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Mylocopos G, Wennberg E, Reiter A, Hébert-Losier A, Filion KB, Windle SB, Gore G, O'Loughlin JL, Grad R, Eisenberg MJ. Interventions for Preventing E-Cigarette Use Among Children and Youth: A Systematic Review. Am J Prev Med 2024; 66:351-370. [PMID: 37802308 DOI: 10.1016/j.amepre.2023.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Many nonregulatory interventions targeting children and youth have been implemented at three levels: directed at the individual (e.g., interactive video games), delivered to students at school (e.g., campus bans), and launched in the community (e.g., mass media campaigns). This systematic review aims to synthesize the evidence on the effectiveness of interventions aimed at preventing e-cigarette initiation among children and youth. METHODS MEDLINE, CINAHL, Embase, APA PsycINFO, and Web of Science Core Collection were searched for papers published between January 1, 2004 and September 1, 2022 that reported more than one outcome on vaping prevention among individuals aged less than 21-years-old: vaping prevalence/incidence, initiation intentions, knowledge/attitudes, and other tobacco product use prevalence/initiation intentions. Interventions were at the individual, school, or community level. The risk of bias was assessed using ROBINS-I and RoB 1. RESULTS Thirty-nine publications met the eligibility criteria. Fourteen individually-based (4 parental monitoring, 3 video games, 2 text messages, 3 graphic message themes, 2 healthcare), 19 school-based (14 educational and skill interventions, 5 vape-free policies/bans), and 6 community-based (3 social media, 3 mass media campaigns) interventions were reported. E-cigarette initiation prevention was observed with high perceived parental monitoring; however, the cross-sectional study designs precluded causal claims. There was promising but limited evidence that social-emotional skills curricula and peer leader programming prevented vaping initiation. DISCUSSION Some individual- and school-based interventions showed promise for preventing e-cigarette initiation among children and youth.
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Affiliation(s)
- Genevieve Mylocopos
- Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada; Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Erica Wennberg
- Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anna Reiter
- Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada; Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Andréa Hébert-Losier
- Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Kristian B Filion
- Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada; Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Sarah B Windle
- Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada
| | - Jennifer L O'Loughlin
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Roland Grad
- Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada; Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Mark J Eisenberg
- Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada; Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada.
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Najafi S, Mohammadkhah F, Harsini PA, Sohrabpour M, Jeihooni AK. Effect of educational intervention based on theory of planned behaviour on promoting preventive behaviours of oral cancer in rural women. BMC Womens Health 2023; 23:249. [PMID: 37161434 PMCID: PMC10170798 DOI: 10.1186/s12905-023-02411-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 05/03/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Oral cancer has created an alarming situation around the world, and being the 16th most common cancer worldwide, it has become a global concern. The present study aimed to investigate the effect of educational intervention based on a theory of planned behavior (TPB) on promoting preventive behaviors of oral cancer in rural women. METHODS This quasi-experimental study was conducted on 120 female hookah users referring to rural health centers in Fasa and Shiraz city, Fars province, Iran. The subjects were divided into experimental and control groups by simple random sampling. The educational intervention for the experimental group consisted of 8 training sessions of 50 min. Both groups completed a questionnaire including demographic characteristics and constructs of TPB before and four months after the educational intervention. Data were analyzed using SPSS 22 software through independent t-test, chi-square, and paired t-test (p = 0.05). RESULTS The mean age of the experimental and control group subjects were 41.12 ± 8.86 and 40.63 ± 9.62 years, respectively (p = 0.185). The mean age of onset of hookah use in the experimental and control group was 24.16 ± 9.50 and 23.35 ± 9.44 years, respectively (p = 0.182). Also, before the educational intervention, there was a significant difference between the experimental and control groups in terms of knowledge (p < 0.189), attitude (p < 0.122), perceived behavioral control (p < 0.142), subjective norms (p < 0.236), behavioral intention (p < 0.126), oral cancer prevention behaviors (p < 0.108) and nicotine dependence (p < 0.218); however, four months after the educational intervention, there was a significant increase in the experimental group in all variables except nicotine dependence (p < 0.005). CONCLUSION Due to the alarming situation of oral cancer and the prevalence of hookah use among women, educational programs based on TPB could effectively prevent hookah use and oral cancer.
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Affiliation(s)
- Siamak Najafi
- Department of Internal Medicine, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Fatemeh Mohammadkhah
- Department of Community health, child nursing and aging, Ramsar School of Nursing, Babol University of Medical Sciences, Babol, Iran
| | - Pooyan Afzali Harsini
- Department of Public Health, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mojtaba Sohrabpour
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Ali Khani Jeihooni
- Nutrition Research Center, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
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Non-Pharmacologic Approaches to Tobacco Cessation. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Little MA, Pebley K, Reid T, Morris JD, Wiseman KP. Rationale, design, and methods for the development of a youth adapted Brief Tobacco Intervention plus automated text messaging for high school students. Contemp Clin Trials 2022; 119:106840. [PMID: 35760339 PMCID: PMC10552657 DOI: 10.1016/j.cct.2022.106840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/31/2022] [Accepted: 06/21/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Tobacco use is increasing among youth in the U.S. The current study seeks to develop and pilot test a universal group-based Youth Brief Tobacco Intervention (Y-BTI) plus mobile phone automated text messaging (ATM) for 9th grade students to both prevent initiation among non-users and promote cessation among current users. METHODS This study will use a sequential, multi-method research design beginning with mixed methods formative work with 9th grade students to adapt the existing young adult Brief Tobacco Intervention (BTI) for youth and develop automated text messages. The formative work with students will identify salient themes and strategies for the interventions and optimal delivery schedules for the ATM intervention. The second phase of the study evaluates the Y-BTI and ATM through a pilot cluster randomized controlled trial that compares four treatment combinations: (1) Y-BTI + ATM, (2) Y-BTI alone, (3) ATM alone, or (4) standard of care. The Y-BTI is a single session, group-based intervention delivered in schools. The ATM intervention will provide comparable content to the Y-BTI but be delivered via text messaging 3-5 times per week for four weeks. CONCLUSION In order to curb the rise of tobacco use among youth, interventions that are easily implemented and disseminated need to be developed. We aim to build upon previous research by showing that a universal group-based Y-BTI and ATM are effective in reducing tobacco use among a 9th graders by preventing initiation among tobacco naïve youth and promoting cessation among current users.
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Affiliation(s)
- Melissa A Little
- University of Virginia School of Medicine, Department of Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA 22903, USA; University of Virginia Cancer Center, 1240 Lee St, Charlottesville, VA 22903, USA.
| | - Kinsey Pebley
- The University of Memphis, Department of Psychology, 400 Innovation Drive, Memphis, TN 38152, USA.
| | - Taylor Reid
- University of Virginia School of Medicine, Department of Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA 22903, USA; University of Virginia Cancer Center, 1240 Lee St, Charlottesville, VA 22903, USA.
| | - James Derek Morris
- The University of Memphis, Department of Psychology, 400 Innovation Drive, Memphis, TN 38152, USA.
| | - Kara P Wiseman
- University of Virginia School of Medicine, Department of Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA 22903, USA; University of Virginia Cancer Center, 1240 Lee St, Charlottesville, VA 22903, USA.
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Dadipoor S, Heyrani A, Mirzaei-Alavijeh M, Aghamolaei T, Ghaffari M, Ghanbarnejad A. Using intervention mapping for hookah smoking cessation: a quasi-experimental evaluation. Addict Sci Clin Pract 2022; 17:18. [PMID: 35287728 PMCID: PMC8919552 DOI: 10.1186/s13722-022-00287-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 01/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background The present study aimed to evaluate the results of a theory-based and systematic intervention on Hookah Tobacco Smoking (HTS) cessation in women local to Bandar Abbas, Iran. Methods In the present quasi-experimental research, we used an intervention mapping approach to develop, implement, and evaluate an education and training course as our intervention. Applying the results of a systematic review and two prior local qualitative studies, we identified six HTS determinants and set goals for the intervention. We selected 212 eligible women through systematic stratified random sampling and enrolled them in control and intervention groups. The course was presented to the intervention group in 17 sessions for four months. The educational material was developed to address the goals of the intervention, improve HTS determinants, and change the HTS behavior. We used a questionnaire to collect data on participants’ characteristics, HTS behavior, and detailed determinants of HTS in the control and intervention groups at the beginning of the study, at the end of the intervention, and at three- and six- months follow-up. All work done in the study was guided by ethical considerations. Results The results showed no significant difference between women enrolled in control and intervention groups regarding participants’ characteristics and HTS behavior. At baseline, there were no differences between groups for six determinants of HTS (knowledge, attitude, social norms, self-efficacy, habit, and intention). At the end of the intervention and at three and six months follow-up, the women in the intervention group had significantly better results in all six domains, compared with those in the control group. The rate of HTS abstinence at the end of the intervention and at the three- and six-month follow-ups was 61.3%, 48.5%, and 45.5% for the intervention and 16%, 14.4%, and 10% for the control groups, respectively. Conclusions HTS is a complicated behavior, and its cessation is hard. However, Intervention Mapping (IM) can be a powerful integrative, purposeful, theory-based, and participation-based method to reduce or cease HTS. This method should be tested in other settings. Trial registration: IRCT20190126042494N1, Registered 3.3.2019. https://en.irct.ir/trial/37129 Supplementary Information The online version contains supplementary material available at 10.1186/s13722-022-00287-5.
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Affiliation(s)
- Sakineh Dadipoor
- Tobacco and Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ali Heyrani
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi Mirzaei-Alavijeh
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Teamur Aghamolaei
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Mohtasham Ghaffari
- Environmental and Occupational Hazards Control Research Center, School of Public Health & Safety, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Amin Ghanbarnejad
- Department of Epidemiology And Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Little MA, Wang XQ, Fahey MC, Wiseman KP, Pebley K, Klesges RC, Talcott GW. Efficacy of a group-based brief tobacco intervention among young adults aged 18-20 years in the US Air Force. Tob Induc Dis 2021; 19:95. [PMID: 34963775 PMCID: PMC8653010 DOI: 10.18332/tid/143282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Most smokers begin using tobacco before the age of 25 years, making it important to reduce tobacco use during adolescence and early adulthood. Rates of use are historically higher among military personnel. While 'Tobacco 21' made it illegal for US retailers to sell tobacco to those aged <21 years, the policy did not address cessation for current youth and young adult tobacco users. Additionally, there is limited research on cessation interventions among young adults under 21 years. The current study evaluated the efficacy of a group-based Brief Tobacco Intervention (BTI) among US Air Force trainees, who are predominantly aged 18-20 years and directly impacted by Tobacco 21 legislation. METHODS Participants were 2969 US Air Force Trainees from April 2017 through January 2018 cluster randomized to three conditions: 1) BTI + Airman's Guide to Remaining Tobacco Free (AG), 2) AG alone, and 3) the National Cancer Institute's Clearing the Air (CTA) pamphlet. To assess the efficacy of the interventions among people aged 18-20 years, a domain analysis (<21 years, n=2117; and ≥21 years, n=852) of a multinomial logistic regression model was run. RESULTS Mono tobacco users aged <21 years at baseline who received the BTI+AG had higher odds of quitting tobacco at 3 months (OR=2.13; 95% CI: 1.02-4.46). Dual and poly users aged <21 years at baseline who received the BTI+AG intervention had higher odds of reducing the number of tobacco products used at 3 months (OR=2.94; 95% CI: 1.03-8.37). CONCLUSIONS The BTI was effective for people aged 18-20 years. The current study offers insight into components of interventions that might be successful in helping this age group decrease tobacco use.
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Affiliation(s)
- Melissa A. Little
- School of Medicine, University of Virginia, Charlottesville, United States
- University of Virginia Cancer Center, Charlottesville, United States
| | - Xin-Qun Wang
- School of Medicine, University of Virginia, Charlottesville, United States
| | - Margaret C. Fahey
- Department of Psychology, University of Memphis, Memphis, United States
| | - Kara P. Wiseman
- School of Medicine, University of Virginia, Charlottesville, United States
- University of Virginia Cancer Center, Charlottesville, United States
| | - Kinsey Pebley
- Department of Psychology, University of Memphis, Memphis, United States
| | - Robert C. Klesges
- School of Medicine, University of Virginia, Charlottesville, United States
- University of Virginia Cancer Center, Charlottesville, United States
| | - Gerald W. Talcott
- School of Medicine, University of Virginia, Charlottesville, United States
- University of Virginia Cancer Center, Charlottesville, United States
- Wilford Hall Ambulatory Surgical Center, 59th Medical Wing, Lackland, United States
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Krukowski RA, Porter K, Boothe T, Talcott GW, Little MA. "Nobody Views It As a Negative Thing to Smoke": A Qualitative Study of the Relationship Between United States Air Force Culture and Tobacco Use. MILITARY PSYCHOLOGY 2021; 33:409-416. [PMID: 34924692 PMCID: PMC8673782 DOI: 10.1080/08995605.2021.1962189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 05/20/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Tobacco use has long been a part of military culture, and rates of tobacco use remain higher among military personnel compared to civilians. The current study examines aspects of Air Force tobacco culture that encourage tobacco use. MATERIALS AND METHODS We conducted 7 focus groups among Air Force Military Training Leaders (n=48) and 5 focus groups among Technical Training Instructors (n=33) from July 2018 to February 2019. RESULTS Tobacco use was seen as a core part of Air Force culture and a low risk behavior, in contrast to other potential activities. Three themes of Air Force culture that facilitate tobacco use emerged: 1) opportunity for work breaks; 2) finding common ground; and 3) stress management or stress relief during deployment. Smoke pits were seen as serving several functions that were not perceived to occur anywhere else: an opportunity for informal communication with leadership, a source of valuable information, and a space for problem solving. CONCLUSIONS Airmen viewed tobacco as serving a functional role, which outweighed its harm. Future programs might try to address the functions fulfilled by tobacco in order to enhance their impact.
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Affiliation(s)
- Rebecca A. Krukowski
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kathleen Porter
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Tina Boothe
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
- Wilford Hall Ambulatory Surgical Center, Joint Base Lackland Air Force Base, San Antonio, Texas, USA
| | - G. Wayne Talcott
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
- Wilford Hall Ambulatory Surgical Center, Joint Base Lackland Air Force Base, San Antonio, Texas, USA
| | - Melissa A. Little
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
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Williams MA, Reddy G, Quinn MJ, Millikan Bell A. Toxicological assessment of electronic cigarette vaping: an emerging threat to force health, readiness and resilience in the U.S. Army. Drug Chem Toxicol 2021; 45:2049-2085. [PMID: 33906535 DOI: 10.1080/01480545.2021.1905657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The U.S. Army and U. S. Army Public Health Center are dedicated to protecting the health, and readiness of Department of the Army Service Members, civilians, and contractors. Despite implementation of health programs, policies and tobacco control interventions, the advent of electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigs), represent unregulated and poorly defined systems to supplant or substitute use of conventional nicotine products (e.g., cigarettes and pipe tobacco). E-cigs present unique challenges to healthcare officials vested in preventive medicine. The health impact of an e-cig and vaping on an individual's acute or chronic disease susceptibility, performance and wellness, is fraught with uncertainty. Given the relatively recent emergence of e-cigs, high-quality epidemiological studies, and applied biological research studies are severely lacking. In sparsely available epidemiological studies of short-term cardiovascular and respiratory health outcomes, any attempt at addressing the etiology of acute and chronic health conditions from e-cig use faces incredible challenges. Until relatively recently, this was complicated by an absent national regulatory framework and health agency guidance on the manufacture, distribution, selling and use of e-cigs or similar ENDS devices and their chemical constituents. Two key issues underpin public health concern from e-cig use: 1) continued or emergent nicotine addiction and potential use of these devices for vaping controlled substances; and 2) inadvertent sudden-onset or chronic health effects from inhalational exposure to low levels of complex chemical toxicants from e-cig use and vaping the liquid. Herein, the health impacts from e-cig vaping and research supporting such effects are discussed.
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Affiliation(s)
- Marc A Williams
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Gunda Reddy
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Michael J Quinn
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Amy Millikan Bell
- Office of the Director - Medical Advisor, U.S. Army Public Health Center, Aberdeen Proving Ground, USA
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Ross CP, Lin J, Hefner K, Waters AJ. Use of electronic cigarettes in the United States service member and Veteran populations: A narrative review (2019). MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1897493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Charles P. Ross
- Department of Medical and Clinical Psychology, Uniformed Services University of Health Sciences (USUHS), Bethesda, Maryland
| | - Jie Lin
- Murtha Cancer Center Research Program, USU Walter Reed Surgery, Uniformed Services University of Health Sciences (USUHS), Bethesda, Maryland
| | - Kathryn Hefner
- National Institute on Drug Abuse (NIDA) Data and Statistics Center, The Emmes Company, Rockville, Maryland
| | - Andrew J. Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of Health Sciences (USUHS), Bethesda, Maryland
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Babaie J, Ahmadi A, Abdollahi G, Doshmangir L. Preventing and controlling water pipe smoking: a systematic review of management interventions. BMC Public Health 2021; 21:344. [PMID: 33632181 PMCID: PMC7908788 DOI: 10.1186/s12889-021-10306-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/21/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Water pipe smoking (WPS) is re-gaining widespread use and popularity among various groups of people, especially adolescents. Despite different adverse health effects of WPS, many of the WPS interventions have failed to control this type of tobacco smoking. This study was conducted to identify experienced management interventions in preventing and controlling WPS worldwide. METHODS A systematic literature review was conducted. Electronic databases were searched for recordes which were published from beginning 1990 to August 2018. Studies aiming at evaluating, at least, one intervention in preventing and controlling WPS were included in this review, followed by performing the quality assessment and data extraction of eligible studies by two independent investigators. Finally, interventions that were identified from the content analysis process were discussed and classified into relevant categories. RESULTS After deleting duplications, 2228 out of 4343 retrieved records remained and 38 studies were selected as the main corpus of the present study. Then, the identified 27 interventions were grouped into four main categories including preventive (5, 18.51%) and control (8, 29.62%) interventions, as well as the enactment and implementation of legislations and policies for controlling WPS at national (7, 25.92%) and international (7, 25.92%) levels. CONCLUSION The current enforced legislations for preventing and controlling WPS are not supported by rigorous evidence. Informed school-based interventions, especially among adolescents can lead to promising results in preventing and controlling WPS and decreasing the effects of this important social and health crisis in the global arena.
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Affiliation(s)
- Javad Babaie
- Department of Health Policy& Management, Tabriz Health Services Management Research Centre, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ayat Ahmadi
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Abdollahi
- Department of Health Policy& Management, Tabriz Health Services Management Research Centre, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Doshmangir
- Department of Health Policy& Management, Tabriz Health Services Management Research Centre, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Little MA, Fahey MC, Klesges RC, McMurry T, Talcott GW. Evaluating the Effects of a Brief Tobacco Intervention in the US Air Force. Nicotine Tob Res 2020; 22:1569-1577. [PMID: 31903494 DOI: 10.1093/ntr/ntaa001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/02/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Military personnel have among the highest rates of tobacco use in the United States. Unfortunately, there are few interventions aimed at reducing tobacco use among this vulnerable population. The current study addresses this need by evaluating the short-term effectiveness of a Brief Tobacco Intervention (BTI), a 40-min group-based intervention designed to reduce contemporary patterns of tobacco use among a sample of US military enlistees during an 11-week period of involuntary tobacco abstinence. AIMS AND METHODS Participants were 2999 US Air Force Technical Trainees at Joint Base San Antonio-Lackland Air Force Base in San Antonio, Texas from April 2017 through January 2018. Participants were cluster randomized to three conditions: (1) BTI + Airman's Guide to Remaining Tobacco Free (AG), (2) AG intervention, or (3) standard smoking cessation intervention. The primary analysis was a comparison of the interventions' efficacies in preventing tobacco use during Technical Training, conducted using a generalized estimating equations logistic regression model controlling for covariates. Multiple imputation was used to account for loss to follow-up. RESULTS There was not a significant difference by condition in the use of tobacco products at follow-up (p = .454). The BTI + AG condition did produce short-term changes in perceived harm, intentions to use tobacco, knowledge about tobacco products, and normative beliefs. CONCLUSIONS These findings suggest that while the intervention was effective in the short term, it was not potent enough over a 12-week period to prevent Airmen from initiating tobacco use. Future studies should examine whether adding a booster session or media campaign enhances the effectiveness of the intervention. IMPLICATIONS Despite the fact that most Airmen believe they will remain tobacco free following the ban in Technical Training, a large percentage of these Airmen resume and initiate tobacco use during this high-risk period. As a result, there is a need for interventions targeting the range of tobacco available to military trainees during a teachable moment when they report intentions to remain tobacco free. The current study shows that a BTI has promise in reducing long-term tobacco use, when coupled with additional interventions, such as a booster session or a media campaign.
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Affiliation(s)
- Melissa A Little
- Center for Addiction and Prevention Research, University of Virginia School of Medicine, Charlottesville, VA.,Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland AFB, TX
| | | | - Robert C Klesges
- Center for Addiction and Prevention Research, University of Virginia School of Medicine, Charlottesville, VA
| | - Timothy McMurry
- Center for Addiction and Prevention Research, University of Virginia School of Medicine, Charlottesville, VA
| | - Gerald W Talcott
- Center for Addiction and Prevention Research, University of Virginia School of Medicine, Charlottesville, VA.,Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland AFB, TX
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Little M, Ebbert JO, Krukowski RA, Halbert J, Kalpinski MR, Patten CA, Talcott GW, Klesges RC. Factors Associated with Cigarette Use During Airmen's First Year of Service in the United States Air Force. Mil Med 2020; 185:e212-e220. [PMID: 31287888 PMCID: PMC7526858 DOI: 10.1093/milmed/usz155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/18/2019] [Accepted: 06/07/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Despite declines of cigarette use in the civilian population, military personnel report alarmingly high rates of cigarette use. Enlisted Air Force recruits are required to remain tobacco-free for the first 12 weeks of training, and the majority express confidence they will not use tobacco after the ban; however, most previous smokers return to smoking and many nonsmokers initiate. Understanding the factors associated with cigarette-smoking initiation among non-users and re-initiation among former users is critical for the development of successful tobacco control efforts. MATERIALS AND METHODS The current study examines predictors of cigarette smoking among a sample of 2,188 USAF personnel after their first year of service. Logistic regression analyses examined associations between baseline predictors and initiation and re-initiation of cigarette smoking at a one-year follow-up. RESULTS Compared to never smokers at both time points, the strongest predictor of smoking initiation over the past 12 months was having owned cigarette-branded merchandise (OR 3.81, 95% CI 1.67, 8.71). Compared to former smokers who remained abstinent, the strongest predictor of re-initiation was intention to use tobacco (OR 2.08, 95% CI 1.53, 2.83). Compared to individuals who initiate, the strongest predictors of re-initiation were prior use of other tobacco products and tobacco use intentions (ORs range 1.85 to 4.63). CONCLUSIONS Multiple risk factors are associated with tobacco use. Given that Airmen are tobacco-free for the first 12 weeks of training, tobacco interventions during this period might be more effective. Our findings can be used to tailor interventions to prevent tobacco use in the U.S. military.
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Affiliation(s)
- Melissa Little
- Center for Addiction and Prevention Research, University of Virginia Medical School, 59 MDW/ 59 SGOWMP, 1100 Wilford Hall Loop, Bldg 4554, Joint Base Lackland AFB, TX 78236
| | - Jon O Ebbert
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Rebecca A Krukowski
- University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163-2181
| | - Jennifer Halbert
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, 560 Ray C. Hunt Drive, PO Box 800717, Charlottesville, VA 22908
| | | | | | - Gerald W Talcott
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, 2200 Bergquist Dr Ste 1, Joint Base Lackland AFB, TX 78236
| | - Robert C Klesges
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, 560 Ray C. Hunt Drive, PO Box 800717, Charlottesville, VA 22908
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Dunkle A, Kalpinski R, Ebbert J, Talcott W, Klesges R, Little MA. Predicting smokeless tobacco initiation and re-initiation in the United States Air Force. Addict Behav Rep 2019; 9:100142. [PMID: 31193918 PMCID: PMC6544562 DOI: 10.1016/j.abrep.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 10/18/2018] [Accepted: 11/02/2018] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Active Duty United States Air Force (USAF) members have substantially higher rates of smokeless tobacco (ST) use than the general population. METHODS We longitudinally assessed demographics, tobacco use, intrapersonal factors, and interpersonal factors to determine associations with the initiation or re-initiation of ST in the year following a period of forced abstinence among 2188 newly recruited Airmen. Logistic regression analyses were conducted to examine associations between baseline predictors and ST use at one-year follow-up. RESULTS In the final multivariate models compared to never users, the strongest predictors of ST use initiation after BMT were male gender (adjusted OR 8.93, 95% CI 3.82, 20.88), pre-BMT cigarette and cigar use (adjusted OR 1.60, 95% CI 1.00, 2.57; adjusted OR 2.50, 95% CI 1.66, 3.81 respectively). Compared to former ST users, the strongest predictors of re-initiation were male gender (adjusted OR 10.68, 95% CI 2.25, 50.62) and intentions to use ST (adjusted OR 2.10, 95% CI 1.42, 3.12). Compared to initiators of ST, the strongest predictors of re-initiation were intentions to use ST and peer use (adjusted OR 3.26, 95% CI 1.94, 5.49; OR 2.55, 95% CI 1.92, 3.41 respectively). CONCLUSIONS Our results suggest that initiators may be exploring and viewing ST as a less harmful alternative to cigarette smoking and ST users reporting intentions to use ST in the future often return to use. The development of interventions able to disrupt the link between intentions to use tobacco and future tobacco use in the USAF is vital.
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Affiliation(s)
- Andrew Dunkle
- Wilford Hall Ambulatory Surgical Center, United States of America
| | - Ryan Kalpinski
- Wilford Hall Ambulatory Surgical Center, United States of America
| | - Jon Ebbert
- Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Wayne Talcott
- University of Virginia, School of Medicine, Department of Public Health Sciences, United States of America
| | - Robert Klesges
- University of Virginia, School of Medicine, Department of Public Health Sciences, United States of America
| | - Melissa A. Little
- University of Virginia, School of Medicine, Department of Public Health Sciences, United States of America
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Little MA, Ebbert JO, Krukowski RA, Halbert JP, Kalpinski R, Patten CA, Boothe TL, Pasker CK, Klesges RC, Talcott GW. Predicting cigarette initiation and reinitiation among active duty United States Air Force recruits. Subst Abus 2019; 40:340-343. [PMID: 30883297 DOI: 10.1080/08897077.2019.1577678] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The first year of military service in the United States Air Force (USAF) is a high-risk time for tobacco use. Previous studies have demonstrated the effectiveness of a tobacco ban during Basic Military Training (BMT). However, no studies have examined the effect of increasing the protracted ban for an additional 4 weeks. Understanding the patterns of initiation and reinitiation following the protracted ban will inform future intervention and policy efforts. Methods: The current study examines patterns of cigarette smoking among a sample of 2188 USAF personnel at baseline and after their first year of service. Results: One year after BMT, we observed that 65.0% of USAF enlistees remained never smokers, 9.6% remained abstinence from cigarettes, 9.3% initiated cigarette smoking, and 16.1% reinitiated cigarette smoking. Despite the extended tobacco ban in BMT and Technical Training, 12.6% of individual who never smoked initiated cigarette smoking and 62.6% of individuals who formerly smoked reinitiated. Over half (54.2%) of Airmen who reported smoking cigarettes at follow-up reported initiating or reinitiating during Technical Training. Conclusions: Our findings indicate that although the increased ban prevents additional individuals who smoked cigarettes prior to joining the Air Force from reinitiating, it has no effect on initiation among individuals who report never using prior to military service. Additional research is needed to understand what may be leading to these high rates of initiation and reinitiation in Technical Training following the ban.
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Affiliation(s)
- Melissa A Little
- Center for Addiction and Prevention Research, University of Virginia Medical School, Joint Base San Antonio-Lackland, Texas, USA
| | | | - Rebecca A Krukowski
- Department of Internal Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Jennifer P Halbert
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, Charlottesville, Virginia, USA
| | - Ryan Kalpinski
- United States Air Force, Joint Base San Antonio-Lackland, Texas, USA
| | | | - Tina L Boothe
- United States Air Force, Joint Base San Antonio-Lackland, Texas, USA
| | - Christin K Pasker
- United States Air Force, Joint Base San Antonio-Lackland, Texas, USA
| | - Robert C Klesges
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, Charlottesville, Virginia, USA
| | - Gerald W Talcott
- United States Air Force, Joint Base San Antonio-Lackland, Texas, USA
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Bursac Z, Klesges RC, Little MA, Linde BD, Popova L, Kaplan CM, Talcott GW. The comparative effectiveness of two brief tobacco interventions in the U.S. Air Force: Perceived harm and intentions-to-use of tobacco products. Tob Induc Dis 2018; 16:26. [PMID: 31516426 PMCID: PMC6659509 DOI: 10.18332/tid/87142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Brief health prevention programs have been shown efficacious in prevention of tobacco use initiation and re-initiation in the US Air Force. In this manuscript we apply a comparative effectiveness assessment of two published studies, based on testing the equality of effect sizes for perceived harm and intentions-to-use for five tobacco products. METHODS We calculate and compare the effect sizes from the brief tobacco intervention (BTI) study (N=1055) with those of the anti-tobacco media campaign (MEDIA) study (N=665), for perceived harm and intentions-to-use of cigarettes, smokeless tobacco, cigarillos, e-cigarettes and hookah, among Airmen in the US Air Force Technical Training. Univariate and multivariate parametric and non-parametric methods and models were applied to compare the outcomes between the interventions. In addition, we calculate and report the cost of each intervention per Airman. RESULTS Effect sizes for perceived harm were 0.24–0.99 for BTI and 0.17–0.33 for MEDIA, while intentions-to-use effect sizes were 0.14–0.34 for BTI and 0.01– 0.07 for MEDIA, depending on the product. BTI intervention effects sizes were significantly greater than MEDIA intervention for all products, mainly among past users, and for both perceived harm (all p<0.0001) and intentions-to-use (all p<0.01). Cost per Airmen was comparable between the two interventions, $14.90 for BTI and $16.52 for MEDIA. CONCLUSIONS Direct comparison suggests that BTI produced effect sizes of significantly higher magnitude in the desired direction for perceived harm and intentions-to-use, for five tobacco products most commonly used by the Airmen, and mainly among past users.
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Affiliation(s)
- Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, United States
| | - Robert C Klesges
- Center for Addiction and Prevention Research, Department of Public Health Sciences, University of Virginia, Charlottesville, United States
| | - Melissa A Little
- Center for Addiction and Prevention Research, Department of Public Health Sciences, University of Virginia, Charlottesville, United States
| | - Brittany D Linde
- Organizational Wellness and Learning Systems, Fort Worth, United States
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, United States
| | - Cameron M Kaplan
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, United States
| | - Gerald W Talcott
- Center for Addiction and Prevention Research, Department of Public Health Sciences, University of Virginia, Charlottesville, United States
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Haibach JP, Haibach MA, Hall KS, Masheb RM, Little MA, Shepardson RL, Dobmeyer AC, Funderburk JS, Hunter CL, Dundon M, Hausmann LR, Trynosky SK, Goodrich DE, Kilbourne AM, Knight SJ, Talcott GW, Goldstein MG. Military and veteran health behavior research and practice: challenges and opportunities. J Behav Med 2016; 40:175-193. [DOI: 10.1007/s10865-016-9794-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 09/09/2016] [Indexed: 12/01/2022]
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