Smoking in Young Adults: A Study of 4-Year Smoking Behavior Patterns and Residential Presence of Features Facilitating Smoking Using Data From the Interdisciplinary Study of Inequalities in Smoking Cohort

Smoking cessation message testing to inform app-based interventions for young adults - an online experiment

BACKGROUND

To improve the efficacy of digital smoking cessation interventions for young adults, intervention messages need to be acceptable and appropriate for this population. The current study compared ratings of smoking cessation and urge reduction messages based on Cognitive Behavioral Therapy (distraction themed) and Acceptance and Commitment Therapy (acceptance themed) in young adults who smoke.

METHODS

A total of 124 intervention messages were rated by an online Qualtrics panel of N = 301 diverse young adults who currently smoked tobacco cigarettes (Age M = 26.6 years; 54.8% male; 51.5% racial/ethnic minority; 16.9% sexual or gender minority (SGM); 62.5% daily smoking). Each participant rated 10 randomly selected messages (3,010 total message ratings; 24.3 ratings per message) on 5-point scales (higher scores representing more favorable ratings) evaluating quality of content, quality of design, perceived support for coping with smoking urges, and perceived support for quitting smoking. Mixed models examined associations between message category (distraction vs. acceptance), participant level predictors (sociodemographic variables, readiness and motivation to quit, daily smoking, psychological flexibility), and message ratings.

RESULTS

Overall ratings ranged from M = 3.61 (SD = 1.25) on support for coping with urges to M = 3.90 (SD = 1.03) on content, with no differences between distraction and acceptance messages. Male participants gave more favorable ratings on the dimensions of support for coping (p < 0.01) and support for quitting (p < 0.01). Participants identifying as SGM gave lower ratings for message design (p < 0.05). Participants with a graduate degree gave higher ratings on support for coping with urges and support for quitting (both p < 0.05). Higher motivation to quit was associated with more favorable scores across all dimensions (all p < 0.01). Those smoking daily rated messages as less helpful for coping with urges (p < 0.01) and quitting smoking (p < 0.05) compared to those smoking non-daily. Few interactions were found between message category distraction vs. acceptance and participant characteristics.

CONCLUSIONS

Distraction and acceptance messages received similar ratings among young adults who smoke cigarettes. Message revisions may be needed to increase appeal to women, SGM, those with lower education, and those less motivated to quit. Messages will be refined and used in an ongoing micro-randomized trial to investigate their real-time impact on smoking urges and behaviors.

Smoking cessation message testing to inform app-based interventions - an online experiment

Background: To improve the efficacy of digital smoking cessation interventions for young adults, intervention messages need to be acceptable and appropriate for this population. The current study compared ratings of smoking cessation and urge reduction messages based on Cognitive Behavioral Therapy (distraction themed) and Acceptance and Commitment Therapy (acceptance themed) in young adults who smoke. Methods: A total of 124 intervention messages were rated by an online Qualtrics panel of N=301 diverse young adults who currently smoked tobacco cigarettes (Age M=26.6 years; 54.8% male; 51.5% racial/ethnic minority; 16.9% sexual or gender minority (SGM); 62.5% daily smoking). Each participant rated 10 randomly selected messages (3,010 total message ratings; 24.3 ratings per message) on 5-point scales (higher scores representing more favorable ratings) evaluating quality of content, quality of design, perceived support for coping with smoking urges, and perceived support for quitting smoking. Mixed models examined associations between message category (distraction vs. acceptance), participant level predictors (sociodemographic variables, readiness and motivation to quit, daily smoking, psychological flexibility), and message ratings. Results: Overall ratings ranged from M=3.61 (SD=1.25) on support for coping with urges to M=3.90 (SD=1.03) on content, with no differences between distraction and acceptance messages. Male participants gave more favorable ratings on the dimensions of support for coping (p<0.01) and support for quitting (p<0.01). Participants identifying as SGM gave lower ratings for message design (p<0.05). Participants with a graduate degree gave higher ratings on support for coping with urges and support for quitting (both p<0.05). Higher motivation to quit was associated with more favorable scores across all dimensions (all p<0.01). Those smoking daily rated messages as less helpful for coping with urges (p<0.01) and quitting smoking (p<0.05) compared to those smoking non-daily. Few interactions were found between message category distraction vs. acceptance and participant characteristics. Conclusions: Distraction and acceptance messages received similar ratings among young adults who smoke cigarettes. Message revisions may be needed to increase appeal to women, SGM, those with lower education, and those less motivated to quit. Messages will be refined and used in an ongoing micro-randomized trial to investigate their real-time impact on smoking urges and behaviors.

Tobacco retail availability and smoking-A systematic review and meta-analysis

ISSUES

Health policy makers worldwide have adopted evidence-based legislation, largely directed at consumers, to reduce tobacco-related harm. It is suggested that limiting supply by decreasing retail availability can also reduce cigarette smoking. To inform policy makers this systematic literature review assesses whether reducing availability is associated with smoking behaviours.

APPROACH

Systematic literature searches of five databases were carried out up to January 2023. Included studies had at least one exposure (tobacco retail density, proximity or mixed measures thereof) and outcomes of smoking behaviour. Meta-analysis of effect estimates were undertaken if there were at least three studies with similar population, exposure and outcome measures.

KEY FINDINGS

Sixty-two studies were included, and positive associations were found between tobacco outlet density and cigarette smoking in pregnancy, youth, adults and cessation. Meta-analyses were undertaken for retail density and ever smoking (odds ratio [OR] 1.20; 95% confidence interval [CI] 1.04, 1.37; I2 = 87.3%), and current youth smoking (OR 1.23; 95% CI 1.08, 1.40; I2 = 0.0%), adult smoking (OR 1.11; 95% CI 1.01, 1.22; I2 = 74.8%); and mixed measures of retail availability near schools and current youth smoking (OR 1.03; 95% CI 1.01, 1.05; I2 = 0.0%).

IMPLICATIONS AND CONCLUSION

There is evidence higher tobacco retail density is consistently associated with cigarette smoking in pregnant women, young people and adults when ecological studies are included in meta-analysis. Meanwhile, evidence synthesis reveals restrictive tobacco retail laws based on proximity or mixed measures near home or very near school may not reduce smoking except in men who smoke heavily. Mechanisms to reduce retailer density should be thus considered part of tobacco control strategies.

Prevalence of smoking cigarettes and beliefs regarding smoking habits among medical students: a cross-sectional study in Sudan

Background

Smoking is a common problem in university students worldwide. Smoking is one of the most dangerous social phenomena and has a significant impact on public health. This study investigated the beliefs and attitudes of medical students toward smoking in Sudan.

Methods

A cross-sectional study was conducted among medical students at Al Neelain University, Sudan, from March to June 2022 using a web-based questionnaire. The questionnaire consisted of eight items on demographic characteristics and 13 on the beliefs and attitudes toward smoking. Other data included smoking status, smoking habits, the number of cigarettes smoked per day, and smoking duration. Data analysis was performed descriptively, and chi-square test and logistic regression were conducted using SPSS version 24. Statistical significance was set at 0.05.

Results

A total of 336 students participated in this study, and the smoking prevalence was 48.8% (41.1% in men and 7.7% in women). In total, 76.8% reported smoking daily at a rate of 5-10 cigarettes per day. In terms of students' beliefs about smoking, 86.8% disagreed with selling cigarettes at the university. Of the respondents, 68.4% did not approve smoking on campus. There was a relationship between smoking habits and the age group of 22-25 years, which was the highest smoking category among students (p-value = 0.01).

Conclusion

The prevalence of cigarette smoking among medical students is disturbing, particularly as they are future doctors. There is a need to include plans to reduce smoking among students that can be incorporated into courses and special programs.

Associations of tobacco retailer density and proximity with adult tobacco use behaviours and health outcomes: a meta-analysis

OBJECTIVE

We sought to conduct a systematic review and meta-analysis of evidence to inform policies that reduce density and proximity of tobacco retailers.

DATA SOURCES

Ten databases were searched on 16 October 2020: MEDLINE via PubMed, PsycINFO, Global Health, LILACS, Embase, ABI/Inform, CINAHL, Business Source Complete, Web of Science and Scopus, plus grey literature searches using Google and the RAND Publication Database.

STUDY SELECTION

Included studies used inferential statistics about adult participants to examine associations between tobacco retailer density/proximity and tobacco use behaviours and health outcomes. Of 7373 studies reviewed by independent coders, 37 (0.5%) met inclusion criteria.

DATA EXTRACTION

Effect sizes were converted to a relative risk reduction (RRR) metric, indicating the presumed reduction in tobacco use outcomes based on reducing tobacco retailer density and decreasing proximity.

DATA SYNTHESIS

We conducted a random effects meta-analysis and examined heterogeneity across 27 studies through subgroup analyses and meta-regression. Tobacco retailer density (RRR=2.55, 95% CI 1.91 to 3.19, k=155) and proximity (RRR=2.38, 95% CI 1.39 to 3.37, k=100) were associated with tobacco use behaviours. Pooled results including both density and proximity found an estimated 2.48% reduction in risk of tobacco use from reductions in tobacco retailer density and proximity (RRR=2.48, 95% CI 1.95 to 3.02, k=255). Results for health outcomes came from just two studies and were not significant. Considerable heterogeneity existed.

CONCLUSIONS

Across studies, lower levels of tobacco retailer density and decreased proximity are associated with lower tobacco use. Reducing tobacco supply by limiting retailer density and proximity may lead to reductions in tobacco use. Policy evaluations are needed.

Prevalence and factors associated with tobacco use in women deprived of liberty in a prison in the Brazilian Midwest

Abstract Tobacco use is a Public Health issue, and the release of its use in the prison system is controversial. Its prevalence in this population is high, including in women’s prisons. The objective of this article is to estimate tobacco use prevalence in women deprived of liberty and its associated factors. Cross-sectional study with 259 participants who answered a questionnaire in a prison in the Brazilian Midwest. The dependent variable was tobacco use, and the independent variables were sociodemographic, life history, legal status, and use of other drugs. Descriptive and bivariate analyses were performed, using prevalence ratios through the Chi-square test and Poisson regression in the multivariate analysis. Tobacco use prevalence was 86.87%. In the final model, the variables: age group, from 18-39 years (PR 1.33; 95%CI 1.10-1.61), alcohol use (PR 1.26; 95%CI 1.00-1.59), marijuana use (PR 1.16; 95%CI 1.03-1.30), and interaction between prison time and cocaine use (PR 1.05; 95%CI 1.00-1.11) remained associated with tobacco use. Tobacco use prevalence was high. The age group 18-39 years, alcohol and marijuana use and interaction between imprisonment length of 36 months or more and cocaine use were associated with tobacco use.

Prevalência e fatores associados ao tabagismo em mulheres privadas de liberdade, numa prisão, Centro-Oeste do Brasil

Resumo O tabagismo é um problema de Saúde Pública e é controversa a liberação do seu uso no sistema prisional. Sua prevalência nesta população é elevada, inclusive nas prisões femininas. O objetivo deste artigo é estimar a prevalência do tabagismo em mulheres privadas de liberdade e os fatores associados. Estudo de corte transversal, com 259 participantes que responderam um questionário numa prisão no Centro-Oeste do Brasil. A variável dependente foi o tabagismo, e as independentes, as sociodemográficas, histórico de vida, situação jurídica e uso de outras drogas. Realizou-se análises descritiva e bivariada, através de razões de prevalência com o teste Qui-quadrado e, na análise multivariável, a regressão de Poisson. A prevalência de tabagismo foi de 86,87%. No modelo final as variáveis: faixa etária, de 18 a 39 anos (RP 1,33; IC95% 1,10-1,61); uso de álcool (RP 1,26; IC95% 1,00-1,59); uso de maconha (RP 1,16; IC95% 1,03-1,30); e interação entre tempo de prisão e uso de cocaína (RP 1,05; IC95% 1,00-1,11) se mantiveram associadas ao tabagismo. A prevalência de tabagismo foi alta. A faixa etária 18-39 anos, uso de álcool, maconha e interação entre tempo de prisão por 36 meses ou mais e uso de cocaína foram fatores associados ao tabagismo.

User pathways of e-cigarette use to support long term tobacco smoking relapse prevention: a qualitative analysis

BACKGROUND AND AIMS

E-cigarettes are the most popular consumer choice for support with smoking cessation in the United Kingdom. However, there are concerns that long-term e-cigarette use may sustain concurrent tobacco smoking or lead to relapse to smoking in ex-smokers. We aimed to explore vaping trajectories, establishing e-cigarette users' perspectives on continued e-cigarette use in relation to smoking relapse or abstinence.

DESIGN

Qualitative longitudinal study collecting detailed subjective data at baseline and ~12 months later.

SETTING

United Kingdom.

PARTICIPANTS

E-cigarette users (n = 37) who self-reported that they had used e-cigarettes to stop smoking at baseline.

MEASUREMENTS

Semi-structured qualitative interviews (face-to-face or telephone) collected self-reported patterns of e-cigarette use. Thematic analysis of transcripts and a mapping approach of individual pathways enabled exploration of self-reported experiences, motives, resources, and environmental and social influences on vaping and any concurrent tobacco smoking.

FINDINGS

Three broad participant pathways were identified: 'maintainer' (e-cigarette use and not smoking), 'abstainer' (neither smoking nor using e-cigarettes), and 'relapser' (dual-using, or relapsed back to tobacco smoking only). In each pathway, individual experiences with vaping nicotine appeared to play an important role and appeared to be related to psychological and social factors. A social context supportive of vaping was important for the maintainers, as was a belief in the need to overcome nicotine addiction for the abstainers, and dislike of the 'vaping culture' expressed by some in the relapser group. Dual-users held beliefs such as a need for cigarettes at time of acute stress that affirmed dependence on tobacco.

CONCLUSIONS

In a sample of UK e-cigarette users who report having used e-cigarettes to quit smoking, a social context that supports continued vaping was perceived to be helpful in preventing relapse to smoking.