Longitudinal transitions in tobacco use in youth and young adults: A latent transition analysis of the population assessment of tobacco and health study from Wave 1 to 5.

BACKGROUND: Tobacco use by youth and young adults can lead to significant long-term health problems. We aim to understand transitions in tobacco use patterns among these groups and the factors that affect transition patterns. METHODS: Using the five waves of data from the nationally representative Population Assessment of Tobacco and Health (PATH) Study (2013-2019), we conducted latent class analysis and latent transition analysis to understand tobacco use classes and the longitudinal transitions between classes. We also adjusted for covariates, including demographics, individual behaviors, household environment, and psychosocial factors, to capture their effects on class transition probabilities. RESULTS: Three tobacco use behaviors were identified: non-current user (C1), moderate e-cigarette user (C2), and poly-tobacco user (C3). At baseline (Wave 1), 94.4% of participants were classified as C1, 3.2% as C2, and 2.4% as C3, and the distribution shifted towards C2 and C3 over time. Progression to the next class represented the most common transitions (14.1% C2 to C3, 10.7% C1 to C2), while the direct progression from C1 to C3 was rare (0.6%). Being male, White, adult, living in smoking-allowed households, past-year alcohol use, drug use, internalizing problems, and social media follower of tobacco brands were associated with a faster progression to poly-tobacco use. CONCLUSIONS: The transition patterns implied that e-cigarette use might be an intermediate progression from non-current use into poly-tobacco use. Individual behaviors, household environment, and psychosocial factors are associated with elevated risks of progression. The findings may inform tobacco prevention and cessation policies among youth and young adults.

Prevalence and Social Contextual Factors of Smokeless Tobacco Use: Insights from Schools of Delhi, India.

BACKGROUND: It was observed that adult users start tobacco use in childhood or adolescence. The influence of digital and print media, social acceptance among peers, and in order to mimic role models from films attracts youth towards tobacco. Hence this study was conducted to assess the prevalence of smokeless tobacco (SLT) use among school-going adolescents with the assessment of the influencing factors such as exposure at school, home, and public places along with the role of various media in SLT use by adolescents. METHODS: Cross sectional study was conducted with 860 students of class 9th -12th enrolled in schools. Purposive sampling of three schools was done from the study area to reach desired sample size. All the students of class 9th - 12th within selected schools were given chance to participate in the study. Data collection was done using pretested modified Global Youth Tobacco Survey (GYTS) questionnaire. RESULTS: Consumption of smokeless tobacco (SLT) was observed in 79 (11%) of 714 subjects. Significantly higher proportion (18.4%) of study subjects consumed SLT who were exposed to tobacco at school premises and 19.1% of study subjects who were exposed to teacher using SLT in schools compared to non-exposed group. (p=0.016). It was observed that 8.1% of subjects without any exposure to tobacco at home and 9.8% of subjects without exposure to tobacco at outdoor public space consumed SLT. Consumption of SLT use was highest (16.7%) among subjects exposed to tobacco advertisement or promotion through social media (p=0.04). CONCLUSION: High prevalence of SLT was detected among adolescents in school. Factors such as exposure to tobacco at home, public places, school and school teacher using SLT, exposure of tobacco advertisement and promotion via different modes of media was found to be significantly associated with the use of SLT in the adolescents of school.
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Associations of parental and peer cross-substance use with 12-17-year-old adolescents' problematic alcohol use: A parent-child dyadic gender analysis.

BACKGROUND: Adolescent alcohol use was found to be influenced by parental and peer alcohol use. Drinking behaviors also differed by gender. However, previous studies mainly focused on adolescents' substance use in relation to the same substance use among their salient others. Hence, this study investigated the cross-substance relationships of alcohol and tobacco use of parents and peers with adolescents' problematic alcohol use, separately by gender. METHODS: Data were derived from 4445 adolescents aged 12-17 years from the 2014 National Survey of Substance Use, a nationally representative survey in Taiwan. Problematic alcohol use was assessed using the Alcohol Use Disorders Identification Test (AUDIT). Multivariate multinomial logistic regression was used, stratified by gender. RESULTS: For males, maternal (adjusted odds ratio [aOR] = 1.73) and peer (aOR = 2.57) alcohol use was related to social drinking (AUDIT < 2); paternal (aOR = 3.58), maternal (aOR = 2.18), peer alcohol use (aOR = 5.37), and their own tobacco use (aOR = 4.72) were related to problem drinking (AUDIT ≥ 2). For females, maternal (aOR = 2.26) and peer (aOR = 2.84) alcohol use was related to social drinking; maternal (aOR = 2.35) and peer tobacco use (aOR = 3.48), and paternal (aOR = 4.56) and peer alcohol use (aOR = 3.36) were linked to problem drinking. CONCLUSIONS: Both male and female adolescents' alcohol use was associated with their peer alcohol use, and gender differences were found in relation to their parental and peer substance use. Specifically, the parental role-modeling of smoking was only significant in mother-daughter dyads. These findings could inform multifaceted adolescent alcohol prevention programs, tailoring for males and females and also targeting their parental and peer substance use.

Price, Income, and Affordability as the Determinants of Tobacco Consumption: A Practitioner's Guide to Tobacco Taxation.

INTRODUCTION: Tobacco product prices and consumers' income are the two major economic determinants of tobacco demand. The affordability of tobacco products is dependent on the price of tobacco products relative to consumer income. Increase in tobacco tax is expected to lead to higher price, lower affordability, and reduced consumption. Price elasticity and affordability elasticity are used in analyzing the effect of tobacco tax increases on tobacco consumption and public health. The availability of both parameters raises the question of which one to apply in policy discussions. AIMS AND METHODS: Using global data on cigarette consumption, price, income, and tobacco control measures for 169 countries over 2007-2016, this study estimated the price elasticity and affordability elasticity of cigarette consumption by country income classification using country-specific fixed effects model for panel data. RESULTS: The estimates show that the restriction of equal strength of the effects of price and income changes on tobacco consumption maintained in affordability elasticity estimation is valid for low- and middle-income countries, while it is rejected for high-income countries. CONCLUSIONS: Affordability elasticity may prove to be a useful parameter to explain and predict the sensitivity of consumers to tobacco tax and price policy changes under conditions of robust economic growth, which are more likely to be observed in countries with initial low- or middle-income setting. It can provide a reasonable benchmark for tobacco tax and price increase necessary to effectively reduce affordability and consumption of tobacco, which can form a basis for building systematic tax and price increases into the tobacco tax policy mechanism. IMPLICATIONS: Price elasticity measures the sensitivity of consumers to changes in real prices, holding real income constant. Affordability elasticity measures the sensitivity of consumers to price changes adjusted for inflation and income changes. Existing scientific literature on tobacco demand abounds in both price and affordability elasticity estimates, without providing a clear explanation of the theoretical and policy implications of using one parameter over the other. By estimating and comparing price and affordability elasticities for high-income and low-and-middle-income countries separately, this article offers a guide to the practitioners in tobacco taxation for evaluating the effectiveness of tax-induced price increases on tobacco consumption.

Sexual minority tobacco use disparities across adolescence and the transition to young adulthood.

INTRODUCTION: Sexual minority (SM; e.g., lesbian, gay, bisexual) youth are disproportionately more likely to use tobacco than non-SM youth, yet there exist several critical gaps in knowledge. This study assessed (a) the timing of SM tobacco use disparities (e.g., during adolescence or early adulthood), (b) whether disparities generalize across different tobacco products, and (c) whether disparities differ by sex. METHODS: Data were from a 6-year prospective cohort of diverse high school students from Southern California who were followed into early adulthood (9 waves, 2013-2019). SM (vs. non-SM) differences in past 6-month use were assessed for: any tobacco products, cigarettes, e-cigarettes, other products (e.g., hookah), and multiple products. Disparities were modeled longitudinally across adolescence (high school) and the transition to early adulthood (end of high school to post-high school). Differences were tested by sex. RESULTS: Among females, SM disparities were evident for all outcomes during both adolescence and early adulthood; no differences were observed among males. For example, SM (vs. non-SM) females had higher odds of cigarette (aOR = 4.4 [3.0-6.5]) and e-cigarette (aOR = 1.7 [1.2-2.4]) use, averaged across adolescence. The timing of disparities varied by product. For example, cigarette use disparities emerged prior to high school and persisted through adolescence and young adulthood, while e-cigarette use disparities were present in early adolescence and young adulthood only. CONCLUSIONS: Young SM females are at especially high risk for tobacco use, across various tobacco products, throughout adolescence and young adulthood. Interventions must consider differences in the timing of disparities by product type.

The level of effectiveness of Polish legislation relating to health protection against the consequences of tobacco use.

The purpose of this work is to analyze the regulatory environment for tobacco use, with particular reference to changes made in the last 10 years. An attempt was made to answer the question of the extent to which the regulatory environment has a real impact on the achievement of the objective set out in the existing legal provisions, which is to protect the health and rights of the persons concerned. An analytical method was used in the work to assess the application of legal principles. A method of analyzing the current line of jurisprudence was also used. In the process of final evaluation of public utilities, certain functional methods were used. The assessment was subjected to Polish law, within the scope of the currently binding Act on Health Protection Against the Consequences of Using Tobacco and Tobacco Products of 1995. The study states that the provisions of this Act are only a formal guarantee of protection. The liability arising from the application of its standard is illusory because the procedure for imposing penalties is ineffective. The pursuit of any property claims related to violation of the rights of related entities, as envisaged in this Act, is complicated. This does not apply to a case which is not affected by the decision. Int J Occup Med Environ Health. 2020;33(5):599-610.

Influence of Puerperal Health Literacy on Tobacco Use during Pregnancy among Spanish Women: A Transversal Study.

Background: Despite the fact that tobacco use during pregnancy produces adverse perinatal effects, some women continue to smoke. Health literacy (HL) is essential for health outcomes in adults. However, little is known about HL in pregnant women or postpartum women. The study aimed to analyse the relationship between the degree of HL of women during the early puerperium and tobacco use during pregnancy. METHODS: A multicentre, descriptive, cross-sectional study was carried out with women in the early puerperium in a region of eastern Spain, between November 2017 and May 2018. Their HL level was obtained using the Newest Vital Sign (NVS) tool. Multivariate logistic models were adjusted to estimate the magnitude of association with tobacco use in pregnancy. Odds ratios (OR) were estimated with a 95% confidence interval. RESULTS: 193 were included in the total. 29.5% (57) of pregnant women smoked tobacco during pregnancy, with a smoking cessation rate of 70.1% (40) while pregnant. 42.0% (81) of pregnant women had inadequate or limited HL. A low level of HL was strongly associated with tobacco use, adjusted by catchment area and age of first pregnancy (LRT p < 0.001; ROC curve = 0.71, 95% CI: 0.64-0.79). CONCLUSION: A low HL is associated with tobacco consumption during pregnancy. Whether low HL reflects the wide constellation of already-known socioeconomic, political and commercial determinants of tobacco use, or whether incorporating HL support interventions strengthens tobacco cessation activities in pregnancy, warrants further research. Still, it should be considered as essential to understanding the health disparities related to its consumption.

Hispanic Health Paradox at the Border: Substance, Alcohol, and Tobacco Use among Latinx Immigrants Seeking Free or Reduced-Cost Care in Southernmost Texas.

OBJECTIVE: Although substantial research has explored the Hispanic health paradox (HHP) and suggests that Latinx immigrants experience positive health outcomes relative to those born in the United States, less research has assessed the role of immigration status. Our aim was to examine this role in Latinx health. METHODS: Using survey data collected at two free/reduced-cost clinics in southernmost Texas, we examined differences in the mental and self-rated health, substance, alcohol, and tobacco use of low-income patients by undocumented/documented immigrant and US-born/naturalized citizen status (N = 588). RESULTS: Based on ordinary least squares regression results, undocumented Latinx immigrants report lower negative self-rated health (coefficient -0.27, 95% confidence interval -0.50 to -0.01) and lower depressive symptoms (coefficient -0.34, 95% confidence interval -0.67 to -0.02]) compared with their US citizen peers (P < 0.05). Logistic regression results suggest that undocumented and documented Latinx immigrants do not differ in alcohol, tobacco, or substance use relative to their citizen peers. CONCLUSIONS: Despite facing potentially adverse social environments, undocumented Latinx immigrants experience positive health outcomes relative to US-born/naturalized citizen peers.

We are in This Together: Promoting Health Equity, Diversity, and Inclusion in Tobacco Research for Sexual and Gender Minority Populations.

INTRODUCTION: Sexual and gender minority (SGM) individuals have higher tobacco use prevalence and consequently higher burden of tobacco-caused diseases, including cancer and cardiovascular disease compared with their heterosexual or cisgender counterparts. Yet, there is a critical gap in research focused on measuring SGM tobacco-related health disparities and addressing unmet needs of SGM individuals in the context of nicotine and tobacco research. AIMS AND METHODS: In this commentary, we summarize recommendations discussed during a pre-conference workshop focused on challenges and opportunities in conducting SGM tobacco control research at the 2019 Society for Research on Nicotine and Tobacco Annual Meeting. RESULTS: Specifically, we recommend defining and measuring SGM identity in all nicotine and tobacco research routinely, using novel methods to engage a demographically diverse sample of the SGM population, and eliciting SGM community voices in tobacco control research. CONCLUSIONS: Addressing these critical research gaps will enable the scientific community to generate the data to fully understand and support SGM individuals in tobacco use prevention and cessation. IMPLICATIONS: Tobacco use and its consequences have become increasingly concentrated in disadvantaged groups, including sexual and gender minority (SGM) populations. Through concrete recommendations in this commentary, we aimed to promote health equity, diversity, and inclusion in tobacco research for SGM populations by urging the scientific community to consider expanding efforts to monitor and address tobacco-related health disparities of SGM populations within their respective research programs.

Determination of factors influencing tobacco consumption in Turkey using categorical data analyses1.

The aim of this study is to specify factors influencing tobacco consumption in Turkey, which belongs to developing countries group, and to determine the extent of their influence. Factors related to the sociodemographic, economic, personal, environmental, and healthy life indicators influencing tobacco consumption in Turkey were determined using logistic and probit regression analyses. According to the results of the study, age, gender, education, marital status, fruit consumption, exposure to tobacco smoke at home, and frequent of alcohol consumption are the most influential variables effecting tobacco consumption. More effective results in policies aimed at preventing tobacco consumption can be accomplished by giving priority to individuals more inclined to tobacco consumption. People in 25-44 age group, men, graduates of high school and its equivalents, divorced/widowed individuals, individuals exposed to tobacco smoke, and alcohol users are individuals who tend to use tobacco.

Receptivity to Tobacco Advertising among Young Adults with Internalizing Problems: Findings from the Population Assessment of Tobacco and Health Study.

Background: Many risk factors for tobacco use among the general young adult population, such as tobacco advertising receptivity, have gone unexamined among those with internalizing problems, despite disproportionately high rates of tobacco use. Objective: The objective of this study was to examine the interrelationship of internalizing problems, tobacco advertising receptivity, and tobacco use among young adults using data from Wave 1 of the Population Assessment for Tobacco and Health Study. Methods: The sample included 9,110 young adults (ages 18-24). Multivariable logistic regression models examined the association between internalizing problems and advertising receptivity and tobacco use. Separate models were run for cigarettes, cigars, e-cigarettes, smokeless tobacco and any tobacco use. An interaction term (receptivity × internalizing problems) was added to each model. Results: Except for smokeless tobacco, individuals with high internalizing problems reported greater odds of product use compared to those with low internalizing problems. There was no association between internalizing problems and use of smokeless tobacco. For all products, receptivity was positively associated with tobacco use. A borderline significant interaction was detected between cigarette advertising receptivity and internalizing problems, such that the magnitude of the relationship between receptivity to cigarette advertising and cigarette use was stronger for those with high internalizing problems compared those with low internalizing problems. Conclusions/Importance: The relationship between cigarette advertising receptivity and cigarette use may differ for those with and without internalizing problems. Disproportionate receptivity to risk-promoting messages among young adults with internalizing problems could exacerbate disparities in cigarette use.

Adolescent Tobacco Use and Misperceptions of Social Norms Across Schools in the United States.

OBJECTIVE: This study assesses tobacco use norm misperceptions by distinguishing between perceived and actual peer norms for both tobacco use attitudes and behavior, and examines the association between perceived norms and personal use among U.S. students in Grades 6-12. METHOD: Anonymous self-report surveys were conducted with 28,070 students across 64 schools in 11 U.S. states between 1999 and 2017. RESULTS: Although 77% of students said tobacco use is never good, 64% of students thought that most students in their grade believed that use is acceptable. Similarly, although 79% of students reported never using tobacco, 85% of students perceived that most students in their grade typically use tobacco, with 66% thinking that peers use monthly or more often. Substantial norm misperception existed regardless of student and school factors, increasing by grade. Perceiving that most peers thought tobacco use is acceptable was highly predictive of personal attitude, and perceiving tobacco use as the norm among same-grade peers strongly predicted personal tobacco use, even after we adjusted for actual peer use prevalence and other factors. Males' perception of the male peer norm was a stronger predictor of personal use than was their perception of the female peer norm. Females' perceptions of sex-specific norms were associated with personal use, each at about the same magnitude. CONCLUSIONS: Norm misperceptions are pervasive across a diversity of students and schools, whereas perceptions of peer norms about tobacco use are highly associated with personal attitude and use. Results suggest that population-wide interventions correcting these misperceptions may help reduce tobacco use broadly among youth.

Prevalence, Use Behaviors, and Preferences among Users of Heated Tobacco Products: Findings from the 2018 ITC Japan Survey.

Heated tobacco products (HTPs), such as IQOS, glo, and Ploom TECH, with a variety of flavored tobacco-containing inserts, have reportedly achieved a significant market share in Japan. We analyzed data from Wave 1 of the ITC Japan Survey, a nationally representative web survey conducted in February to March 2018 among 4684 adult participants to estimate the prevalence of HTP use, describe characteristics of HTP users, and explore user preferences for HTP device and flavor. The overall prevalence of monthly HTP use was 2.7% (1.7% daily use). Virtually all HTP users were current cigarette smokers (67.8%) or former smokers (25.0%); only 1.0% of HTP users were never smokers. Among HTP users, IQOS was the most frequently reported brand used (64.5%), and menthol was the most common flavor reported (41.5%). IQOS was used more by younger respondents and those who reported daily use, while Ploom TECH was more popular among older respondents and non-daily HTP users. This is one of the first non-industry funded studies to explore the use of HTPs in Japan.

Tobacco use and the interplay of internalizing, externalizing and substance use problems: A latent class analysis of data from the Population Assessment of Tobacco and Health Study.

BACKGROUND: Cigarette smoking is disproportionately high among adults with two or more psychiatric disorders (psychiatric comorbidities), yet research on non-cigarette tobacco use among this population is scant. Additionally, most studies on tobacco use this among this population rely on psychiatric diagnoses rather than individual symptoms, potentially excluding individuals with symptom-specific issues that increase their risk for tobacco use but do not meet the criteria for diagnosis. The objectives of this study were to identify unique classes of individuals based on symptoms of psychiatric disorders and to assess differences in demographic characteristics and tobacco use behaviors between classes. METHODS: This study used data from Wave 2 of the Population Assessment of Tobacco and Health Study adult dataset. Latent class analysis was used to classify individuals based on internalizing, externalizing and substance use problems. Bivariate and multivariable models examined the association between latent class membership and current use of cigarettes, cigar products, electronic nicotine delivery systems, pipe, hookah and smokeless tobacco products. Poly tobacco use was also examined. RESULTS: Three latent classes were identified. The "normative" class reported low prevalence of all symptoms, the "severe internalizing and non-violent externalizing" class reported severe internalizing problems and non-violent externalizing problems and the "severe" class reported high prevalence of all symptoms. Tobacco use was highest for the "severe" class and lowest for the "normative" class across products. CONCLUSIONS: Individuals in the "severe" class may be at elevated risk of tobacco-related morbidity and mortality and would likely benefit from targeted tobacco control interventions.

Self-esteem and consumption of alcohol, tobacco, and other substances in outsourced workers. / Autoestima e o consumo de álcool, de tabaco e de outras substâncias em trabalhadores terceirizados.

OBJECTIVE: to evaluate self-esteem, the consumption of alcohol, tobacco and other substances in outsourced workers of a public university. METHOD: a descriptive-analytical, cross-sectional, quantitative study developed with 316 outsourced workers from a municipality in the Southeast of Brazil. Data was collected through a characterization tool, the Rosenberg Self-Esteem Scale and the Alcohol, Smoking and Substance Involvement Screening Test. For data analysis, we used descriptive statistics, Pearson's chi-square test, Fisher's exact test, odds ratio and logistic regression. RESULTS: the majority of workers had high self-esteem and some used alcohol, tobacco, marijuana and inhalants. A significant association between gender, age group and work shift with self-esteem; between the risk of developing problems related to alcohol consumption with sex, age group, marital status, religious belief and number of children; between the practice of physical activity and the risk of developing problems related to the consumption of tobacco products was found. CONCLUSION: this study contributes to the increase of knowledge due to the small number of researches involving this subject and to contribute to the nurses to have subsidies to work with this population using strategies to combat the triggers of psychic disorders.

Support for Local Tobacco Policy in a Preemptive State.

Policy at the local level is a critical component of comprehensive tobacco control programs. This study examined the relationships of individual and social factors with support for tobacco-related public policy using cross-sectional data (n = 4461) from adults participating in a statewide survey. Weighted multivariate, multinomial logistic regression examined associations between individual and social factors and support for tobacco-free city properties and support for limiting the number of stores that sell tobacco near schools. Oklahomans were more likely to favor policies that create tobacco-free city properties than policies that limit the number of stores that sell tobacco near schools. While non-smokers were most likely to favor both policies, support for both policies was greater than 50% among current smokers. Knowledge of secondhand smoke (SHS) exposure harm and female gender were predictors of support for both policies and among current, former, and never smokers. Rural-urban status was a predictor of support among former smokers and never smokers. Tobacco use among friends and family was only a predictor among never smokers' support for limiting the sale of tobacco near schools. This study demonstrates that level of support differs by policy type, individual smoking status, as well as among subpopulations, and identifies critical elements in the theory of change for tobacco control programs.

Public attitudes towards healthcare policies promoting tobacco cessation in Germany: results from the representative German study on tobacco use (DEBRA study).

OBJECTIVE: The aim of this study was to assess public acceptance of four possible healthcare policies supporting tobacco dependence treatment in line with the Framework Convention for Tobacco Control, Article 14 recommendations in Germany. DESIGN: Cross-sectional household survey. SETTING: Data were drawn from the German population and collected through computer-assisted, face-to-face interviews. PARTICIPANTS: Representative random sample of 2087 people (>14 years) from the German population. OUTCOME MEASURES: Public acceptance was measured regarding (1) treatment cost reimbursement, (2) standard training for health professionals on offering cessation treatment, and making cessation treatment a standard part of care for smokers with (3) physical or (4) mental disorders. Association characteristics with smoking status and socio-economic status (SES) were assessed. RESULTS: Support for all policies was high (50%-68%), even among smokers (48%-66%). Ex-smokers and never-smokers were more likely to support standard training on cessation for health professionals than current smokers (OR 1.43, 95% CI 1.07 to 1.92; OR 1.43; 95% CI 1.14 to 1.79, respectively). Ex-smokers were also more likely than current smokers to support cessation treatment for smokers with mental disorders (OR 1.39, 95% CI 1.11 to 1.73). Men were less likely than women to support cessation treatment for smokers with physical diseases (OR 0.74, 95% CI 0.60 to 0.91) and free provision of treatment (OR 0.80, 95% CI 0.66 to 0.97). Offering cessation treatment to smokers with physical disorders was generally more accepted than to those with mental health issues. CONCLUSIONS: The majority of the German population supports healthcare policies to improve the availability and affordability of tobacco dependence treatment. Non-smokers were more supportive than current smokers of two of the four policies, but odds of support were only about 40% higher. SES characteristics were not consistently associated with public acceptance. TRIAL REGISTRATION NUMBER: DRKS00011322.

[Smoking prevalence and health-related lifestyle behaviours according to tobacco use after the smoke-free law in Spain: analysis of Spanish National Health Surveys 2009-2017.] / Prevalencia de tabaquismo y hábitos de vida relacionados con la salud en función del uso del tabaco tras la implantación de la Ley 42/2010: análisis de encuestas de salud en España 2009-2017.

OBJECTIVE: Smoking is one of the health risk factors most associated with population morbidity and mortality. In Spain, legal restrictions have been introduced for the use of tobacco. The objective of this study was to analyse the smoking prevalence in Spain during the period 2009-2017, following the implementation of these legal restrictions, and the relationship and evolution between smoking and other health-related lifestyle factors. METHODS: We analyzed data in 2019 from the European Health Survey in Spain 2009 and National Health Surveys of Spain 2012 and 2017. Smoking, selfperceived health status, weight status and other health-related lifestyle behaviors (physical activity, vegetable intake, fruit intake and alcohol use). A multinomial logistic regression analysis was used to obtain the odds ratio adjusted to sex and age ("odds ratio" and 95% confidence interval). RESULTS: Smoking decreased by 3.13% during 2009-2012, and by 4.81% during 2009-2017. Smoking population presenting 2 or 3 risk factors in 2009 was OR=1.17 (1.08-1.26), p<0.0001, in 2012 OR=1.23 (1.12-1, 34), p<0.0001, and in 2017 OR=1.32 (1.21-1.44), p<0.0001. For 4 or 5 risk factors it was in 2009 OR=1.51 (1.31-1.74), p<0.0001, in 2012 OR=1.60 (1.42-1.81), p <0.0001, and in 2017 OR=1.70 (1.51-1.92), p <0.0001. For ex-smokers, the probability of presenting 2 or 3 risk factors in 2009 is not significant, in 2012 OR=0.88 (0.80-0.98), p = 0.013, and in 2017 it is not significant. In the case of 4 or 5 risk factors in 2009 it is not significant, in 2012 OR=0.86 (0.75-1.00), p = 0.045, and in 2017 OR=1.15 (1.02 -1.30), p =0.028. CONCLUSIONS: There is a decrease in the smoking population in Spain during 2009-2017. People who smoke have also an unhealthy lifestyle. People who smoke presented a greater number of health-related risk factors.

OBJETIVO: El tabaquismo es una de las conductas de riesgo para la salud más asociadas a morbilidad y mortalidad de la población. En España se han implantado restricciones legales para el uso del tabaco. El objetivo de este estudio fue analizar la prevalencia del uso del tabaco en España durante el período 2009-2017, tras la implantación de estas restricciones, y la relación y evolución entre uso del tabaco y otros factores del estilo de vida relacionados con la salud. METODOS: Durante 2019, se analizaron los datos de la Encuesta Europea de Salud en España correspondiente a 2009 y de la Encuesta Nacional de Salud de España en 2012 y 2017. Se analizó el uso del tabaco, el estado de salud percibido, el estatus de peso y otras conductas de la salud (actividad física, consumo de frutas y verduras y consumo de alcohol). Se obtuvo la razón de probabilidades ajustada a sexo y edad ("odds ratio" e intervalo de confianza al 95%), mediante un análisis de regresión logística multinomial. RESULTADOS: La población fumadora disminuyó un 3,13% durante el período 2009-2012, y un 4,81% durante el período 2009-2017. Para la población fumadora, la probabilidad de presentar 2 o 3 factores de riesgo reflejó un odds ratio (OR) de 1,17 (1,08-1,26), p<0,0001 en 2009; de 1,23 (1,12-1,34), p<0,0001 en 2012; y de 1,32 (1,21-1,44), p<0,0001 en 2017. La probabilidad de presentar 4 o 5 factores de riesgo reflejó un OR de 1,51 (1,31-1,74), p<0,0001 en 2009; de 1,60 (1,42-1,81), p<0,0001 en 2012; y de 1,70 (1,51-1,92), p<0,0001 en 2017. En cuanto a la población exfumadora, la probabilidad de presentar 2 o 3 factores de riesgo no fue significativa en 2009, con un OR de 0,88 (0,80-0,98), p=0,013 en 2012; y no fue significativa en 2017. En el caso de la probabilidad de presentar 4 o 5 factores de riesgo no fue significativa en 2009, con un OR de 0,86 (0,75-1,00), p=0,045 en 2012, y con 1,15 (1,02-1,30), p=0,028 en 2017. CONCLUSIONES: La población fumadora disminuyó durante el período 2009-2017. Las personas que fuman presentan un estilo de vida menos saludable. Las personas que fuman muestran, en las sucesivas encuestas, un incremento de conductas de riesgo.

Young people's perspectives of e-cigarette use in the home.

There is concern that the emergence of e-cigarettes could result in an increase in young people's intake of, and exposure to, nicotine. This UK study used friendship group interviews to elicit the perspectives of young people from socioeconomically contrasting backgrounds regarding e-cigarettes. Young people from both advantaged and disadvantaged backgrounds described similar e-cigarette practices in the home environment, and, for both health and sensory reasons, viewed these as preferable to tobacco smoking. Space-related practices of adult e-cigarette use in the home were revealed to be more malleable than those of tobacco use. Results also highlighted that e-cigarettes offered young people new opportunities for nicotine consumption in the home. Methods of storing e-cigarettes in domestic spaces posed safety risks to younger children and easy access to e-cigarettes for others.

Youth perception of harm and addictiveness of tobacco products: Findings from the Population Assessment of Tobacco and Health Study (Wave 1).

PURPOSE: We provide a US national assessment of youth perceptions of the harm and addictiveness of six separate tobacco products, identifying a continuum of perceived harm associated with a range of products in relation to patterns of current use, former use, and susceptibility to use tobacco products. METHODS: We evaluated youth respondents (N = 13,651) ages 12-17 from Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study. Analyses (2015-2016) focused on refining measures of perceived harm for each product and delineating youth characteristics (demographic, tobacco use status) associated with beliefs about the harmfulness and addictiveness of tobacco products. RESULTS: Cigars, hookah and e-cigarettes were each perceived as having significantly lower harm (p's < 0.05) than smokeless products, with the lowest ratings of harmfulness and addictiveness observed for hookah and e-cigarettes (p's < 0.001). Incrementally lower levels of harm and addictiveness perceptions were observed among youth at increasing risk for tobacco use (p's < 0.05). CONCLUSIONS: Among U.S. youth, lower perceptions of harm and addictiveness of tobacco products were associated with susceptibility to use tobacco and patterns of tobacco product use. Future longitudinal assessments from the PATH Study can provide key information on youth development of perceptions of harm and addictiveness and influences on patterns of tobacco use.