Adolescent and young adult tobacco prevention and cessation: current status and future directions

Smartphone Apps Targeting Youth Tobacco Use Prevention and Cessation: An Assessment of Credibility and Quality

Purpose of Review

The goals of this study were to identify smartphone apps targeting youth tobacco use prevention and/or cessation discussed in the academic literature and/or available in the Apple App Store and to review and rate the credibility of the apps. We took a multiphase approach in a non-systematic review that involved conducting parallel literature and App Store searches, screening the returned literature and apps for inclusion, characterizing the studies and apps, and evaluating app quality using a standardized rating scale.

Recent Findings

The negative consequences of youth tobacco use initiation are profound and far-reaching. Half of the youth who use nicotine want to quit, but quit rates are low. The integration of smartphone apps shows promise in complementing and enhancing evidence-based youth tobacco prevention and treatment methods.

Summary

Consistent with prior reviews, we identified a disconnect between apps that are readily accessible and those that have an evidence base, and many popular apps received low quality scores. Findings suggest a need for better integration between evidence-based and popular, available apps targeting youth tobacco use.

Transitions in risk-behavior profiles among first-year college students

ObjectiveThe current study utilized a longitudinal person-centered approach (latent transition analysis [LTA]) to assess transitions into and out of risk-behavior profiles during the transition into and throughout the first year of college. Participants: Participants included 579 first-year college students (Mage = 18.13, SD = .94) from a large mid-Atlantic university. Methods: Participants completed surveys at five points throughout their freshman year. Results: LTA suggested that most individuals either abstained from engaging in risk behaviors or transitioned toward profiles of less risk over time. A smaller portion of individuals either began and ended the year in the same risk profile or transitioned into profiles of greater risk. Conclusions: The findings highlight the importance of utilizing person-centered analyses to examine change in multiple health-risk behaviors.

Development and Reach of the Stanford Tobacco Prevention Toolkit: Implementation of a Community-Based Participatory Approach

BACKGROUND

We developed the Tobacco Prevention Toolkit (Toolkit) to enhance the impact of school-based tobacco education. This study describes the process of developing the Toolkit, its contents, and reach.

METHODS

Qualitative community-based participatory research (CBPR), including focus group discussions (N = 152) and working groups with parents, educators, researchers, and youth (N = 87) were used to develop the Toolkit and design its implementation. Toolkit reach was assessed through number of trained educators using the Toolkit, estimated number of youth recipients of the Toolkit resources, and using Google Analytics for online engagement.

RESULTS

The Toolkit is a free, online resource aimed at preventing tobacco use by middle and high school students. Toolkit content addresses varied forms of tobacco including electronic cigarettes, hookah, smokeless tobacco, and cigarettes; addiction; and positive youth development; and is available in multiple interactive formats such as real-time quizzes, factsheets, activities, and presentations. The Toolkit is mainly delivered by trained educators, who adapt its content and duration to tailor their drug prevention teaching to student needs. As of April 2020, when data for this paper were collected, 4,750 educators have reached an estimated 1.3 million youth. The Toolkit website has 186,116 users and 802,602 page views, growing steadily since 2016. As of August 2021, additional students have been reached, for now a total of 1.85 million students reached.

CONCLUSION

The Toolkit resources are evidence-based, comprehensive, responsive, interactive, easily accessible, and flexible. Applying CBPR was instrumental in developing the Toolkit and expanding its reach.

Health promotion through youth empowerment to prevent and control smoking behavior: a conceptual paper

Purpose

This paper aimed to review globally the empowerment programs for the prevention and control of smoking behavior among youths, to examine the role of empowerment in health promotion, to explore the stages of health promotion through community empowerment strategies including planning, implementation and evaluation. Finally, this paper will develop a model of youth empowerment to prevent and control smoking behavior that reflects theory and experience drawn from the literature.

Design/methodology/approach

This review synthesized articles on community empowerment and health promotion, youth empowerment programs for tobacco prevention and control globally from books and electronic databases from the Universitas Gadjah Mada (UGM) library in the publication period 2000–2020. Relevant literature was selected and critically reviewed which reflected the role empowerment in health promotion, stage of community empowerment strategy as described by Laverack and youth empowerment concept in tobacco control as described by Holden.

Findings

Documents that specifically discuss empowerment programs for smoking prevention and control are still limited. The findings document that youth empowerment in tobacco control do not fully integrate the theory empowerment as described by Laverack and Holden. This paper provides information about the stages of youth empowerment, and a conceptual framework of youth empowerment for the prevention and control of smoking behavior. Youth empowerment is done through the direct involvement of youth in programs starting from program design, planning, implementation and evaluation. Indicators of the success of the empowerment process are reflected in the increase in the empowerment domain. Meanwhile, the output of empowerment can be seen from the individual- or group-level changes.

Originality/value

This paper proposes a model of youth empowerment for the prevention and control of smoking behavior among youths based on theory and experience in the field.

School-based e-cigarette education in Alabama: Impact on knowledge of e-cigarettes, perceptions and intent to try

BACKGROUND AND OBJECTIVES

Educational programs are needed to combat the sharp rise in adolescent e-cigarette use. We assessed adolescent knowledge about e-cigarettes, perceptions of harmfulness and addictiveness and intent to try e-cigarettes before and after an e-cigarette educational session.

METHODS

We conducted a one-group pre- and post-test study among middle and high school students in Alabama in 2019. The intervention included a 30-minute educational session based on the Stanford Tobacco Prevention Toolkit on e-cigarette types, contents, marketing and advertising, health effects and nicotine addiction. McNemar tests of paired proportions and multi-level, mixed-effects logistic regression models were used to analyze intervention effects.

RESULTS

Surveys were completed by 2,889 middle and high school students. The intervention was associated with significantly increased knowledge about e-cigarettes and perceptions that e-cigarettes are harmful and addictive, and with significantly lower intent to try e-cigarettes. At pre-test, middle school students had lower knowledge, believed that e-cigarettes were not as addictive and showed higher intent to try both e-cigarettes and cigarettes compared to high school students. Groups that were associated with lower perceived harmfulness and addictiveness were: ever-users of e-cigarettes, ever-users of both e-cigarettes and cigarettes and prior users of mint/menthol flavored e-cigarettes.

CONCLUSIONS

A school-based educational session was significantly associated with improved adolescent knowledge about e-cigarettes, increased the perceived harmfulness and addictiveness of e-cigarettes, and reduced intent to try e-cigarettes. E-cigarette education should be prioritized for middle school students due to lower levels of knowledge and higher intent to try tobacco compared to high school students.

Developing a framework for youth empowerment to prevent smoking behavior in a rural setting: study protocol for a participatory action research

Purpose

There is limited research examining community-based youth empowerment that addresses smoking prevention in the rural Indonesian context. This paper describes participatory action research (PAR) applied to develop a framework for empowering youth aged 17–25 years toward smoking prevention. This research conducted in the Indonesian rural community setting was divided into four stages: diagnosing, planning action, taking action and evaluating action.

Design/methodology/approach

PAR was chosen as the approach to developing a framework for youth empowerment in smoking prevention programs. In this study, the PAR cycle started with a prestep stage through interviews with village heads, community leaders, youth organization organizers, observations of target resources and observations of participation in youth activities as well as forming teamwork with target participants. The diagnosis stage consists of three activities, that is, focus group discussions with youth groups of male and female, youth assessment of empowerment domains through the Participatory Rural Appraisal (PRA) with the Empowerment Assessment Rating Scale (EARS) and measuring individual and group involvement levels related to the smoking behavior prevention program by questionnaire. The EARS assessment results were presented in the action planning stage, followed by a discussion on youth empowerment plans and strategies. In the action stage, activities and programs are planned according to the planning discussion, that is: training in healthy life skills (outbound and training) and initiating youth health programs without smoking called “Remaja Berdaya Sehat Tanpa Rokok” (Empowered Youth Healthy Without Smoking) or the JayaStar Program. After these community participation activities, the evaluating action stage will assess the empowerment domain in the youth groups, conduct focus group discussions with parents, evaluate the impact of empowerment on individual and group changes with a questionnaire and facilitate self-reflection by the youth community called Madiska.

Findings

This protocol describes a doctoral research project on developing a youth empowerment framework in smoking prevention programs through PAR. The intended study will provide valuable information on the planning, implementation and evaluation of youth empowerment in the prevention of smoking behavior.

Originality/value

This research project is expected to contribute to the literature relating to PAR for rural settings and the use of empowerment strategies to prevent youth smoking behavior. The results can be replicated in the same settings, but the process of empowerment must still be adapted to the characteristics and local wisdom of the community.

Adolescent Tobacco Exposure in 31 Latin American Cities before and after the Framework Convention for Tobacco Control

Our objective was to describe the prevalence and changes in tobacco use and tobacco control policies in Latin American countries and cities before and after ratification of the 2003 Framework Convention on Tobacco Control (FCTC). Country-level tobacco policy data came from reports on the global tobacco epidemic (World Health Organization, 2007-2014). Global Youth Tobacco Survey data, 2000-2011, came from six countries (Argentina, Brazil, Chile, Colombia, Mexico, Peru), 31 cities and 132,065 students. Pre- and post-FCTC prevalence and relative changes were estimated. All countries showed improvements in tobacco control policies but Mexico and Peru showed the smallest improvements. In general, adolescents reduced their tobacco use, reported less exposure to smoking at home, more tobacco education, and more retailer refusals to sell them cigarettes. Adolescents reported smaller reductions in secondhand smoke exposure outside the home and no change in exposure to tobacco media/promotions. Pre-FCTC prevalence and relative changes during the post-FCTC period were more heterogeneous across cities than across countries. Despite overall improvements in tobacco policies and the decline in exposure to tobacco, policies related to media/promotions and secondhand smoke need strengthening. There was wide variation in adolescent exposure to tobacco between cities (within countries), which suggested major heterogeneity of policy implementation at the local level.

Smoking Social Norms Among Young Adults in New York City

More than half of young adult (YA) (ages 18-26) smokers are non-daily smokers. While standard cessation methods are generally successful with adults and daily smokers, there is evidence that they are not as successful among non-daily smokers or young adults. Additionally, YA smokers are also in a transition period to regular smoking, making research on understanding how interpersonal and environmental factors affect this group of smokers critical. Randomized time location sampling was used to create a sample of New York City YA bar patrons between June and November 2013, who completed a self-administered survey (1,916 surveys). Questions were asked about perceived smoking social norms, stigma, behaviors, and demographics. Overall, almost half of the YA reported being current smokers (44.1%); one-third were non-daily smokers (36.7%) and less than ten percent were daily smokers (7.4%). Non-daily smokers compared with daily smokers had greater odds of believing New Yorkers disapproved of smoking [adjusted odds ratio (OR_adj 1.76, 95 % CI 1.10-2.79)], keeping tobacco a secret from certain people (OR_adj 1.84, 1.14-2.96) and feeling guilty when smoking (OR_adj: 2.54; 1.45-4.45). Non-daily smokers had 41% lower odds of reporting how people who are important to you disapproved of smoking than daily smokers (OR_adj: 0.59; 0.38-0.94). Further studies of interpersonal/environmental factors among YA smokers may support modifications to cessation programs that result in more successful YA quit attempts.

The association between new graphic health warning labels on tobacco products and attitudes toward smoking among south Korean adolescents: a national cross-sectional study

BACKGROUND

Graphic health warning labels (GHWLs) on tobacco products are more effective than text warnings for communicating the risk of smoking. The implementation of GHWLs can prevent adolescents from initiating smoking. Therefore, this study examined the association between GHWLs newly implemented on December 23, 2016, in South Korea and attitudes toward smoking among adolescents.

METHODS

This post-implementation cross-sectional analysis examined the responses of 62,276 students (31,624 boys and 30,652 girls) who participated in the 2017 Web-based Korean Youth Risk Behavior Survey, which was completed anonymously as a self-administered questionnaire by middle and high school students. Multinomial logistic regression was applied to explore the attitudes toward smoking among the youth (13-18 years old) who have been exposed to GHWLs in order to identify relationship of exposure to the GHWLs with smoking initiation and awareness of the danger of smoking.

RESULTS

Six months after implementation, 69.4% of adolescents reported having been exposed to GHWLs in the previous 30 days. Among those exposed to GHWLs both boys and girls in grade 7 were significantly more likely than grade 12 high school students to decide not to start smoking (boys: AOR = 3.96, 95% CI 3.31-4.75, p < 0.001; girls: AOR = 2.76, 95% CI 2.32-3.30, p < 0.001) and to think that smoking was dangerous to their health (boys: AOR = 3.01, 95% CI 2.52-3.58, p < 0.001; girls: AOR = 2.42, 95% CI 2.03-3.88, p < 0.001) after seeing GHWLs. These associations were greater for adolescents who had experienced smoking-prevention education or had been exposed to anti-tobacco advertisements. However, those who smoked, used e-cigarettes, or experienced secondhand smoking were significantly less likely to decide not to smoke and to view smoking as dangerous.

CONCLUSIONS

To maintain the perception of the harm of tobacco from childhood through adolescence, the government should implement both comprehensive tobacco controls, including smoking-prevention education in schools, and measures to encourage a smoke-free environment in homes.

Demographics and medical disorders associated with smoking: a population-based study

Background

Few studies have investigated factors associated with smoking behaviors. In this population-based study, we investigated demographics and medical comorbid diseases to establish a prediction model for smoking behaviors by using the National Health Interview Survey (NHIS) and National Health Insurance Research Database (NHIRD).

Methods

We enrolled individuals aged ≥40 years who had participated in the NHIS in 2001, 2005, and 2009. We identified the smoking behaviors of the study participants in the NHIS. Smoking behaviors were divided into ever smokers (current smokers and ex-smokers) and nonsmokers (never smokers).We defined medical comorbid disorders of the study participants by using medical claim data from the NHIRD. We used multivariable logistic regression models to calculate the adjusted odds ratio and 95% confidence interval for variables associated with smoking. The significant variables in the multivariable model were included in the receiver operating characteristic curves (ROC) to predict the sensitivity and specificity of the model.

Results

In total, 26,375 participants (12,779 men and 13,596 women) were included in the analysis. The prevalence of smoking was 39.29%. The mean ages of the 16,012 nonsmokers were higher than those of the 10,363 smokers (57.86 ± 12.92 years vs. 53.59 ± 10.82 years). Men outnumbered women among smokers (68.18% vs. 31.82%). Male sex, young age and middle age, being insured categories, residence in suburban areas, and chronic obstructive pulmonary disease (COPD) were independent factors associated with smoking. The area under the ROC curve of these significant factors to predict smoking behaviors was 71.63%.

Conclusion

Sex, age, insured categories, residence in suburban areas, and COPD were associated with smoking in people.

Patterns of Tobacco Use and Related Protective Factors Among Somali Youth in the United States

Anti-smoking norms and educational aspirations are established tobacco prevention targets for general United States (U.S.) adolescent populations but protective factors remain poorly characterized for Somali-American youth. Here we describe patterns of past 30-day tobacco use and associated protective factors among eighth, ninth, and eleventh grade Somali adolescent respondents (n = 2009) to the 2016 Minnesota Student Survey using multivariate logistic regressions. E-cigarette (5.7%) and hookah (5.0%) use were most prevalent. Male youth reported higher levels of tobacco use across products. Adjusted odds ratios showed that internal developmental assets (e.g., e-cigarettes aOR 0.37, 95% CI 0.37, 0.79) and parental anti-smoking norms (e.g., e-cigarettes aOR 0.19, 95% CI 0.09, 0.38) protected against use of all tobacco products. E-cigarettes and hookah are prevalent among U.S. Somali youth, highlighting the need for prevention efforts that address emerging tobacco products and leverage protective factors such as internal assets and parental anti-smoking norms.

Study protocol of the X:IT II - a school-based smoking preventive intervention

BACKGROUND

The X:IT intervention, conducted in 2010 to 2013, showed overall smoking preventive effect. However, parts of the intervention appeared less appealing to children from families with lower socioeconomic backgrounds. Therefore, the intervention components were modified and an evaluation of the amended intervention X:IT II is needed to show the effect of this revised intervention and whether children from different social backgrounds benefits equally from the current intervention.

METHODS

Main intervention components are smoke free schools, a curricular component, and parental involvement (smoke free agreements and talks about tobacco). Components have been revised from the first version; 1) previously, schools should be smoke free on the school ground and were encouraged to hide smoking so that it wasn't visible to pupils from the school ground. Now they are encouraged to tighten the rules so that no pupils or teachers smoke during the school day, no matter where they are; 2) the specifically developed educational material (Up in Smoke) has been revised so that all materials are online and all texts has a ARI; 3) the parental involvement is now targeted multiple groups of parents, e.g. parents that are smokers, and parents of children that smoke. Language used is simpler and the website for parents presents very specific examples. X:IT is implemented in 46 Danish public schools from fall 2017 until summer 2020. Data is collected through electronic questionnaires to students and coordinators four times (fall 2017, spring/summer 2018, 2019 and 2020). Further, qualitative interviews and observations are conducted.

DISCUSSION

Prevalence of smoking among Danish adolescents is high compared to other Nordic countries and there is social inequality in smoking, leaving individuals from the lowest social backgrounds at higher risk. Although there has been an overall decline in smoking among Danish adolescents over the last decades, a recent levelling of this development indicates an urgent need for smoking prevention in Denmark. The X:IT intervention has the potential to prevent uptake of smoking among adolescents. However, there is a particular need for evaluating the effectiveness of the revised X:IT intervention, X:IT II, with focus on the effect across socioeconomic groups of adolescents.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN31292019 , date of registration 24/10/2017. Retrospectively registered.

Obscenity of Cigarette and Hookah Smoking in Iranian Adolescents: A Longitudinal School-based Study

Background:

There is a very limited information on the obscenity of cigarette and hookah smoking among adolescents. Using a large and representative longitudinal sample of adolescents (n = 4820) aged 14–19 years from Tabriz (a metropolitan city in northwestern Iran), this study aimed at comparing the obscenity of cigarette and hookah smoking and assessing factors associated with obscenity of smoking. Moreover, we examined how the obscenity of cigarette and hookah smoking affected by the progress in the stages of cigarette and hookah smoking.

Methods:

In this longitudinal study, a random sample of high-school students was selected in Tabriz in 2010. Using a valid and reliable self-administered questionnaire, the data from the sampled students were collected twice at two points in time, 12 months apart. Multivariate backward logistic regression was used to determine the effect of the transition in cigarette (or hookah) smoking stages on the obscenity of cigarette (or hookah) smoking.

Results:

While 3,079 (63.9%) students expressed that obscenity of cigarette smoking is higher than obscenity of hookah smoking, 1,741 (36.1%) students expressed that obscenity of hookah smoking is higher than obscenity of cigarette smoking. The results of multivariate backward logistic regression indicated that the transition in cigarette (hookah) smoking stages was not related to the obscenity of cigarette (hookah) smoking.

Conclusions:

The results showed that obscenity of hookah smoking was less than obscenity of cigarette smoking, especially among females. Further study is required to understand the effect of obscenity on smoking and transition to different stages of cigarette and hookah smoking.

UPPS-P impulsive personality traits and adolescent cigarette smoking: A meta-analysis

BACKGROUND

Adolescence is a critical developmental period in the trajectory of nicotine dependence, highlighting the need for a greater understanding of the modifiable risk factors. An extensive body of research has found that trait impulsivity is associated with higher levels of adolescent smoking; however, findings have been mixed. The present study aimed to synthesise existing literature to determine the strength and nature of the relationship between the UPPS-P impulsive traits and both adolescent cigarette consumption and nicotine dependence.

METHODS

Fifty-one studies were meta-analysed using a random effects model to determine the association between each UPPS-P impulsive trait and both adolescent cigarette consumption and nicotine dependence. Age, gender, ethnicity and sample type were examined as potential moderators.

RESULTS

Cigarette consumption was positively associated with each UPPS-P impulsive trait (r's ranging from 0.17-0.20). There were an insufficient number of studies to meta-analyse the association between nicotine dependence and the UPPS-P impulsive traits. There were no significant moderation effects of age, gender, ethnicity or sample type.

CONCLUSIONS

Findings suggest that each UPPS-P impulsive trait shares similar associations with adolescent cigarette consumption. Additional studies are needed to determine the relationship between adolescent nicotine dependence and impulsivity. As most adult smokers initiate during adolescence, targeting these impulsive traits via novel prevention and intervention strategies may assist in reducing the prevalence of smoking.

Tobacco use among adolescents in Qatar: Findings from Global Youth Tobacco Surveys 2004-2013

INTRODUCTION

Tobacco use has become a global health concern. Almost a third of the adolescents of the Eastern Mediterranean Region (EMR) have reported tobacco use and the percentage is expected to rise in the future, making tobacco consumption a main public health issue among students, 13–15 years old, in the region’s countries. We aimed to conduct an analysis of the previous Global Youth Tobacco Surveys (GYTS) in Qatar to detect any significant changes that might inform decision makers on planning policies and interventions accordingly.

METHODS

This study presents a retrospective data analysis, based on three GYTS conducted in Qatar during 2004, 2007, and 2013. All analyses were weighted to account for the complex survey design and for differential non-response at school, class and student levels, with the exception of the analysis of sociodemographic characteristics. The differences between the proportions were tested by Pearson’s chi-squared test. Data were analyzed using the statistical software SPSS (Statistical Package for Social Sciences), version 21.0 (Chicago, IL). A p-value <0.05 was considered to be significant.

RESULTS

There was an overall increase in the prevalence of smoking, the accessibility, and the availability of cigarettes. Additionally, the percentage of participants who desired to stop smoking decreased between 2004 and 2013, while that of students who reported ‘exposure to free tobacco promotion’ was highest in 2013.

CONCLUSIONS

Despite the effort made by the local authorities in Qatar to reverse the spread or limit the growing tobacco epidemic, there is a need for multidisciplinary interventions through tobacco prevention and control programs targeting youths.

Implementation fidelity and adolescent smoking: The X:IT study-A school randomized smoking prevention trial

BACKGROUND

Assessing the actual implementation of multi-component interventions can provide important knowledge for future interventions. Intervention components may be implemented differently, knowledge about this can provide an understanding of which components are essential and therefore must be included. The aim of this study was to examine the implementation of one, two, or all three main intervention components at the individual level and to assess the association to current smoking among 13 year-olds in the X:IT study.

METHODS

Data stems from a cluster-randomized controlled trial in 94 Danish elementary schools (51 intervention; 43 control schools). Implementation was measured by aspects of adherence, dose, quality of delivery, and participant responsiveness based on questionnaire data from 4161 pupils at baseline (mean-age: 12.5 years) and 3764 pupils at first follow-up eight months later. Coordinator responses from 49 intervention schools were also included. Associations between individual level implementation of the three main components and pupil smoking were examined through a 3-level logistic regression model.

RESULTS

Although implementation fidelity for the three main intervention components was good, only one third (38.8%) of pupils in intervention schools were exposed to full implementation of the intervention. Among these pupils odds ratio for smoking was 0.25 (95% CI: 0.15 - 0.42).

CONCLUSIONS

School-based programs can be very effective if carefully implemented. Future school-based smoking preventive initiatives should include multiple components, and seek to enhance implementation quality of all components.

Tobacco Smoking, Lung Cancer, and Therapy in Iraq: Current Perspective

Tobacco smoking is a research topic of high interest to the public health in Iraq. Although Iraq is a country with a high percentage of smokers, we noticed the dearth of adequate studies and programs to deal with this problem. The percentage of smokers exceed 30% of the population and smoking problem becomes a permanent habit in adults and young people. The problems associated with tobacco smoking behavior related to individuals' post-traumatic stress disorder following post-war conflicts, and the social and cultural environment. The health consequences of tobacco smoking can harm almost every organ in the body, and there are reports confirmed the tobacco smoking is a high-risk factor for lung cancer and other diseases. The relative risk of lung cancer increases with increasing duration and intensity of smoking. Also, smoking associated with bladder, prostate, and head and neck cancers, in addition to respiratory diseases. Intervention efforts should focus on reducing the prevalence of cigarette smoking, introduce effective treatments for cancer and quit smoking. In this perspective article, we present our viewpoint and three scenarios to deal with the problem of tobacco smoking in Iraq. We recommend introducing educational, health and legislative policies for quitting smoking and using effective treatments for cancer.

Informing population-specific smoking policy development for college campuses: An observational study

INTRODUCTION

In Canada, young adults have the highest smoking rates among all other population groups and specifically college students are at a higher risk. To implement effective policies that can prevent smoking and increase cessation, a population-specific approach is recommended.

METHODS

Smoking and non-smoking young adults enrolled in a college program were recruited. Participants who did not smoke were asked to complete questionnaires about their demographics, college experience and the college environment. Additionally, they completed The Perceived Stress Scale and The Center for Epidemiologic Studies - Depression Scale. Students who were current smokers completed the same questionnaires with the addition of one questionnaire about their smoking behaviors. Percentages, means and standard deviations were used to describe the variables of interest and a chi-squared analysis was performed, when possible, to test the difference in response frequency between smoking and non-smoking participants.

RESULTS

Differences were observed between smoking (n=65) and non-smoking students (n=214). Specifically, smokers were more likely to have a family member that smoked and to participate in binge drinking. Both groups indicated that they are unaware of campus smoking regulations; however smokers were more opposed to implementing smoke-free policies.

CONCLUSIONS

College students are unaware of campus smoking regulations. The descriptive information and differences observed between smoking and non-smoking students in this study should be taken into consideration when developing future smoking regulations/policies on college campuses.

Acceptability and compliance with a remote monitoring system to track smoking and abstinence among young smokers

BACKGROUND

Similar to adult smokers, quit attempts among younger smokers almost inevitably result in relapse. Unlike adults, less is known about the process of relapse in this younger age group. A technology-based remote monitoring system may allow for detailed and accurate characterization of smoking and abstinence and would help to improve cessation strategies.

OBJECTIVES

This study describes a mobile system that captures smoking using breath carbon monoxide (CO) and real-time self-reports of smoking behavior. Compliance, feasibility, acceptability, and accuracy of the system were measured during a quit attempt and subsequent monitoring period.

METHODS

The mobile application (My Mobile Monitor, M3) combined breath CO with ecological momentary assessment, delivered via smartphone. Participants (N = 16; 75% female) were daily smokers between the ages of 19 and 25, who used the app for 11 days during which they agreed to make a quit attempt. Acceptability, compliance, and abstinence were measured.

RESULTS

Participants averaged 22.3 ± 2.0 years old and smoked an average of 13.0 ± 6.1 cigarettes per day. Overall session compliance was 69% and during the quit attempt, 56% of participants abstained from smoking for at least 24 hours. Agreement between self-reported smoking compared to breath CO was generally high, when available for comparison, though underreporting of cigarettes was likely.

CONCLUSION

This study demonstrates feasibility of a remote monitoring app with younger smokers, though improvements to promote compliance are needed. Remote monitoring to detect smoking and abstinence represents a step forward in the improvement of cessation strategies, but user experience and personalization are vital.

Correlates of attempting to quit smoking among adults in Bangladesh

Background

Quit attempts are very essential in population-based smoking cessation. Little is known about the correlates of making a quit attempt of smoking in Bangladesh. We aimed to examine correlates of making a quit attempt of smoking among adults in Bangladesh.

Methods

We used data from the 2009 Global Adult Tobacco Survey, Bangladesh. A total of 2217 adult current smokers (2141 males and 76 females) aged 15 years and older who participated in the survey were included. We compared socio-demographic, behavioral, motivational, knowledge and attitudes towards smoking, quitting methods utilized, use of social media to quit smoking, and environmental characteristics of current smokers who made an attempt to quit with those who made no quit attempt during the previous 12 months of the survey. We applied multivariable logistic regression models for analyzing the data.

Results

Among the 2217 current smokers, 1058 (47.72%) made attempt to quit. We found respondents who smoked their first cigarette within 6 to 30 min of waking up were more likely to make an attempt to quit than those who smoked their first cigarette within 5 min of waking. Moreover, among daily current smokers who smoked 10–19 manufactured cigarettes per day were less likely to make a quit attempt. We also found intention to quit smoking, smoking rules inside the home, and exposure to anti-smoking advertisements as significant correlates of making a quit attempt of smoking among adults in Bangladesh.

Conclusions

Policymakers should consider our findings when implementing tobacco control programs in Bangladesh.

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Quit attempts are very essential in population-based smoking cessation.

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Among the 2233 current smokers, 1058 individuals attempted to quit smoking.

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Smokers who don't smoke quickly after waking were more likely to make quit attempt.

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Smokers who lived in a smoke-free home were also more likely to make quit attempt.

Young Australian women's accounts of smoking and quitting: a qualitative study using visual methods

Background

Although the overall rate of smoking in Australia continues to decline, the rate of decline has begun to slow. Rates of smoking among young women in Australia have been a particular concern, which has led to the development of targeted public health campaigns. Poststructuralist theory has successfully been used in research to explore the way in which young women experience smoking. However, there is an absence of poststructuralist analysis of young women’s experiences of quitting. This study aims to address this gap.

Methods

We carried out 27 interviews with young Australian women smokers and ex-smokers. Eighteen of those women then participated in a photography activity and follow-up interviews. A Foucauldian discourse analysis of the data was conducted.

Results

Through our analysis, we identified three discourses: ‘The irresponsibility of smoking: Quitting as responsible’, ‘The difficulties of quitting: Smoking as addictive’, and ‘Making a decision to quit: Smoking as a choice’. In relation to these discourses, participants took up contradictory positions of responsibility and resistance, addiction and agency. Taking up these positions had implications for young women’s subjectivity, and the way they engaged with tobacco controls and cessation support.

Conclusions

The analysis highlights the complex and contradictory nature of young women’s experiences with smoking and quitting. The study’s findings are considered in relation to the improvement of tobacco control policies and cessation support programmes targeted at young women.

Discontinuous Patterns of Cigarette Smoking From Ages 18 to 50 in the United States: A Repeated-Measures Latent Class Analysis

INTRODUCTION

Effective cigarette smoking prevention and intervention programming is enhanced by accurate understanding of developmental smoking pathways across the life span. This study investigated within-person patterns of cigarette smoking from ages 18 to 50 among a US national sample of high school graduates, focusing on identifying ages of particular importance for smoking involvement change.

AIMS AND METHODS

Using data from approximately 15,000 individuals participating in the longitudinal Monitoring the Future study, trichotomous measures of past 30-day smoking obtained at 11 time points were modeled using repeated-measures latent class analyses. Sex differences in latent class structure and membership were examined.

RESULTS

Twelve latent classes were identified: three characterized by consistent smoking patterns across age (no smoking; smoking < pack per day; smoking pack + per day); three showing uptake to a higher category of smoking across age; four reflecting successful quit behavior by age 50; and two defined by discontinuous shifts between smoking categories. The same latent class structure was found for both males and females, but membership probabilities differed between sexes. Although evidence of increases or decreases in smoking behavior was observed at virtually all ages through 35, 21/22 and 29/30 appeared to be particularly key for smoking category change within class.

CONCLUSIONS

This examination of latent classes of cigarette smoking among a national US longitudinal sample of high school graduates from ages 18 to 50 identified unique patterns and critical ages of susceptibility to change in smoking category within class. Such information may be of particular use in developing effective smoking prevention and intervention programming.

IMPLICATIONS

This study examined cigarette smoking among a national longitudinal US sample of high school graduates from ages 18 to 50 and identified distinct latent classes characterized by patterns of movement between no cigarette use, light-to-moderate smoking, and the conventional definition of heavy smoking at 11 time points via repeated-measures latent class analysis. Membership probabilities for each smoking class were estimated, and critical ages of susceptibility to change in smoking behaviors were identified.

Pilot trial and process evaluation of a multilevel smoking prevention intervention in further education settings

Background

Preventing smoking uptake among young people is a public health priority. Further education (FE) settings provide access to the majority of 16- to 18-year-olds, but few evaluations of smoking prevention interventions have been reported in this context to date.

Objectives

To evaluate the feasibility and acceptability of implementing and trialling a new multilevel smoking prevention intervention in FE settings.

Design

Pilot cluster randomised controlled trial and process evaluation.

Setting

Six UK FE institutions.

Participants

FE students aged 16–18 years.

Intervention

‘The Filter FE’ intervention. Staff working on Action on Smoking and Health Wales’ ‘The Filter’ youth project applied existing staff training, social media and youth work resources in three intervention settings, compared with three control sites with usual practice. The intervention aimed to prevent smoking uptake by restricting the sale of tobacco to under-18s in local shops, implementing tobacco-free campus policies, training FE staff to deliver smoke-free messages, publicising The Filter youth project’s online advice and support services, and providing educational youth work activities.

Main outcome measures

(1) The primary outcome assessed was the feasibility and acceptability of delivering and trialling the intervention. (2) Qualitative process data were analysed to explore student, staff and intervention team experiences of implementing and trialling the intervention. (3) Primary, secondary and intermediate (process) outcomes and economic evaluation methods were piloted.

Data sources

New students at participating FE settings were surveyed in September 2014 and followed up in September 2015. Qualitative process data were collected via interviews with FE college managers (n = 5) and the intervention team (n = 6); focus groups with students (n = 11) and staff (n = 5); and observations of intervention settings. Other data sources were semistructured observations of intervention delivery, intervention team records, ‘mystery shopper’ audits of local shops and college policy documents.

Results

The intervention was not delivered as planned at any of the three intervention settings, with no implementation of some community- and college-level components, and low fidelity of the social media component across sites. Staff training reached 28 staff and youth work activities were attended by 190 students across the three sites (< 10% of all eligible staff and students), with low levels of acceptability reported. Implementation was limited by various factors, such as uncertainty about the value of smoking prevention activities in FE colleges, intervention management weaknesses and high turnover of intervention staff. It was feasible to recruit, randomise and retain FE settings. Prevalence of weekly smoking at baseline was 20.6% and was 17.2% at follow-up, with low levels of missing data for all pilot outcomes.

Limitations

Only 17% of eligible students participated in baseline and follow-up surveys; the representativeness of student and staff focus groups is uncertain.

Conclusions

In this study, FE settings were not a supportive environment for smoking prevention activities because of their non-interventionist institutional cultures promoting personal responsibility. Weaknesses in intervention management and staff turnover also limited implementation. Managers accept randomisation but methodological work is required to improve student recruitment and retention rates if trials are to be conducted in FE settings.

Trial registration

Current Controlled Trials ISRCTN19563136.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 5, No. 8. See the NIHR Journals Library website for further project information. It was also funded by the Big Lottery Fund.

A longitudinal study of the reciprocal relationship between ever smoking and urgency in early adolescence

BACKGROUND

Among early adolescents in the United States (U.S.), the prevalence of cigarette smoking is at its lowest level in recent decades. Nonetheless, given the risks of smoking in early development, it remains critically important to study both risk factors for smoking and risks from smoking. This longitudinal study with U.S. early adolescents examines smoking initiation and tests a model of reciprocal prediction between ever smoking and the personality trait of urgency (i.e., mood-based impulsivity), a trait that increases risk for multiple forms of dysfunction.

METHODS

Participants (n=1906; 90% 10-11 years old, 50% female, 39% racial minorities at baseline) completed questionnaires 1-2 times per year starting in 5th grade and ending in 9th grade. Structural equation modeling allowed tests of bidirectional relationships between ever smoking and urgency controlling for pubertal status and negative affect at each wave.

RESULTS

Incidence of ever smoking increased from 5% to 27% over time, with current smoking around 5% at the last wave. Urgency at each wave predicted ever smoking at the next wave above and beyond covariates and prior smoking (all p<0.01). Likewise, with one exception, ever smoking predicted an increase in urgency at the subsequent wave above and beyond covariates and prior urgency (all p<0.05).

CONCLUSION

Results show that risk for smoking increases with higher levels of urgency and urgency increases secondary to engagement in smoking. Future work should therefore explore urgency as a point of prevention for smoking and smoking cessation as a means to mitigate mood-based impulsivity.

Smoking Initiation and Cessation among Youths in Vietnam: A Longitudinal Study Using the Chi Linh Demographic-Epidemiological Surveillance System (CHILILAB DESS)

Study of smoking initiation and cessation is particularly important in adolescent population because smoking prevention and cessation at this time may prevent several health consequences later in life. There is a very limited knowledge about the determinants of smoking initiation and cessation among youths in Vietnam. This limits the development and implementation of appropriately targeted anti-smoking prevention interventions. This study applied pooled data from 3 rounds of a longitudinal survey in the Chi Linh Demographic—Epidemiological Surveillance System (CHILILAB DESS) in a northern province in Vietnam to analyse the determinants of smoking initiation and cessation among youths. The total of youths in the first round, second, and third rounds was 12,406, 10,211, and 7,654, respectively. The random-effects logit model controlling for both time-variant and time-invariant variables was conducted to explore the associated factors with new smokers and quitters. We found an increase trend of new smokers (7.0% to 9.6%) and quitters (27.5% to 31.4%) during 2009–2013. Smoking initiation and cessation are the result of multifactorial influences of demographic and health behaviours and status. Demographic background (older youths, male, unmarried youths, and youths having informal work) and health behaviours and status (youths who had smoking family members and/or smoking close friends, and had harmful drinking) were more likely to initiate smoking and more difficult to quit smoking. Among these variables, youths who had smoking close-friends had the highest likelihood of both initiating smoking and failed quitting. Our results could represent the similar health problems among youths in peri-urban areas in Vietnam. Further, our findings suggested that anti-smoking interventions should involve peer intervention, integrated with the reduction of other unhealthy behaviours such as alcohol consumption, and to focus on adolescents in their very early age (10–14 years old).

Adolescents’ Perceptions Regarding Effective Tobacco Use Prevention Strategies for their Younger Counterparts: A Qualitative Study in Malaysia

Purpose:The present qualitative study explored adolescents’ perceptions regarding effective strategies to prevent adolescents from using tobacco products (TP). Apart from the commercial TPs, there has been emerging use of alternatives such as vapes, e-cigarettes and shisha. This unfortunate phenomenon continues despite the currently available preventive strategies. Thus, understanding of the perceptions of the current generation would be valuable to provide new insights. Methods: Purposive sampling was utilized to recruit 40 adolescents between the age of 15 and 16 years old attending public daily secondary schools. Eight focus group discussions were conducted among the TP users, ex-users and non-users. Data were analyzed using a thematic content analysis procedure with NVivo. Results: Among barriers with the currently available strategies were having teachers who smoke tobacco, addiction to nicotine and self-perceptions of being healthy. The content of any program should include knowledge on negative outcomes of using tobacco products and awareness of the legislation together with ways to overcome peer and family influence including improving self-efficacy and refusal skills. Strategies were suggested to be delivered using information technology which provides interactive learning and visual effects. Conclusions: Adolescents agreed that the content and delivery of tobacco use prevention strategies need to be revised to suit the current generation to ensure sustainability.

The Social Prioritization Index and Tobacco Use Among Young Adult Bar Patrons

Social benefits likely play a role in young adult tobacco use. The Social Prioritization Index (SPI) was developed to measure the degree to which young adults place a great importance on their social lives. We examined the usefulness of this measure as a potential predictor of tobacco use controlling for demographics and tobacco-related attitudes. Young adults completed cross-sectional surveys between 2012 and 2014 in bars in seven U.S. cities (N = 5,503). The SPI is a 13-item scale that includes personality items and information on how frequently participants attend bars and how late they stay out. Three step-by-step multinomial regression models were run using the SPI as a predictor of smoking status (nondaily and daily smoking vs. nonsmoking): (1) SPI as the sole predictor, (2) SPI and demographics, and (3) SPI, demographics, and tobacco-related attitude variables. Next, we conducted an exploratory factor analysis to examine if the number of items in SPI could be reduced and retain its strong relationship with smoking. Higher scores on the SPI were related to an increased probability of being a Nondaily Smoker (odds ratio = 1.09, 95% confidence interval [1.04, 1.14], p < .001) or Daily Smoker (odds ratio = 1.14, 95% confidence interval [1.07, 1.22], p < .0001) compared to a Nonsmoker, controlling for demographics and other tobacco-related attitudes. The SPI and reduced SPI were independently related to young adult tobacco use. The measure's brevity, ease of use, and strong association with tobacco use may make it useful to tobacco and other prevention researchers.

The Role of Pharmacotherapy in the Treatment of Adolescent Substance Use Disorders

Adolescent substance use disorders (SUDs) are a significant public health issue due to the associated morbidity, mortality, and societal cost. While effective for some adolescents, psychosocial interventions generally produce small-to-moderate reductions in substance use. Most youth relapse within 12 months of treatment. One approach to improve outcomes is through adjunctive pharmacotherapy. Medication assisted treatments have been shown to improve adult SUD treatment outcomes, and preliminary studies in adolescents suggest that combining medication with psychosocial interventions may also enhance SUD outcomes for youth. This article presents a comprehensive review and grading of the evidence from studies conducted in adolescents with SUDs.

The Logic Model in Action against Tobacco Use: A Case Study

Mississippi, an early player in tobacco prevention efforts, used a logic model based in CDC's Best Practices that had seven levels: inputs (community leaders, statewide partners, state Health Department, Attorney General's office), activities (cessation, chronic disease, media/marketing, youth programs, school programs, community/state programs, law enforcement), outputs (nicotine cessation and treatment programs, exposure to no-tobacco, pro-health media and other programs, smoking bans, ordinances, and policies), initial outcomes (awareness of programs, changes in youth knowledge and attitudes, increased enforcement efforts), intermediate outcomes (increased program utilization, reduced youth initiation of tobacco use, improved community culture regarding tobacco), long-term outcomes (reduced youth tobacco use, reduced exposure to secondhand smoke), and impact (reduced tobacco-related sickness and death). With enough simplicity to be clear, enough detail to offer guidance, and sufficient grounding in CDC's Best Practices to provide a persuasive rationale for each component, the present logic model had immediate applications and helped with program evaluation.

Pharmacotherapy for Substance Use Disorders in Youths

Despite recent advances in psychosocial treatments targeting adolescent substance use disorders (SUD), effect sizes generally remain small to modest, and few treatment-enrolled youth achieve sustained abstinence. Among adults, SUD-targeted pharmacotherapies have emerged as viable options to complement psychosocial treatments and enhance outcomes. Developmental differences exist in pharmacodynamics and treatment-response, and comparatively little research has focused on SUD-targeted pharmacotherapies for youth. This article provides a review and synthesis of relevant published clinical trials focusing on youth SUDs and co-occurring/comorbid psychiatric and substance use disorders. It offers recommendations for clinical practice and further research based on the limited findings to date.

Effectiveness of health education and behavioral intervention for tobacco de-addiction among degree students: A clinical trial

Background:

Objectives of the study were to assess the prevalence of tobacco use among the degree students of Oxford institutions in Bangalore city, offer a tobacco cessation intervention for tobacco users among the degree students, and assess the effectiveness of intervention by comparing with the control group.

Materials and Methods:

A randomized control trial was conducted to assess the prevalence of tobacco use and the effectiveness of tobacco cessation behavioral intervention offered to degree students of Oxford institutions in Bangalore city. Then were randomly selected and divided into 55 students in the study group (group A) and 60 students in the control group (group B).

Results:

The effect of intervention of tobacco cessation in group A showed an increase of 29.1% students who stopped using tobacco completely after intervention compared to 15% in group B, and the highest reduction of 21.8% change was noticed in the students using one to five tobacco products per day and the least reduction in percentage (1.8%) change was noticed in the students using one tobacco product per day.

Conclusion:

Findings from the present study suggest that the intervention has suggestive significance on tobacco intervention.

Effectiveness of Short Message Service Text-Based Smoking Cessation Intervention Among University Students: A Randomized Clinical Trial

IMPORTANCE

Smoking is globally the most important preventable cause of ill health and death. Mobile telephone interventions and, in particular, short message service (SMS) text messaging, have the potential to overcome access barriers to traditional health services, not least among young people.

OBJECTIVE

To determine the effectiveness of a text-based smoking cessation intervention among young people.

DESIGN, SETTING, AND PARTICIPANTS

A single-blind, 2-arm, randomized clinical trial (Nicotine Exit [NEXit]) was conducted from October 23, 2014, to April 17, 2015; data analysis was performed from April 23, 2014, to May 22, 2015. Participants included daily or weekly smokers willing to set a quit date within 1 month of enrollment. The study used email to invite all college and university students throughout Sweden to participate.

INTERVENTIONS

The NEXit core program is initiated with a 1- to 4-week motivational phase during which participants can choose to set a stop date. The intervention group then received 157 text messages based on components of effective smoking cessation interventions for 12 weeks. The control group received 1 text every 2 weeks thanking them for participating in the study, with delayed access to the intervention.

MAIN OUTCOMES AND MEASURES

The primary outcomes were self-reported prolonged abstinence (not having smoked >5 cigarettes over the past 8 weeks) and 4-week point prevalence of complete smoking cessation shortly after the completion of the intervention (approximately 4 months after the quit date).

RESULTS

A total of 1590 participants, mainly between 21 and 30 years of age, were randomized into the study; 827 (573 [69.3%] women) were allocated to the intervention group and 763 (522 [68.4%] women) were included in the control group. Primary outcome data were available for 783 (94.7%) of the intervention group and 719 (94.2%) of the control group. At baseline, participants were smoking a median (range) of 63 (1-238) and 70 (2-280) cigarettes per week, respectively. Eight-week prolonged abstinence was reported by 203 participants (25.9%) in the intervention group and 105 (14.6%) in the control group; 4-week point prevalence of complete cessation was reported by 161 (20.6%) and 102 (14.2%) participants, respectively, a mean (SD) of 3.9 (0.37) months after the quit date. The adjusted odds ratios (95% CIs) for these findings were 2.05 (1.57-2.67) and 1.56 (1.19-2.05), respectively.

CONCLUSIONS AND RELEVANCE

With the limitation of assessing only the short-term effect of the intervention, the effects observed in this trial are comparable with those for traditional smoking cessation interventions. The simple NEXit intervention has the potential to improve the uptake of effective smoking cessation interventions.

TRIAL REGISTRATION

isrctn.org Identifier: ISRCTN75766527.

Reinforcing value of smoking relative to physical activity and the effects of physical activity on smoking abstinence symptoms among young adults

This study sought to evaluate whether individual differences in the reinforcing value of smoking relative to physical activity (RRVS) moderated the effects of physical activity on smoking abstinence symptoms in young adult smokers. The repeated-measures within-subjects design included daily smokers (N = 79) 18-26 years old. RRVS was measured with a validated behavioral choice task. On 2 subsequent visits, participants completed self-report measures of craving, withdrawal, mood, and affective valence before and after they engaged in passive sitting or a bout of physical activity. RRVS did not moderate any effects of physical activity (ps > .05). Physical activity compared with passive sitting predicted decreased withdrawal symptoms, β = -5.23, 95% confidence interval (CI) [-6.93, -3.52] (p < .001), negative mood, β = -2.92, 95% CI [-4.13, -1.72] (p < .001), and urge to smoke. β = -7.13, 95% CI [-9.39, -4.86] (p < .001). Also, physical activity compared with passive sitting predicted increased positive affect, β = 3.08, 95% CI [1.87, 4.28] (p < .001) and pleasurable feelings, β = 1.07, 95% CI [0.58, 1.55] (p < .001), and greater time to first cigarette during the ad libitum smoking period, β = 211.76, 95% CI [32.54, 390.98] (p = .02). RRVS predicted higher levels of pleasurable feelings, β = 0.22, 95% CI [0.01, 0.43] (p = .045), increased odds of smoking versus remaining abstinent during the ad libitum smoking period, β = 0.04, 95% CI [0.01, 0.08] (p = .02), and reduced time to first cigarette, β = -163.00, 95% CI [-323.50, -2.49] (p = .047). Regardless of the RRVS, physical activity produced effects that may aid smoking cessation in young adult smokers. However, young adult smokers who have a higher RRVS will be less likely to choose to engage physical activity, especially when smoking is an alternative.

Risk Factors Associated With Hookah Use

BACKGROUND

Potential harms associated with hookah smoking are largely unrecognized and it is emerging as a trendy behavior. To help inform policy and preventive interventions, we used responses from a population survey of US adults to examine risk factors associated with hookah involvement.

METHOD

An online survey of 17 522 US adults was conducted in 2013. The nationally representative sample was drawn from GfK Group's KnowledgePanel plus off-panel recruitment. Multinomial logistic regression was used to examine the relationships between tobacco use patterns across multiple products (cigarettes, cigars, and dissolvables), perceived harms towards regular pipe/hookah use, and demographic characteristics with hookah involvement (never used, ever used with/without reusing intent).

RESULT

Nearly one in five (16%) of the respondents had smoked hookah at least once in their life ("ever users"). Ever users of hookah were at higher risk of having used cigarettes, cigars, and dissolvable tobacco products (all P < .01). Odds for hookah use were greater for those who perceived regular pipe/hookah use as less dangerous (P < .05). Odds for hookah involvement were higher among young adults (P < .001), individuals with higher educational attainment (P < .01), and Hispanics/Latinos (P < .05).

CONCLUSIONS

Information about the public health harms associated with hookah smoking should be delivered to individuals at-risk for hookah smoking. It is likely that misconceptions about the safety of hookah smoking could be driving, at least in-part, its increase in popularity.

FDA cigarette warning labels lower craving and elicit frontoinsular activation in adolescent smokers

Cigarette smoking is an economically and epidemiologically expensive public health concern. Most adult smokers become addicted during adolescence, rendering it a crucial period for prevention and intervention. Although litigation claims have delayed implementation, graphic warning labels proposed by the U.S. Food and Drug Administration (FDA) may be a promising way to achieve this goal. We aimed to determine the efficacy of the labels in reducing in-scanner craving and to characterize the neurobiological responses in adolescent and adult smokers and non-smokers. While undergoing functional magnetic resonance imaging, thirty-nine 13- to 18-year-old adolescent and forty-one 25- to 30-year-old adult smokers and non-smokers rated their desire to smoke when presented with emotionally graphic warning labels and comparison non-graphic labels. Compared with adult smokers, adolescent smokers exhibited greater craving reduction in response to the warning labels. Although smokers evinced overall blunted recruitment of insula and dorsolateral prefrontal cortex (DLPFC) relative to non-smokers, an effect that was stronger in adolescent smokers, parametrically increasing activation of these regions was associated with greater craving reduction. Functional connectivity analyses suggest that greater DLPFC regulation of limbic regions predicted cigarette craving. These data underscore a prominent role of frontoinsular circuitry in predicting the efficacy of FDA graphic warning labels in craving reduction in adult and adolescent smokers.

Perspectives in Implementing a Pragmatic Pediatric Primary Care-Based Intervention Trial

The 2013 U.S. Preventive Services Task Force (USPSTF) concluded that behavioral interventions are effective in reducing initiation of smoking in youth, recommending primary care clinicians provide education or brief counseling to prevent initiation, and that there are promising trends toward behavioral interventions improving cessation in this population. Our primary care-based intervention RCT conducted between 2000 and 2004, Air It Out, informed these USPSTF recommendations. Our trial was designed to determine whether a pediatric primary care practice-based smoking prevention and cessation intervention would be effective in increasing abstinence rates among adolescents under usual clinic conditions, to inform clinical practice. Therefore, the trial was designed to be largely a pragmatic trial. In this paper, we describe where each of the Air It Out study components falls along the pragmatic-explanatory continuum regarding participant eligibility criteria, intervention and comparison condition design, follow-up and outcomes, compliance and adherence assessments, and analysis. Such an assessment assists researchers by providing a framework to guide decisions regarding study design and implementation. We then share a few principles and lessons learned in developing and implementing the primary care-based intervention trial, focusing on study setting selection, engaging providers who will be delivering the intervention and the target population who will be receiving it in designing the trial and interventions to be tested, and the need to carefully plan recruitment and retention procedures. The hope is to increase the number of well-designed studies that can be included in the evidence reviews to guide future USPSTF recommendation statements.

Tobacco Use Prevention by Integrating Inside and Outside of School Based Programs: A Systematic Review Article

BACKGROUND

Experience of tobacco use in early ages will increase probability of addiction to nicotine therefore, efficient tobacco control programs for teenagers are crucial. This study was conducted to recognize elements of successful integrated inside and outside of school based smoking prevention programs.

METHODS

MeSH terms and related keywords were used to search PubMed, Cochrane, Medline, EMBASE, ERIC, SID databases from inception to 29th October 2013. Trials with random and non-random designs, systematic reviews and cohort studies that assessed or reported application of integrated tobacco control programs were included. Quality of the retrieved publications was checked independently by the authors and any disagreement was resolved by consensus.

RESULT

Among the 745 identified publications, only 15 studies had the inclusion criteria with a considerable methodological heterogeneity. While, precise out-come of integrated out of school/school-based interventions were not percepti-ble but this study's findings implied that outside of school intervention could strengthen school-based tobacco prevention programs. No study was found to examine school-based interventions integrated with primary health care such as anti-tobacco consultations, high-risk students screening and their referral to special centers.

CONCLUSION

Integration of outside and inside of school-based programs may boost probability of obtaining favorable outcomes and success rate in practice.

Promoting Policy, Systems, and Environment Change to Prevent Chronic Disease: Lessons Learned From the King County Communities Putting Prevention to Work Initiative

CONTEXT

Initiatives that convene community stakeholders to implement policy, systems, environment, and infrastructure (PSEI) change have become a standard approach for promoting community health.

OBJECTIVE

To assess the PSEI changes brought about by the King County, Washington, Communities Putting Prevention to Work initiative and describe how initiative structures and processes contributed to making changes.

DESIGN

The impact evaluation used a logic model design, linking PSEI changes to longer-term behavioral impacts in healthy eating active living and tobacco use and exposure. Qualitative methods, including stakeholder interviews and surveys, were used to identify initiative success factors.

SETTING

Communities Putting Prevention to Work activities occurred throughout King County, with a focus on 7 low-income communities in South Seattle/King County.

PARTICIPANTS

The focus communities had a combined population of 652 000, or 35% of the county total, with lower incomes and higher rates of physical inactivity, tobacco use, poor diet, and chronic disease.

INTERVENTION

Twenty-four PSEI strategies were pursued by organizations in sectors including schools, local governments, and community organizations, supported by the public health department. There were 17 healthy eating active living strategies (eg, enhancements to school menus, city planning policies) and 7 tobacco strategies (eg, smoke-free policies in schools, housing, and hospitals).

MAIN OUTCOME MEASURE

PSEI changes made and numbers of residents reached.

RESULTS

Twenty-two of the 24 strategies achieved significant progress toward implementing PSEI changes. The most common success factor was a "dyad" consisting of a dedicated technical assistance provider-either an outside consultant or public health department staff-working closely with a champion from the participating organizations to bring about PSEI changes.

CONCLUSIONS

An initiative structure that creates and supports external consultant/internal organizational champion dyads in key community sectors offers a promising approach that may be adopted by similar community health efforts in the future.

Trends and timing of cigarette smoking uptake among US young adults: survival analysis using annual national cohorts from 1976 to 2005

AIMS

To measure changes over time in cigarette smoking uptake prevalence and timing during young adulthood (ages 19-26 years), and associations between time-invariant/-varying characteristics and uptake prevalence/timing.

DESIGN

Discrete-time survival modeling of data collected from United States high school seniors (modal age 17/18) enrolled in successive graduating classes from 1976 to 2005 and participating in four follow-up surveys (to modal age 25/26).

SETTING

The longitudinal component of the Monitoring the Future study.

PARTICIPANTS

A total of 10 758 individuals reporting no life-time smoking when first surveyed as high school seniors.

MEASUREMENTS

Smoking uptake (any, experimental, occasional and regular); socio-demographic variables; marital, college and work status; time spent socializing.

FINDINGS

The percentage of young adults moving from non-smoker to experimental smoking [slope estimate 0.11, standard error (SE) = 0.04, P = 0.005] or occasional smoking (slope estimate 0.17, SE = 0.03, P < 0.001) increased significantly across graduating classes; the percentage moving from non-smoker to regular smoker remained stable. All forms of smoking uptake were most likely to occur at age 19/20, but uptake prevalence at older ages increased over time [e.g. cohort year predicting occasional uptake at modal age 25/26 adjusted hazard odds ratio (AHOR) = 1.05, P = 0.002]. Time-invariant/-varying characteristics had unique associations with the timing of various forms of smoking uptake (e.g. at modal age 21/22, currently attending college increased occasional uptake risk (AHOR = 2.11, P < 0.001) but decreased regular uptake risk (AHOR = 0.69, P = 0.026).

CONCLUSIONS

Young adult occasional and experimental smoking uptake increased in the United States for non-smoking high school seniors graduating from 1976 to 2005. Smoking uptake for these cohorts remained most likely to occur at age 19/20, but prevalence of uptake at older ages increased.

Evaluation of a tobacco prevention programme among teenagers in Sweden

OBJECTIVE

To study the prevalence of tobacco use among teenagers, to evaluate a tobacco prevention programme and to study factors related to participation in the prevention programme.

DESIGN AND SETTING

Population-based prospective cohort study.

METHOD

Within the Obstructive Lung disease in Northern Sweden (OLIN) studies, a cohort study about asthma in schoolchildren started in 2006. All children aged 7-8 years in three municipalities were invited to a questionnaire survey and 2585 (96%) participated. The cohort was followed up at age 11-12 years (n=2612, 95% of invited) and 14-15 years (n=2345, 88% of invited). In 2010, some of the children in the OLIN cohort (n=447) were invited to a local tobacco prevention programme and 224 (50%) chose to participate.

RESULTS

At the age of 14-15 years, the prevalence of daily smoking was 3.5%. Factors related to smoking were female sex, having a smoking mother, participation in sports and lower parental socioeconomic status (SES). The prevalence of using snus was 3.3% and risk factors were male sex, having a smoking mother, having a snus-using father and non-participation in the prevention programme. In the prevention programme, the prevalence of tobacco use was significantly lower among the participants compared with the controls in the cohort. Factors related to non-participation were male sex, having a smoking mother, lower parental SES and participation in sports.

CONCLUSIONS

The prevalence of tobacco use was lower among the participants in the tobacco prevention programme compared with the non-participants as well as with the controls in the cohort. However, the observed benefit of the intervention may be overestimated as participation was biased by selection.

Determinants of cigarette smoking initiation in Jordanian schoolchildren: longitudinal analysis

OBJECTIVE

To identify determinants of cigarette smoking initiation, by gender, among schoolchildren in Irbid, Jordan.

METHODS

Between 2008 and 2011, data were collected annually using self-reported questionnaires over 4-years in a prospective cohort of 1,781 students recruited from all 7th grade classes in 19 secondary schools, selected out of a total 60, using probability-proportionate-to-size method. Independent predictors of smoking initiation were identified among the cigarette naïve participants (N = 1,454) with mixed-effect multivariable logistic regression.

RESULTS

Participants were 12.6 years of age on average at baseline. 29.8% of the 1,454 students (37.2% of boys and 23.7% of girls) initiated cigarette smoking by 10th grade. Of those who initiated (n = 498), 47.2% of boys and 37.2% of girls initiated smoking in the 8th grade. Determinants of cigarette smoking initiation included ever smoking a waterpipe, low cigarette refusal self-efficacy, intention to start smoking cigarettes, and having friends who smoked. For girls, familial smoking was also predictive of cigarette initiation.

CONCLUSION

This study shows that many Jordanian youth have an intention to initiate cigarette smoking and are susceptible to cigarette smoking modeled by peers and that girls are influenced as well by familial cigarette smoking. Prevention efforts should be tailored to address culturally relevant gender norms, help strengthen adolescents' self-efficacy to refuse cigarettes, and foster strong non-smoking social norms.

SMS-based smoking cessation intervention among university students: study protocol for a randomised controlled trial (NEXit trial)

BACKGROUND

Most smoking efforts targeting young people have so far been focused on prevention of initiation, whereas smoking cessation interventions have largely been targeted towards adult populations. Thus, there is limited evidence for effective smoking cessation interventions in young people, even though many young people want to quit smoking. Mobile communication technology has the potential to reach large numbers of young people and recent text-based smoking cessation interventions using phones have shown promising results.

METHODS/DESIGN

The study aims to evaluate a newly developed text-based smoking cessation intervention for students in colleges and universities in Sweden. The design is a randomised controlled trial (RCT) with a delayed/waiting list intervention control condition. The trial will be performed simultaneously in all colleges and universities served by 25 student health care centres in Sweden. Outcomes will be evaluated after 4 months, with 2 cessation primary outcomes and 4 secondary outcomes. After outcome evaluation the control group will be given access to the intervention.

DISCUSSION

The study will examine the effectiveness of a stand-alone SMS text-based intervention. The intervention starts with a motivational phase in which the participants are given an opportunity to set a quit date within 4 weeks of randomisation. This first phase and the subsequent core intervention phase of 12 weeks are totally automated in order to easily integrate the intervention into the daily routines of student and other health care settings. As well as providing data for the effectiveness of the intervention, the study will also provide data for methodological analyses addressing a number issues commonly challenging in Internet-based RCTs. For example, an extensive follow-up strategy will be used in order to evaluate the use of repeated attempts in the analysis, and in particular to explore the validity of a possible missing not at random assumption that the odds ratio between the primary outcome and response is the same at every attempt.

TRIAL REGISTRATION

ISRCTN

ISRCTN75766527, dated assigned 4 November 2014. Protocol version: Version 1, and date 7 November 2014.

Gender differences in a randomized controlled trial treating tobacco use among adolescents and young adults with mental health concerns

INTRODUCTION

Treatment of tobacco use in mental health settings is rare despite high rates of comorbidity. With a focus on early intervention, we evaluated a tobacco treatment intervention among adolescents and young adults recruited from outpatient, school-based, and residential mental health settings and tested for gender differences.

METHODS

Intervention participants received computerized motivational feedback at baseline, 3 months, and 6 months and were offered 12 weeks of cessation counseling and nicotine patches. Usual care participants received a self-help guide and brief cessation advice. We examined 7-day point prevalence abstinence with biochemical confirmation at 3, 6, and 12 months; smoking reduction; and 24-hr quit attempts.

RESULTS

At baseline, the sample (N = 60, 52% female, mean age = 19.5±2.9 years, 40% non-Hispanic Caucasian) averaged 7±6 cigarettes/day, 62% smoked daily, 38% smoked ≤ 30 min of waking, 12% intended to quit in the next month, 47% had a parent who smoked, and 3 of 5 of participants' closest friends smoked on average. During the 12-month study, 47% of the sample reduced their smoking, 80% quit for 24 hr, and 11%, 13%, and 17% confirmed 7-day point prevalence abstinence at 3-, 6-, and 12-month follow-up, respectively, with no differences by treatment condition (ps > .400). Over time, abstinence was greater among girls (adjusted odds ratio [AOR] = 8.9) than among boys, and abstinence was greater for lighter smokers than heavier smokers (AOR = 4.5) (p < .05). No mental health or other measured variables predicted abstinence.

CONCLUSIONS

Adolescent and young adult smokers with mental health concerns are a challenging group to engage and to effectively treat for tobacco addiction, particularly heavier smokers and boys. Innovative approaches are needed.

Risk Factors Associated With Hookah Use

BACKGROUND

Potential harms associated with hookah smoking are largely unrecognized and it is emerging as a trendy behavior. To help inform policy and preventive interventions, we used responses from a population survey of US adults to examine risk factors associated with hookah involvement.

METHOD

An online survey of 17 522 US adults was conducted in 2013. The nationally representative sample was drawn from GfK Group's KnowledgePanel plus off-panel recruitment. Multinomial logistic regression was used to examine the relationships between tobacco use patterns across multiple products (cigarettes, cigars, and dissolvables), perceived harms towards regular pipe/hookah use, and demographic characteristics with hookah involvement (never used, ever used with/without reusing intent).

RESULT

Nearly one in five (16%) of the respondents had smoked hookah at least once in their life ("ever users"). Ever users of hookah were at higher risk of having used cigarettes, cigars, and dissolvable tobacco products (all P < .01). Odds for hookah use were greater for those who perceived regular pipe/hookah use as less dangerous (P < .05). Odds for hookah involvement were higher among young adults (P < .001), individuals with higher educational attainment (P < .01), and Hispanics/Latinos (P < .05).

CONCLUSIONS

Information about the public health harms associated with hookah smoking should be delivered to individuals at-risk for hookah smoking. It is likely that misconceptions about the safety of hookah smoking could be driving, at least in-part, its increase in popularity.

Tobacco use and exposure among youth undergoing cancer treatment

INTRODUCTION

Adolescents with cancer are susceptible to the health consequences associated with secondhand smoke exposure (SHSE) and tobacco use. The present study compared tobacco use, exposure, and risk factors between patients and population peers.

METHOD

Self-reported data on tobacco use, SHSE, and tobacco-related risk factors were drawn from a pediatric oncology hospital and the National Youth Tobacco Survey. Conditional logistic regression was used to estimate odds ratios for patients and control subjects.

RESULTS

Patients were as likely to have tried tobacco and report home SHSE as control subjects. Patients were more likely to report car SHSE, less likely to report that SHSE is harmful, and less likely to report home smoking bans.

DISCUSSION

Patients experienced SHSE, tobacco use, and tobacco-related risk factors at rates greater than or equal to control subjects. These results provide support for consideration of intervention targets, health status, and delivery mechanisms, particularly by health care providers, when developing comprehensive tobacco control strategies.

Efficacy of a telephone-delivered sexually transmitted infection/human immunodeficiency virus prevention maintenance intervention for adolescents: a randomized clinical trial

IMPORTANCE

Behavioral change interventions have demonstrated short-term efficacy in reducing sexually transmitted infection (STI)/human immunodeficiency virus (HIV) risk behaviors; however, few have demonstrated long-term efficacy.

OBJECTIVE

To evaluate the efficacy of a telephone counseling prevention maintenance intervention (PMI) to sustain STI/HIV-preventive behaviors and reduce incident STIs during a 36-month follow-up.

DESIGN, SETTING, AND PARTICIPANTS

In a 2-arm randomized supplemental treatment trial at 3 clinics serving predominantly minority adolescents in Atlanta, Georgia, 701 African American adolescent girls aged 14 to 20 years received a primary treatment and subsequently received a different (supplemental) treatment (PMI) to enhance effects of the primary treatment.

INTERVENTIONS

Participants in the experimental condition (n = 342) received an adapted evidence-based STI/HIV intervention (HORIZONS) and a PMI consisting of brief telephone contacts every 8 weeks over 36 months to reinforce and complement prevention messages. Comparison-condition participants (n = 359) received HORIZONS and a time- and dose-consistent PMI focused on general health.

MAIN OUTCOMES AND MEASURES

The primary outcomes were percentage of participants with a laboratory-confirmed incident chlamydial infection and percentage of participants with a laboratory-confirmed gonococcal infection during the 36-month follow-up. Behavioral outcomes included the following: (1) proportion of condom-protected sexual acts in the 6 months and 90 days prior to assessments; (2) number of sexual episodes during the past 90 days in which participants engaged in sexual intercourse while high on drugs and/or alcohol; and (3) number of vaginal sex partners in the 6 months prior to assessments.

RESULTS

During the 36-month follow-up, fewer participants in the experimental condition than in the comparison condition had incident chlamydial infections (94 vs 104 participants, respectively; risk ratio = 0.50; 95% CI, 0.28 to 0.88; P = .02) and gonococcal infections (48 vs 54 participants, respectively; risk ratio = 0.40; 95% CI, 0.15 to 1.02; P = .06). Participants completing more telephone contacts had a lower risk of chlamydial infection (risk ratio = 0.95; 95% CI, 0.90 to 1.00; P = .05). Participants in the experimental condition reported a higher proportion of condom-protected sexual acts in the 90 days (mean difference = 0.08; 95% CI, 0.06 to 0.11; P = .02) and 6 months (mean difference = 0.08; 95% CI, 0.06 to 0.10; P = .04) prior to assessments and fewer episodes of sexual acts while high on drugs and/or alcohol (mean difference = -0.61; 95% CI, -0.98 to -0.24; P < .001).

CONCLUSIONS AND RELEVANCE

Sustaining the long-term impact of an STI/HIV intervention is achievable with brief, tailored telephone counseling.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00279799.

A social media approach to inform youth about breast cancer and smoking: an exploratory descriptive study

Tobacco exposure during periods of breast development has been shown to increase risk of premenopausal breast cancer. An urgent need exists, therefore, to raise awareness among adolescent girls about this new evidence, and for adolescent girls and boys who smoke to understand how their smoking puts their female peers at risk for breast cancer. The purpose of this study was to develop two youth-informed, gender specific YouTube-style videos designed to raise awareness among adolescent girls and boys about tobacco exposure as a modifiable risk factor for breast cancer and to assess youths' responses to the videos and their potential for inclusion on social media platforms. Both videos consisted of a combination of moving text, novel images, animations, and youth-friendly music. A brief questionnaire was used to gather feedback on two videos using a convenience sample of 135 youth in British Columbia, Canada. The overall positive responses by girls and boys to their respective videos and their reported interest in sharing these videos via social networking suggests that this approach holds potential for other types of health promotion messaging targeting youth. The videos offer a promising messaging strategy for raising awareness about tobacco exposure as a modifiable risk factor for breast cancer. Tailored, gender-specific messages for use on social media hold the potential for cost-effective, health promotion and cancer prevention initiatives targeting youth.

Design of a school-based randomized trial to reduce smoking among 13 to 15-year olds, the X:IT study

BACKGROUND

Adolescent smoking is still highly prevalent in Denmark. One in four 13-year olds indicates that they have tried to smoke, and one in four 15-year olds answer that they smoke regularly. Smoking is more prevalent in socioeconomically disadvantaged populations in Denmark as well as in most Western countries. Previous school-based programs to prevent smoking have shown contrasting results internationally. In Denmark, previous programs have shown limited or no effect. This indicates a need for developing a well-designed, comprehensive, and multi-component intervention aimed at Danish schools with careful implementation and thorough evaluation.This paper describes X:IT, a study including 1) the development of a 3-year school-based multi-component intervention and 2) the randomized trial investigating the effect of the intervention. The study aims at reducing the prevalence of smoking among 13 to 15-year olds by 25%.

METHODS/DESIGN

The X:IT study is based on the Theory of Triadic Influences. The theory organizes factors influencing adolescent smoking into three streams: cultural environment, social situation, and personal factors. We added a fourth stream, the community aspects. The X:IT program comprises three main components: 1) smoke-free school premises, 2) parental involvement including smoke-free dialogues and smoke-free contracts between students and parents, and 3) a curricular component. The study encompasses process- and effect-evaluations as well as health economic analyses. Ninety-four schools in 17 municipalities were randomly allocated to the intervention (51 schools) or control (43 schools) group. At baseline in September 2010, 4,468 year 7 students were eligible of which 4,167 answered the baseline questionnaire (response rate = 93.3%).

DISCUSSION

The X:IT study is a large, randomized controlled trial evaluating the effect of an intervention, based on components proven to be efficient in other Nordic settings. The X:IT study directs students, their parents, and smoking prevention policies at the schools. These elements have proven to be effective tools in preventing smoking among adolescents. Program implementation is thoroughly evaluated to be able to add to the current knowledge of the importance of implementation. X:IT creates the basis for thorough effect and process evaluation, focusing on various social groups.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN77415416.

Factors associated with intent to quit tobacco use in Cyprus adolescents

OBJECTIVES

To identify factors associated with adolescent smokers' desire to quit based on the 2006 Cyprus Global Youth Tobacco Survey.

METHODS

A cluster sample design was used to select a representative sample of students from all registered middle and high schools in Cyprus with >40 students in academic year 2005-2006. Multivariable logistic regression was used taking into account the weight associated with each of the respondents.

RESULTS

Out of the total sample with available information (N=12,629), 1591 students were current smokers (weighted frequency=14%) and were included in the analysis, with 734 (46.1%) of them reporting that they want to quit smoking. In both males and females, strong predictors of intention to quit smoking include past quit attempts and physical activity. Intention to quit is also associated with the belief that smoking is harmful to them and inversely associated with having peers who smoke, in boys, and the belief that smoking is harmful to others and perceiving smokers as less attractive, and inversely associated with pocket money, in girls.

CONCLUSIONS

The present study has identified factors that appear to influence youth's intention to quit tobacco, which is of major importance in developing successful tobacco cessation programs targeting adolescents.

Craving, cue reactivity, and stimulus control among early-stage young smokers: effects of smoking intensity and gender

INTRODUCTION

Smoking initiation usually begins in adolescence, but how and for whom nicotine dependence emerges during this period is unclear. The cue-reactivity paradigm is well suited to examine one marker of dependence: craving-related stimulus control, i.e., the ability of environmental cues to elicit craving to smoke. This study examined the effects of both level of smoking involvement (daily vs. occasional smoking) and gender on reactivity to both smoking and alcohol cues.

METHODS

Young (age range 16-20; 42% female) daily (n = 55) and occasional (n = 52) smokers were exposed to each of three counterbalanced cues: (a) in vivo smoking (e.g., sight, smell, lighting of cigarette), (b) alcohol (e.g., opening, pouring, and smell of preferred beverage), and (c) neutral cue.

RESULTS

Daily smokers exhibited higher levels of tonic (i.e., noncue-elicited) craving than did occasional smokers. Both groups showed significant increases in craving in response to cues (i.e., cue-elicited craving), with little evidence that cue-elicited craving differed between groups. Females were more cue reactive to both the alcohol and smoking cues than males, particularly for the positively reinforced aspects of smoking (i.e., hedonic craving). There were no gender × group interaction effects in response to either the alcohol or the smoking cue.

CONCLUSIONS

Findings show the presence of cue-elicited craving even among occasional smokers and are consistent with literature demonstrating heightened sensitivity to environmental cues among females. Cue-elicited craving may be one mechanism that contributes to the maintenance of smoking behavior and perhaps to the development of nicotine dependence within early stage smokers.