Electronic Cigarettes and Tobacco Product Cessation: A Survey of Healthcare Providers' Opinions on Safety and Recommendation.

Background: This study aimed to: (1) assess healthcare providers' opinions on e-cigarette safety and compare them across professions; (2) evaluate providers' recommendations for e-cigarettes as a tobacco product cessation tool and identify any associations with their safety perceptions. Methods: A self-administered questionnaire was completed by 760 healthcare professionals (January-March 2020). The survey included eight opinions on e-cigarette safety with five Likert-scale answers and a question on recommending them for tobacco product cessation. Results: Among 760 healthcare providers (173 physicians/dentists, 69 pharmacists, and 518 nurses), only 20% reported prior experience with tobacco product cessation counseling. Providers expressed uncertainty regarding e-cigarette safety (mean ± SD: 2.5 ± 0.7 on a 5-point Likert scale), with no significant differences between professions (p = 0.836). Similarly, e-cigarette recommendations for tobacco product cessation remained low across professions (13%, 85/637), with no significant differences found (p = 0.072). The recommendation of e-cigarettes for tobacco cessation is associated with perceived safety, lower respiratory irritation, lower coughing, a lower risk of cancer, and a lower risk for secondhand smokers when compared to traditional cigarettes (p < 0.05). Conclusions: Most healthcare providers were unsure about the safety of e-cigarettes; about 13% of providers suggested using them for tobacco product cessation, with safety perceptions influencing recommendations.

The Association Between Personality Traits and Health-Related Quality of Life and the Mediating Role of Smoking: Nationwide Cross-Sectional Study.

Background: There are positive and negative correlations in different directions between smoking, personality traits, and health-related quality of life (HRQOL), where smoking may mask the pathway between personality traits and HRQOL. Understanding the masking pathway of smoking between personality traits and HRQOL can elucidate the mechanisms of smoking's psychosocial effects and provide new ideas for developing tobacco control strategies. Objective: The purpose of this study was to investigate the correlation between Big Five personality traits and HRQOL and whether smoking mediates the relationship between them. Methods: This was a cross-sectional study using data from 21,916 respondents from the 2022 Psychology and Behavior Investigation of Chinese Residents survey. Linear regression models were used to analyze the correlations between smoking, Big Five personality traits, and HRQOL while controlling for potential confounders. The mediating role of smoking on the association between Big Five Personality traits and HRQOL was analyzed using the Sobel-Goodman mediation test. Results: Extraversion (ß=.001; P=.04), agreeableness (ß=.003; P<.001), and neuroticism (ß=.003; P<.001) were positively correlated with HRQOL, whereas openness was negatively correlated with HRQOL (ß=-.001; P=.003). Smoking was associated with a decrease in HRQOL and mediated the positive effect of HRQOL on extraversion (z=-2.482; P=.004), agreeableness (z=-2.264; P=.02), and neuroticism (z=-3.230; P=.001). Subgroup analyses further showed that smoking mediated the effect of neuroticism on HRQOL in the population with chronic illnesses (z=-2.724; P=.006), and in the population without chronic illnesses, smoking contributed to the effect of HRQOL on extraversion (z=-2.299; P=.02), agreeableness (z=-2.382; P=.02), and neuroticism (z=-2.213; P=.03). Conclusions: This study provided evidence that there is a correlation between personality traits and HRQOL. It also found that smoking plays a role in mediating the connection between personality traits and HRQOL. The development of future tobacco control strategies should consider the unique traits of each individual's personality, highlighting the significance of extraversion, agreeableness, and neuroticism.

Recognition of online e-cigarette marketing and e-cigarette-related attitudes and behaviors among young adults.

INTRODUCTION: Past research examining the relationship between exposure to online e-cigarette marketing and e-cigarette-related attitudes and behaviors has relied on unaided recall measures that may suffer from self-report bias. To date, few studies have presented participants with e-cigarette marketing stimuli and assessed recognition. This study examined the associations between recognition of online e-cigarette marketing stimuli and e-cigarette-related attitudes and behaviors among young adults in California. METHODS: A non-probability representative sample of young adults (ages 18-24; N=1500) living in California completed an online survey assessing their recognition of online e-cigarette marketing stimuli, including image-based (i.e., Instagram, email) and audiovisual (i.e., YouTube, TikTok) promotions, and positive e-cigarette-related attitudes (e.g., appeal of e-cigarettes) and behaviors (e.g., e-cigarette use). Adjusted and weighted logistic regression analyses were used. RESULTS: 79.0% (n=1185) of young adults, including 78.1% (n=310/397) of participants under 21 years old, recognized online e-cigarette marketing. Participants who reported recognition of stimuli, compared with those who did not, had greater odds of reporting appeal of e-cigarettes (AOR=2.26, 95% CI=1.65-3.09) and e-cigarette purchase intentions (AOR=1.66, 95% CI=1.13-2.43) among all participants, and susceptibility to use e-cigarettes among never users (AOR=2.29, 95% CI=1.59-3.29). CONCLUSIONS: Young adults in California recognized audiovisual and image-based online e-cigarette marketing. Such recognition may lead to positive e-cigarette-related attitudes and behavioral intentions, especially among never users. Future research should examine the causal relationship between the associations found in this study. Findings may inform the development and evaluation of psychometrically valid measures of online e-cigarette marketing exposures. IMPLICATIONS: Recognition of online e-cigarette marketing stimuli was associated with greater odds of reporting appeal and benefits of e-cigarettes, purchase intentions, and lifetime e-cigarette use among all participants, and susceptibility to use e-cigarettes among never users. These findings may motivate the development and evaluation of psychometrically valid measures of online e-cigarette marketing exposures.

New Zealand's world-first smokefree legislation 'goes up in smoke': A setback in ending the tobacco epidemic.

For several decades, Aotearoa New Zealand has maintained a relatively strict regulatory approach towards tobacco. In response to the significant impact of tobacco-related illnesses, many countries worldwide have worked to enhance tobacco control measures. These efforts include introducing plain tobacco packaging with graphic health warnings, improving access to smoking cessation services and offering supportive treatments for tobacco dependence. In December 2022, New Zealand enacted world-leading tobacco control legislation aimed at leading the nation towards a 'smokefree' future by 2025, a future where the smoking prevalence falls below 5 percent across all population groups. To achieve this goal, revolutionary measures were needed. These measures included denicotinising cigarettes, reducing the number of tobacco retail outlets, and implementing a generational ban on smoked products. Despite receiving support from academics, clinicians, leaders of local indigenous communities, and the general public, the sixth National-led coalition government remained resolute in repealing the law and did so through parliamentary urgency on 27 February 2024. The reversal of this health policy is anticipated to result in thousands of lives lost and widen life expectancy gaps between indigenous and non-indigenous populations. This decision, driven by political agenda objectives and interference from the tobacco industry, has not only impeded New Zealand's progress but also weakened global efforts in tobacco control.

The effect of vertical identification card laws on teenage tobacco and alcohol use.

We study the impact of vertical identification card laws, which changed the orientation of driver's licenses and state identification cards from horizontal to vertical for those under 21 years, on teenage tobacco and alcohol use. We study this question using four national datasets (pooled national and state Youth Risk Behavior Surveillance System, National Youth Tobacco Survey, Current Population Survey to Tobacco Use Supplements, and Behavioral Risk Factor Surveillance System). We improve previous databases of vertical ID law implementation by using original archival research to identify the exact date of the law change. We estimate models using standard two-way fixed effects and stacked difference-in-differences that avoid bias from dynamic and heterogeneous treatment effects. Using data through 2021, we do not find evidence of reductions in teenage tobacco and alcohol use. While these laws reduce retail-based purchasing, they also increase social sourcing, thus leading to no net impact on use.

A compartmental model for smoking dynamics in Italy: a pipeline for inference, validation, and forecasting under hypothetical scenarios.

We propose a compartmental model for investigating smoking dynamics in an Italian region (Tuscany). Calibrating the model on local data from 1993 to 2019, we estimate the probabilities of starting and quitting smoking and the probability of smoking relapse. Then, we forecast the evolution of smoking prevalence until 2043 and assess the impact on mortality in terms of attributable deaths. We introduce elements of novelty with respect to previous studies in this field, including a formal definition of the equations governing the model dynamics and a flexible modelling of smoking probabilities based on cubic regression splines. We estimate model parameters by defining a two-step procedure and quantify the sampling variability via a parametric bootstrap. We propose the implementation of cross-validation on a rolling basis and variance-based Global Sensitivity Analysis to check the robustness of the results and support our findings. Our results suggest a decrease in smoking prevalence among males and stability among females, over the next two decades. We estimate that, in 2023, 18% of deaths among males and 8% among females are due to smoking. We test the use of the model in assessing the impact on smoking prevalence and mortality of different tobacco control policies, including the tobacco-free generation ban recently introduced in New Zealand.

Identifying factors influencing local governments' adoption of comprehensive smoke-free policies: an event history analysis based on panel data from 36 key cities in China (2013-2021).

Introduction: The issue of tobacco control remains a significant concern for public health worldwide. In recent years, remarkable progress has been made toward adopting smoke-free measures in indoor public places. Although China has yet to introduce a national regulation, specifically for smoke-free public places, more than a dozen cities have successively approved and implemented comprehensive smoke-free regulations. Different cities in China have diverse attitudes and behaviors toward smoke-free policies; however, the reasons for these policy differences and the influencing factors have not received sufficient attention and research. Methods: On the basis of the multiple streams framework, this study selects 36 key Chinese cities as research samples and uses a directed dyad-year event history analysis method to analyze the factors influencing the implementation of comprehensive smoke-free policies in cities. Results: Results show that the adoption of such policies is positively influenced by scientific evidence, focal events, media coverage, institutional foundations, economic comparisons, and the influence of health departments and of tobacco control groups. By contrast, policy adoption is negatively affected by the differences in administrative levels, central policy signals, and the influence of the tobacco industry. Discussion: This study contributes to understanding the internal logic behind local governments' adoption of comprehensive smoke-free policies, offering insights for further advocacy at the city and national levels in China and providing experiences that can promote the global tobacco control movement.

Smoking patterns by birth cohort in Argentina: an age-period-cohort population-based modeling study.

Background: Argentina's smoking rates remain high. We aim to estimate Argentina age-specific histories of smoking initiation, cessation, prevalence, and intensity by birth-cohort to inform policy interventions. Methods: Modeling study. Data from three Argentinian nationally representative surveys conducted from 2004 to 2018 (n = 268,193) were used to generate smoking histories. The Cancer Intervention and Surveillance Modeling (CISNET) Network Lung Working Group age, period, and cohort modeling approach was used to calculate smoking initiation and cessation probabilities, ever and current smoking prevalence, and intensity (cigarettes per day, CPD) by age, sex, and birth cohort from 1950 to 2018. Findings: Ever smoking prevalence increases with age up to 25 and decreases with birth cohorts after 1990. Smoking initiation peaks between 15 and 18 years of age. Among females, initiation probabilities increased until the 1955 cohort, reaching a second peak in 1980-85 cohorts and declining thereafter. Males have higher initiation probabilities than females. Among males, initiation has decreased since the 1950 birth cohort, with a slight increase around the 1985 cohort. Current smoking prevalence has been decreasing since the 1960 birth cohort, except for a peak in 1980-85 cohorts. Cessation increases with age. Mean CPD increases with age and peaks around age 40, appearing flat in females since the 1985 cohort. Interpretation: Recent birth cohorts seem to be experiencing lower rates of initiation, stable rates of quitting and lower current and ever smoking prevalence. The stabilization of cessation probabilities and mean CPD indicate the need to strengthen existing tobacco control measures and advance new ones. Funding: NIH/NCI U01CA253858 grant.

Interaction Between State-Level Cigarette Prices and County-Level Tobacco 21 Coverage on Cigarette Smoking Outcomes Among US Adolescents.

PURPOSE: To examine whether Tobacco 21 (T21) law coverage moderated associations between cigarette prices and adolescent smoking and associated disparities. METHODS: We used nationally representative, repeated cross-sectional 2014-2020 Monitoring the Future study data (n = 20,547-96,083) to examine associations between state-level average cigarette price per pack and county-level T21 coverage (100% vs. < 100%) on past 30-day smoking participation, first and daily cigarette smoking initiation, and smoking intentions in US adolescents in eighth, 10th, and 12th grade. We implemented weighted, grade-stratified, modified Poisson regression models to test for interactions between price and T21 coverage for each outcome. We also tested for disparities by sex, race and ethnicity, parental education, and college educational expectations. RESULTS: Higher cigarette prices were associated with a lower probability of past 30-day smoking participation among eighth graders in counties with < 100% T21 coverage (average marginal effect = -0.003, 95% confidence interval = -0.006, 0.000) but not among eighth graders in counties with 100% T21 coverage (average marginal effect = 0.001, 95% confidence interval = -0.001, 0.004) (p for interaction = 0.005). There were no associations with other smoking outcomes or grades or evidence of differential associations by sociodemographic factors. DISCUSSION: Our findings suggested that higher cigarette prices were associated with lower adolescent smoking among eighth graders living in counties with < 100% T21 coverage. However, no such association was observed in other grades or smoking outcomes. Further investigation is necessary to determine the best combination of policies to reduce adolescent smoking, related sociodemographic disparities, and the use of other tobacco products in areas with fewer tobacco control policies.

The Perfect Storm: Applying the Multiple Streams Framework to Understand the Adoption of a WHO Framework Convention on Tobacco Control-Based Policy in Mexico.

BACKGROUND: The aim of this study was to document how Mexico adopted a WHO Framework Convention on Tobacco Control (FCTC)-based national tobacco control law. METHODS: We analyzed publicly available documents and interviewed 14 key stakeholders. We applied the Multiple Streams Framework (MSF) to analyze these findings. RESULTS: Previous attempts to approve comprehensive FCTC-based initiatives failed due to a lack of political will, the tobacco industry's close connections to policymakers, and a lack of health advocacy coordination. Applying the MSF reveals increased attention towards collecting and sharing data to frame the severity of the problem (problem stream). The expansion of a coordinated health advocacy coalition and activities led to increased support for desired FCTC policy solutions (policy stream). The election of President López Obrador and legislative changes led to a deep renewed focus on tobacco control (politics stream). These three streams converged to create a policy window to secure a strong FCTC-based initiative on the political agenda that was ultimately passed. CONCLUSIONS: The Mexican experience illustrates the importance of continued health advocacy and political will in adopting FCTC-based policies. Other countries should follow Mexico's lead by collecting and sharing data through coordinating efforts in order to be prepared to seize political opportunity windows when strong political will is present.

Tobacco smoking-attributable mortality in Kenya, 2012-2021.

INTRODUCTION: Tobacco smoking poses a significant risk for various diseases, including cardiovascular diseases, chronic respiratory diseases, and cancers. In Kenya, tobacco-related deaths contribute substantially to non-communicable disease mortality. This study aims to quantify the mortality attributed to tobacco smoking in Kenya from 2012 to 2021. METHODS: Employing a prevalence-based analysis model, the study utilized population attributable fraction (PAF) to estimate age-specific smoke attributable mortality (SAM) rates for individuals aged ≥35 years. Causes of death associated with tobacco use, including cancers, cardiovascular diseases, respiratory diseases, tuberculosis, and diabetes, were analyzed based on age, sex, and death records between 2012 and 2021. RESULTS: Over the study period, 60228 deaths were attributed to tobacco-related diseases, with an annual increase observed until 2016 and subsequent fluctuations. Respiratory diseases, diabetes mellitus, malignant cancers, tuberculosis, and cardiovascular diseases collectively accounted for 16.5% of deaths among individuals aged ≥35 years. Notable contributors were pneumonia and influenza (respiratory diseases), esophageal cancer (cancers), and cerebrovascular diseases (cardiovascular diseases). Of the observed deaths, 16.5% were attributed to smoking, with respiratory diseases (40.5%), malignant cancers (31.4%), tuberculosis (13%), cardiovascular diseases (8.9%), and diabetes mellitus (6.1%) contributing. Pneumonia and influenza, esophageal cancer, chronic airway obstruction, and tuberculosis were primary causes, comprising 70% of all SAM. CONCLUSIONS: Tobacco-related mortality is a significant public health concern in Kenya. Efforts should focus on preventing tobacco use and managing associated disease burdens. Smoking cessation initiatives and comprehensive tobacco control measures are imperative to mitigate the impact on population health.

Susceptibility to e-cigarette among high school students: a study based on the ecological model of health behavior.

Introduction: Youth e-cigarette (EC) use has rapidly increased in the last few years. It is crucial to identify the susceptible youth and prevent them from EC uptake. This study was conducted to investigate factors that affect youth susceptibility to EC use. Methods: This study employed a cross-sectional survey design, utilizing multi-center stratified cluster sampling method to select two junior high schools and two senior high schools in Shanghai, Guangzhou, and Chengdu. One-third of classes of each grade in the selected schools were involved in this survey. After obtaining the informed consent of parents, an anonymous and self-administered questionnaire was distributed to students. Questionnaire was designed based on the Ecological Models of Health Behavior. Associations between EC susceptibility and covariates were identified using multivariate logistic regression. Results: Among 2,270 students who had never vaped, 38.0% were susceptible to ECs. Logistic regression analysis identified factors on different levels affecting the susceptibility. Individual factors included senior high school students (OR = 1.34, 95% CI: 1.08-1.65), sensation seeker (OR = 1.11, 95%CI: 1.08-1.14), poor academic performance (OR = 1.24, 95% CI: 1.01-1.54), ever cigarette user (OR = 2.27, 95% CI: 1.29-4.01), unaware of the second-hand smoke from vaping (OR = 1.56, 95% CI: 1.25-1.96), agreeable with "I do not want to hang around vapers" (OR = 0.79, 95% CI: 0.64-0.97), agreeable with "ECs are more fashionable than cigarette" (OR = 2.50, 95% CI: 1.72-3.62) and favorable attitudes toward vaping (OR = 5.09, 95% CI: 3.78-6.85) were significantly associated with susceptibility to ECs. At interpersonal level, students who believe they would not be punished by parents for vaping increased susceptibility (OR = 1.27, 95% CI:1.01-1.59). At community level, exposure of EC advertising (OR = 1.81, 95% CI:1.46-2.25), exposure to hazard information (OR = 0.76, 95% CI: 0.59-0.97) and seeing vaping in daily life (OR = 2.11, 95% CI: 1.62-2.74), were statistically significantly associated with youth susceptibility to ECs. Conclusion: EC susceptibility was observed in a substantial proportion of adolescents who had never vaped, influenced by factors on different levels. This research underscores the urgent need for comprehensive intervention strategies to prevent the youth susceptibility to ECs.

Is It Time to Ban Flavored Cigarettes in Asia-Pacific Countries? A Scoping Review.

Flavored cigarettes encourage youth smoking and deter quitting. No country in Asia-Pacific, a region with some of the world's highest smoking rates, has regulated tobacco flavors. We examined market data, academic literature, and gray literature to describe what is known on flavored cigarettes in the Asia-Pacific region. Of the 12 countries for which market data were available, ten had substantial flavored cigarette market shares ranging from 10% to 97%. With no regulations and growing markets for flavor capsule variants, the tobacco industry's ongoing promotion of flavored cigarettes, which targets primarily youth and women, is expected to drive further increases in smoking prevalence. There are significant research and monitoring gaps on the industry's marketing tactics and use of flavored cigarettes in the region. Given the large market shares, Asia-Pacific countries stand to benefit substantially from a tobacco flavors ban.

Examining U.S. disparities in smoking among rural versus urban women of reproductive age: 2002-2019.

OBJECTIVE: This study is part of a programmatic investigation of rural disparities in cigarette smoking examining disparities in smoking prevalence and for the first-time quit ratios among adult women of reproductive age (18-44 years), a highly vulnerable population due to risk for multigenerational adverse effects. METHODS: Data came from 18 years (2002-2019) of the U.S. National Survey on Drug Use and Health (NSDUH) among women (n = 280,626) categorized by rural-urban residence, pregnancy status, using weighted logistic regression models testing time trends and controlling for well-established sociodemographic predictors of smoking (race/ethnicity, education, income). Concerns regarding changes in survey methods used before 2002 and after 2019 precluded inclusion of earlier and more recent survey years in the present study. RESULTS: Overall smoking prevalence across years was greater in rural than urban residents (adjusted odds ratio [AOR] = 1.11; 95%CI, 1.07-1.15; P < .001) including those not-pregnant (AOR = 1.10; 1.07-1.14; P < .001) and pregnant (AOR = 1.29; 1.09-1.52; P < .001). Overall quit ratios across years were lower in rural than urban residents (AOR = 0.93; 0.87-0.99; P < .001) including those not-pregnant (AOR = 0.93; 0.88-1.00, P = .035) and pregnant (AOR = 0.78; 0.62-0.99; P = .039). Interactions of rural versus urban residence with study years for prevalence and quit ratios overall and by pregnancy status are detailed in the main text. CONCLUSIONS: These results support a longstanding and robust rural disparity in smoking prevalence among women of reproductive age including those currently pregnant and provides novel evidence that differences in smoking cessation contribute to this disparity further underscoring a need for greater access to evidence-based tobacco control and regulatory interventions in rural regions.

"The ban is there, but it is not there": perceptions of cigarette users and tobacco vendors regarding ban on the sale of loose cigarettes in India.

Introduction: Banning the sales of loose cigarettes is recommended by Article 16 of the World Health Organization - Framework Convention on Tobacco Control. This study aims to understand the perceptions of cigarette users and tobacco vendors regarding such a ban. Methods: Using a systematic recruitment and interview protocol, we interviewed cigarette users (n = 28) and tobacco vendors (n = 28) from two Indian cities where sales of loose cigarettes were banned (Mumbai) or not banned (Delhi). Separate semi-structured interview guides were used for users and vendors. Interview questions focused on reasons for purchasing loose cigarettes, preference for buying and selling loose vs. packs, thoughts on the necessity of banning loose cigarettes, and the perceived impact of the policy ban for vendors and cigarette users. We performed thematic analysis and used NVivo for organizing transcript coding. Results: The main reasons users cited for purchasing loose cigarettes were financial constraints, social restrictions (fear of getting caught), and limiting cigarette consumption. In Mumbai, awareness of the existing ban was poor among both users and vendors. Those who were aware did not think the policy had been implemented. Users thought that loose cigarettes promoted smoking initiation and prevented them from quitting. Both users and vendors reported that a ban on loose cigarettes would reduce cigarette consumption and promote quit attempts as it would not be possible for everyone to purchase packs because of financial and social reasons. Conclusion: Users in both cities reported easy access to and widespread availability of loose cigarettes. Low awareness of the ban in Mumbai suggested inadequate enforcement. A country-wide ban on the sale of loose cigarettes could be highly effective in preventing smoking initiation and promoting quitting.

[Application of the cigarette purchase tasks in achieving China' s tobacco control goals].

OBJECTIVE: To assess cigarette demand among Chinese smokers through a cigarette purchase task (CPT) and to evaluate cigarette prices under different hypothetical scenarios in order to meet the goals of smoking prevalence reduction in China. METHODS: In the study, 447 participants completed a hypothetical CPT at baseline assessments of a trial, thus, cigarette demand curves were individually fitted for each participant using an exponentiated version of the exponential demand model. Typically, five demand indices were derived, intensity (consumption when free), breakpoint (first price at which consumption is suppressed to 0), maximum output (Omax), maximum price (Pmax, price at which Omax occurred), and elasticity (the ratio of the change in quantity demanded to the change in price). A one-way analysis of variance was used to explore the correlations between the cigarette purchase task indices and socio-demographic and smoking characteristics. The one-way decay model was employed to simulate the smoking cessation rates and determine optimal cigarette prices in a series of scenarios for achieving 20% smoking prevalence. RESULTS: The price elasticity drawn from CPT was 0.54, indicating that a 10% price increase could reduce smoking by 5.4% in the participated smokers. Smokers with higher income were less sensitive to cigarette prices (elasticity=-2.31, P=0.028). Cigarette purchase task indices varied significantly among the smokers with different prices of commonly used cigarettes, tobacco dependence, and smoking volume. The smokers who consumed cigarettes of higher prices reported higher breakpoint, Omax and Pmax, but lower intensity (P=0.001). The smokers who were moderately or highly nicotine dependent reported higher intensity, breakpoint, Omax and Pmax, and they had lower intensity (P=0.001). The smokers who had a higher volume of cigarettes reported higher intensity and Omax, and lower intensity (P < 0.001). To achieve the goal of reducing smoking prevalence to 20% in mainland China, we estimated the desired increase on smoking cessation rate and prices accordingly in a series of scenarios, considering the gender variance and reduced smoking initiation. In scenario (a), to achieve a smoking prevalence goal of 20%, it would be necessary for 24.81% of the current smokers to quit smoking when there were no new smokers. Our fitting model yielded a corresponding value of 59.64 yuan (95%CI 53.13-67.24). Given the assumption in scenario (b) that only males quitted smoking, the desired cessation rates would be 25.82%, with a higher corresponding price of 62.15 yuan (95%CI 55.40-70.06) to induce desired cessation rates. In the proposed scenario (c) where 40 percent of the reduction in smoking prevalence came from reduced smoking initiation, and females and males equally quitted smoking due to increased cigarette prices, the price of a pack of cigarettes would be at least 37.36 yuan (95%CI 32.32-42.69) (equals to $ 5.20) per pack to achieve the cessation rate of 14.89 percent. In scenario (d) where only males quitted smoking due to increased cigarette prices considering the reduced smoking initiation, the respective smoking cessation rates should be 15.49% with the desired prices of 38.60 yuan (95%CI 33.53-44.02). After adjusting for education levels and income levels in scenario (c), the price of cigarettes would be at least 37.37 yuan/pack (equals to $ 5.20) (95%CI 30.73-44.94) and 37.84 yuan/pack (equals to $ 5.26) (95%CI 31.94-44.53), respectively. CONCLUSION: Cigarette purchase task indices are significantly associated with income levels and prices of commonly used cigarettes, levels of tobacco dependence, and smoking volume, which is inspiring in studying price factors that influence smoking behavior. It is suggested that higher cigarette prices, surpassing the current actual market level, is imperative in mainland China. Stronger policy stra-tegies should be taken to increase tobacco taxes and retail cigarette prices to achieve the Healthy China 2030 goal of reducing smoking prevalence to 20%.

Patterns and Determinants of Exclusive Smokeless Tobacco (Snus) Use, Exclusive Smoking and Dual Use in General Population During 20 Years.

BACKGROUND: We investigate smokeless tobacco (snus) use and its correlates over 20 years in a country where selling snus is prohibited but a large import quota and illicit market exists. METHODS: Repeated cross-sectional population-based surveys during 2000 to 2020 in Finland, including N = 57 111 adults aged 20 to 64 years. The outcome measures were current tobacco use (exclusive snus use, dual use, exclusive smoking, no tobacco use) and snus use (daily, occasional, no snus use). Study years, gender, age, education, marital status, self-rated health, body mass index, and binge drinking were used as explanatory variables. RESULTS: Exclusive snus use and dual use increased 3.6% units and 2.6% units from 2000 to 2005 and from 2018 to 2020, respectively. Overall decrease of tobacco use was led by decreasing exclusive smoking from 30.1% to 18.2%. The shared risk factors for snus use and dual use were male gender, age group 20 to 34 years, and binge drinking. The increases in snus and dual use over time were also most prevalent among these groups. Among men, occasional smoking increased the likelihood of daily (relative risk ratio [RRR] 2.38, 95% confidence interval [CI] 1.42, 3.99) and occasional (RRR 3.11, 95% CI 1.93, 5.03) snus use. CONCLUSIONS: Snus use has increased among the general adult population in Finland during 2000 to 2020 yet remains less common than smoking. Snus use and dual use share some common risk factors. Snus use should be considered in cessation services, with support for quitting developed and targeted predominantly for men, younger adults, and persons drinking to intoxication.

Real-World Treatment Adherence to Smoking Cessation Medications and Association with Treatment Outcome - 27 Centers, China, 2017-2022.

What is already known about this topic?: Medication non-adherence significantly impedes smoking cessation efforts. While effective smoking cessation medications are accessible in China, real-world adherence and its correlation with treatment outcomes remain largely unexplored. What is added by this report?: From December 2017 to January 2022, 1,120 participants were recruited from 27 centers in all seven geographical regions of China. Results revealed that only 38.2% of smokers adhered to the prescribed 12-week smoking cessation treatment and those with a higher education level were more likely to be adherent. In addition, smokers with good adherence were more likely to successfully quit smoking. What are the implications for public health practice?: The data obtained could enhance our understanding of smoking cessation practices in China. Improving adherence is a crucial strategy to enhance the effectiveness of smoking cessation treatments and management provided to smokers.