E-cigarette use among women of reproductive age: Impulsivity,cigarette smoking status,and other risk factors

IntroductionThe study aim was to examine impulsivity and other risk factors for e-cigarette use among women of reproductive age comparing current daily cigarette smokers to never cigarette smokers. Women of reproductive age are of special interest because of the additional risk that tobacco and nicotine use represents should they become pregnant.MethodSurvey data were collected anonymously online using Amazon Mechanical Turk in 2014. Participants were 800 women ages 24–44 years from the US. Half (n = 400) reported current, daily smoking and half (n = 400) reported smoking < 100 cigarettes lifetime. Participants completed questionnaires regarding sociodemographics, tobacco/nicotine use, and impulsivity (i.e., delay discounting & Barratt Impulsiveness Scale). Predictors of smoking and e-cigarette use were examined using logistic regression.ResultsDaily cigarette smoking was associated with greater impulsivity, lower education, past illegal drug use, and White race/ethnicity. E-cigarette use in the overall sample was associated with being a cigarette smoker and greater education. E-cigarette use among current smokers was associated with increased nicotine dependence and quitting smoking; among never smokers it was associated with greater impulsivity and illegal drug use. E-cigarette use was associated with hookah use, and for never smokers only with use of cigars and other nicotine products.ConclusionsE-cigarette use among women of reproductive age varies by smoking status, with use among current smokers reflecting attempts to quit smoking whereas among non-smokers use may be a marker of a more impulsive repertoire that includes greater use of alternative tobacco products and illegal drugs.     

Pilot weight control intervention among US veterans to promote diets high in fruits and vegetables

BackgroundObesity is a significant problem among US veterans. Diets high in fruits and vegetables (FV) can lower obesity risk. Health communication interventions are promising strategies for promoting healthy eating. We evaluated whether an enhanced intervention with tailored newsletters and motivational interviewing calls would be more effective than the Veterans Affairs (VA) weight management program, MOVE!, at increasing FV intake among overweight/obese veterans.MethodsUsing a quasi-experimental design, 195 veterans at two clinics participated at baseline and 6-month follow-up from 2005 to 2006. Measures included daily FV intake and information processing of the intervention. The control group (MOVE!) received educational information, group sessions, and standard phone calls about weight. The intervention included MOVE! components plus tailored newsletters and motivational interviewing calls.ResultsThe intervention group reported a statistically significant increase in FV servings compared to control (1.7 vs. 1.2; p ≤ 0.05). Veterans who read more of the tailored newsletters (β = 0.15, p = 0.01) and perceived the messages as important (β = 0.12, p < 0.01) and applicable to their lives (β = 0.12, p < 0.01) ate more FV than those who did not. However, receiving MI calls and information processing regarding the calls were not associated with FV intake.ConclusionA tailored intervention can impact short term FV intake for obesity prevention.     

Abstinence rates among college cigarette smokers enrolled in a randomized clinical trial evaluating Quit and Win contests: The impact of concurrent hookah use

ObjectiveTo examine baseline characteristics and biochemically verified 1-, 4-, and 6-month tobacco quit rates among college students enrolled in a Quit and Win cessation trial, comparing those who concurrently smoke both hookah and cigarettes with those who deny hookah use.MethodsAnalyses were conducted on data from 1217 college students enrolled in a Quit and Win tobacco cessation randomized clinical trial from 2010–2012. Multivariable logistic regression (MLR) analyses examined group differences in baseline characteristics and cotinine verified 30-day abstinence at 1, 4, and 6-month follow-up, adjusting for baseline covariates.ResultsParticipants smoked 11.5(± 8.1) cigarettes per day on 28.5(± 3.8) days/month, and 22% smoked hookah in the past 30 days. Hookah smokers (n = 270) were more likely to be male (p < 0.0001), younger (p < 0.0001), report more binge drinking (p < 0.0001) and score higher on impulsivity (p < 0.001). MLR results indicate that hookah users, when compared to non-users, had a 36% decrease in odds of self-reported 30-day abstinence at 4-months (OR = 0.64, 95% CI = 0.45–0.93, p = 0.02) and a 63% decrease in odds in biochemically verified continuous abstinence at 6-months (OR = 0.37, CI = 0.14–0.99, p = 0.05).ConclusionCollege cigarette smokers who concurrently use hookah display several health risk factors and demonstrate lower short and long-term tobacco abstinence rates.     

Determinants of use of smoking cessation aids in 27 European countries

ObjectiveTo identify determinants of use of smoking cessation aids among current and former smokers in the European Union (EU).MethodsData from n = 9921 current and ex-smokers from 27 European countries (Eurobarometer 77.1, February–March 2012) were analysed. Multivariate binary logistic regression was used to assess for correlates of use of any recommended aid with proven efficacy, defined as use of pharmacotherapy or psychosocial counselling (p < 0.05). The regression analyses assessed for socio-demographic characteristics, EU region, as well as scope of national smoking cessation policies.ResultsAmong current smokers who had made a quit attempt and ex-smokers, 19.9% had used any recommended aid with proven efficacy. Respondents from Northern (adjusted odds ratio [aOR] = 1.90), Western (aOR = 3.21) and Eastern Europe (aOR = 1.69) were more likely to have used an efficacious smoking cessation aid compared to respondents from Southern Europe (all p < 0.05). Respondents in countries with comprehensive tobacco cessation programmes that offered cost-covered national quit lines, medication, and other cessation services had increased likelihood of using efficacious cessation aids (OR = 1.29; 95% Confidence Interval: 1.07–1.55).ConclusionsThese findings underscore the need for enhanced and sustained efforts to ensure increased access to cessation services and aids as part of a comprehensive tobacco control programme.     

Evolución del tabaquismo según clase social en la población adulta de las Islas Canarias durante el periodo 2000-2015: seguimiento de la cohorte CDC-Canarias

ObjectiveTo determine the status of tobacco consumption in the Canary Islands during 2000-2015, according to social class.LocationCanary Islands.ParticipantsGeneral population cohort, with contacts in 2000 (n = 6,729), 2008 (n = 6,171) and 2015 (n = 4,705).Main measurementsSmoking, gender, age, and social class.ResultsConsumption decreased by 6% (5-7%, P < .001) in general, being more accentuated in the period 2000-2008 (5%). The decrease was greater in men, although they continued to smoke more than women, with a prevalence of 25% (24-26%) compared to 18% (17-19%, P < .001). A decrease in consumption was only observed in the younger groups (6% [3-5%], P = .011) and intermediate ages (7% [6-8%], P < .001). A similar decrease was observed in all the social classes, but there was a higher prevalence of smoking in the upper class: 24% (23-25%) in 2015 (P < .001). By jointly assessing gender, age, and social class, younger and middle age men had the greatest decreases in consumption: 8% (7-9%) low and upper classes, 10% (9-11%) middle class. In the lower social class, younger women continue to smoke more (27%) although more of them quit smoking (14%), a phenomenon that occurred in the middle class at intermediate ages.ConclusionsThe evolution of tobacco consumption in the Canary Islands follows a pattern similar to that of mainland Spain. The abandonment of tobacco consumption has slowed down in the period 2008-2015, especially in men, and middle and upper social classes.     

Prevalencia y perfil de uso del cigarrillo electrónico en España (2014)

ObjectiveTo describe the prevalence and user profile of electronic cigarettes among Spanish adults and evaluate the potential dual use of these devices with combustible or conventional tobacco in 2014 in Spain.MethodsCross-sectional study of a representative sample of the Spanish adult (16-75 years old) population (n = 1,016). A computer-assisted telephone survey was conducted in 2014. The prevalence and 95% confidence intervals (95% CI) for the use of electronic cigarettes stratified by gender, age, tobacco consumption and social status were calculated. The sample was weighted and a logistic regression model adjusted to obtain the crude odds ratios (OR) adjusted by gender, age and social status.Results10.3% (95% CI: 8.6-12.4) of the Spanish adult population stated being ever users of electronic cigarettes (2% current users, 3.2% past users and 5.1% experimental users). Among current electronic cigarette users, 57.2% also smoked combustible or conventional tobacco, 28% had never smoked and 14.8% were former smokers. The prevalence of electronic cigarette use was higher in the younger population (adjusted OR = 23.8; 95% CI: 2.5-227.7) and smokers of combustible tobacco (adjusted OR = 10.1; 95% CI: 5.8-17.5).ConclusionsThe use of electronic cigarettes in Spain is scarce and is most prevalent among young people and tobacco smokers. Nevertheless, one out of four current electronic cigarette users have never smoked. Hence, the regulation of these devices should be reinforced to avoid a possible gateway to nicotine products among never smokers.     

Longitudinal patterns of youth access to cigarettes and smoking progression: Minnesota Adolescent Community Cohort (MACC) study (2000–2003)

ObjectivesTo measure community-level changes in the methods youth use to obtain cigarettes over time and to relate these methods to the progression of smoking.MethodsWe analyzed 2000–2003 data from the Minnesota Adolescent Community Cohort study, where youth (beginning at age 12), who were living in Minnesota at baseline, were surveyed every 6 months via telephone. We conducted mixed model repeated measures logistic regression to obtain probabilities of cigarette access methods among past 30-day smokers (n = 340 at baseline).ResultsThe probability of obtaining cigarettes from a commercial source in the past month declined from 0.36 at baseline to 0.22 at the sixth survey point while the probability of obtaining cigarettes from a social source during the previous month increased from 0.54 to 0.76 (p for both trends = 0.0001). At the community level, the likelihood of adolescents obtaining cigarettes from social sources was inversely related to the likelihood of progressing to heavy smoking (p < 0.001).ConclusionsDuring this time, youth shifted to greater reliance on social sources and less on commercial sources. A trend toward less commercial access to cigarettes accompanied by an increase in social access may translate to youth being less likely to progress to heavier smoking.     

Smokers' physical activity and weight gain one year after a successful versus unsuccessful quit attempt

ObjectiveTo examine whether smokers' physical activity is related to weight change following a quit attempt.MethodData were analyzed for participants (n = 683) of a randomized controlled trial comparing the efficacy of different smoking cessation pharmacotherapies (Wisconsin, 2005–2008). Activity (assessed via pedometry) and body weight were measured in the days surrounding the quit day and again one year later, at which time 7-day point-prevalence abstinence from smoking was assessed. We examined the effects of quitting, physical activity, and their interaction, on a one-year weight change with relevant covariate adjustment.ResultsParticipants were predominantly female (57%), 46 ± 11 years of age (mean ± SD), and took 7544 ± 3606 steps/day at baseline. Of those who quit, 87% gained weight. A main effect was found for quitting (p < 0.001), but not physical activity (p = 0.06). When pattern of activity was examined across the 1-year study period, quitters who decreased their physical activity had significantly greater weight gain than quitters who increased their physical activity (p < 0.01) or maintained a high level of activity (p = 0.02).ConclusionPhysical activity is associated with an attenuation of the weight gain that often occurs after quitting smoking.     

Magazine hyped: Trends in tobacco advertising and readership characteristics, 2010–2014

We tracked magazine advertisements for seven tobacco products in U.S. magazines from 2010 to 2014 and examined magazine readership characteristics that are associated with advertising placement in 2014.Advertising data came from Kantar Media's Intelligence and readership data came from a 2014 Experian's nationally representative survey of 4667 adult tobacco users. At magazine level, we aggregated total and product-specific number of advertisements and expenditures by year and calculated readership demographics. We used linear and poisson regression models to examine trends in number of tobacco advertisements and expenditures and readership characteristics associated with number of tobacco advertisements in 2014. Analyses were conducted in 2015.There were 5317 tobacco advertisements with expenditures of $796 million that appeared in 322 magazines during 2010–2014. Cigarette advertisements accounted for 2928 (55%), followed by e-cigarettes (n = 862, 16%), and snus (n = 534, 10%). Advertisements increased by 2.79 ad/year for cigarettes, 1.94 ad/year for e-cigarettes, and 0.78 ad/year for chewing tobacco (p < 0.05). In 2014, number of advertisements was associated with select readership characteristics (p < 0.05). For every 10% increase in 18–39 year-old readers, advertisement rate increased by 1.48 times for cigarettes, 3.44 times for e-cigarettes, and 2.15 times for chewing tobacco. For every 10% increase in readers who earn ≤$24,999, advertisement rate increased by 1.37 times for cigarettes and 1.70 times for e-cigarettes.Magazine tobacco advertising has increased especially for cigarettes and is targeted toward certain demographic subgroups. Regulating tobacco magazine advertising should be integral to tobacco control policies.     

Military combat and burden of subclinical atherosclerosis in middle aged men: The ARIC Study

BackgroundStudies of the cardiovascular consequences of combat stress are few and inconclusive.ObjectiveThe association between combat exposure and subclinical atherosclerosis at Atherosclerosis Risk in Communities (ARIC) Study visits 1 (1987–1989) and 2 (1990–1992) was assessed among 5347 men from four U.S. communities.MethodsMeasured an average of 36 years after military entry, carotid intima-media thickness (CIMT) and carotid plaque among non-combat veterans (n = 2127) were compared with non-veterans (n = 2042) and veterans reporting combat experience (n = 1178).ResultsCompared to non-combat veterans, non-veterans (risk difference (RD): 10.61; 95% confidence interval (CI): 0.81, 20.41) and combat veterans (RD: 12.79; 95% CI: 0.72, 24.86) had higher age-adjusted mean CIMT. Differences remained for combat veterans after adjustment for race, father's education and age at service entry but not years of service and for non-veterans after adjustment for race but not father's education. No differences in carotid plaque were noted.ConclusionResults do not suggest that combat has a long-term detrimental effect on subclinical atherosclerosis among men.     

Waterpipe and Cigarette Smoking Among College Athletes in the United States

PurposeTobacco use using a waterpipe is an emerging trend among college students. Although cigarette smoking is low among college athletes, waterpipe tobacco smoking may appeal to this population. The purpose of this study was to compare cigarette and waterpipe tobacco smoking in terms of their associations with organized sport participation.MethodsIn the spring of 2008, we conducted an online survey of 8,745 college students at eight institutions as part of the revised National College Health Assessment. We used multivariable regression models to assess the associations between tobacco use (cigarette and waterpipe) and organized sports participation.ResultsParticipants reported participation in varsity (5.2%), club (11.9%), and intramural (24.9%) athletics. Varsity athletes and individuals who were not varsity athletes had similar rates of waterpipe tobacco smoking (27.6% vs. 29.5%, p = .41). However, other types of athletes were more likely than their counterparts to have smoked waterpipe tobacco (35.1% vs. 28.7%, p < .001 for club sports and 34.8% vs. 27.7%, p < .001 for intramural sports). In fully-adjusted multivariable models, sports participants of any type had lower odds of having smoked cigarettes, whereas participants who played intramural sports (odds ratio = 1.15, 95% confidence interval = 1.03, 1.29) or club sports (odds ratio = 1.15, 95% confidence interval = 1.001, 1.33) had significantly higher odds of having smoked waterpipe tobacco.ConclusionsCollege athletes are susceptible to waterpipe tobacco use. In fact, compared with their nonathletic counterparts, club sports participants and intramural sports participants generally had higher odds of waterpipe tobacco smoking. Allure for waterpipe tobacco smoking may exist even for individuals who are traditionally considered at low risk for tobacco use.     

Smoking and mortality among persons aged 75–94

ObjectivesExamine the effect of current level of smoking and lifetime tobacco consumption on mortality in persons 75–94 years of age.MethodsData were from a representative sample of older Jewish persons in Israel, which included 1,200 self-respondent participants aged 75–94 (Mean = 83.1, SD = 5.3) from the Cross-Sectional and Longitudinal Aging Study (CALAS). Data collection took place during 1989–1992. Mortality data on 95.1% of the sample at 20-year follow up were recorded from the Israeli National Population Registry.ResultsThe following variables adversely affected mortality for the whole sample: Smoking 11–20 cigarettes daily (HR = 1.276, p < .05), smoking over 20 cigarettes daily (HR = 1.328, p < .05), total tobacco consumption (HR = 1.002, p < .01), and heavy lifetime tobacco consumption (HR = 1.270, p < .01). Results were similar for persons aged 75–84, but the effect of smoking seems to decrease or disappear for ages 85 and above.ConclusionThis is the first report of all-cause mortality risk in both genders of a representative population aged 75 and over. Increased mortality risk is related to high daily quantity of current smoking, and to cumulative amount of lifetime smoking. The effect of smoking may disappear for ages 85 and above, and should be studied in larger oldest–old samples.     

Cigarette package inserts can promote efficacy beliefs and sustained smoking cessation attempts: A longitudinal assessment of an innovative policy in Canada

BackgroundIn June 2012, Canada implemented new pictorial warnings on cigarette packages, along with package inserts with messages to promote response efficacy (i.e., perceived quitting benefits) and self-efficacy (i.e., confidence to quit). This study assessed smokers' attention toward warnings and inserts and its relationship with efficacy beliefs, risk perceptions and cessation at follow-up.MethodsData were analyzed in 2015 from a prospective online consumer panel of adult Canadian smokers surveyed every four months between September 2012 and September 2014. Generalized Estimating Equation models were estimated to assess associations between reading inserts, reading warnings and efficacy beliefs (self-efficacy, response efficacy), risk perceptions, quit attempts of any length, and sustained quit attempts (i.e., 30 days or more) at follow-up. Models adjusted for socio-demographics, smoking-related variables, and time-in-sample effects.ResultsOver the study period, reading warnings significantly decreased (p < 0.0001) while reading inserts increased (p = 0.004). More frequent reading of warnings was associated independently with stronger response efficacy (B_{often/very often vs never} = 0.28, 95% CI: 0.11–0.46) and risk perceptions at follow-up (B_{often/very often vs never} = 0.31, 95% CI: 0.06–0.56). More frequent reading of inserts was associated independently with stronger self-efficacy to quit at follow-up (B_{twice or more vs none} = 0.30, 95% CI: 0.14–0.47), quit attempts (OR_{twice or more vs none} = 1.68, 95% CI: 1.28–2.19), and sustained quit attempts (OR_{twice or more vs none} = 1.48, 95% CI: 1.01–2.17).ConclusionsMore frequent reading of inserts was associated with self-efficacy to quit, quit attempts, and sustained quitting at follow-up, suggesting that inserts complement pictorial HWLs.     

Cigarette smoking and 9/11-related posttraumatic stress disorder among World Trade Center Health Registry enrollees, 2003–12

ObjectiveNumerous studies have observed higher rates of smoking among adults with mental health conditions. We examined posttraumatic stress disorder (PTSD) and smoking over a 7–9 year period among adults with firsthand exposure to the 9/11 attacks enrolled in the World Trade Center Health Registry.MethodData were collected at three waves: W1 (2003–04), W2 (2006–07), and W3 (2011–12). Enrollees aged ≥ 25 at W1 and who completed all three waves (n = 34,458) were categorized by smoker-type: non-smoker, non-daily (smoked some days in last 30 days), light (1–10 cigarettes per day (CPD)), or heavy (11 + CPD). Enrollees who smoked at W1 but not W3 were considered to have quit. PTSD was defined as a score of ≥ 44 on the PTSD Checklist—Civilian Version.ResultsSmoking declined significantly from W1 (12.6%) to W3 (9.2%). Smoking prevalence was higher among enrollees with PTSD. In multivariable models, odds of quitting were 25–39% lower among heavy, light, and non-daily smokers with PTSD compared to those without.ConclusionPTSD was associated with reduced odds of quitting regardless of smoker-type. Disaster-exposed smokers with PTSD are likely in need of more supportive services in order to abstain from smoking.     

Annual influenza vaccination reduces total hospitalization in patients with chronic hepatitis B virus infection: A population-based analysis

BackgroundThis study evaluated hospitalization and mortality in patients with chronic hepatitis B virus infection (HBV (+)) and matched comparison patients after stratifying the patients according to annual influenza vaccination (Vaccine (+)).MethodsData from Taiwan's National Health Insurance program from 2000 to 2009 were used to identify HBV(+)/vaccine(+) (n = 4434), HBV(+)/Vaccine(−) (n = 3646), HBV(−)/Vaccine(+) (n = 8868), and HBV(−)/Vaccine(−) (n = 8868) cohorts. The risk of pneumonia/influenza, respiratory failure, intensive care, hospitalization, and mortality in the four cohorts was evaluated.ResultsThe total hospitalization rate was significantly lower in patients with chronic HBV infection who received an annual influenza vaccination than in chronic HBV-infected patients who did not receive an influenza vaccination (16.29 vs. 24.02 per 100 person-years), contributing to an adjusted hazard ratio (HR) of 0.56 (95% confidence interval (CI) = 0.50–0.62). The HBV(+)/Vaccine(+) cohort also had lower risks than the HBV(+)/Vaccine(−) cohort for pneumonia and influenza (adjusted HR = 0.79, 95% CI = 0.67–0.92), intensive care unit admission (adjusted HR = 0.33, 95% CI = 0.25–0.43), and mortality (adjusted HR = 0.19, 95% CI = 0.15–0.24).ConclusionsOur results suggest that annual influenza vaccination can reduce the risk of hospitalization and mortality in patients with chronic HBV infection.     

Participant-level meta-analysis of mobile phone-based interventions for smoking cessation across different countries

With meta-analysis, participant-level data from five text messaging-based smoking cessation intervention studies were pooled to investigate cessation patterns across studies and participants. Individual participant data (N = 8315) collected in New Zealand (2001–2003; n = 1705), U.K. (2008–2009; n = 5792), U.S. (2012; n = 503; n = 164) and Turkey (2012; n = 151) were collectively analyzed in 2014. The primary outcome was self-reported 7-day continuous abstinence at 4 weeks post-quit day. Secondary outcomes were: (1) self-reported 7-day continuous abstinence at 3 months and (2) self-reported continuous abstinence at 6 months post-quit day. Generalized linear mixed models were fit to estimate the overall treatment effect, while accounting for clustering within individual studies. Estimates were adjusted for age, sex, socioeconomic status, previous quit attempts, and baseline Fagerstrom score. Analyses were intention to treat. Participants lost to follow-up were treated as smokers. Twenty-nine percent of intervention participants and 12% of control participants quit smoking at 4 weeks (adjusted odds ratio [aOR] = 2.89, 95% CI [2.57, 3.26], p < .0001). An attenuated but significant effect for cessation for those in the intervention versus control groups was observed at 3 months (aOR = 1.88, 95% CI [1.53, 2.31]) and 6 months (aOR = 2.24, 95% CI [1.90, 2.64]). Subgroup analyses were conducted but few significant findings were noted. Text messaging-based smoking cessation programs increase self-reported quitting rates across a diversity of countries and cultures. Efforts to expand these low-cost and scalable programs, along with ongoing evaluation, appear warranted.     

Tobacco control environment in the United States and individual consumer characteristics in relation to continued smoking: Differential responses among menthol smokers?

ObjectiveWe used a consumer panel augmented with state-specific measures of tobacco control activities to examine the main effects and interactions among consumer behaviors, particularly menthol cigarette smoking, and tobacco control environment on cessation over a six-year period.MethodsWe used the Nielson Homescan Panel, which tracks consumer purchasing behaviors, and tobacco control information matched to panelist zip code. We focused on 1582 households purchasing ≥ 20 packs from 2004 to 2009. Our analysis included demographics; purchasing behavior including menthol versus nonmenthol use (≥ 80% of cigarettes purchased being menthol), quality preferences (average price/pack), purchase recency, and nicotine intake (nicotine levels of cigarettes purchased); and tobacco control metrics (taxation, anti-tobacco advertising, smoke-free policies).ResultsMenthol smoking (Hazard Ratio [HR] = 0.79, 95% Confidence Interval [CI] 0.64, 0.99), being African American (HR = 0.67, CI 0.46, 0.98), being male (HR = 0.46, CI 0.28, 0.74), higher quality premium preferences (HR = 0.80, CI 0.77, 0.91), lower recency (HR = 1.04, CI 1.02, 1.05), and higher nicotine intake rates (HR = 0.99, CI 0.99, 0.99) were related to continued smoking. No significant interactions were found.ConclusionWhile there were no interactions between menthol use and effects of tobacco control activities, we did find additional support for the decreased cessation rates among menthol cigarette smokers, particularly in the African American population.     

Tobacco use transitions in the United States: The National Longitudinal Study of Adolescent Health

ObjectivesThe purpose of this study is to evaluate and describe transitions in cigarette and smokeless tobacco (ST) use, including dual use, prospectively from adolescence into young adulthood.MethodsThe current study utilizes four waves of the National Longitudinal Study of Adolescent Health (Add Health) to examine patterns of cigarette and ST use (within 30 days of survey) over time among a cohort in the United States beginning in 7th–12th grade (1995) into young adulthood (2008–2009). Transition probabilities were estimated using Markov modeling.ResultsAmong the cohort (N = 20,774), 48.7% reported using cigarettes, 12.8% reported using ST, and 7.2% reported dual use (cigarettes and ST in the same wave) in at least one wave. In general, the risk for transitioning between cigarettes and ST was higher for males and those who were older. Dual users exhibited a high probability (81%) of continuing dual use over time.ConclusionsFindings suggest that adolescents who use multiple tobacco products are likely to continue such use as they move into young adulthood. When addressing tobacco use among adolescents and young adults, multiple forms of tobacco use should be considered.     

Medical school curriculum characteristics associated with intentions and frequency of tobacco dependence treatment among 3rd year U.S. medical students

ObjectivePhysicians play a critical role in addressing tobacco dependence, yet report limited training. Tobacco dependence treatment curricula for medical students could improve performance in this area. This study identified student and medical school tobacco treatment curricula characteristics associated with intentions and use of the 5As for tobacco treatment among 3rd year U.S. medical students.MethodsThird year medical students (N = 1065, 49.3% male) from 10 U.S. medical schools completed a survey in 2009–2010 assessing student characteristics, including demographics, tobacco treatment knowledge, and self-efficacy. Tobacco curricula characteristics assessed included amount and type of classroom instruction, frequency of tobacco treatment observation, instruction, and perception of preceptors as role models.ResultsGreater tobacco treatment knowledge, self-efficacy, and curriculum-specific variables were associated with 5A intentions, while younger age, tobacco treatment self-efficacy, intentions, and each curriculum-specific variable were associated with greater 5A behaviors. When controlling for important student variables, greater frequency of receiving 5A instruction (OR = 1.07; 95%CI 1.01–1.12) and perception of preceptors as excellent role models in tobacco treatment (OR = 1.35; 95%CI 1.04–1.75) were significant curriculum predictors of 5A intentions. Greater 5A instruction (B = .06 (.03); p < .05) and observation of tobacco treatment (B = .35 (.02); p < .001) were significant curriculum predictors of greater 5A behaviors.ConclusionsGreater exposure to tobacco treatment teaching during medical school is associated with both greater intentions to use and practice tobacco 5As. Clerkship preceptors, or those physicians who provide training to medical students, may be particularly influential when they personally model and instruct students in tobacco dependence treatment.     

Ready for a goodbye to tobacco? — Assessment of support for endgame strategies on smoking among adults in a Danish regional health survey

ObjectivesTo assess support for a future ban on smoking and for increasing tobacco taxes in Denmark, and to explore if support differed across sex, age, educational attainment, smoking status and intention to quit.MethodsData from a 2013 health survey representative of the population aged ≥ 16 years in the Capital Region of Denmark (N = 41,356, response rate = 43.5) was linked with data on sex, age and education from central registers. Participants were asked if they supported: 1) a future ban on smoking in Denmark, and 2) increased taxes on tobacco products. Subgroup differences were explored using logistic regression.Results30.6% supported a future ban on smoking, while 59.0% supported increased taxes. Women were less supportive of a future ban (OR = 0.83 (0.78–0.88)) and more supportive of increasing taxes (OR = 1.11 (1.06–1.18)) than men. Support for both measures was higher among the youngest. Only small differences were found in ban support across educational attainment, while support for taxes increased with increasing education. Support for both measures were greatest among never smokers (OR = 2.66 (2.40–2.93) and OR = 9.69 (8.83–10.63)) compared to daily smokers. Smokers intending to quit were two to three times as likely to support a future ban or increased taxes compared to smokers with no quit intensions.ConclusionOne third supported a future ban on smoking, while six out of ten supported increasing taxes. This first Danish study of support for more radical tobacco control adds to the growing literature on tobacco endgame and sets a baseline for future assessments of public support.