoke-free spaces should be increased than those who smoke (57.7%) (P < .001). Among the students, 17.6% of nonsmokers and 37.8% of smokers find the information about smoke-free spaces sufficient (P < .001). The rate of those who consider smoke-free space inspections to be sufficient is lower for nonsmoking students than for nonsmokers (P = .017). Nonsmokers (89.5%) support the existence of smoke-free spaces to a higher degree than smokers (71.2%) (P < .001). One-third of Pamukkale University Faculty of Medicine students smoke, and smoking rates are higher among men and those who do not live with family or relatives. All participants strongly support the existence of smoke-free zones (84.3%), while a proportion of tobacco users (31.4%) support the implementation of a smoke-free campus. Student opinions of the smoke-free zones and the smoke-free campus application are more positive among nonsmokers than smokers.

Lifestyle Differences in the Metabolic Comorbidity Score of Adult Population From South Asian Countries: A Cross-Sectional Study

BackgroundMetabolic comorbidities are involved in the development and progression of non-communicable diseases (NCDs). There is convincing evidence that lifestyles are important contributors to metabolic comorbidities. This study measured the metabolic comorbidity score of South Asian adults, and identified its relationship with lifestyles. MethodsWe studied five South Asian countries including Afghanistan, Bangladesh, Bhutan, Nepal, and Sri Lanka, using WHO's Stepwise approach to NCD risk factor surveillance data between 2014 and 2019. This was a nationally representative and cross-sectional survey on participants aged 15-69 years old. The sample size was 27,616. The outcome was metabolic comorbidity score, calculated based on total cholesterol, fasting plasma glucose, blood pressure, and abdominal obesity. Total metabolic comorbidity score of each participant varied between 0-8. It was then divided into three ranges – the lowest range (total metabolic comorbidity score <3), medium range (total metabolic comorbidity score ≥3 & ≤5), and the highest range (total metabolic comorbidity score ≥6). Based on the outcome of non-parametric receiver operating characteristics analysis, the medium and the highest range together was considered as higher metabolic comorbidity score. The lowest range was considered as lower metabolic comorbidity score. The higher metabolic comorbidity score was coded as “1”and the lower metabolic comorbidity score was coded as “0”. Thus, the outcome variable, metabolic comorbidity score, became a binary variable. Exposures included physical inactivity (<150 minutes of MVPS /week), high daily sedentary time (≥ 9 hours/day), use of tobacco (present or past smoking or daily use of smokeless tobacco products), and consumption of alcohol (at least once/month in the last one year). Binomial logistic regression model produced the odds ratios (OR) with corresponding 95% confidence intervals (CI). ResultsThe prevalence of higher metabolic comorbidity score was 34% among South Asian adults, 25% among the male respondents and 41% among the female respondents. Participants who were physically inactive (OR, 1.26; 95% CI, 1.17-1.36), had high sedentary time (OR, 1.24; 95% CI, 1.11-1.33), and consumed alcohol (OR, 1.40; 95% CI, 1.23-1.53) showed higher metabolic comorbidity score compared with the participants who were physically active, had low sedentary time and did not consume alcohol respectively. However, we found an inverse association (OR, 0.75; 95% CI, 0.71-0.81) between the use of tobacco and metabolic comorbidity score. ConclusionsOne third of South Asian adults had higher metabolic comorbidity score. Physical inactivity, daily sedentary hours and minimal alcohol consumption was associated with higher metabolic comorbidity score.

Association of conventional and electronic cigarette use with suicidality in Chinese adolescents: The moderating effect of sex and school type

BackgroundTo estimate the prevalence of lifetime e-cigarette use and explore the association between lifetime conventional and electronic cigarette use with suicidality among Chinese adolescents, focusing on sex and school-type differences. MethodsA total of 22,509 students from 432 classes in 80 schools were recruited in Guangdong Province using a multistage, stratified cluster, random sampling method in 2021. Self-report questionnaires were used to collect information. Multivariable logistic regression models were performed and stratification analysis was conducted. All analyses were weighted and adjusted for the complex survey design. ResultsThe weighted prevalence of lifetime e-cigarette use among adolescents in Guangdong Province was 8.7 % (4.3 % were dual users and 4.4 % were e-cigarette-only users) and 2.6 % were conventional-cigarette-only users. Lifetime e-cigarette-only users (AOR [Adjusted OR] =1.46, 95 % CI = 1.21–1.76), conventional-cigarette-only users (AOR = 1.97, 95 % CI = 1.58–2.46) and dual users (AOR = 1.67, 95 % CI = 1.38–2.02) were at a higher risk of suicidal ideation than non-users. Lifetime e-cigarette-only users (AOR = 2.03, 95 % CI = 1.53–2.70), conventional-cigarette-only users (AOR = 1.97, 95 % CI = 1.42–2.73), and dual users (AOR = 2.76, 95 % CI = 2.10–3.61) had a significantly higher risk of suicide attempts than non-users. After further analysis stratified by sex and school type, the associations of lifetime cigarette use patterns with suicidality slightly varied. LimitationThe cross-sectional study design and self-report information. ConclusionThe prevalence of e-cigarettes among Chinese adolescents is concerning. Lifetime conventional and e-cigarette use were associated with suicidality among Chinese adolescents, with sex and school type moderating these associations. Targeted measures to restrict cigarette use, including new tobacco product (e-cigarette) use, among adolescents are warranted.

E-cigarette use and respiratory illnesses among U.S. adults: An analysis of the Population Assessment of Tobacco and Health Study

IntroductionElectronic cigarettes (e-cigarette) entered the United States marketplace in 2007. Because of the chemical composition of e-cigarette liquid, there are concerns related to its effects on respiratory illnesses. MethodsUsing Wave 4 (2016–2018) of the adult (≥18 years of age) Population Assessment of Tobacco and Health study, logistic regression was used to quantify the association between e-cigarette use and any respiratory illness (asthma, chronic bronchitis, COPD, emphysema, or other lung or respiratory conditions). Age, gender, and the use of other tobacco products were assessed as modifiers of this relationship via interactions on the additive and multiplicative scales. ResultsAfter adjustment, ever e-cigarette use was associated with a 1.32 (95 % confidence intervals [CI]:1.03, 1.69) greater odds of any respiratory illness compared with never e-cigarette users among U.S. adults. When comparing ever and never e-cigarette users, older adults (Odds Ratio [OR] = 1.65, 95 %CI:1.20, 2.26), and ever users of other tobacco products (OR = 1.77, 95 %CI:1.37, 2.29) had greater odds of reporting any respiratory illness than younger adults and those who never used other tobacco products. Among never e-cigarette users, men (OR = 1.51, 95 %CI:1.12, 2.04) were less likely to report any respiratory illness than women. Only the joint effect of age and e-cigarette use on any respiratory illness was statistically significant, suggesting this effect was greater than expected on the additive and multiplicative scales. ConclusionThese findings suggest that the relationship between e-cigarette use and any respiratory illness varies with age. Interventions and policies to reduce e-cigarette use should target high-risk groups for any respiratory illness.

Do e-cigarette retail licensure laws reduce youth tobacco use?

E-cigarette licensure laws (ELLs) require retailers to obtain a state license to sell e-cigarettes over the counter. This study is the first to comprehensively explore the effect of ELL adoption on youth tobacco product use. Using data from the State Youth Risk Behavior Survey (YRBS) and a difference-in-differences approach, we find no evidence that ELL adoption reduces youth ENDS use. The precision of our estimates allows us to rule out, with 95 % confidence, ELL-induced declines in prior-month, frequent, and everyday youth ENDS use of more than 0.7, 0.3, and 0.4 percentage points, respectively. The pattern of null findings persists when we examine ELLs that impose higher penalties for retailer non-compliance, higher renewable licensure fees, and criminal in addition to civil penalties. We conclude that ELLs have only limited success in curbing access to ENDS among youths.

Association between current cigarette prices and cessation behaviors among male adult smokers: findings from 2018 to 2020 ITC Vietnam surveys

BackgroundThis study evaluated the impact of the tax increase in January 2019 on changes in intention to quit and the effect of cigarette prices on quit attempts and successful quitting among male cigarette smokers in Vietnam.MethodsData were derived from the ITC project in Vietnam, which included 1585 adult smokers at baseline (Wave 1, Aug-Oct 2018) followed up to waves 2 (Sep-Nov 2019) and 3 (Sep-Dec 2020). Generalized estimating equations regression was performed to estimate changes in the intention to quit. Multiple logistic regression analysis was used to evaluate the cigarette price of a cigarette pack in relation to quit attempts and successful quitting.ResultsThe increase in cigarette tax in 2019 did not significantly increase the likelihood of the intention to quit. After the tax increase, 63.6% of participants who smoked made a quit attempt, and 27.6% successfully quit smoking in the follow-up waves. However, the price of a cigarette pack was not significantly associated with quit attempts and successful quitting. The study did not observe a significant impact of cigarette prices on quit attempts and successful quitting in all subgroups of household income. Factors associated with quit attempts included the number of cigarettes smoked and the intention to quit, while those associated with successful quitting included age, dual use of cigarettes and other tobacco products, and the intention to quit.ConclusionCurrent cigarette prices were not associated with cessation behaviors even within the lowest household income group. Therefore, a sharp rise in cigarette tax is required to incentivize smokers to quit smoking.

Association of conventional cigarette smoking, heated tobacco product use and dual use with hypertension.

Heated tobacco products (HTPs) have emerged as alternatives to conventional cigarettes. However, their health effects remain largely unknown. This study aimed to prospectively explore the association between the use of cigarettes and HTPs and the risk of hypertension. This cohort study analysed data from 30152 workers (82.0% men, mean age 42.9 ± 11.0 years) who were initially free of hypertension, participating in the Japan Epidemiology Collaboration on Occupational Health Study. Participants were categorized into five groups based on their self-reported tobacco product use: never smokers, past smokers, exclusive cigarette smokers, exclusive HTP users and dual users of cigarettes and HTPs. Hypertension cases were identified using three data points from annual health checkup data collected between 2019 and 2021. Cox proportional hazards regression models were used to investigate the association between tobacco product use and hypertension. During a mean follow-up of 2.6 years (range: 0.1-4.0 years), 3656 new cases of hypertension were identified. Compared with never smokers, the risk of hypertension was higher among exclusive cigarette smokers [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.13-1.41] and exclusive HTP users (HR 1.19, 95% CI 1.06-1.34). There was also a suggestion of increased risk of hypertension among dual users (HR 1.16, 95% CI 0.98-1.38). Furthermore, the risk of hypertension increased with the intensity of cigarette/HTP use in all tobacco product users. Similarly, both cigarette smoking and HTP use elevate the risk of hypertension. HTPs should not be regarded as less harmful alternatives to traditional cigarettes for preventing hypertension.

Electronic Cigarette and Heated Tobacco Product Use and Their Association With Tobacco Control Factors Among Adults in Indonesia, Kazakhstan, and the Philippines.

Data on e-cigarette (EC) and heated tobacco product (HTP) use and the reasons for their use are useful for policy making. We report comparable nationally representative estimates of EC and HTP use and their associated factors. Global Adult Tobacco Survey data from Indonesia (2021), Kazakhstan (2019), and the Philippines (2021) were analyzed. The weighted prevalence rates and 95% CI of EC and HTP awareness, current use, and ever use, and their distribution by cigarette smoking status were calculated. Binary logistic regression analyses assessed socioeconomic, and tobacco control factors associated with EC and HTP use. The prevalence (%) of EC awareness, ever use and current use were 48.7-69.4, 3.6-8.8, and 1.9-3.0, respectively. The prevalence(%) of HTP awareness, ever use and current use were 2.7-21.7, 0.2-2.1, and 0.1-1.2, respectively. The main reasons for EC and HTP use were attractive flavors(45.8%-73.9%), less harmful than smoking(23.0%-70.1%), and enjoyment(40.8%-76.7%). Avoiding going back to smoking(0.9%-54.4%) and quitting smoking(19.4%-49.8%) were less frequently cited reasons (except in the Philippines). EC/HTP use was associated with younger age, higher education and wealth, current/past smoking, exposure to information about the dangers of tobacco use, and advertisements about tobacco products and smoke-free rules at home. The prevalence of EC and HTP use was higher among younger men with higher education and wealth, and current/past smoking. EC and HTP use should be closely monitored. Regulations to restrict the widespread marketing and sales of EC and HTP are needed to prevent the escalation of their use. The population-level data provide the benchmark for future monitoring use of e-cigarettes and HTPs and identify population subgroups for future surveillance in low- and middle-income countries. The association of EC/HTP use with tobacco control-related factors provides leads for policies that should be formulated and implemented to regulate the product contents, marketing, and sales of EC and HTP.

Urinary anatalline and nicotelline cut-points to distinguish between exclusive and dual use of tobacco products

Objective This study measured anatalline and nicotelline, two minor tobacco alkaloids, to discriminate between exclusive smokeless tobacco (SLT) use, exclusive electronic nicotine delivery systems (ENDS) use, exclusive cigarette use, dual SLT and cigarette use, and dual ENDS and cigarette use. Methods N = 664 urine samples from participants in the Population Assessment of Tobacco and Health Study were analyzed for anatalline and nicotelline. Geometric means and 95% confidence intervals were calculated for biomarker levels and their ratios. Non-parametric Receiver Operating Characteristic analyses were used to determine optimal cut-points of natural log-transformed biomarker ratios for distinguishing between tobacco use groups. Results The anatalline/nicotelline ratio distinguished exclusive cigarette from exclusive SLT use (threshold = 18.1, sensitivity = 89.3%, specificity = 86.4%, AUC = 0.90), and exclusive SLT from exclusive ENDS use (threshold = 12.8, sensitivity = 96.4%, specificity = 76.3%, AUC = 0.90) very well, but had reduced sensitivity and specificity when distinguishing exclusive cigarette from exclusive ENDS or any dual use with cigarettes. Conclusions This research fills a gap in understanding the public health consequences of SLT and ENDS use by providing objective measures that can signal use of these products alone or in combination with cigarettes.

A systematic review of predictors of vaping cessation among young people.

Understanding the factors influencing vaping cessation among young people is crucial for targeted interventions. This review aimed to summarize the individual and environmental factors that predict vaping cessation related behaviours in the young population. We systematically searched five databases for studies investigating predictors of vaping cessation behaviours among young people aged 10-35 years. Studies that examined predictors of cessation of cigarettes, other tobacco products, cannabis vaping, and studies evaluating efficacy of cessation interventions were excluded. Quality in Prognosis Studies tool was used to assess risk of bias. We found 24 studies analyzing predictors of intention to quit vaping (n=15), quit attempts (n=11), and vaping abstinence (n=7). Most studies had low risk of bias, except for study attrition. We identified 107 predictors and grouped them into 'probable', 'possible', 'insufficient evidence', 'probably unrelated', and 'inconsistent direction' categories. For 'probable' predictors, we found 11 for intention to quit, 8 for quit attempts and 5 for vaping abstinence. Overall, harm perception of vaping, current other tobacco products use, frequency of use, and level of nicotine dependence were common 'probable' predictors across three outcomes, with low harm perception of vaping, dual use, and poly tobacco use associated with decreased intention to quit and quit attempts in younger population (~10-19 years). Predictive modelling studies investigating vaping cessation related behaviours among young people is still limited. Future research should specifically study the natural history of vaping in youth in different jurisdictions, populations, and age groups to expand our knowledge on this area. We identified and categorized predictors of intention to quit vaping, quit attempts, and vaping abstinence among young people. While the 'probable' predictors can inform public health and policymakers to plan targeted vaping cessation programs for high-risk populations, raising public harm perception of vaping and encouraging to quit other tobacco products might increase intention to quit and quit attempts among younger population. However, the 'possible', 'insufficient evidence' and 'inconsistent direction' predictors needs further testing by future prospective longitudinal research. Additionally, we emphasized the significance of appropriate study designs, conducting research across various jurisdictions, and different population groups to obtain comprehensive insights.