Does sensation-seeking behavior influence the patterns of flavored e-cigarette use? A cross-sectional study among Indonesian adolescents and young adults.

BACKGROUND: The variety of available flavors in e-cigarettes may be a driver for young people to start using these products. The objectives of our study were to examine the relationship between sensation-seeking behavior and e-cigarette use, and to identify the predictors of flavor use patterns among adolescents in Indonesia. METHODS: Students aged 15 to 24 years participated from randomly selected high schools and universities in Indonesia. Participants answered questions about their demographic data, e-cigarette use, conventional cigarette use, and sensation-seeking. Flavor preferences were identified from eight different flavor categories. Multivariate multinomial regression analysis was employed to predict conventional cigarette and e-cigarette use among students. A latent class analysis was conducted to determine the number of latent classes of flavor use. RESULTS: One thousand six hundred high school and university students, with a mean age of 18.2 years (SD 2.19), were recruited between March and August, 2023. Conventional cigarette use in the past 30 days was higher (16.3%) compared to e-cigarette use (13.3%, p = 0.017), with approximately 8.5% of students were being dual users. Higher levels of sensation-seeking significantly increased the odds of being a current e-cigarette user (OR = 2.54, 95%CI 1.99-3.25) and a current conventional cigarette smoker (OR = 2.38, 95%CI 1.85-3.07). Three groups of flavor classes were identified: 1) primarily menthol flavor users (14%), who had a strong association with current conventional cigarette use; 2) experimenters, who mostly preferred fruit-flavored e-cigarettes (76%); and 3) the multi-flavor user group (10%), who had a higher sensation-seeking tendency. CONCLUSIONS: Flavors, especially menthol and fruit flavors, attract youth, broaden the e-cigarette audience and are particularly appealing to high sensation-seekers. Banning these flavors could significantly deter e-cigarette initiation among youth.

Impact of regulatory tightening of the Hungarian tobacco retail market on availability, access and cigarette smoking prevalence of adolescents.

INTRODUCTION: Policies that reduce tobacco retail density to decrease tobacco use among the youth are critical for the tobacco endgame. This paper reviews a Hungarian tobacco regulatory measure, which, since 2013, has confined the sale of tobacco products exclusively to so-called National Tobacco Shops, summarises the changes in the national tobacco retail marketplace and reports on analyses of the impact of this intervention on illegal sales to minors and adolescent smoking behaviour. METHODS: We reviewed the available national statistical data on the structure and dynamics of the tobacco retail market. Changes in lifetime and current (past 30 days) use of cigarettes among Hungarian adolescents aged 13-17 years were assessed using data from international youth surveys on health behaviours collected in 2010-2020. RESULTS: Since the start of policy implementation, the density of tobacco shops in Hungary decreased by 85%, from 4.1 to 0.6 per 1000 persons. The prevalence of lifetime and current cigarette smoking among adolescents declined by 13-24 percentage points (pp) and by 4.8-15 pp, respectively. The rate of illegal sales of tobacco products to minors decreased by 27.6 pp, although the prevalence of compensatory access strategies, especially asking others to buy cigarettes for minors, increased. CONCLUSIONS: After a significant decrease in the nationwide availability of licensed tobacco retailers, Hungary experienced short-term reductions in youth smoking prevalence. However, the sporadic implementation of complementary, evidence-based tobacco control strategies might limit further declines in youth smoking initiation and tobacco product use.

COVID-19 vaccination refusal in the active Hungarian adult population in December, 2021 An exploratory study / A COVID-19 elleni oltóanyagot elutasítók az aktív korú felnott magyar lakosság körében 2021 decemberében

Introduction: In 2021, vaccines against COVID-19 became widely available in Hungary, but a part of the population refuses to be vaccinated, which hinders the control of the pandemic. Objective: To explore the sociodemographic characteristics of the Hungarian vaccination-refusing population and to preliminarily explore the reasons behind their refusal. Methods: In December 2021, survey data were collected online using quota-sampling among the Hungarian population aged 18-65 years with internee access. Sociodemographic variables, individual variables, and reasons for refusal were asked. 1905 completed questionnaires were included in this analysis. After variable selection using LASSO regression, binary logistic regression was used to identify the influencing variables. Reasons for rejection were examined both descriptively and using hierarchical classification. Results: Respondents with lower income, lower education, females, younger age, people living in smaller municipalities and who perceived their own health as better were more likely to refine vaccination. No similar associations were found with marital status, household size, life satisfaction and loneliness. Distrust of vaccination, safety concerns (especially side effects) and efficacy concerns are the main reasons for refusal, and to a lesser extent, the belief of immunity. Conclusions: Vaccination refusal is higher in vulnerable groups, which further increases their health risks. Alongside a well-designed health communication campaign, restoring trust in scientific and health institutions, transparent communication and a community-based approach appear to be important to increase vaccination uptake in Hungary.

Comorbidities and increased mortality of COVID-19 among the elderly: A systematic review.

Purpose: The purpose of current review is to conduct a systematic overview of articles published between 2019 and 2021 on the relationship of comorbidities and mortality due to Coronavirus Disease 2019 (COVID-19) among the elderly population. Methods: We conducted a systematic search on PubMed for articles published between 2019 and 2021 to identify any cohort and case-control studies that investigated the relationship of comorbidities and COVID-19 mortality among the elderly, defined as 60 years of age and above. Databases were searched independently by two authors. Disagreements were resolved by the inclusion of a third investigator. Reviews, systematic reviews, and meta-analyses were excluded from our systematic review. Results: A total of 15 studies were selected for our systematic review. Of the included studies, 3 were case-control, 3 were prospective cohort studies and 9 were retrospective cohort studies. As for size, 10 studies were conducted on populations of <1000 participants, 3 ranging from 1001 to 10,000, and 2 on populations of >10,000 individuals. The included studies found that the presence of certain conditions, such as cardiovascular, respiratory, renal diseases, malignancies, diseases of the nervous system and diabetes are associated to increased mortality in populations that consisted of elderly patients. Conclusion: Results of our systematic review suggest that comorbidities contribute to increased COVID-19 mortality among the elderly. The detrimental effect of comorbidities and advanced age on the immune response could lead to a more frequent occurrence of symptomatic and severe infections with COVID-19.

Perceived harm of heated tobacco products, e-cigarettes, and nicotine replacement therapy compared with conventional cigarettes among ever and current heated tobacco users.

Aims: There is limited knowledge on how ever and current heated tobacco product (HTP) users perceive the relative harm of various nicotine-containing products. The aim of this study was to explore relative harm perceptions of HTPs, e-cigarettes, and nicotine replacement therapy (NRT) relative to conventional cigarettes (CCs) among ever versus current HTP users, and exclusive (who use only a HTP) versus dual/poly-users (concurrent users of HTP and CCs and/or e-cigarettes). Methods: Data came from 1423 ever or current Hungarian adult HTP users who participated in a cross-sectional web-based survey in 2020. Unadjusted and adjusted logistic regression analyses were performed to explore the associations between relative harm perceptions, HTP use patterns, past tobacco use, HTP dependence, and socio-demographic variables. Results: 81.2% of the sample was current HTP users, of them 78.4% were exclusive HTP users. Compared to CCs, 86.2% of the sample perceived HTP to be less harmful, with current and exclusive HTP users endorsing more this belief, followed by NRT (79.8%), and e-cigarettes (45.2%). In general, neither socio-demographic variables nor past tobacco use, HTP use pattern, and HTP dependence were related to perceived harmfulness across the tested products. However, there was a specific pattern for each tested product with a set of explanatory variables. Conclusions: Ever/current HTP users presented misperceptions about the harms of HTPs, e-cigarettes, and NRT. They underestimated the potential health benefits of NRT and had distorted harm perceptions about HTPs and e-cigarettes. Public education about the relative harms of different nicotine and tobacco products is urgently needed.

The epidemiology of smoking and e-cigarette use in the Hungarian adult population in 2018 / A dohányzás és az e-cigaretta-használat epidemiológiája a felnott magyar népesség körében 2018-ban.

Összefoglaló. Bevezetés: Nagyszámú kutatás igazolta, hogy a dohányzás növeli a legjelentosebb krónikus betegségek kockázatát. Habár 2009 óta csökkeno tendenciát mutat Magyarországon a hagyományos dohányzók aránya, az e-cigarettát kipróbálóké az utóbbi években folyamatosan növekszik. Célkituzés: A 2018-ban a felnott lakosság körében végzett Népegészségügyi Felmérés dohányzásra és e-cigaretta-használatra vonatkozó eredményeinek bemutatása az elozo vizsgálatok tükrében. Módszer: A kérdoíves felmérésben 1586 fo került személyesen lekérdezésre. Az iteratív súlyozás a többlépcsos mintavételi designhatást és a 2016-os mikrocenzus adatait vette figyelembe. Eredmények: 2018-ban a dohányzók aránya a magyar felnott lakosság körében 28,7% (95% MT: 26,3-31,1%), az e-cigarettát használók aránya pedig 1,7% (95% MT: 1,1-2,5%) volt. Az iskolai végzettség a 65 év alattiak esetében a dohányzást befolyásoló tényezo volt (EH: 3,32; 95% MT: 2,53-4,34), de a 65 éves és annál idosebb korcsoportban már nem (EH: 1,11; 95% MT: 0,59-2,09). Az e-cigarettát kipróbálók és használók között a leginkább említett (54,3% 95% MT: 44,0-64,5%) motivációs tényezocsoport a dohányzásról való leszokással, az ártalomcsökkentéssel és a visszaesés megelozésével volt kapcsolatos. A 65 éves és idosebb korcsoportban a dohányzók aránya 2015-höz képest emelkedett. 2018-ban az alapfokú iskolai végzettséguek körében volt a legmagasabb a dohányzók aránya, míg 2014-ben az érettségivel nem rendelkezo középfokú végzettséguek körében. Következtetés: Bár összességében csökkent, az alacsony iskolai végzettséguek és az idosek körében emelkedett a dohányzók aránya Magyarországon. Az e-cigarettát kipróbálók és használók száma növekvo tendenciát mutat hazánkban. Eredményeink az alacsony iskolai végzettséguekre kiemelten fókuszáló, megelozo és leszokást támogató népegészségügyi alprogramokat is tartalmazó komplex beavatkozást sürgetnek. Orv Hetil. 2022; 163(1): 31-38. INTRODUCTION: The body of evidence suggests that smoking increases the risk of the most prevalent chronic diseases. Although the proportion of traditional smokers in Hungary has been on a declining trend since 2009, the proportion of those who tried e-cigarette has been steadily increasing in recent years. OBJECTIVE: To present - in the light of previous studies - the results of the Public Health Survey among adults in 2018 on smoking and e-cigarette use. METHOD: 1586 persons were personally interviewed in a survey. The iterative weighting algorithm considered both the design effect of multistaged sampling and the 2016 Hungarian microcensus. RESULTS: In 2018, the proportion of smokers in the Hungarian adult population was 28.7% (95% CI 26.3-31.1%), and the proportion of e-cigarette users was 1.7% (95% CI 1.1-2.5%). Educational level was a predictor of smoking among respondents younger than 65 years old (OR 3.32; 95% CI 2.53-4.34), but not for those aged 65 years or older (OR 1.11; 95% CI 0.59-2.09). Among e-cigarette ever or current users, the most commonly mentioned (54.3% 95% CI 44.0-64.5%) motivational factor-group to try or use e-cigarettes included motivations to quit smoking, to reduce harm, and to avoid relapsing. In the population aged 65 years old or older, the proportion of smokers increased compared to 2015. The proportion of smokers was the highest among those with primary education in 2018, while in 2014, it was the highest among those with secondary education without a graduation certificate. CONCLUSION: In Hungary, although overall smoking rates are declining, the smoking rate in the low educational group and among the elderly increased. The number of people trying or using e-cigarettes is showing an increasing trend in our country. Our results call for a complex public health intervention program including prevention and smoking cessation supporting subprograms with high focus on those with primary education. Orv Hetil. 2022; 163(1): 31-38.

Vaping-Related Adverse Events and Perceived Health Improvements: A Cross-Sectional Survey among Daily E-Cigarette Users.

Web-based samples of e-cigarette users commonly report significant vaping-related health improvements (HIs) and mild adverse events (AEs). This cross-sectional study with in-person interviewing data collection examined self-reported AEs and perceived HIs among Hungarian adult current daily exclusive e-cigarette (n = 65) and dual users (n = 127), and former daily e-cigarette users (n = 91) in 2018. Logistic regression was used to evaluate associations between reporting any AEs/HIs, vaping status, and covariates. More former users (52.7%) reported AEs than current users (39.6%; p = 0.038). Exclusive and dual daily users reported similar rates of AEs (44.6% and 37.0%, respectively; p = 0.308). More current users (46.9%) experienced HIs than former users (35.2%; p = 0.064). Exclusive daily users were more likely to report HIs than dual users (63.1% versus 38.6%; p = 0.001). Former user status and smoking cessation/reduction reasons increased the odds of reporting AEs, whereas nicotine-containing e-liquid use and older age decreased the odds of reporting AEs. Exclusive vaper status, using advanced generation devices, and smoking cessation/reduction reasons increased the odds of experiencing HIs. This study, which used a traditional data collection methodology, found a higher rate of AEs and a lower rate of HIs compared to web-based surveys. Our results highlight that experiencing AEs and HIs is affected by users' characteristics, in addition to the device and e-liquid type.

Parental occupational exposure and congenital heart diseases in a Hungarian case-control study.

PURPOSE: Our study aimed to explore the effect of parental occupational exposure to endocrine disrupting chemicals (EDCs) on the development of congenital heart diseases (CHDs) in the offspring, and to compare job-exposure matrix (JEM)-assessed and self-reported occupational exposures with each other. METHODS: Live-born infants born in 2007-2008 were selected from the population-based Hungarian Case-Control Surveillance of Congenital Abnormalities Study. 577 cases with any CHDs were compared to 1731 matched controls. Parental periconceptional occupational exposure to EDCs was assessed by a JEM and by questionnaire-based self-reporting of parents. Multivariate conditional logistic regression analyses were conducted to explore associations between parental occupational exposure to EDCs and the entire spectrum of CHDs and by CHD subtypes in the offspring. Kappa statistics were also performed to determine the consistency among JEM-assessed and self-reported occupational exposure of parents. RESULTS: JEM-assessed paternal exposure to polychlorinated organic substances, phthalates, biphenolic compounds, and solvents were significantly associated with the entire spectrum of CHDs. Ventricular septal defects were significantly associated with paternal self-reported exposure to pesticides, while atrial septal defects were significantly associated to paternal JEM-assessed phthalate exposure. Paternal solvent exposure was significantly associated with atrial septal defects and right ventricle outflow tract obstructions. JEM-assessed and self-reported exposures to pesticides, heavy metals, and solvents exhibited poor agreement for mothers and slight agreement for fathers. CONCLUSION: Even though parental occupational exposure to EDCs seems to have a minor impact on the occurrence of CHDs, the results of biological and environmental monitoring should be taken into consideration as well.

Congenital heart diseases and parental occupational exposure in a Hungarian case-control study in 1997 to 2002.

The etiology of congenital heart diseases is not fully understood yet, however, endocrine disrupting chemicals may have a causative role in their development. The purpose of our study was to examine the association between congenital heart diseases and periconceptional parental occupational exposure to endocrine disrupting chemicals. In our Hungarian population-based case-control study, we examined 2263 live born cases with any congenital heart disease and 6789 matched controls selected between years 1997 to 2002. Occupational exposure was assessed with a job-exposure matrix developed for endocrine disrupting chemicals. Conditional multiple logistic regression analyses were performed to test associations between parental occupational exposure to endocrine disrupting chemicals and congenital heart diseases of the offspring as a whole and by congenital heart disease subtypes. The prevalence of exposure to endocrine disrupting chemicals was 4.5% for both case and control mothers and 19.1% and 19.4% for case and control fathers, respectively. We found a positive association between paternal pesticide (adjusted odds ratio = 1.66, 95% confidence interval: 1.03-2.69) and alkylphenolic compound exposure (adjusted odds ratio = 1.95, 95% confidence interval: 1.30-2.93) and the development of patent ductus arteriosus in the offspring. Alkylphenolic compound exposure occurred among painters, famers, and those working in the food service industry, while pesticide exposure occurred predominantly among farm workers. We identified that certain occupations may increase the occurrence of certain congenital heart disease phenotypes in the offspring. By paying closer attention to those working in these areas, antenatal detection rates of congenital heart diseases may be improved.

Oral Hygiene Practices of Hungarian Adult E-Cigarette-Only and Dual Users.

PURPOSE: This study aimed to explore self-reported oral hygiene practices (OHPs) among Hungarian adult e-cigarette-only (former smokers who switched completely to e-cigarette use or vaping) and dual users (smokers who use e-cigarettes and combustible tobacco cigarettes concomitantly). MATERIALS AND METHODS: A cross-sectional, web-based survey of 930 adult Hungarian e-cigarette users was conducted in 2015. Participants reported 10 OHPs, which were included in analyses as separate binary variables and as a composite variable of the 10 OHP items (inadequate/adequate). Chi-square test was used to explore whether separate OHPs differ by vaping status, and to examine the relationship between inadequate OHPs and past combustible or e-cigarette use characteristics. Associations between separate OHPs and vaping status, and between inadequate OHPs and vaping status were tested by multiple logistic regression analyses. RESULTS: More dual users reported toothbrushing twice a day or more than e-cigarette-only users (73.6% vs 65.3%, respectively, p = 0.041) and using sugar-free chewing gum (57.7% vs 45.8%, respectively, p = 0.006) while adequacy of other OHPs did not differ statistically significantly by vaping status. Inadequate OHPs were more typical in the sample (63.7%) than adequate OHPs, however, inadequate OHPs did not differ statistically significantly among dual users and e-cigarette-only users (62.0% vs 64.0%, respectively, OR = 1.20, p = 0.400), controlling for age, gender, education, past combustible and current e-cigarette use characteristics. CONCLUSION: In this study, both e-cigarette-only and dual users demonstrated similarly high prevalence of inadequate OHPs. Therefore dentists should educate them about effective OHPs and the role of tobacco and e-cigarette use in the development of oral diseases.

Smoking prevalence and desire to quit among employees in Transylvanian foster care homes.

OBJECTIVES: Few studies have investigated smoking habits among foster care home children and employees, who are at high risk for smoking. Additionally, there are no published studies on the intention to quit smoking among employees of the Romanian Child Protection system, a gap we address in this manuscript. METHODS: A repeated cross-sectional survey was conducted among foster care employees in three Transylvanian counties (Mures, Sibiu, Covasna) in January 2014 to February 2015 (baseline) and September-December 2016 (follow-up). A foster home-based smoking prevention and cessation intervention targeting employees and children was conducted between the two waves. Multivariate logistic regression analysis was conducted to determine associations between socio-demographics, reasons for smoking, tobacco use patterns, reasons for quitting, and tobacco policy attitudes on intention to quit (dependent variable), controlling for participation in the smoking prevention intervention. RESULTS: 305 employees participated in the baseline (76.4% of females, 23.6% of males) and 304 employees in the follow-up surveys (68.8% of females, 31.2% of males) after the smoking prevention and cessation intervention. At baseline, 34.8% of respondents reported that no one was smoking within the foster care home, which increased to 59.1% at follow-up (p < 0.001). Being male and a high level of professional satisfaction were the only correlates of intention to quit in the bivariate models at baseline. Professional satisfaction and a belief that smoking is bad for one's health were the only correlates of intention to quit at follow-up. In multivariable models, professional satisfaction was the only consistent predictor of intention to quit at both time points (OR 5.63, 95% CI 1.71-18.56; OR 4.98, 95% CI 1.43-17.30). CONCLUSIONS: Efforts should be made to promote cessation among foster care employees that includes evidence-based support, along with compliance to policies that prohibit smoking indoors to reinforce cessation efforts.

Perceived health effects of vaping among Hungarian adult e-cigarette-only and dual users: a cross-sectional internet survey.

BACKGROUND: Knowledge about the health effects of e-cigarette use (or vaping) among past and current combustible cigarette users is limited. Several studies have assessed vaping-related adverse events (AEs) and beneficial health effects, however, most studies focused on AEs in general and examined only a few physiological changes that vapers experience. This study aims to explore self-reported AEs and perceived health changes due to e-cigarette use among Hungarian adult e-cigarette-only users (former smokers who switched completely to e-cigarette use) and dual users (smokers who use e-cigarettes and combustible tobacco cigarettes concomitantly). METHODS: A cross-sectional, web-based survey of 1042 adult Hungarian e-cigarette users was conducted in 2015. Participants reported AEs and changes in physiological functions since they switched from smoking to e-cigarette use or while dually using e-cigarettes and combustible cigarettes. Confirmatory factor analysis with covariates was applied to explain perceived health changes due to e-cigarette-only use and dual use. RESULTS: Dual users (17.6%) were significantly more likely to report AEs of vaping than e-cigarette-only users (26.2% vs. 11.8%, p < 0.001). Experiencing health improvements were significantly more likely among e-cigarette-only users than for dual users for all surveyed physiological functions. E-cigarette-only users reported larger effects of vaping on sensory, physical functioning, and mental health factors compared to dual users. Self-reported changes in sensory and physical functioning were significantly higher among individuals using e-cigarettes more than a year and people who were past heavy smokers (smoked ≥20 cigarettes per day). Gender was related to sensory improvement only; males reported greater improvement than females. CONCLUSIONS: The majority of e-cigarette-only users reported more perceived beneficial changes in physiological functions and fewer AEs than dual users. Perceived short-term benefits of e-cigarette use may reinforce users despite the uncertainty of long-term health consequences. Health professionals should provide balanced information regarding the possible short- and long-term positive and negative health effects of e-cigarette use during consultations with patients.

Patterns of alternative tobacco product experimentation among ever smoker adolescents.

OBJECTIVES: Alternative tobacco product (ATP) use is popular among adolescents in Western countries, however, little is known about factors influencing ATP experimentation in Europe. The aim of this study was to explore factors associated with ATP experimentation, and to identify patterns of ATP experimentation among Hungarian adolescents who had ever tried manufactured cigarette smoking. METHODS: Logistic regression analyses were applied to estimate the relationship between individual cigarette smoking experiences, social smoking influences, demographics, and ATP experimentation (roll-your-own (RYO) cigarettes, cigars/cigarillos, waterpipe, traditional pipe and flavoured cigarettes) in a cross-sectional sample of 8th and 11th grade students (N = 1,067, 56.0% of girls) who had ever tried manufactured cigarette smoking in six metropolitan cities of Hungary. Latent class analysis (LCA) was performed to identify patterns of different ATP use. RESULTS: Almost 90% of the sample had ever tried ATPs and significantly more commonly older (91.8%) versus younger (79.8%) students. Waterpipe was the most popular product to try followed by flavoured cigarettes, cigars/cigarillos, RYO cigarettes, and pipe. Boys were more likely to report ATP experimentation compared to girls. Younger age of cigarette smoking experimentation, greater frequency of past month cigarette smoking and history of ever daily smoking for 30 days showed strong association with ATP experimentation. Students with one or more smoking friends were more vulnerable to experiment with ATPs. Weekly allowance, school academic achievement and household smoking exposure showed no effect on the experimentation. LCA identified four subgroups of ATP experimenters comprising intense polytobacco experimenters (38.4%), mainly waterpipe experimenters (34.2%), moderate polytobacco experimenters (14.9%), and less interested experimenters (12.5%). CONCLUSION: Tobacco prevention programmes targeting adolescents should emphasize the risks of using ATPs in addition to manufactured cigarettes. Accessibility of ATPs should be better regulated and restrictions should be strongly enforced in order to prevent potential harmful consequences of adolescent polytobacco use.

Home- and Car-Based Rules in Foster Care Settings to Reduce Exposure to Secondhand Smoke: Before and after Romanian National Clean Air Legislation.

Background: To evaluate changes in smoke free rules in the foster care system after the implementation of the Romanian national clean air law. Methods: A repeated cross-sectional, self-administered questionnaire among foster care employees (n = 599) was conducted in 58 foster care homes during 2014 (n = 295) and 51 homes during 2016 (n = 304). We estimated the absolute difference in the proportion of employees who stated that smoke free rules existed before and after national clean air legislation. Results: There was an absolute increase in 4 of 5 smoke free measures after the law: bans on non-cigarette tobacco products (n = 169 to 206, +10.6%), non-smoking on premises for adults (n = 142 to 202, +18.3%), and for children (n = 201 to 239, +10.3%), and no smoking in cars to transport children (n = 194 to 227, +9%). There was a significant increase in the perception of outdoor bans that prohibit employees from smoking on foster care home premises (AOR 2.24, 95% CI 1.14⁻4.38). The increase in the perception of indoor smoking bans did not change. Conclusion: The national law may have had a spillover influence by strengthening smoke free rules in unregulated spaces. Nonetheless, foster care home rules could be further enhanced, particularly in cars that transport children.

Bidirectional associations of e-cigarette, conventional cigarette and waterpipe experimentation among adolescents: A cross-lagged model.

PURPOSE: With an increasingly diverse tobacco product market, it is imperative to understand the trajectories of product experimentation in order to design effective prevention programs. This study aims to explore the bidirectional associations of conventional cigarette, e-cigarette and waterpipe experimentation in a large adolescent sample. METHODS: Longitudinal assessment of conventional cigarette, e-cigarette and waterpipe use initiation was conducted in a school-based cohort of 1369 9th graders (mean age=14.88 SD=0.48 at baseline) during fall 2014 and reassessed 6-months later using online self-reported questionnaires. Autoregressive cross-lagged analysis within structural equation modeling framework was performed to simultaneously estimate the initiation of these products over a six-month period, controlling for age, gender, and participation in an intervention program to reduce conventional cigarette initiation. RESULTS: Tobacco product lifetime use was prevalent at baseline in the sample: conventional cigarettes (48.4%), e-cigarettes (35.8%), and waterpipe (20.8%). At six-month follow-up, trying conventional cigarettes predicted trying e-cigarette (adjusted odds ratio (AOR)=3.78, CI95%: 2.66-5.37) and trying waterpipe (AOR=2.82, CI95%: 2.00-3.97). Trying e-cigarette predicted trying conventional cigarette (AOR=3.57, CI95%: 1.96-6.49) and trying waterpipe (AOR=1.51, CI95%: 1.07-2.14). Although trying waterpipe predicted trying e-cigarette at follow-up (AOR=2.10, CI95%: 1.30-3.40), its use did not predict trying conventional cigarette (AOR=0.55, CI95%: 0.24-1.30). CONCLUSIONS: The high rates of poly-tobacco use and the bidirectionality of tobacco product experimentation demands comprehensive tobacco control and prevention programs that address the increasingly diverse tobacco product market targeting adolescents.

[Smoking trajectories among Hungarian adolescents]. / Dohányzói életutak magyar serdülok körében.

INTRODUCTION: Understanding adolescent smoking trajectories is necessary for tailored prevention programs. AIM: To identify adolescent cigarette use patterns and risk factors of smoking trajectories by a longitudinal study. METHOD: We conducted a three-year prospective survey in two age cohorts (6th and 9th school grades) of metropolitan adolescents (n = 1,092) with yearly data collection by self-administered questionnaires. Five smoking trajectory groups were defined by cigarette smoking data. RESULTS: 67.5% of the sample remained nonsmoker, 11.3% smoked all the time, 14.3% were initiators, 3.3% quitters and 3.7% experimenters. Members of smoking trajectory groups differed significantly from each other according to number of smoking friends, parental smoking, family structure, academic achievement and weekly allowance at baseline. CONCLUSIONS: Concerning tobacco prevention programs, adolescents are not homogenous population, because distinct set of risk factors are highlighted in their different smoking behavior groups. Orv. Hetil., 2017, 158(2), 67-76.

The Short-term Effects of ASPIRA: A Web-based, Multimedia Smoking Prevention Program for Adolescents in Romania: A Cluster Randomized Trial.

INTRODUCTION: Although web-based, multimedia smoking prevention programs have been tested in several high-income countries, their efficacy in Central and Eastern Europe is unknown. The aim of this trial was to assess the short-term effects of ASPIRA, among Romanian and Hungarian speaking ninth graders in Tirgu Mures, Romania. ASPIRA is the Romanian acronym for the translated and adapted version of ASPIRE, "A Smoking Prevention Interactive Experience," an evidence-based smoking prevention program originally developed to prevent tobacco use among high school students in the United States. METHODS: Sixteen high schools in Tirgu Mures, Romania were randomized to receive five weekly sessions of the ASPIRA web-based, multimedia program or to a control condition. Socio-demographic data, psychosocial characteristics, and smoking behavior were collected from students at baseline and at 6 months. A hierarchical logistic regression analysis was conducted to test the efficacy of the intervention on smoking initiation and current smoking among 1369 students. RESULTS: Never-smoker students in the intervention arm were 35% less likely to report smoking initiation 6 months after the baseline assessment (OR = 0.65, 95%CI: 0.44-0.97). Reduced smoking initiation was observed most notably among students who were exposed to at least 75% of the ASPIRA program. There was no statistically significant effect of the intervention on current tobacco use (OR = 0.80, 95%CI: 0.44-1.46). CONCLUSIONS: ASPIRA, an adapted version of the evidence-based, multimedia ASPIRE program that was originally developed and tested in the United States may decrease smoking initiation among multi-ethnic adolescents in Central and Eastern Europe. IMPLICATIONS: (1). Web-based, multimedia smoking prevention programs may be effective tools to prevent smoking initiation among multi-ethnic adolescent communities in Central and Eastern Europe. (2). The degree of exposure is critical, only high exposure to the multimedia smoking prevention program is associated with reduced smoking initiation.

[Summary of the existing knowledge about electronic cigarettes]. / Az elektronikus cigarettáról meglévo ismeretek összefoglalása.

The decreasing proportion of smokers due to smoking restrictions have led producers to invent and disseminate electronic cigarettes (e-cigarettes) worldwide as a new form of nicotine enjoyment. This review summarizes the existing knowledge about e-cigarettes based on publications of PubMed, and on reviews and research data published by national and international scientific institutions. Present knowledge about the composition of e-cigarettes confirms that they are harmful products since their vapor is equally detrimental to the health of users and bystanders. Their benefits in smoking cessation still have not been justified by adequate scientific evidence, however, it has been proven that e-cigarettes uphold nicotine addiction and may increase the risk of starting conventional cigarette use by youth. In order to ensure the results of tobacco control policy and to assist smoking cessation, the same regulations are to be applied to e-cigarettes as to conventional tobacco products.

Intention to Experiment With E-Cigarettes in a Cross-Sectional Survey of Undergraduate University Students in Hungary.

BACKGROUND: Electronic cigarettes are often used to promote cessation. Only a few studies have explored the motivations for e-cigarette experimentation among young adults. OBJECTIVES: The goals of this study were to assess the intention to try e-cigarettes among Hungarian university students and to develop a motivational scale to measure vulnerability to e-cigarette experimentation. METHODS: 826 Hungarian university students completed an internet-based survey in 2013 to measure motives for trying e-cigarettes. We conducted exploratory factor analyses and identified factors that promote and deter experimentation. Logistic regression analysis was performed to test the concurrent predictive validity of the identified motivational factors and we used these factors to predict e-cigarette experimentation, controlling for other known correlates of e-cigarette use. RESULTS: 24.9% of the participants have ever tried an e-cigarette and 17.2% of current nonsmokers experimented with the product. Almost 11% of respondents intended to try an e-cigarette in the future, yet only 0.6% were current e-cigarette users. Six factors were identified in the motivational scale for experimentation, four that promote usage (health benefits/smoking cessation; curiosity/taste variety; perceived social norms; convenience when smoking is prohibited) and two that deter usage (chemical hazard; danger of dependence). In a logistic regression analysis, the curiosity/taste factor was the only motivational factor significantly associated with the intention to try e-cigarettes in the future. CONCLUSIONS: This is the first study to test a motivational scale about what motivates e-cigarettes usage among university students. Additional research is needed to better understand these factors and their influence on e-cigarette uptake.