Association between loneliness and cigarette smoking attitudes among university students in Iran: a cross-sectional study.

OBJECTIVES: During the last two decades, cigarette smoking witnessed a global increase in use, especially among youth. Loneliness is one of the possible psychosocial determinants of smoking. This study examined the association between loneliness and attitudes towards cigarette smoking among university students of Iran. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: This study was conducted among 538 university students, who were recruited using the cluster random sampling method. Loneliness and smoking attitudes of the samples were assessed using the revised version of the University of California Los Angeles Loneliness Scale and the Scale of Cigarette Smoking Attitude (CSA). Descriptive statistics, Pearson's correlation coefficient and multivariable regression analysis were used to analyse the data. RESULTS: From a total of 538 participants, 301 (59.9%) students were young women. The mean age of the students was 22.2±2.9 years. Only 56 (10.4%) of the students were married and 370 (87.9%) of them were lived with their families. 131 (24.3%) students experienced cigarette smoking. In terms of university-related characteristics, 205 (38.1%) of the students studied in the faculty of medicine. Also, 30% of the students had a positive or indifferent attitude towards smoking, while 26.4% of the students reported feeling lonely. The mean scores for loneliness and CSA were 41.42±11.29 and 48.64±11.2, respectively. Statistically, a significant positive correlation was found between loneliness and CSA (r=0.289; p<0.001). After controlling for potential confounders by regression analysis, loneliness scores were also positively associated with CSA scores (B: 0.14; 95% CI 0.097 to 0.18). CONCLUSIONS: According to the positive association between loneliness and students' CSA, paying more attention to the state of loneliness in college students, examining situations and reasons that increase it and identifying the interventions that might reduce it are necessary. Reducing loneliness among college students can correct their attitudes towards smoking.

The role of interoceptive awareness in shaping the relationship between desire thinking and cigarette consumption.

Interoception, the ability to sense and interpret bodily sensations, has recently emerged as a crucial factor in substance use disorders, including smoking. However, the role of interoceptive awareness in tobacco use remains poorly understood. The relationship between interoceptive ability and addictive behavior is complex, and attempting to conceptualize it as a linear association is unlikely to fully capture the complexity of the mechanisms underlying cravings and urges. We hypothesized that the role played by interoceptive awareness in tobacco use is deeply linked to desire thinking, that is, the conscious and voluntary cognitive process orienting to prefigure images, information, and memories about positive target-related experiences. Desire thinking is typically observed in addiction, where it may contribute to interpreting specific bodily sensations, such as the perceived need for a cigarette. From this perspective, the physiological impact and inclination toward desire thinking contribute to a higher daily cigarette consumption, particularly in situations of low interoceptive awareness. To test this hypothesis, we assessed the physiological activation, the tendency toward desire thinking about smoking, cigarette consumption, and the interoceptive abilities of smoking volunteers. Through a moderation analysis, we showed that desire thinking about smoking predicts a higher number of cigarettes per day in individuals with lower interoceptive awareness (p < .05). These findings suggest that the relationship between desire thinking and interoceptive awareness is a fundamental component of tobacco use, highlighting the importance of taking into account the bodily feedback deriving from the cognitive representation of smoking in addiction research and therapy.

Attentional Bias Toward Cigarette-Related Cues in Male Smokers is Modulated by Cognitive Control Mechanisms.

Background: Many studies have found that smokers' attentional bias toward cigarette-related cues and cognitive control impairment significantly impacts their cigarette use. However, there is limited research on how the interaction between attentional bias and cognitive control may modulate smokers' cigarette-seeking behavior. Objectives: This study used a cigarette Stroop task to examine whether smokers with different attentional control ability had different levels of attentional bias toward cigarette-related cues. Methods: A total of 130 male smokers completed the Flanker task to measure their attentional control ability. The attentional control scores of all participants were ranked from low to high, with the top 27% placed in the high attentional control group and the bottom 27% in the low attentional control group. Subsequently, both groups completed the cigarette Stroop task to measure their attentional bias toward cigarette-related cues. Results: Smokers with low attentional control responded more slowly to cigarette-related cues than to neutral cues, while smokers with high attentional control showed no significant difference in their response time to either condition. Conclusions/Importance: Attentional control ability can regulate smokers' attentional bias toward cigarette-related cues. Smokers with low attentional control ability are more likely to have attentional bias toward cigarette-related cues, offering insights for targeted prevention of cigarette addiction.

Is impulsivity related to attentional bias in cigarette smokers? An exploration across levels of nicotine dependency and deprivation.

Research has largely focused on how attentional bias to smoking-related cues and impulsivity independently influence the development and maintenance of cigarette smoking, with limited exploration of the relationship between these mechanisms. The current experiments systematically assessed relationships between multiple dimensions of impulsivity and attentional bias, at different stages of attention, in smokers varying in nicotine dependency and deprivation. Nonsmokers (NS; n  = 26), light-satiated smokers (LS; n  = 25), heavy-satiated smokers (HS; n  = 23) and heavy 12-hour nicotine-deprived smokers (HD; n  = 30) completed the Barratt Impulsivity Scale, delayed discounting task, stop-signal task, information sampling task and a visual dot-probe assessing initial orientation (200 ms) and sustained attention (2000 ms) toward smoking-related cues. Sustained attention to smoking-related cues was present in both HS and LS, while initial orientation bias was only evident in HS. HS and LS also had greater levels of trait motor and nonplanning impulsivity and heightened impulsive choice on the delay discounting task compared with NS, while heightened trait attentional impulsivity was only found in HS. In contrast, in HD, nicotine withdrawal was associated with no attentional bias but heightened reflection impulsivity, poorer inhibitory control and significantly lower levels of impulsive choice relative to satiated smokers. Trait and behavioral impulsivity were not related to the extent of attentional bias to smoking-related cues at any stage of attention, level of nicotine dependency or state of deprivation. Findings have both clinical and theoretical implications, highlighting the unique and independent roles impulsivity and attentional bias may play at different stages of the nicotine addiction cycle.

Methodological considerations when assessing symptoms of nicotine dependence by cigarette and e-cigarette use behavior and brand.

Letter to the Editor re: Adjei et al., 2024. Symptoms of nicotine dependence by e-cigarette and cigarette use behavior and brand: A population-based, nationally representative cross-sectional study. Drug and Alcohol Dependence 255, 111059 concerning issues of context, citations, non-psychometrically validated dependence items, and disclosure transparency.

Eating Disorder Symptomatology Among Young Adult Cigarette and E-Cigarette Users.

Objective: Tobacco use is elevated among individuals with eating disorders (EDs). Yet, further research is needed to understand associations between cigarette and e-cigarette use patterns and ED symptomatology. To gain a more comprehensive understanding of tobacco use and EDs, this study characterized ED symptomatology and tobacco use patterns, including exclusive cigarette use, e-cigarette use, dual use, and nonuse. Method: Young adults aged 18-24 years who self-reported exclusive cigarette, e-cigarette, dual, or nonuse (N = 2500) were recruited via Lucid, an online survey management company. Participants completed questionnaires assessing body dissatisfaction, global ED psychopathology, binge eating and self-induced vomiting frequency, and demographics. ED diagnostic groups included: anorexia nervosa (AN), bulimia spectrum eating disorders (BSED), atypical AN, and night eating syndrome (NES). Results: Multinomial logistic models revealed those with AN were more likely to be dual users, those with atypical AN were more likely to be exclusive e-cigarette users, and participants with a BSED or NES were more likely to be exclusive e-cigarette or dual users, compared to those without an ED. General linear models suggested body dissatisfaction and global ED psychopathology were higher among exclusive e-cigarette and dual users, while binge eating and self-induced vomiting frequencies were greater among all tobacco use groups compared to nonusers. Discussion: Our findings suggest young adults with ED symptomatology were more likely to be users of e-cigarettes exclusively or dual users. It will be necessary to examine how these associations manifest using longitudinal and clinical populations in future research.

Temporal associations linking alcohol and cannabis use to cigarette smoking in young adults engaged in a tobacco cessation and relapse monitoring study.

Young adulthood remains a developmental period in which cigarette smoking initiation and progression to dependence and regular use is common. Moreover, co-use of alcohol and/or cannabis with tobacco is common in this age group and may have detrimental effects on tobacco use rates and cessation outcomes. Although young adults are interested in quitting smoking, achieving abstinence remains difficult, even with evidence-based treatment strategies. Understanding proximal associations between other substance use (e.g., alcohol and cannabis) and smoking may have important treatment implications. This exploratory analysis investigated the role of alcohol and/or cannabis use in contributing to smoking events on the same day or next day among young adults engaged in a smoking cessation and relapse monitoring study. We used ecological momentary assessment (EMA) data from 43 young adults (ages 18-25; 932 observations) who smoked cigarettes daily and agreed to participate in a 5-week study that included a 2-day smoking quit attempt and provision of tobacco treatment in the form of nicotine replacement therapy, brief cessation counseling, and financial incentives for abstinence (incentives were provided only during the 2-day quit attempt). We tested multilevel time-series models of daily associations between alcohol use, cannabis use, and smoking. Consistent with hypotheses, days on which participants were more likely to drink alcohol predicted increased likelihood of smoking the next day (OR = 2.27, p =.003). This effect was significant after controlling for both the one-day lagged effect of smoking (i.e., autoregression) and the concurrent (i.e., same day) effects of drinking and cannabis use. Although there was a positive concurrent effect of cannabis use on smoking (OR = 12.86, p =.003), the one-day lagged effect of cannabis use and the concurrent effect of drinking was not significant, contrary to hypotheses. Results indicate that alcohol use presents a potential threat to successful smoking cessation that extends to the following day. This suggests a risk-window in which treatment could be supplemented with just-in-time interventions and extending the focus on co-use to include this lagged impact on cessation outcomes.

Differences in biobehavioral measures of cigarette smoking by depression symptomology.

INTRODUCTION: Research that explores the clinical relevance of subclinical depressive symptoms and smoking is primarily focused on smoking cessation. We examine whether depression symptoms vary across an array of biological (carbon monoxide boost), behavioral (FagerströmTest of Nicotine Dependence, cigarettes per day, smoking topography), and psychological smoking-related outcomes (Questionnaire on Smoking Urges, Withdrawal Symptoms Checklist) in non-treatment-seeking smokers. METHODS: Baseline data were pooled from three research trials with identical procedures designed to assess individual smoking behavior using smokers preferred cigarette brands. Depression symptom level (asymptomatic, subsyndromal, syndromal) was defined using established Center for Epidemiological Depression Scale (CES-D) cutpoint criteria. Smokers were instructed to smoke as usual for one-week. At the beginning and end of the baseline period, nicotine dependence, smoking topography, CO boost, desire to smoke, anticipation of positive reinforcement, negative affect, and withdrawal were measured. RESULTS: Ordinary least squares linear regression models were used to test the association between depression symptom level and outcome measures adjusting for sex and education (N = 355). The results revealed no differences in topography measures, cigarettes per day and FTND. Smoking withdrawal and smoking urges were higher among both individuals with subsyndromal symptoms and syndromal depression symptoms compared to those who were asymptomatic. Individuals with subsyndromal depressive symptoms experienced higher smoke exposure and higher relief from negative affect. CONCLUSION: Increased smoke exposure, greater withdrawal symptoms and urges to smoke, and anticipation of negative affect relief among smokers with subsyndromal depression symptoms suggest that depression symptoms need not reach syndromal levels to alter smoking-related outcomes.

Pain Severity and Smoking Abstinence Expectancies among Latinx Individuals Who Smoke Cigarettes: The Moderating Role of Perceived Discrimination.

Latinx individuals experience significant health disparities related to smoking cessation in the United States (US). Although past works have consistently implicated pain in the maintenance of smoking behavior, limited research has examined the role of social determinants (e.g., perceived discrimination) in pain-smoking relations. The current study sought to examine the moderating role of perceived discrimination in the relation between pain severity and smoking abstinence expectancies (i.e., a cognitive factor related to poor smoking outcomes) among 226 Latinx individuals who currently smoke cigarettes (Mage = 34.95 years; SD = 8.62; 38.5% female). The results indicated a statistically significant interaction between pain severity and perceived discrimination with regard to smoking abstinence expectancies (i.e., negative mood, somatic symptoms, harmful consequences, and positive consequences). Post-hoc analyses revealed the association of pain severity and negative mood, harmful consequences, and positive consequences smoking abstinence expectancies evident for individuals with higher perceived discrimination. Moreover, the association between pain severity and somatic symptoms smoking abstinence expectancies was stronger for individuals with higher perceived discrimination. Overall, these results suggest that clinical and community-based public health strategies may benefit from addressing the role of perceived discrimination among Latinx individuals who smoke cigarettes in the context of pain.

The Impact of the Covid-19 Pandemic on Smoking Among Vulnerable Populations.

AIM: While accumulating evidence suggests that people modified their smoking during the ongoing COVID-19 pandemic, it remains unclear whether those most at risk for tobacco-related health disparities did so. The current study examined changes in smoking among several vulnerable smoker populations during the COVID-19 pandemic. METHODS: A web-based survey was distributed in 2020 to 709 adults with socioeconomic disadvantage, affective disorders, or opioid use disorder who participated in a previous study investigating the effects of very low nicotine content (VLNC) cigarettes on smoking. Current smoking status and rate, and adoption of protective health behaviors in response to the pandemic (eg social distancing, mask wearing) were examined. RESULTS: Among 332 survey respondents (46.8% response rate), 84.6% were current smokers. Repeated measures ANOVA showed that current cigarettes/day (CPD) was higher during COVID than pre-COVID (12.9 ± 1.0 versus 11.6 ± 1.0; p < .001). Most respondents had adopted protective health behaviors to prevent infection (>79% for all behaviors). More than half indicated that they were still leaving their homes specifically to buy cigarettes (64.6%) and were buying more packs per visit to the store (54.5%) than pre-COVID. Individuals unemployed at the time of the survey experienced greater increases in CPD (from 11.4 ± 1.4 to 13.3 ± 1.4, p = .024) as did those with higher levels of anxiety (from 11.5 ± 1.1 to 13.6 ± 1.1, p < .001). CONCLUSIONS: Smoking increased during the COVID-19 pandemic in this sample of adults from vulnerable populations, even while most adopted protective health measures to prevent infection. Unemployment and anxiety might identify those at greatest risk for increases in tobacco use. IMPLICATIONS: Individuals from populations especially vulnerable to smoking might be at risk for greater harm from cigarette smoking during times of pandemic-related stress. Public health interventions are warranted to ameliorate increases in smoking among these populations. Special attention should be paid to those experiencing unemployment and high anxiety.

Characterizing risky alcohol use, cigarette smoking, e-cigarette use, and physical inactivity among cancer survivors in the USA-a cross-sectional study.

PURPOSE: Unhealthy lifestyle behaviors are associated with inferior health outcomes among cancer survivors, including increased mortality. It is crucial to identify vulnerable subgroups, yet investigations have been limited. Thus, this study aimed to examine sociodemographic and clinical characteristics associated with risky health behaviors among cancer survivors. METHODS: We used national, cross-sectional survey data (Health Information National Trends Survey, HINTS 2017-2020) for 2579 cancer survivors. We calculated the prevalence of risky alcohol use, current cigarette smoking, e-cigarette use, and not meeting physical activity guidelines. We performed weighted logistic regression to obtain multivariable-adjusted odds ratios (OR) for the association between each unhealthy behavior with sociodemographic and clinical characteristics. RESULTS: Overall, 25% showed risky alcohol use, 12% were current cigarette smokers, 3% were current e-cigarette users, and 68% did not meet physical activity guidelines. Cancer survivors who were males, non-Hispanic Whites or African Americans, without a college education, not married and with comorbidities or psychological distress were more likely to have unhealthy behaviors. Those with lung disease or depression were 2 times as likely to smoke cigarette or e-cigarettes and those with psychological distress were 1.6 times as likely to be physically inactive. Moreover, risky drinkers (OR = 1.75, 95% CI = 1.22-2.52) and e-cigarette smokers (OR = 16.40, 95% CI 3.29-81.89) were more likely to be current cigarette smokers. CONCLUSIONS: We identified vulnerable subpopulations of cancer survivors with multiple unhealthy lifestyle behaviors. IMPLICATIONS FOR CANCER SURVIVORS: Our findings inform clinicians and program and policy makers of the subgroups of cancer survivors to target for multiple health behavior interventions.

Race, Concern About COVID-19 Discrimination, and Cigarette Smoking Behavior: Comparison Between US Asian and White Adults Who Use Commercial Tobacco.

Anti-Asian discrimination incidents in the USA have resurged during the COVID-19 pandemic. It is unclear how concern about being discriminatorily treated due to the COVID-19 pandemic varies between Asian and Asian American (A&AsA) and White adults. We examined A&AsA vs. White differences in concern about COVID-19 discrimination and associations of this concern with changes in cigarette smoking behaviors before and during the pandemic. Data were from a US representative sample of A&AsA and White adults (≥ 21 years) who currently and formerly used commercial tobacco (n = 1052), collected through an online panel oversampling A&AsA adults in January-February 2021. Participants reported their concern, worry, and stress about COVID-19 discrimination and past-30-day cigarette consumption before and during the pandemic. We examined the association between race and overall concern about COVID-19 discrimination, and this concern's associations with changes in past-30-day cigarette smoking consumption, smoking continuation, and return to smoking using weighted multivariable logistic and linear regression models. Overall concern about COVID-19 discrimination was higher (adjusted mean = 1.7, standard error = 0.16) among A&AsA adults who currently and formerly used commercial tobacco than their White counterparts (adjusted mean = 0.60, standard error = 0.04; p < 0.01). Overall concern about COVID-19 discrimination was associated with increased past-30-day cigarette consumption by 26.5 cigarettes (95% confidence interval [CI] = 1.2-51.9) and 4.4 times (95% CI = 2.3-8.5) greater odds of return to smoking among adults who smoke cigarettes. A&AsA adults who currently and formerly used commercial tobacco disproportionately bore higher concern about COVID-19 discrimination, and in turn could lead to increased smoking behavior and related morbidity and mortality among A&AsA adults.

Disparities in Current Cigarette Smoking Among US Adults With Mental Health Conditions.

INTRODUCTION: Prevalence of cigarette smoking is disproportionally high among US adults with mental health conditions. Adults with mental health conditions who smoke cigarettes are at increased risk for smoking-related illness and death compared with adults without mental health conditions. METHODS: We analyzed pooled data from the 2019 and 2020 National Survey on Drug Use and Health to provide national estimates of current cigarette smoking prevalence among US adults aged 18 years or older who reported having in the past year any mental illness, serious mental illness, mild or moderate mental illness, serious psychological distress, and/or major depressive episode (N = 19,398) and state-level estimates for any mental illness. RESULTS: Prevalence of cigarette smoking for serious mental illness was 27.2%; serious psychological distress and major depressive disorder, 25.0%; serious psychological distress, 24.5%; any mental illness, 22.8%; mild or moderate mental illness, 21.2%; and major depressive disorder, 17.6%. State-level cigarette smoking prevalence among adults with any mental illness ranged from 11.7% in Utah to 42.1% in Louisiana, with a median of 24.7%. CONCLUSION: The prevalence of current cigarette smoking is higher among adults with any mental illness, psychological distress, and major depressive disorder than among those without any mental illness, especially among adults who are non-Hispanic American Indian or Alaska Native, Hispanic, lesbian, gay, or bisexual and among those who are experiencing poverty, are uninsured, or have been arrested and booked in the past year. Continued improvement in integration of smoking cessation interventions into mental health treatment, equitable implementation of comprehensive commercial tobacco control policies, and population-specific approaches could reduce cigarette smoking among adults with mental health conditions.

Predictors of electronic nicotine product quit attempts and cessation: Analysis of waves 3 and 4 of the PATH study.

INTRODUCTION: Identifying theory-based predictors of electronic nicotine product (ENP) quit attempts and cessation can guide the development of effective vaping cessation interventions, which are currently limited. This study examined predictors of ENP quit attempts and cessation among adult ENP users. METHODS: Using data from wave 3 (W3; 2015-2016) current established ENP users in the Population Assessment of Tobacco and Health study, we used multivariable logistic regression to identify predictors of (i) wave 4 (W4; 2016-2018) quit attempts (unweighted n = 1,135); and (ii) W4 cessation among those who made a quit attempt (unweighted n = 610). Predictors included Social Cognitive Theory (SCT)-based cognitive (interest in quitting, self-efficacy to quit, outcome expectancies, risk perception), behavioral (smoking status, and use of combustibles, non-combustibles, cannabis, and alcohol), and socio-environmental (perceived disapproval, household rules, exposure to advertising) factors. RESULTS: Between W3 and W4, 51.7% of W3 ENP users made a quit attempt. Among those who tried quitting, 68.4% stopped using ENPs. SCT-based predictors of ENP quit attempts included higher interest in quitting ENPs (aOR = 1.18), greater self-efficacy to quit ENPs (aOR = 1.31), and currently using cigarettes (vs non-smoker; aOR = 1.71), non-combustibles (aOR = 2.25), and cannabis (aOR = 1.80). Predictors of ENP cessation included greater self-efficacy to quit ENPs (aOR = 1.33), greater perceived risk of ENPs (aOR = 1.35), and being a current smoker (vs non-smoker; aOR = 3.28). CONCLUSIONS: ENP cessation interventions should address cognitive factors, particularly self-efficacy, as it predicted quit attempts and cessation. Cigarette smoking among dual users should be monitored and addressed to ensure that those who quit using ENPs do not maintain cigarette use.

Factors associated with baseline smoking self-efficacy among male Qatari residents enrolled in a quit smoking study.

Smoking self-efficacy, described as confidence in one's ability to abstain from smoking in high-risk situations is a key predictor in cessation outcomes; however, there is a dearth of research on factors that influence self-efficacy surrounding smoking behavior. This study examines factors associated with baseline self-efficacy among treatment seeking participants enrolled in a pilot feasibility smoking cessation study. Participants (n = 247) were daily male smokers, residents of Doha in Qatar (18-60 years) who were enrolled in a telephone-based smoking cessation study. Baseline assessments included self-efficacy, home smoking rules, socio-demographic variables, smoking history, and psychosocial characteristics. Factors associated with self-efficacy were assessed using multiple linear regression analysis. Results showed that after controlling for relevant variables, number of cigarettes smoked ([Formula: see text] = -0.22; 95% CI: -0.37, -0.06), having at least one quit attempt in the past year ([Formula: see text] = 2.30; 95% CI: 0.27, 4.35), and reporting a complete home smoking ban ([Formula: see text] = 3.13; 95% CI: 0.56, 5.70) were significantly associated with higher self-efficacy to quit smoking. These results provide data-driven indication of several key variables that can be targeted to increase smoking self-efficacy in this understudied population.

The Association of Cannabis Use and Cigarette Smoking with Psychological Distress Among Adults in California.

BACKGROUND: In November 2016, California voters passed the Adult Use of Marijuana Act making recreational cannabis sales legal to adults aged 21and older starting January 1st, 2018. This study aims to understand the relationship of cannabis use and cigarette smoking with serious psychological distress (SPD) in California in light of the legalization of recreational cannabis sales. METHODS: This cross-sectional study included 42,313 adult participants from the 2017 to 2018 California Health Interview Surveys. We used the Kessler-6 (K6) scale to measure psychological distress in the past 30 days. Multiple logistic regression models were used to examine the association between cannabis/cigarette use and SPD. RESULTS: Cannabis use was positively associated with SPD (AOR = 2.48, 95% CI = 1.57, 3.91), but this association was not significantly different before and after recreational cannabis sales legalization in California (AOR = 0.82, 95% CI = 0.72, 2.05). Cigarette smoking was also positively associated with SPD (AOR = 2.76, 95% CI = 2.05, 3.71). Compared to those who used neither cannabis nor cigarettes, sole cannabis users (AOR = 2.51, 95% CI = 1.75, 3.60), sole cigarette smokers (AOR = 3.23, 95% CI = 2.28, 4.60), and dual users of cannabis and cigarettes (AOR = 5.65, 95% CI = 4.04, 7.89) were more likely to report SPD. Dual users were also more likely to report SPD than sole cannabis users (AOR = 2.25; 95% CI = 1.48, 3.43) and sole cigarette smokers (AOR = 1.75; 95% CI = 1.18, 2.59). CONCLUSIONS: These findings provide evidence for the need to develop effective cessation intervention strategies targeting individuals with SPD to reduce their cannabis use and dual-use of cannabis and cigarettes.

Evidence of the Effectiveness of Pictorial Health Warnings on Cigarette Packaging in Nepal.

BACKGROUND: Tobacco Control Act of 2010 mandates government to implement at least 75% pictorial health warnings (PHWs) on tobacco packaging that was enforced in 2013. The purpose of the study was to assess the effectiveness of PHWs and its impact to the policy change. METHODS: A cross-sectional study was conducted in 9 cities between September 2014 and March 2015. Direct interviews were made among 2250 randomly selected individuals. The effectiveness of PHWs were measured as perceived: i) scariness; ii) quit motivation iii) convincing youth not to start smoking; iv) encouraging ex-smokers to remain as quitters; v) building public awareness. Logistic regression analysis was used to determine the factors associated with the effectiveness of PHWs. RESULTS: Of the 2250 participants, 29.8% (670) were current smokers, 8.6% (193) were ex-smokers and 97.6% believed that smoking was addictive. PHWs made 83% of the participants scared. Participants believed that PHWs would be effective in motivating smokers to quit (80.2%), in convincing youth not to start smoking (86.8%), in encouraging ex-smokers to remain as quitters (89.1%) and in building public awareness on the dangers of smoking (94%). PHWs made 58% of the current smokers intended to quit smoking and reduced their daily intake of cigarettes from 11 to 5 on average.  Current smokers preferred to purchase loose cigarettes rather than a pack. The covariates significantly associated with the effectiveness of PHWs were current smokers, ex-smokers and addiction. CONCLUSION: PHWs were found important to motivate smokers to quit smoking, to reduce consumption of cigarettes and to prevent relapse in ex-smokers. Evidence from the study had triggered policy changes which included enlargement of the size of PHW to 90% and the release of a notification to ban selling of loose cigarettes. Thus, the warning messages with pictures are required to be improved and rotated.

Pilot randomised controlled trial of the Risk Acceptance Ladder (RAL) as a tool for targeting health communications.

BACKGROUND: Improving adherence to self-protective behaviours is a public health priority. We aimed to assess the potential effectiveness and ease of use of an online version of the Risk Acceptance Ladder (RAL) in promoting help-seeking for cigarette smoking, excessive alcohol consumption, insufficient physical activity, or low fruit and vegetable consumption. METHODS: 843 UK adults were recruited, of whom 602 engaged in at least one risky behaviour. Those with no immediate plans to change (n = 171) completed a behaviour specific RAL. Participants were randomised to one of two conditions; a short message congruent (on-target, n = 73) or incongruent (off-target, n = 98) with their RAL response. Performance of the RAL was assessed by participants' ability to select an applicable RAL item and reported ease of use of the RAL. Effectiveness was assessed by whether or not participants clicked a link to receive information about changing their target behaviour. RESULTS: Two thirds (68.9%, 95% CI = 61.8%-75.3%) of participants were able to select an applicable RAL item that corresponded to what they believed would need to change in order to alter their target behaviour, with 64.9% (95% CI = 57.5%-71.7%) reporting that it was easy to select one option. Compared with the off-target group, participants allocated to the on-target group had greater odds of clicking on the link to receive information (31.5% vs 19.4%; OR = 2.07, 95% CI = 1.01-4.26). CONCLUSION: The Risk Acceptance Ladder may have utility as a tool for tailoring messages to prompt initial steps to engaging in self-protective behaviours.

Conjoint Developmental Trajectories of Adolescent E-cigarette and Combustible Cigarette Use.

OBJECTIVES: In this study, we sought to identify which adolescents progress to regular electronic cigarette (e-cigarette) use (without cigarette smoking), which adolescents become dual users of both types of cigarettes, and how dual use develops across time. METHODS: Adolescents (N = 1808) from public high schools outside Philadelphia, Pennsylvania, completed in-classroom surveys at wave 1 (fall 2016, beginning of ninth grade) and at 6-month intervals for the following 36 months (fall 2019, beginning of 12th grade). RESULTS: A sequential processes growth mixture model identified 4 conjoint latent classes: later, rapid e-cigarette uptake (class 1: n = 230); no use of e-cigarettes or combustible cigarettes (class 2: n = 1141); earlier, steady e-cigarette uptake (class 3: n = 265); and dual use of e-cigarettes and combustible cigarettes (class 4: n = 204). Using a rich set of potential risk factors, multinomial logistic regression assessed the likelihood of belonging to each conjoint class compared with the comparison class (dual use). Adolescents in the dual use class were characterized by a greater number and severity of e-cigarette and combustible cigarette risk factors. Adolescents in the 2 e-cigarettes-only classes were characterized by either e-cigarette-specific risk factors (earlier onset) or no risk factors (later onset). The no use class had an absence of risk factors for e-cigarette and cigarette use. CONCLUSIONS: This study provides new prospective evidence for distinct patterns and profiles of adolescents who progress to current e-cigarette use, including adolescents who were initially cigarette smokers. The findings have implications for prevention intervention timing, tobacco product focus, content, and the adolescent subgroups to target.

Changes of Exercise, Screen Time, Fast Food Consumption, Alcohol, and Cigarette Smoking during the COVID-19 Pandemic among Adults in the United States.

OBJECTIVE: To investigate the impact of the COVID-19 pandemic on multiple lifestyle changes among adults in the United States (USA). METHODS: We conducted a survey, the Health, Ethnicity, and Pandemic (HEAP) Study, in October 2020 among USA adults. Participants were selected from the United States using 48 sampling strata, including age, race, ethnicity, education, and gender, and were asked to report five lifestyle behaviors (i.e., exercise time, screen time, fast-food meal consumption, alcohol drinking, and cigarette smoking) before and during the COVID-19 pandemic. The associations of sociodemographic factors with each lifestyle change were estimated using weighted multivariable logistic regression models. RESULTS: All 2709 HEAP participants were included in this study. Compared to pre-pandemic, the time spent on exercise decreased (32.06 vs. 38.65 min/day; p < 0.001) and screen time increased (6.79 vs. 5.06 h/day; p < 0.001) during the pandemic. The percentage of individuals who reported consuming fast-food meals ≥3 times/week decreased from 37.7% before the pandemic to 33.3% during the pandemic. The percentage of heavy drinkers (≥5 times/week) increased from 20.9% before the pandemic to 25.7% during the pandemic. Among smokers, heavy smoking (≥11 cigarettes/day) increased from 5.8% before the pandemic to 7.9% during the pandemic. We also identified subgroups who were more vulnerable to adverse influences from the pandemic, including racial/ethnic minority groups and young adults. CONCLUSIONS: The COVID-19 pandemic had negative impacts on multiple lifestyle behaviors among Americans. Mitigating such negative impacts of COVID-19 requires effective interventions, particularly for some vulnerable subgroups.