Public Support for Tobacco Endgame Policies: A Systematic Review and Meta-analysis.

INTRODUCTIONS: An increasing number of countries are adopting the tobacco endgame goal. High levels of public support can accelerate momentum towards implementing tobacco endgame policies. We aimed to conduct a systematic review of public support for tobacco endgame policies and to examine the geographical distribution of studies, support among key populations (adolescents and young adults, people who smoke), and the association between survey design and support. METHODS: We searched Embase, PubMed, Scopus, Web of Science, and Google Scholar for studies published from 2013 onwards. Google was used to search the grey literature. The reference lists of included articles were hand-searched. Studies were included if they reported the proportions of people supporting one or more endgame policies. Risk of bias was assessed using the JBI checklist for prevalence studies. RESULTS: Forty-seven articles were included. Aotearoa/New Zealand and the United States were the countries with the most studies (n=11, respectively). Three-level meta-analyses showed the highest support for mandating a very low nicotine content in tobacco products (76%, 95% CI 61-87%). Meta-regressions were performed to assess the associations of population subgroup and survey design with support levels. The level of support was lower among people who smoke compared to the general population (ß range: -1.59 to -0.51). Support for some policies was lower when neutral or don't know response options were included. CONCLUSIONS: Public support for most tobacco endgame policies was high. IMPLICATIONS: Assessing public support can assist with progressing tobacco endgame policies. Policies that are widely supported by the public may be more politically feasible to implement. Qualitative studies and trial studies can further inform communication and implementation strategies for tobacco endgame policies.

Restricting supply of tobacco products to pharmacies: a scoping review.

OBJECTIVE: We synthesised the published literature on proposals to restrict tobacco supply to pharmacies, covering (1) policy concept/rationale/attempts, (2) policy impact and implementation and (3) policy and research recommendations. DATA SOURCES: We searched eight databases (PubMed, CINAHL, Scopus, Web of Science, Embase, IPA, ProQuest and OATD) for publications with at least an English-language abstract. We searched reference lists of included publications manually. STUDY SELECTION: One author screened all publications, and a second author reviewed a 10% subset. We focused on approaches to restrict the supply of tobacco products to pharmacies, without any restrictions on study design, location, participants or publication date. DATA EXTRACTION: Data extraction adhered to the JBI Scoping Review Methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. DATA SYNTHESIS: We included 18 publications. Among the 13 studies conducted in specific geographical contexts, 8 were from Aotearoa/New Zealand. Most publications (n=8) focused on effectiveness domains, indicating potential reductions in retailer density, smoking prevalence, disease burden, cost and increased opportunities for cessation advice. Seven explored policy acceptability among experts, pharmacists and people who smoke. Publications noted that pharmacy-only supply aligns with other programmes involving pharmacists, such as needle exchange programmes, but conflicts with efforts to phase out tobacco sales from the US and Canadian pharmacies. CONCLUSIONS: Progress in tobacco retailing policy (eg, licensing, retailer incentives) and research (eg, assessment of policy equity and durability, application in other geographical contexts) are needed before a pharmacy-only tobacco supply model would be feasible.

Systematic review and meta-analysis of text messaging interventions to support tobacco cessation.

OBJECTIVE: To review randomised controlled trials (RCTs) investigating the effectiveness of text message-based interventions for smoking cessation, including the effects of dose (number of text messages) and concomitant use of behavioural or pharmacological interventions. DATA SOURCES: We searched seven databases (PubMed, CINAHL, PsycINFO, Scopus, EMBASE, Cochrane Library and Web of Science), Google Scholar and the reference lists of relevant publications for RCTs. Eligible studies included participants aged ≥15 years who smoked tobacco at enrolment. STUDY SELECTION: One reviewer screened titles and abstracts and two reviewers independently screened full texts of articles. DATA EXTRACTION: One of three reviewers independently extracted data on study and intervention characteristics and smoking abstinence rates using Qualtrics software. DATA SYNTHESIS: 30 of the 40 included studies reported higher rates of smoking cessation among those receiving text messaging interventions compared with comparators, but only 10 were statistically significant. A meta-analysis of seven RCTs found that participants receiving text messages were significantly more likely to quit smoking compared with participants in no/minimal intervention or 'usual care' conditions (risk ratio 1.87, 95% CI 1.52 to 2.29, p <0.001). Three trials found no benefit from a higher dose of text messages on smoking cessation. Two trials that tested the added benefit of text messaging to pharmacotherapy reported outcomes in favour of adding text messaging. CONCLUSIONS: Findings suggest that text messaging-based interventions are effective at promoting smoking cessation. Further research is required to establish if any additional benefit is gained from an increased number of text messages or concurrent pharmacotherapy or behavioural counselling.

Public support for tobacco endgame policies in South Korea: Findings from the 2020 International Tobacco Control Korea Survey.

BACKGROUND: Strong public support can increase the likelihood of adopting tobacco control policies. We assessed support for six commercial tobacco endgame policies in South Korea: limiting the nicotine in cigarettes, banning all additives in cigarettes, restricting the number of places where cigarettes are sold, and banning the manufacture and sales of cigarettes (unconditionally, with the provision of cessation support and with alternative tobacco products available). METHODS: Data were obtained from 4740 adults who completed the 2020 International Tobacco Control Korea Survey. Participants were categorised based on their nicotine use: (1) did not use any products, (2) vaped and/or used heated tobacco products (HTPs) but did not smoke cigarettes, (3) smoked cigarettes only and (4) smoked cigarettes and vaped and/or used HTPs. Attitudes towards the policies were classified as supportive, undecided or opposed. Weighted multinomial logistic regression models assessed support levels according to nicotine use. RESULTS: Support was highest for limiting the nicotine content in cigarettes (68.4%; 95% CI 64.6% to 72.3%) and restricting the number of retailers (68.1%; 95% CI 64.5% to 71.7%), and lowest for banning cigarette sales if alternative products are made available (45.0%; 95% CI 40.9% to 49.1%). People who did not use any products were most likely to support endgame policies, except for banning cigarette sales with alternatives available. The proportion of undecided participants exceeded 10% (range 13%-25%) for all policies. CONCLUSION: There is a strong public support for tobacco endgame policies in South Korea. Further research should prioritise the development of strategies to ensure the effective implementation of highly supported policies.

Use of geographically weighted regression models to inform retail endgame strategies in South Korea: application to cigarette and ENDS prevalence.

BACKGROUND: Reducing tobacco retailer availability is a key tobacco endgame policy. The development and evaluation of retail-based policies require spatial methodologies. We modelled the prevalence of adult cigarette and electronic nicotine delivery system (ENDS) use according to tobacco retailer density, considering geographical variations. METHODS: Registration data for tobacco retail businesses, a population-representative survey of South Koreans aged ≥19 years, and population and land area data were used. We merged the datasets according to geographical units. Ordinary least squares (OLS) and geographically weighted regression (GWR) analyses were conducted to model cigarette and ENDS use prevalence, respectively. FINDINGS: Tobacco retailer density was associated with increased cigarette use prevalence in the OLS model (ß=2.19, p=0.02). A 1.9-fold difference by region was identified for the coefficient, indicating an association with tobacco retailer density (minimum 1.39, maximum 2.65), in the GWR analysis. No significant association was present between tobacco retailer density and ENDS prevalence in either the OLS (ß=0.24, p=0.37) or the GWR model (minimum 0.20, maximum 0.28). CONCLUSION: Our results suggest the importance of using spatial methods to develop and evaluate retail-based endgame policies. The establishment of tobacco retailer databases by the introduction of licensing is necessary to develop and evaluate the effectiveness of tobacco retailer regulations.

Vision for tobacco endgame in Korea: suggestions for countries with endgame aspirations.

Tobacco endgame is a focal point of discussion at both national and international levels. We aimed to describe efforts related to achieving the tobacco endgame in the Republic of Korea, an exemplar of a country with endgame aspirations, and compare them with the efforts of other nations. We reviewed the tobacco endgame efforts of three nations considered tobacco control leaders: New Zealand (NZ), Australia and Finland. The efforts/attempts of each country were described using an endgame strategy category. The tobacco control leaders had explicit goals to achieve a smoking prevalence of <5% before a target date and had legislation and research centres for tobacco control and/or endgame. NZ is implementing a mixture of conventional and innovative endgame interventions; the others use incremental conventional approaches. In Korea, there has been an attempt to ban the sale and manufacture of combustible cigarettes. The attempt led to the filing of a petition, and a survey of adults showed 70% supported the legislation banning tobacco. The Korean government mentioned a tobacco endgame in a 2019 plan, yet a target and an end date were absent. The 2019 plan in Korea included incremental FCTC strategies. Practices in the leading countries show that legislation and research are key to ending the tobacco epidemic. The MPOWER measures must be strengthened, endgame objectives must be set and bold strategies must be adopted. Key endgame policies include those with evidence of effectiveness, such as retailer reductions.

Environment-Stratified Age-Period-Cohort Effects on the Prevalence of Walking Among Older Adults.

Walking promotes active aging; however, walking prevalence changes among older adults by age and environmental conditions remain unclear. Age-period-cohort (APC) differences in walking trends among Korean older adults were examined. Data included adults aged ≥ 65 years (n = 592,235) from the nationally representative Korean Community Health Survey. Regional units examined were metropolitan cities, small- and medium-sized cities, and rural areas. Environment-stratified APC modeling was applied for walking prevalence (walking days/time during the past week). From 2008 to 2017, the walking prevalence gap between regional units widened. Decreasing trends were most apparent in rural areas, including by birth year. In all areas, walking decreased with increased age. No distinct period effects were found. Each effect's magnitude was larger in rural areas than cities. Differential APC effects by environmental conditions likely influence walking prevalence changes among older adults. Walking promotion for older adults should consider APC effects and environmental conditions.

Cohort effects of tobacco control policy: evidence to support a tobacco-free norm through smoke-free policy.

BACKGROUND: The prevalence of cigarette smoking among South Korean adolescents has decreased markedly over the past decade, which may indicate a norm shift between generations of adolescents. The present study aims to identify the effect of banning smoking in public places and increasing cigarette prices on current adolescent smoking, and to determine whether these policies additionally resulted in cohort effects. METHODS: Repeated cross-sectional survey data, nationally representative of South Korean adolescents, were used. A total of 853 441 adolescents ranging in age from 12 to 18 years (mean age, 15 years) were identified. Models applied were segmented regression model to detect changes in smoking trends and age-period-cohort model to determine the cohort effects on the trends. FINDINGS: Between 2006 and 2017, smoking decreased from 16% to 9% in boys and from 9% to 3% in girls. After a complete ban on smoking in public places, there were significantly negative trends in the prevalence of smoking for both boys (ß=-1.1; 95% CI: -1.9 to -0.2) and girls (ß=-0.4; 95% CI: -0.6 to -0.1). Immediate decrease among girls was found after cigarette prices increased (ß=-0.8; 95% CI: -1.5 to -0.2). For the cohort effect, the risk of smoking decreased with every consecutive year for boys born after 1998 and girls born after 1997. CONCLUSIONS: Our results indicate the presence of cohort effects in the reduction of adolescent smoking. The cohort effect was induced by smoke-free legislation. Research on cohort effects, and methods to denormalise tobacco, will contribute to preventing adolescents from ever trying a cigarette.

Heated tobacco product use among Korean adolescents.

BACKGROUND: Heated tobacco products (HTPs) may compromise decades-long efforts to marginalise the tobacco industry. Their appeal to adolescents imposes a risk of a new tobacco epidemic. Empirical evidence on the behavioural patterns of HTP use among adolescents is required. We investigated the prevalence of HTP use and the association between use of HTPs and e-cigarettes and attempts to quit smoking cigarettes. METHODS: Nationally representative cross-sectional survey data of South Korean adolescents aged 12-18 years (mean age: 15 years) were used. The survey was conducted 1 year after the introduction of HTPs in Korea. A total of 59 532 adolescents were identified. Descriptive statistics and multiple logistic regression results are presented. RESULTS: In all, 2.8% of South Korean adolescents were ever HTP users. Among these, 75.5% were current cigarette users, 45.6% were current e-cigarette users and 40.3% were concurrent users of cigarettes and e-cigarettes. Unlike ever use of e-cigarettes, which was associated with a higher likelihood of cigarette quit attempts (adjusted OR (aOR)=1.35, 95% CI: 1.16 to 1.58), no difference in cigarette quit attempts was found for ever use of HTPs (aOR=1.07, 95% CI: 0.91 to 1.26). CONCLUSION: Considering the recent introduction of HTPs to the Korean market and less than 1% prevalence of e-cigarette when first introduced, the prevalence of ever HTP use among Korean adolescents is an important concern. The results showing high polytobacco use and the lack of an association between HTP use and cigarette quit attempts call for a ban on HTP advertisements with modified harm claims.

Estimating the Effectiveness of Non-Pharmaceutical Interventions on COVID-19 Control in Korea.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has posed significant global public health challenges and created a substantial economic burden. Korea has experienced an extensive outbreak, which was linked to a religion-related super-spreading event. However, the implementation of various non-pharmaceutical interventions (NPIs), including social distancing, spring semester postponing, and extensive testing and contact tracing controlled the epidemic. Herein, we estimated the effectiveness of each NPI using a simulation model. METHODS: A compartment model with a susceptible-exposed-infectious-quarantined-hospitalized structure was employed. Using the Monte-Carlo-Markov-Chain algorithm with Gibbs' sampling method, we estimated the time-varying effective contact rate to calibrate the model with the reported daily new confirmed cases from February 12th to March 31st (7 weeks). Moreover, we conducted scenario analyses by adjusting the parameters to estimate the effectiveness of NPI. RESULTS: Relaxed social distancing among adults would have increased the number of cases 27.4-fold until the end of March. Spring semester non-postponement would have increased the number of cases 1.7-fold among individuals aged 0-19, while lower quarantine and detection rates would have increased the number of cases 1.4-fold. CONCLUSION: Among the three NPI measures, social distancing in adults showed the highest effectiveness. The substantial effect of social distancing should be considered when preparing for the 2nd wave of COVID-19.

Comprehensive review of the global trends and future perspectives for recycling of decommissioned photovoltaic panels.

With the rapid deployment of renewable energy using photovoltaic (PV) panels, the sustainable management of decommissioned PV modules has become challenging. Decommissioned modules contain heavy metals, such as copper, cadmium, and lead, and hazardous polymer substances, such as ethylene vinyl acetate, polyethylene terephthalate, and polyvinylidene fluoride, which can pose a serious threat to the environment if disposed in a landfill. In addition, the low concentration value of critical metals, such as silver, indium, and tellurium, can also be lost. In this context, recycling decommissioned PV panels can be useful to resource recovery of valuable metals while lowering environmental stress. However, the lower share of PV modules and the prolonged life of 25-30 years compared to other waste volumes (e.g., electronic waste) hinder the progress in this direction. In contrast, reaching the end-of-life of the deployed first-generation PV panels is creating attraction toward the recycling of decommissioned modules. Henceforth, exploring the commercial viability of PV recycling necessitates a review of the methodologies that have been investigated on a laboratory scale and have the potential to be up-scaled. In this review, the recent trends in various PV-recycling steps, including frame disassembly, delamination, metal extraction, and recovery, are underlined while the associated problems are determined to suggest the required improvements in future technology. Furthermore, the environmental and economic feasibility of a few techniques are discussed to establish the viability of the recycling process. This review contributes to formulating PV waste management strategies and providing future research directions.

Decrease in household secondhand smoking among Korean adolescents associated with smoke-free policies: grade-period-cohort and interrupted time series analyses.

OBJECTIVES: Smoke-free areas have expanded and related campaigns have been implemented since 1995 in Korea. As a result, household secondhand smoke (SHS) exposure has decreased over the past 15 years. We assessed the cohort effect, the effect of a 2008 campaign on household SHS exposure, and the impact of a complete smoking ban in public places along with increased penalties, as implemented in December 2011. METHODS: Nationally representative cross-sectional 15-wave survey data of Korean adolescents were used. The 810,516 participants were classified into 6 grade groups, 15 period groups, and 20 middle school admission cohorts. An age-period-cohort analysis, conducted with the intrinsic estimator method, was used to assess the cohort effect of household SHS exposure, and interrupted-time series analyses were conducted to evaluate the effects of the smoke-free policy and the campaign. RESULTS: For cohorts who entered middle school from 2002 to 2008, the risk of household SHS exposure decreased among both boys and girls. Immediately after implementation of the smoke-free policy, the prevalence of household SHS exposure by period decreased significantly for boys (coefficient, -8.96; p<0.05) and non-significantly for girls (coefficient, -6.99; p=0.07). After the campaign, there was a significant decrease in household SHS exposure by cohort among boys, both immediately and post-intervention (coefficient, -4.84; p=0.03; coefficient, -1.22; p=0.02, respectively). CONCLUSIONS: A school-admission-cohort effect was found on household SHS exposure among adolescents, which was associated with the smoke-free policy and the campaign. Anti-smoking interventions should be implemented consistently and simultaneously.

Epidemiological Model for Conventional Tobacco Control Measures and Tobacco Endgame Policies.

Epidemiological models, also known as host-agent-vector-environment models, are utilized in public health to gain insights into disease occurrence and to formulate intervention strategies. In this paper, we propose an epidemiological model that incorporates both conventional measures and tobacco endgame policies. Our model suggests that conventional measures focus on relationships among agent-vector-host-environment components, whereas endgame policies inherently aim to change or eliminate those components at a fundamental level. We also found that the vector (tobacco industry) and environment (physical and social surroundings) components were insufficiently researched or controlled by both conventional measures and tobacco endgame policies. The use of an epidemiological model for tobacco control and the tobacco endgame is recommended to identify areas that require greater effort and to develop effective intervention measures.

Required Elements for an Integrated Biosurveillance Platform: A Capacity and Needs Assessment of the Central Government in the Republic of Korea.

New and reemerging infectious disease outbreaks threaten human safety worldwide, increasing the urgency to implement biosurveillance systems that enhance government capacity in public health emergency preparedness and response. To do so, it is necessary to evaluate existing surveillance and response activities and identify potential barriers at the national level. This study aimed to assess the current status and readiness of government agencies in South Korea, particularly for information sharing and use, and to identify barriers and opportunities in developing an agency-integrated biosurveillance system. The target sample size was 66 government officials, working at 6 relevant government ministries. We invited a total of 100 officials to participate. A total of 34 government officials completed the survey (34.0% response rate), 18 (52.9%) of whom were affiliated with the Korea Disease Control and Prevention Agency or the Ministry of Health and Welfare. Findings revealed that information sharing between government agencies occurred frequently, but a discrepancy existed in terms of the type of information shared and stored. Although information sharing with other agencies and ministries occurred at all stages-prevention, preparation, response, and recovery-it mostly revolved around preventive activities, with no respondents reportedly sharing recovery-related information. An agency-integrated biosurveillance system is crucial in preparing for the next pandemic, as well as supporting information sharing, analysis, and interpretation across humans, animals, and the environment. It is key to national and global health security.

Trends in adolescent secondhand smoke exposure at home over 15 years in Korea: Inequality by parental education level.

INTRODUCTION: Low parental education level and parental smoking are major risk factors for household secondhand smoke (SHS) exposure among adolescents. We investigated the trend in household SHS exposure according to sex, school, and parental education level to determine whether the decline in household SHS exposure over time depends on parental education level. METHODS: We used cross-sectional Korea Youth Risk Behavior datasets (2006-2020; 806829 subjects were eligible). We applied binary logistic regression to assess household SHS exposure trends and evaluated the interaction between period and parental education level. RESULTS: Household SHS exposure over 15 years has declined. The difference (0.121) was the smallest for male middle school students with low-educated parents. The slope for the estimated probability of household SHS exposure among students with high-educated parents was steeper than that for those with low-educated parents, except for female high school students (difference=0.141). Students with low-educated parents were at higher risk of household SHS exposure (male middle school students, adjusted odds ratio, AOR=1.52; 95% CI: 1.47-1.56; male high school students, AOR=1.42; 95% CI: 1.38-1.47; female middle school students, AOR=1.62; 95% CI: 1.58-1.67; female high school students, AOR=1.62; 95% CI: 1.57-1.67). The interaction between parental education level and period was significant. We also found a significant interaction between parental education level and parental smoking (other × present interaction, AOR=0.64; 95% CI: 0.60-0.67; low-low × present interaction, AOR=0.89; 95% CI: 0.83-0.95). CONCLUSIONS: Changes in parental education level over time mainly contributed to changes in adolescents' household SHS exposure. Adolescents with low-educated parents were at higher risk of household SHS exposure, with a slower decline. These gaps must be considered when creating and implementing interventions. Campaigns and community programs to prevent household SHS need to be emphasized among vulnerable adolescents.

Tobacco consumption, sales, and output as monitoring indicators in the era of the tobacco endgame: a Korean example.

OBJECTIVES: The consumption, sales, and output of tobacco products each suggest different areas of intervention for tobacco control. In the era of the tobacco endgame, as increasingly stronger supply-side measures are implemented, multifaceted indicators that assess both supply and/or demand are required. We aimed to estimate the consumption of cigarette and heated tobacco products (HTPs) and sought agreement between the various indicators. METHODS: The annual cigarette and HTP consumption in 2014-2020 was calculated using the frequency and intensity of cigarette use from representative surveys of adults and adolescents by sex and age. Sales and output data were acquired from governmental sources. Spearman correlation coefficients and Bland-Altman plots were used to compare the indicators. RESULTS: Tobacco output, cigarette sales, and cigarette consumption were greatest in 2014. The HTP consumption calculated for 2020 was 292.28 million packs. Cigarette consumption and sales correlated significantly, as did tobacco output and tobacco sales. A Bland-Altman plot comparing the difference between cigarette consumption and sales showed that this difference was largest in 2014, immediately before cigarette prices increased. With the exception of a single year, all cigarette consumption values were within the limits of agreement for cigarette sales and tobacco output. CONCLUSIONS: Our analyses showed agreement between demand-side (tobacco consumption) and supply-side (sales and output) indicators. We recommend using all indicators to monitor the impacts of tobacco control on both demand and supply sides. The systematic use of various indicators is critical to achieve the end of the tobacco epidemic.

Association between tobacco industry advertising expenses and tobacco advertising exposure among Korean adolescents.

INTRODUCTION: Monitoring the activities and impacts of tobacco industries is vital for tobacco control. Based on tobacco industry financial statements and a nationally representative survey of Korean adolescents, we examined the association between tobacco industry commercial advertising expenses and advertising exposure among Korean adolescents. METHODS: The commercial advertising expenses of three major tobacco industries in Korea (KT&G, Philip Morris Korea, and British and American Tobacco Korea) were identified in a repository (Data Analysis Retrieval and Transfer System) established by the Korean Financial Supervisory Service. The yearly advertising expenses were merged with data from the Korean Youth Risk Behavior Survey (2015-2018 and 2021, total N=309 190). We used logistic regression analyses to analyse the associations between tobacco industry advertising expenses and adolescent tobacco advertisement exposure. RESULTS: In 2021, the total advertising expenses of the three companies exceeded US$260 million, and the proportion of Korean adolescents exposed to tobacco advertisements ranged from 65.9% to 78.7% during 2015-2018 and 2021. Higher advertising expense sizes were associated with the risk of exposure to tobacco advertisements in both girls and boys, with OR of 1.009 (95% CI (1): 1.008 to 1.010) and 1.010 (95% CI: 1.009 to 1.011), respectively. CONCLUSION: Tobacco industry advertising expenses are associated with tobacco marketing exposure among adolescents. We used financial data to identify the reach of tobacco advertising among Korean adolescents. It is essential to increase tobacco industry surveillance using various data sources and to regulate tobacco advertising more strongly.

Modeling the future of tobacco control: Using SimSmoke to explore the feasibility of the tobacco endgame in Korea.

INTRODUCTION: We used a simulation model to assess the feasibility of reaching the tobacco endgame target (reducing the smoking prevalence to below 5% by 2050) and explored potential implementation strategies. METHODS: The impact of strengthened tobacco-control policies on smoking prevalence was analyzed using Korea SimSmoke, a discrete-time Markov process. We considered the effects of various scenarios from 2023 and predictions were conducted until 2050. To confirm the stability of the results, deterministic and probabilistic sensitivity analyses were carried out by increasing and decreasing parameter estimates. RESULTS: The implementation of tobacco-control policies in accordance with the WHO MPOWER (Μonitor tobacco use and prevention policies; Protect people from tobacco smoke; Offer help to quit tobacco smoking; Warn of the dangers of tobacco; Enforce bans on tobacco advertising, promotion, and sponsorship; Raise taxes on tobacco) measures were insufficient to achieve the tobacco endgame objective of 5% by 2050. The overall predicted smoking prevalence in 2050 is 4.7% if all policies are fully implemented in accordance with the FCTC guidelines together with a complete ban on the sale of cigarettes to people born after 2003 and annual 10% increases in price. Sensitivity analyses using the varying policy effect assumptions demonstrated the robustness of the simulation results. CONCLUSIONS: For a substantive reduction in smoking prevalence, it is essential to strongly implement the MPOWER strategy. Beyond this foundational step, the eradication of smoking requires a paradigm shift in the perception of conventional tobacco-control policies, including a tobacco-free generation strategy and radical increases in the price of tobacco products.

Corrigendum: Modeling the future of tobacco control: Using SimSmoke to explore the feasibility of the tobacco endgame in Korea.

[This corrects the article DOI: 10.18332/tid/174127.].

Mechanisms to prevent caspase activation in rotenone-induced dopaminergic neurodegeneration: role of ATP depletion and procaspase-9 degradation.

The evidence implicating a mode of cell death that either favors or argues against caspase-dependent apoptosis is available in studies that used experimental models of Parkinson's disease. We sought to investigate the mechanisms by which release of cytochrome c is not linked to caspase activation during rotenone-induced dopaminergic (DA) neurodegeneration. Unlike caspase activation in 6-hydroxydopamine-treated cells, both MN9D DA neuronal cells and primary cultures of mesencephalic neurons showed no obvious signs of caspase activation upon exposure to rotenone. We found that intracellular levels of ATP significantly decreased at the early phase of neurodegeneration (<~24 h) and therefore external addition of ATP to the lysates obtained at this stage reconstituted caspase-3 activity. At a later phase of cell death (>~24 h), both decreased levels of ATP and procaspase-9 contributed to the lack of caspase-3 activation. Under this condition, calpain and the proteasome system were responsible for the degradation of procaspase-9. Consequently, external addition of ATP and procaspase-9 to the lysates harvested at the later phase was required for activation of caspase-3. Similarly, caspase-3 activity was also reconstituted in the lysates harvested from cells co-treated with inhibitors of these proteases and incubated in the presence of external ATP. Taken together, our findings provided a sequential mechanism underlying how DA neurons may undergo caspase-independent cell death, even in the presence of cytoplasmic cytochrome c following inhibition of mitochondrial complex I.