搜索结果：Tobacco use insights

The variation of language concerning tobacco products and tobacco use is known to impact the understanding of related risks and influence behaviors including use uptake and product cessation. Transnational tobacco companies can use such complexities to change the acceptability of tobacco use and influence public understanding of related risks. These changes, in turn, impact tobacco use behaviors. Looking at variations in the language used by different groups can therefore offer helpful insights into tobacco use cultures and make imbalances of information between groups plain. This paper examines the language of tobacco use, specifically smoking, across a sample of health organizations (the National Health Service, the World Health Organization, the National Institute for Health and Care Excellence, and the Centers for Disease Control and Prevention), the tobacco industry (British American Tobacco and Philip Morris International), and in "general English." Through corpus-assisted analysis, the study aims to illustrate differences in tobacco use and tobacco user characterizations by 2 transnational tobacco companies, health organizations, and users of general English. The study assesses the possible implications of these differences for public health. We queried 4 bodies of text (corpora) from 3 different groups; 2 of these corpora were preexisting corpora of general spoken and written English in the United Kingdom and the United States. The remaining 2 sampled tobacco-related documents from 2 transnational tobacco companies and from the United Kingdom and international organizations with a focus on health between 2003 and 2023. The 2 sampled corpora contained 1355 documents and 10,023,538 words. We used the corpus analysis software LancsBox (Lancaster University) to identify variations in characterizations of tobacco users and tobacco use behaviors between these groups, using the stems "smoker*" and "smok*." Frequency and collocation analysis showed clear differences in how the 3 groups described smokers and smoking, with only limited overlap in the terms they used. Only 7 of 23 unique categorizations of "smoker*" were shared. There was a significant association (P<.001) between individual corpora and singular or plural noun forms. Health organization texts more often used clinical and population-focused classifications, whereas tobacco industry texts more often framed smokers as consumers or people involved in legal disputes. General English corpora showed the widest range of labels for tobacco users. While there was some overlap in terminology used between corpora, the most common categorizations in each corpus were highly varied, showing very little shared language between groups in their descriptions of either tobacco users or use behaviors. This variance indicates that these groups may not share the same sense-making resources related to tobacco use, which may render information flows around tobacco vulnerable to distortion.

Arab Americans are one of the fastest-growing immigrant populations in the United States, yet they remain largely invisible in tobacco surveillance and prevention efforts due to their classification as "White" in national data. Despite evidence of elevated tobacco use and chronic disease burden, limited research has examined how cultural, psychological, and social factors shape tobacco-related health risks in this community. This study examined associations between ethnic identity, tobacco use, and health outcomes (self-rated health, chronic disease diagnosis) among Arab American adults, and tested whether ethnic identity moderated the association between tobacco use and health outcomes. In a cross-sectional study, a convenience sample of 112 Arab American adults residing in Central California completed a survey assessing ethnic identity, tobacco use, and health. Ethnic identity was measured using an abbreviated, Arabic-translated adaptation of Phinney's Multigroup Ethnic Identity Measure. Tobacco use was categorized as non-use, single-product use, or multi-product use. Multivariable regression models assessed associations and potential moderating effects of ethnic identity on health outcomes. Over 48% of study participants reported current use, defined as at least some use or more, of at least one tobacco or nicotine product, including cigarettes, e-cigarettes (which may contain synthetic rather than tobacco-derived nicotine), and hookah. Higher ethnic identity scores were associated with significantly lower odds of tobacco use (adjusted OR = 0.35, 95% CI: 0.15-0.83). Single-product users had 75% lower odds of reporting better self-rated health compared to non-users (OR = 0.25, 95% CI: 0.07-0.96). No significant associations were found for multi-product use or chronic disease in adjusted models, and ethnic identity did not significantly moderate associations with health outcomes. Ethnic identity is associated with lower tobacco use among Arab Americans, though its protective effects on health outcomes remain less clear. These findings underscore the need to move beyond acculturation-based frameworks and incorporate identity-informed, culturally responsive approaches to tobacco control in marginalized immigrant communities.

The use of non-combustible tobacco-free nicotine (TFN) products has increased markedly among adolescents. Although often perceived as less harmful than traditional tobacco products, nicotine use has been associated with psychological distress. This study examined whether TFN use is associated with symptoms of anxiety and depression in adolescents, whether these associations differ from those of traditional tobacco products, and whether gender identity affects the outcome. Adolescents aged 17 to 19 years were invited to complete an online questionnaire assessing nicotine use and psychological distress, measured using the Hospital Anxiety and Depression Scale (HADS). Data were analyzed using chi-square tests and logistic regression models. A total of 3730 adolescents participated, of whom 30% reported nicotine use. TFN use was more common than tobacco use, while dual use was more prevalent among boys. Both TFN and tobacco use were associated with increased odds of anxiety or depression symptoms, with similar effect sizes across product types. However, association were partly gender-dependent. Among girls using nicotine, 80% reported anxiety symptoms, with higher frequency of use associated with greater risk. Among boys, nicotine use was associated with depressive symptoms, and dual product use was associated with an increased risk of psychological distress. Nicotine use is associated with psychological distress regardless of product type. Girls may be particularly vulnerable to anxiety-related symptoms, while dual use appears especially risky among boys. These findings highlight the need for gender-sensitive prevention strategies targeting dual use and the progression to regular nicotine use.

Background Marijuana and tobacco use have become increasingly prevalent, raising concerns regarding their cardiovascular effects. Atrial fibrillation (AF), a common cardiac arrhythmia associated with increased morbidity and mortality, has been linked to substance use. Nicotine in tobacco products increases sympathetic activity, heart rate, and blood pressure, predisposing individuals to arrhythmias. Similarly, tetrahydrocannabinol (THC), the primary psychoactive component of marijuana, has been associated with cardiac ion channel modulation and QT interval prolongation, although this continues to be debated. This study aimed to evaluate and compare the association between marijuana and tobacco use and the risk of developing AF. Methods A retrospective cohort study was conducted using the TriNetX&#xa0;database. Two cohorts were identified: individuals aged 18-65 with cannabis abuse diagnoses and no history of tobacco use, and individuals with documented tobacco use disorder and no documented cannabis exposure. Index events were defined as the first qualifying diagnosis. AF incidence was assessed beginning one day after the index event with no predetermined end date. Propensity score matching was performed to balance baseline demographic variables. Outcomes were evaluated using measures of association, survival analysis, and hazard ratios. Results After propensity score matching, the cannabis cohort included over 500,000 patients, and the tobacco cohort exceeded 1.5 million patients. AF incidence was 1.8% in the cannabis cohort compared to 2.0% in the tobacco cohort, demonstrating a statistically significant risk difference of -0.002 favoring cannabis exposure. However, the effective size of this remained small and is thus a limitation of this study. Additionally, tobacco use disorder and marijuana usage encompass two different levels of consumption, which means that the groups distinctly vary in their substance usage, which was not further quantified in this study. Mean follow-up duration was 1,435 days for the cannabis cohort and 1,696 days for the tobacco cohort. Hazard ratio analyses further supported an increased AF risk associated with tobacco use. Conclusions Tobacco use disorder was associated with a higher incidence of AF than with marijuana. Although this is a retrospective cohort study based on ICD-10 codes and therefore has limitations to generalizability, it suggests a potential association that should be further evaluated in randomized control trials. These findings provide important insights for clinicians and public health initiatives addressing substance-related cardiovascular risk and highlight the need for further longitudinal investigations.

This study examines the prevalence and predictors of cigarette and hookah smoking among Syrian Americans, a growing U.S. immigrant population with historically high tobacco use. To assess tobacco use behaviors and identify demographic and behavioral predictors of cigarette and hookah use, as well as key motivators for tobacco use, among Syrian American adults. A cross-sectional survey study of Syrian American adults in 2 U.S. states. Data were collected from 919 Syrian American adults in Southern California and Florida between 2018 and 2019. Multinomial regression analyses were used to identify demographic and behavioral predictors of cigarette and hookah use. Among participants, 16% were current cigarette users, and 37% were current hookah users, both exceeding U.S. national averages. Social occasions and flavored tobacco were key motivators for hookah use, with most participants perceiving hookah as equally or more harmful than cigarettes. Male gender, older age, longer U.S. residency among females, alcohol use, and lower education levels predicted cigarette smoking. Hookah use was associated with younger age, alcohol consumption, and the perception that hookah is less harmful than cigarettes, while health insurance and higher education were protective factors. Cigarette users were less likely to use hookah, whereas former cigarette users had a higher likelihood of hookah use. Education was a key factor in quitting both cigarettes and hookah. Individuals with health insurance were more likely to quit hookah, while those who perceived hookah as less harmful were less likely to quit. These findings emphasize the need for culturally tailored tobacco prevention and cessation programs for Syrian Americans, addressing misperceptions of hookah harms and leveraging community-specific motivators to develop effective interventions.

Staphylococcus aureus (S. aureus) can cause life-threatening infections, with colonization often preceding infection. Understanding the determinants of S. aureus carriage may improve infection prevention. While smoking has been associated with S. aureus carriage, studies on smokeless tobacco products remain scarce. This study aimed to investigate whether the use of snuff (Swedish snus), a smokeless tobacco product, is associated with S. aureus carriage in adolescents. We used data from Fit Futures 1, a population-based cross-sectional study including 1,038 participants (93% attendance). A total of 457 boys and 443 girls had data on snuff use and two nasal and throat swab cultures for S. aureus carriage assessment. Snuff use was defined as occasional or daily use. Logistic regression analysis was used to examine the association between snuff use and S. aureus carriage, with odds ratios (ORs) adjusted for known risk factors. Snuff use was associated with a 64% higher odds of nasal carriage (95% CI = 1.18-2.26; carriage defined as one or two positive nasal cultures) compared to non-use. In sex-stratified analyses, this association was observed only among girls, with an adjusted OR of 1.62 (95% CI = 1.03-2.55; carriage defined as two positive nasal cultures) and an adjusted OR of 1.99 (95% CI = 1.25-3.16; carriage defined as one or two positive nasal cultures). Among girls using snuff, the adjusted OR for S. aureus throat carriage was 1.66 (95% CI 1.06-2.59; carriage defined as two positive throat cultures) compared to non-users. We identified an association between snuff use and S. aureus nasal and throat carriage among adolescent girls. Girls who used snuff had higher odds of S. aureus nasal (62%) and throat (66%) carriage compared to female non-users. Futures longitudinal studies are needed to clarify whether the observed associations reflect casual relationships.

Alaska Native (AN) youth and their communities experience many health inequities, including increased rates of substance use. AN youth have earlier initiation and heavier use of substances compared to other youth, with over half of AN youth having engaged in use by 13. While prior research has examined risk factors, few studies have evaluated how social network structures may protect against substance use in youth. This study used social network analysis to examine associations between peer ties, connections with school staff, cultural connectedness, victimization, and substance use among AN youth. This cross-sectional study collected social network data from 7th -12th grade students (n&#x2009;=&#x2009;109) at an urban school in Alaska using Network Canvas, a tablet-based platform. Students nominated peers, school staff, family, and non-family, non-school individuals to whom they are close. They then completed survey items assessing cultural connectedness, substance use, depression, victimization, and suicidal ideation. Multivariate logistic regression models examined associations between demographic, psychosocial, and network characteristics and alcohol, tobacco, and marijuana use in AN youth. The mean age of participants was 14.7 years, with youth nominating an average of 15.4 network members. Victimization was consistently associated with greater odds of alcohol, tobacco, and marijuana use. For alcohol use, contact frequency with staff was protective at higher levels, demonstrated by a negative quadratic effect, while greater emotional closeness to those in one's network had a positive linear effect. Similar patterns were observed for marijuana use, including a significant negative quadratic effect of contact frequency and a positive linear effect of closeness. Neither contact frequency nor closeness was significantly associated with tobacco use. Greater cultural connectedness was associated with greater odds of tobacco use but was not significantly associated with alcohol or marijuana use. Substance use among urban AN youth is influenced by complex social processes involving victimization, peer relationships, and connections with school staff. Frequent contact with school staff appears to play a protective role against alcohol and marijuana use. This study demonstrates how network data can identify both risk and protective factors embedded in youths' social environments and insights can be directly applied to the development of prevention strategies.

Tobacco advertising and promotion remain major drivers of tobacco use, particularly at points of sale (PoS). Ethiopia has enacted comprehensive tobacco control laws, including bans on TAPS at PoS. However, little is known about how these laws are implemented, monitored, and enforced in practice. This study explored the facilitators and barriers to implementing, monitoring compliance with, and enforcing TAPS laws at PoS in Ethiopia. Qualitative interviews with 41 key informants were conducted between December 2022 and January 2023 across 10 purposively selected cities. Participants included policy implementers and stakeholders from government agencies, civil society organizations (CSOs), and international partners. Participants were purposively selected from national and sub-national actors involved in tobacco control, including government agencies (MoH, EFDA, Ministry of Trade, regional health and trade authorities, regulatory bodies, and research institutions) and non-governmental stakeholders (WHO Ethiopia, professional associations, and CSOs). Semi-structured interview guides were developed and administered in local languages. Interviews were audio-recorded, transcribed verbatim, translated into English, and analyzed thematically using ATLAS.ti software. Key facilitators included strong tobacco control laws (Proclamation No. 1112/2019), federal-level political commitment, and the national tobacco control committee (NTCC). Barriers included the absence of EFDA structures at lower administrative levels, a lack of regionally adapted tobacco control laws, limited dedicated tobacco control departments, unclear enforcement mandates, advertisement of illicit tobacco products, not being a prioritized agenda, low awareness among non-health departments and retailers, tobacco industry interference, and, in some areas, a culture that normalizes tobacco smoking. Strong legislation banning 100% of TAPS and the presence of a national tobacco control committee support implementation; however, enforcement remains limited by structural, operational, and socio-cultural challenges. Enhancing compliance requires strengthening regional regulations, establishing clear institutional frameworks, raising stakeholder awareness about the tactics of the tobacco industry, and ensuring adequate allocation of human and financial resources, particularly in regions with a high prevalence of illicit tobacco products, to achieve the intended public health impact of TAPS laws in Ethiopia.

Substance use is common among employed people and has the potential to negatively impact productivity and worker health. However, the literature is inconclusive regarding the extent to which substance use impacts absenteeism. This study sought to extend the literature by investigating the relationship between substance use and absenteeism in the Australian workforce. The analysis included N = 12,557 employed respondents of the 2022-23 National Drug Strategy Household Survey. We employed quasi-Poisson models to examine the impact of heavy episodic drinking (HED), illicit substance use, and tobacco smoking on work absences. In fully adjusted models, workers who engaged in weekly illicit substance use exhibited significantly elevated absenteeism rates (OR = 1.48, 95% CI [1.08, 2.03]) when compared to abstainers. This finding suggests that each worker who used illicit substances weekly was absent from work for an additional 3.6 days (95% CI [0.52, 6.61]) annually in comparison to those who abstained. HED engagement and smoking were not significantly associated with absenteeism. This contemporary Australian study provides more refined insights into the relationship between varying levels of substance use and absenteeism at the population level. Findings illustrate the substantial productivity burden attributable to substance use, reinforcing the importance of workplace-targeted interventions and health policies to mitigate substance use and its effects on productivity and worker health.

Tobacco use increases risk for serious pregnancy complications, increasing infant and maternal morbidity and mortality. Cessation treatments are safe during pregnancy, increase the likelihood of successfully quitting, and decrease risk of negative neonatal health outcomes. All Florida Medicaid plans cover evidence-based cessation treatments. This study analyzed Medicaid claims to better understand cessation treatment utilization for pregnant people enrolled in Florida Medicaid. We analyzed Florida Medicaid claims from 2018-2021 to assess utilization of tobacco cessation services among Medicaid beneficiaries with a delivery during the study period. We identified tobacco use status and perinatal episodes using diagnostic and procedural codes; we identified treatment utilization (counseling, pharmacotherapy) using procedural and prescription drug claims. We identified 46&#x2009;512 deliveries for people who use tobacco during the study period, making up 17.5% of all deliveries; among them, 6.3% received Medicaid covered tobacco cessation treatment during pregnancy and 2.4% postpartum. Among those treated, counseling was the most prevalent treatment during pregnancy (61.2%) and pharmacotherapy (NRT and cessation medication) was the most prevalent treatment (75.8%) postpartum. Best practices indicate that clinicians should ask pregnant patients about tobacco use at every visit, document their status, and offer brief counseling and cessation treatment. Despite cessation treatment coverage by Medicaid, our analysis indicates that few clinicians and beneficiaries are using Medicaid coverage for cessation treatment during the perinatal period. These findings suggest an opportunity to increase utilization of covered cessation services for individuals who use tobacco who are pregnant/postpartum, reducing risk factors for morbidity and mortality.

Adolescent electronic cigarette use is a significant public health concern due to its potential for negative health effects and prevalence among youth. The primary aim of the current study is to examine the moderation effect of perceived harm (i.e., low versus high) on the relation between passive and active social media use and past 30-day adolescent e-cigarette use. We hypothesized that the relation between type of social media use and e-cigarette use would be contingent on the level of perceived harm. This study was conducted via secondary data analysis with the public use files from the 2023 National Youth Tobacco Survey that provides a nationally representative sample (N = 22,069) of youth in the United States. The primary analysis consisted of logistic regression that accounted for complex survey sampling and missing data; primarily testing for a moderation effect. We found a significant omnibus interaction, F(2,37) = 3.83, p = 0.0307, confirming that high versus low perceived harm moderated the relationship between social media use type and past 30-day e-cigarette use. The difference in probabilities between levels of perceived harm for using e-cigarettes was significantly larger for those reporting high active social media use (i.e., Pr = 0.214) compared to those reporting passive social media use (i.e., Pr = 0.084). We found that high versus low perceived harm moderated the relationship between passive and active engagement with e-cigarette-related social media content and past 30-day e-cigarette use for a nationally representative sample of adolescents in the U.S. Based on these findings, prevention strategies targeting adolescent e-cigarette use may be enhanced through tailoring educational messaging that focus on the potential effects of exposure to e-cigarette related social media content in conjunction with the known effects of using e-cigarettes on one's health. Examining the moderating effects of variables provides a greater understanding of the ways multiple factors interplay and influence adolescent e-cigarette use. The results of the current study demonstrated that differences between perceived levels of harm occurred at each category of social media use, while these differences were most pronounced between the passive use and the high active use social media categories. Prevention strategies targeting adolescent e-cigarette use may be enhanced through tailoring educational messaging and teaching strategies that focus on the potential effects of exposure to e-cigarette related social media content in conjunction with the known biological effects of using e-cigarettes on one's health.

In 2021, a total of 82 million people used electronic cigarettes (e-cigarettes) globally. E-cigarette regulations around the globe vary widely from the product being banned in some jurisdictions to being completely unregulated in others. The Tobacco Pack Surveillance System (TPackSS) was initiated in 2012 to monitor tobacco packs available in 14 low- and middle-income countries with the greatest number of people who smoke. The aim of TPackSS is to assess compliance with country-specific tobacco packaging and labeling requirements and identify marketing features and appeals used on tobacco packaging. The objective of this study was to adapt and expand the previous TPackSS protocol to also include disposable e-cigarette devices and their accompanying products: e-cigarette liquids and pods or cartridges. E-cigarettes were added to TPackSS data collection in Indonesia in 2022 and in China in 2023. Collection took place in Jakarta, Medan, and Surabaya in Indonesia and Shanghai, Beijing, Chongqing, Guangzhou, Kunming, and Shenzhen in China. A total of 15 neighborhoods per city in Indonesia and 12 per city in China were visited. The TPackSS protocol developed for tobacco products in 2012 to 2013 was used as the foundation for the adapted protocol for e-cigarettes. The adaptation of the original TPackSS protocol followed an iterative process involving extensive discussions among the TPackSS study team, comprising researchers with expertise in tobacco control and 13 years of experience in tobacco product packaging surveillance. The study adapted the sampling frame and sampling strategy, pack collection procedures, photography guide, shipment and translation procedures, and codebook to account for the unique country contexts for e-cigarettes (eg, regulations, market for e-cigarettes, and retailer landscape) and the heterogeneity of e-cigarette packaging observed. These adaptations were based on the review of peer-reviewed literature, white papers, Euromonitor data, and consultation with researchers with expertise in e-cigarette marketing and with in-country public health professionals. Using Indonesia as a pilot country, the protocol was evaluated and further refined post implementation for use in China. The TPackSS study began in 2012 and was funded by Bloomberg Philanthropies. Data collection took place from September to October 2022 in Indonesia and April to May 2023 in China. Across Indonesia and China, 968 unique e-cigarette products were collected. TPackSS data collection, coding procedures, and study findings are publicly available for use on the TPackSS website. The protocols presented here, which were used in 2 countries with contrasting e-cigarette markets and regulatory requirements, can be adapted for use in other countries. Findings from use of this adapted protocol can inform policy by providing insights into the design features and marketing appeals of e-cigarette products available on the market, as well as compliance with health warning label requirements where applicable.

Cigarette smoking remains a major public health concern among people living with HIV (PLWH), particularly those from under-resourced communities. Digital health may improve access to cessation support, yet its potential among this population remains understudied. This study explored barriers to quitting smoking and evaluated the potential of digital health for tobacco treatment among PWLH smokers. We surveyed 205 PLWH who smoked cigarettes (45.4% female; mean age 51.2 years; response rate 92.3%) to examine smoking behaviors, cessation barriers, technology access, use pattern, and interest in digital health for tobacco treatment. Multivariable logistic regression models were employed to assess how demographics and smoking behaviors influence interest in using digital health (phone calls, text messages, smartphone applications, or combinations) for tobacco treatment. Participants were primarily racial and ethnic minorities, including 55.1% non-Hispanic Black and 34.2% Hispanic individuals, with 74.4% earning less than $10,000 annually. Most participants reported previous quit attempts (76.5%). Common barriers to quitting included difficulty managing cravings (45.4%), cost of treatment (28.8%), and limited access to care (25.9%), while depression (58.9%) and risky alcohol use (39.6%) were also prevalent. Access to technology was high: 91.7% owned a cell phone, 61.0% owned a smartphone, and 63.9% reported internet access. Among smartphone owners, 74.0% used mobile applications. Phone calls were the most preferred single digital health modality for tobacco treatment (51.7%), followed by text messaging (43.9%), smartphone applications (39.0%), and video conferencing (38.5%). Preferred intervention methods included mindfulness strategies (73.0%), nicotine replacement therapy (71.1%), and counseling (63-65%). Non-Hispanic Black and non-heterosexual participants showed significantly higher interest in digital health for tobacco treatment, with aOR 5.49 (1.44 - 20.90) and 6.02 (1.46 - 24.82), respectively. Despite barriers, PLWH smokers are interested in digital health for tobacco treatment. Incorporating digital tools could improve access and reduce disparities in this population.

Waterpipe tobacco (hookah or shisha) and other alternative nicotine delivery methods are increasingly used by young adults. Understanding their prevalence, risk perceptions, motivations and predictors is essential for developing effective public health responses, especially in university settings. We determined the prevalence, risk perception, motivations and predictors of shisha use among university students in Nigeria. This is a cross-sectional mixed-methods study. We collected quantitative data via self-administered questionnaires (n=431) and identified predictors using multivariable logistic regression analysis. Qualitative insights were obtained from in-depth interviews with a purposive subsample of participants (n=20) and analysed thematically. Among 431 respondents, 83.1% (n=358) recognised that shisha contains harmful substances; however, 10.4% (n=45) believed water filtration removed toxins. Approximately 23.0% of respondents (n=99) perceived shisha as being less addictive than cigarettes. The prevalence of ever-use was 26.2% (n=113) and 13.7% (n=59) for current use. Shisha use was independently associated with cigarette smoking (adjusted OR (aOR)=10.42, 95% CI 6.43 to 16.35), male sex (aOR=3.76, 95%&#x2009;CI 1.43 to 6.89), perception of shisha as being less harmful (aOR=3.53, 95%&#x2009;CI 1.17 to 6.34), higher weekly allowances (&#x2265;&#x20a6;20 000) (aOR=3.63, 95%&#x2009;CI 1.42 to 7.36), course major (agriculture/management, aOR=2.47, 95%&#x2009;CI 1.43 to 7.24) and state of origin (aOR=1.99, 95%&#x2009;CI 1.12 to 4.75). Qualitative themes identified peer influence, accessibility, stress relief, psychological factors, misinformation and societal acceptance as key drivers of use. Shisha smoking is prevalent among university students in Nigeria and influenced by a combination of behavioural, socioeconomic and regional factors. Our findings could inform the development of tailored interventions that reflect these sociocultural and contextual realities and guide national youth tobacco control strategies in similar settings.

Smokeless tobacco (SLT) use remains disproportionately high in rural regions of the United States, particularly among youth, due to perceptions of lower risk compared with smoking. Despite clear evidence of its addictive potential and serious health consequences, limited attention has been given to the social, cultural, and structural drivers of SLT use in these underserved communities. This review aims to synthesize existing evidence on the prevalence, risk factors, and prevention strategies related to SLT use in rural America. Narrative review. A narrative synthesis of peer-reviewed studies was conducted to integrate findings across heterogeneous study designs and contexts. The literature highlights multiple contributors to SLT use, including ease of access, lower taxation, reduced risk perception, and demographic influences such as age, gender, race/ethnicity, and educational attainment. Cultural acceptance and intergenerational norms further reinforce its use. While interventions such as public health campaigns and behavioral therapies have been attempted, their effectiveness has often been limited by insufficient cultural tailoring and persistent misinformation. SLT use in rural America reflects deeply rooted sociocultural dynamics and structural inequities that are not adequately addressed by existing tobacco control approaches. Sustainable prevention requires culturally informed, community-driven strategies that address local realities while tackling broader determinants of health. These insights underscore the need for more tailored policies and interventions to reduce health disparities in rural populations.

Understanding youth tobacco use is essential to informing timely regulatory and public health responses. Triangulating traditional nationally representative survey results with more rapid and flexible survey data can provide important interim surveillance opportunities to confirm prevalence trends and timely opportunities to respond to observed changes. This paper reports on the generation of rapid surveillance data on youth tobacco use by triangulating three exemplar online survey data sources: two U.S. nationally representative Ipsos surveys (Ipsos-1: n&#xa0;=&#xa0;1039 youth ages 15-20 in November-December 2024; Ipsos-2: n&#xa0;=&#xa0;921 with youth ages 13-17 in February-March 2025) and a Qualtrics survey (n&#xa0;=&#xa0;930 youth ages 13-17) in six sentinel U.S. states in March-May 2025. Findings demonstrate consistency across surveys, with e-cigarettes being the most prevalent product among youth (5.6-14.6&#xa0;%), while other product use was low, including nicotine pouches (1.3-2.6&#xa0;%). Popular brands (e.g., Geek Bar&#xae;, Juul&#xae;), appeal of e-cigarette characteristics (e.g., ability to use discreetly), and perceptions of colorful devices (e.g., less harsh, better tasting) versus plain/black/Gy devices were recurrent themes, suggesting that rapid surveillance can effectively identify and monitor trends in real time. These insights underscore the need for continued agile surveillance systems and tailored regulatory strategies focused on youth-attractive e-cigarette features.

Adolescence is a critical developmental stage marked by increased susceptibility to engaging in risky health behaviors, including the use of alcohol, energy drinks (EDs), and tobacco products. A cross-sectional sample of 1249 individuals aged 10-24 years was analyzed, stratified into two age groups (<16 and >16 years). The study sample comprised volunteers living in Rome, Italy, who were recruited for the ALIMA (ALImentazione Multiculturale negli Adolescenti) study. Categorical variables were analysed using the Pearson chi-square test and p < 0.05 was considered statistically significant. Alcohol consumption was higher among participants aged &#x2265;16 years (62.2%) than among those age <16 years (39.9%), without significant gender difference, with binge drinking also more common, especially among older males. ED use was widespread, more frequent in males, and often associated with alcohol consumption. Smoking prevalence differed by age group, reaching 41.5% among participants over 16 years of age, with higher rates among younger females. Finally, 17.3% reported combined use of alcohol, EDs, and tobacco, with significant gender differences in both age groups. These findings highlight a clear age-related escalation and co-occurrence of substance-use behaviors, with emerging gender differences in specific patterns. The results underscore the need for integrated, age-targeted prevention strategies addressing multiple substance use simultaneously to reduce long-term health risks and promote adolescent well-being.

Evidence-based interventions to reduce adolescents' exposure to tobacco and air pollution are rarely implemented in low- and middle-income countries, often because they lack contextual fit. The 'FRESHAIR4Life' project aimed to optimise implementation of contextually adapted, evidence-based interventions in Greece, Kyrgyzstan, Pakistan, Romania, and Uganda. Selecting appropriate interventions required deliberate, inclusive, and context-sensitive decision-making. This paper outlines the co-creation approach for selecting and adapting interventions, developing implementation strategies and addressing the challenges that arose. Each country followed a four-step process. First, findings from local situational analyses were consolidated to identify barriers and facilitators across individual, community, and system levels and to map targets for change using the Theoretical Domains Framework. This was followed by a workshop with country-teams to identify key risk factors, target behaviours, relevant populations and settings, and to shortlist potential interventions from the FRESHAIR4Life palette alongside implementation strategies using option grids and ranking. A subsequent stakeholder workshop applied a Socio Technical Allocation of Resources informed approach to elicit perspectives on the interventions' value using qualitative (Conversation Caf&#xe9; style discussions) and quantitative methods (ratings of need, importance, likely reach, feasibility, and local adaptations required, fixed budget allocation exercises or ranking of options). Finally, selection meetings with country teams finalised intervention choices and implementation strategies, informed by stakeholder input. Countries chose to target the risk factors that were considered most prevalent and the biggest threat to adolescent health in their settings. Of the four countries addressing tobacco use, Pakistan, Greece, and Romania selected 'implementation intentions (If-Then approach)' for prevention, while Kyrgyzstan selected 'very brief advice plus behavioural counselling (VBA+)' for cessation. All three countries addressing air pollution, Pakistan, Uganda and Kyrgyzstan selected social media campaigns. Key challenges included: (1) establishing a sound basis for selection decisions, which was overcome by adopting a systematic, transparent and inclusive decision process (2) ethical and practical considerations for addressing tobacco/nicotine use within school-based prevention, tackled by adapting intervention to include offer of cessation support (3) limited evidence-based interventions targeting ambient air pollution, addressed by flexibly moving beyond the palette (4) the evolving nature of implementation strategies and (5) embedding interventions into routine practice, both addressed through flexibility and adaptation. This study shows that, across diverse country contexts, defensible intervention selection depends not only on which intervention is chosen, but on how choices are made and by whom. A transparent, stakeholder-owned co-creation process, involving the target audience of adolescents, helped country teams navigate trade-offs between evidence, local burden, feasibility, fit with routine practice, and ethical obligations, while exposing important evidence gaps for individual- and community-level ambient air-pollution interventions in LMICs.

Surveillance of nicotine/tobacco use typically examines binary use (vs. non-use) of each product in isolation, but this fails to capture product substitution and subtypes of multi-product use. The current analysis uses more temporally and behaviorally granular classifications to examine trends of electronic nicotine delivery systems (ENDS) and/or cigarette use. Quarterly trends in cigarette and ENDS use from the National Health Interview Survey (NHIS) 2014-2024 were examined. Smoking/vaping status was defined using self-reported frequency (every day, some days, not at all) for each product, yielding nine categories including non-use. Trends were analyzed overall and by age groups (18-29, 30-44, 45-59, &#x2265;60). Use of either product declined modestly (18% in 2014 Q1 to 16% in 2024 Q4). Exclusive smoking decreased substantially (80% to 50% of those using either product), which was largely offset by a pronounced increase in exclusive vaping (from 5% to 40%). Dual use exhibited a U-shaped pattern with an initial decline and subsequent increase. While use of either product remained stable for most age groups, age significantly moderated trends: adults aged 18-29 exhibited the steepest decline in exclusive smoking (73% to 7%), followed by adults aged 30-44 (78% to 47%) and 45-59 (84% to 72%). Conversely, exclusive smoking among adults aged &#x2265;60 remained predominant and largely unchanged (86% to 85%). A marked shift from exclusive smoking to exclusive vaping occurred from 2014-2024. This transition may represent population-level harm reduction by migration to noncombustible products, especially among younger adults, with limited change among older adults. Population-level shifts from exclusive smoking to exclusive vaping - within an overall stable level of tobacco/nicotine product use - may indicate that noncombustible nicotine products have complemented traditional tobacco control efforts over this time period in reducing and/or preventing cigarette smoking. The balance between allowing access to lower-risk alternatives for adults who smoke and preventing uptake among non-users remains critical. The persistence of exclusive smoking among older adults highlights the need for targeted interventions for this priority population. Finally, the recent increase in dual use underscores the importance of continued surveillance, for which quarterly NHIS data can provide valuable insights.