Nicotine and Cardiovascular Health: When Poison is Addictive - a WHF Policy Brief.

Nicotine is universally recognized as the primary addictive substance fuelling the continued use of tobacco products, which are responsible for over 8 million deaths annually. In recent years, the popularity of newer recreational nicotine products has surged drastically in many countries, raising health and safety concerns. For decades, the tobacco industry has promoted the myth that nicotine is as harmless as caffeine. Nonetheless, evidence shows that nicotine is far from innocuous, even on its own. In fact, numerous studies have demonstrated that nicotine can harm multiple organs, including the respiratory and cardiovascular systems. Tobacco and recreational nicotine products are commercialized in various types and forms, delivering varying levels of nicotine along with other toxic compounds. These products deliver nicotine in profiles that can initiate and perpetuate addiction, especially in young populations. Notably, some electronic nicotine delivery systems (ENDS) and heated tobacco products (HTP) can deliver concentrations of nicotine that are comparable to those of traditional cigarettes. Despite being regularly advertised as such, ENDS and HTP have demonstrated limited effectiveness as tobacco cessation aids in real-world settings. Furthermore, ENDS have also been associated with an increased risk of cardiovascular disease. In contrast, nicotine replacement therapies (NRT) are proven to be safe and effective medications for tobacco cessation. NRTs are designed to release nicotine in a slow and controlled manner, thereby minimizing the potential for abuse. Moreover, the long-term safety of NRTs has been extensively studied and documented. The vast majority of tobacco and nicotine products available in the market currently contain nicotine derived from tobacco leaves. However, advancements in the chemical synthesis of nicotine have introduced an economically viable alternative source. The tobacco industry has been exploiting synthetic nicotine to circumvent existing tobacco control laws and regulations. The emergence of newer tobacco and recreational nicotine products, along with synthetic nicotine, pose a tangible threat to established tobacco control policies. Nicotine regulations need to be responsive to address these evolving challenges. As such, governments should regulate all tobacco and non-medical nicotine products through a global, comprehensive, and consistent approach in order to safeguard tobacco control progress in past decades.

Progress, challenges and the need to set concrete goals in the global tobacco endgame.

The tobacco endgame is rapidly moving from aspirational and theoretical toward a concrete and achievable goal and, in some cases, enacted policy. Endgame policies differ from traditional tobacco control measures by explicitly aiming to permanently end, rather than simply minimize, tobacco use. The purpose of this paper is to outline recent progress made in the tobacco endgame, its relationship to existing tobacco control policies, the challenges and how endgame planning can be adapted to different tobacco control contexts. Examples of implemented policies in three cities in the United States and national policies in the Netherlands and New Zealand are outlined, as well as recent endgame planning developments in Europe. Justifications for integrating endgame targets into tobacco control policy and the need to set concrete time frames are discussed, including planning for ending the sale of tobacco products. Tobacco endgame planning must consider the jurisdiction-specific tobacco control context, including the current prevalence of tobacco use, existing policies, implementation of the World Health Organization's Framework Convention on Tobacco Control, and public support. However, the current tobacco control context should not determine whether endgame planning should happen, but rather how and when different endgame approaches can occur. Potential challenges include legal challenges, the contested role of e-cigarettes and the tobacco industry's attempt to co-opt the rhetoric of smoke-free policies. While acknowledging the different views regarding e-cigarettes and other products, we argue for a contractionary approach to the tobacco product market. The tobacco control community should capitalize on the growing theoretical and empirical evidence, political will and public support for the tobacco endgame, and set concrete goals for finally ending the tobacco epidemic.

La fase final para poner fin al consumo de tabaco está rápidamente dejando de ser una aspiración y una teoría y se está convirtiendo en un objetivo concreto y alcanzable y, en algunos casos, una política promulgada. Las políticas para poner fin al consumo de tabaco difieren de las medidas tradicionales de control porque están dirigidas explícitamente a poner fin al consumo de tabaco de forma permanente, en lugar de solo minimizarlo. El propósito de este artículo es describir los progresos recientes en la fase final para poner fin al consumo de tabaco, su relación con las políticas existentes de control del tabaco, los desafíos que se enfrentan y cómo la planificación de la fase final se puede adaptar a los diferentes contextos de control del tabaco. Se describen ejemplos de políticas implementadas en tres ciudades de los Estados Unidos y de políticas nacionales en los Países Bajos y Nueva Zelanda, así como los progresos recientes en la planificación de la fase final en Europa. Se abordan las justificaciones para integrar los objetivos de fase final en las políticas de control del tabaco y la necesidad de establecer plazos concretos, incluida la planificación para poner fin a la venta de productos de tabaco. La planificación de la fase final para poner fin al consumo de tabaco debe considerar el contexto de control del tabaco específico según la jurisdicción, así como la prevalencia actual del consumo, las políticas existentes, la aplicación del Convenio Marco de la Organización Mundial de la Salud para el Control del Tabaco y el apoyo público. Sin embargo, el contexto actual no debe determinar si se debe realizar la planificación de la fase final, sino más bien cómo y cuándo pueden desarrollarse los diferentes planteamientos de la fase. Entre los posibles desafíos se encuentran los legales, el controvertido papel de los cigarrillos electrónicos y el intento de la industria tabacalera de incorporarse a la retórica de las políticas libres de humo. Si bien reconocemos las diferentes opiniones con respecto a los cigarrillos electrónicos y otros productos, abogamos por un enfoque restrictivo con respecto al mercado de productos de tabaco. La comunidad que trabaja por el control del tabaco debe capitalizar la creciente evidencia teórica y empírica, la voluntad política y el apoyo público para lograr la fase final para poner fin al consumo de tabaco, y establecer objetivos concretos para acabar finalmente con la epidemia de tabaquismo.

A erradicação do tabaco está passando rapidamente de uma aspiração teórica para um objetivo concreto e alcançável e, em alguns casos, está se tornando política em vigor. As políticas de erradicação diferem das medidas tradicionais de controle do tabagismo pois visam explicitamente ao fim permanente do consumo de tabaco, ao invés de simplesmente minimizá-lo. O objetivo deste artigo é delinear os avanços recentes rumo à erradicação do tabaco, sua relação com as políticas existentes de controle do tabaco, os desafios e como o planejamento da erradicação pode ser adaptado aos diferentes contextos de controle do tabaco. São apresentados exemplos de políticas implementadas em três cidades nos Estados Unidos e políticas nacionais na Holanda e Nova Zelândia, assim como desdobramentos recentes do planejamento da erradicação na Europa. São discutidas justificativas para integrar metas de erradicação nas políticas de controle do tabaco e a necessidade de estabelecer prazos concretos, incluindo o planejamento para encerrar a venda de produtos de tabaco. O planejamento da erradicação do tabaco deve considerar o contexto do controle do tabaco específico a cada jurisdição, incluindo a prevalência atual do consumo de tabaco, as políticas existentes, a implementação da Convenção-Quadro para o Controle do Tabaco da Organização Mundial da Saúde e o apoio do público. Porém, o contexto atual de controle do tabaco não deve determinar se o planejamento da erradicação deve acontecer, mas sim, como e quando diferentes abordagens à erradicação podem ocorrer. Os desafios potenciais incluem recursos judiciais, o papel polêmico dos cigarros eletrônicos e a tentativa da indústria do tabaco de cooptar a retórica das políticas antitabagistas. Embora reconhecendo os diferentes pontos de vista em relação aos cigarros eletrônicos e outros produtos, defendemos uma abordagem contracionista ao mercado de produtos de tabaco. A comunidade de controle do tabaco deve aproveitar as crescentes evidências teóricas e empíricas, a vontade política e o apoio do público à erradicação do tabaco para estabelecer metas concretas e, finalmente, pôr fim à epidemia de tabagismo.

Seguir avanzando en las Américas: el control del tabaco fomenta el desarrollo sostenible*

[EXTRACTO]. el presente número especial de la Revista Panamericana de Salud Pública aporta datos relevantes y actuali- zados de la Región de las Américas, abriendo camino por una senda en la que aún queda mucho trabajo por hacer para mejo- rar las medidas de control del tabaco. Además, las múltiples iniciativas de investigación descritas en este número demues- tran la enorme capacidad y colaboración presentes en la Región. Este número especial ha sido posible gracias a la cooperación de investigadores, organizaciones nacionales e internacionales, organismos intergubernamentales, puntos focales de control del tabaco en los ministerios de salud y diferentes especialistas en el control del tabaco que colaboran de forma continua para lograr los objetivos de salud.

Moving forward in the Americas: tobacco control fosters sustainable development

[EXTRACT]. This special issue applies this lens, bringing an equity focus to tobacco control measures, with particular attention paid to vulnerable groups (e.g., youth and low-income quintiles) and including a gender perspective. Further, one analysis empha- sizes the extent of environmental damage posed across the tobacco production chain, including the economic cost of tobacco products waste, and proposes policies to address this.

Progress, challenges and the need to set concrete goals in the global tobacco endgame

[ABSTRACT]. The tobacco endgame is rapidly moving from aspirational and theoretical toward a concrete and achievable goal and, in some cases, enacted policy. Endgame policies differ from traditional tobacco control measures by explicitly aiming to permanently end, rather than simply minimize, tobacco use. The purpose of this paper is to outline recent progress made in the tobacco endgame, its relationship to existing tobacco control policies, the challenges and how endgame planning can be adapted to different tobacco control contexts. Examples of implemented policies in three cities in the United States and national policies in the Netherlands and New Zealand are outlined, as well as recent endgame planning developments in Europe. Justifications for inte- grating endgame targets into tobacco control policy and the need to set concrete time frames are discussed, including planning for ending the sale of tobacco products. Tobacco endgame planning must consider the jurisdiction-specific tobacco control context, including the current prevalence of tobacco use, existing pol- icies, implementation of the World Health Organization’s Framework Convention on Tobacco Control, and public support. However, the current tobacco control context should not determine whether endgame plan- ning should happen, but rather how and when different endgame approaches can occur. Potential challenges include legal challenges, the contested role of e-cigarettes and the tobacco industry’s attempt to co-opt the rhetoric of smoke-free policies. While acknowledging the different views regarding e-cigarettes and other products, we argue for a contractionary approach to the tobacco product market. The tobacco control com- munity should capitalize on the growing theoretical and empirical evidence, political will and public support for the tobacco endgame, and set concrete goals for finally ending the tobacco epidemic.

[RESUMEN]. La fase final para poner fin al consumo de tabaco está rápidamente dejando de ser una aspiración y una teoría y se está convirtiendo en un objetivo concreto y alcanzable y, en algunos casos, una política promulgada. Las políticas para poner fin al consumo de tabaco difieren de las medidas tradicionales de control porque están dirigidas explícitamente a poner fin al consumo de tabaco de forma permanente, en lugar de solo minimizarlo. El propósito de este artículo es describir los progresos recientes en la fase final para poner fin al consumo de tabaco, su relación con las políticas existentes de control del tabaco, los desafíos que se enfrentan y cómo la planificación de la fase final se puede adaptar a los diferentes contextos de control del tabaco. Se describen ejemplos de políticas implementadas en tres ciudades de los Estados Unidos y de políticas nacionales en los Países Bajos y Nueva Zelanda, así como los progresos recientes en la planificación de la fase final en Europa. Se abordan las justificaciones para integrar los objetivos de fase final en las políticas de control del tabaco y la necesidad de establecer plazos concretos, incluida la planificación para poner fin a la venta de productos de tabaco. La planificación de la fase final para poner fin al consumo de tabaco debe considerar el contexto de control del tabaco específico según la jurisdicción, así como la prevalencia actual del consumo, las políti- cas existentes, la aplicación del Convenio Marco de la Organización Mundial de la Salud para el Control del Tabaco y el apoyo público. Sin embargo, el contexto actual no debe determinar si se debe realizar la planifi- cación de la fase final, sino más bien cómo y cuándo pueden desarrollarse los diferentes planteamientos de la fase. Entre los posibles desafíos se encuentran los legales, el controvertido papel de los cigarrillos electróni- cos y el intento de la industria tabacalera de incorporarse a la retórica de las políticas libres de humo. Si bien reconocemos las diferentes opiniones con respecto a los cigarrillos electrónicos y otros productos, abogamos por un enfoque restrictivo con respecto al mercado de productos de tabaco. La comunidad que trabaja por el control del tabaco debe capitalizar la creciente evidencia teórica y empírica, la voluntad política y el apoyo público para lograr la fase final para poner fin al consumo de tabaco, y establecer objetivos concretos para acabar finalmente con la epidemia de tabaquismo.

[RESUMO]. A erradicação do tabaco está passando rapidamente de uma aspiração teórica para um objetivo concreto e alcançável e, em alguns casos, está se tornando política em vigor. As políticas de erradicação diferem das medidas tradicionais de controle do tabagismo pois visam explicitamente ao fim permanente do consumo de tabaco, ao invés de simplesmente minimizá-lo. O objetivo deste artigo é delinear os avanços recentes rumo à erradicação do tabaco, sua relação com as políticas existentes de controle do tabaco, os desafios e como o planejamento da erradicação pode ser adaptado aos diferentes contextos de controle do tabaco. São apre- sentados exemplos de políticas implementadas em três cidades nos Estados Unidos e políticas nacionais na Holanda e Nova Zelândia, assim como desdobramentos recentes do planejamento da erradicação na Europa. São discutidas justificativas para integrar metas de erradicação nas políticas de controle do tabaco e a necessidade de estabelecer prazos concretos, incluindo o planejamento para encerrar a venda de produ- tos de tabaco. O planejamento da erradicação do tabaco deve considerar o contexto do controle do tabaco específico a cada jurisdição, incluindo a prevalência atual do consumo de tabaco, as políticas existentes, a implementação da Convenção-Quadro para o Controle do Tabaco da Organização Mundial da Saúde e o apoio do público. Porém, o contexto atual de controle do tabaco não deve determinar se o planejamento da erradicação deve acontecer, mas sim, como e quando diferentes abordagens à erradicação podem ocorrer. Os desafios potenciais incluem recursos judiciais, o papel polêmico dos cigarros eletrônicos e a tentativa da indústria do tabaco de cooptar a retórica das políticas antitabagistas. Embora reconhecendo os diferen- tes pontos de vista em relação aos cigarros eletrônicos e outros produtos, defendemos uma abordagem contracionista ao mercado de produtos de tabaco. A comunidade de controle do tabaco deve aproveitar as crescentes evidências teóricas e empíricas, a vontade política e o apoio do público à erradicação do tabaco para estabelecer metas concretas e, finalmente, pôr fim à epidemia de tabagismo.

What facilitates policy audacity in tobacco control? An analysis of approaches and supportive factors for innovation in seven countries.

BACKGROUND: Tobacco control policy audacity can make radical ideas seem possible, and set in motion a 'domino' effect, where precedents in one jurisdiction are followed by others. This review examines tobacco control policy audacity from seven countries to identify and compare factors that facilitated it. METHODS: A targeted search strategy and purposive sampling approach was used to identify information from a range of sources and analyse key supportive factors for policy audacity. Each case was summarised, then key themes identified and compared across jurisdictions to identify similarities and differences. RESULTS: Included cases were Mauritius' ban on tobacco industry corporate social responsibility, Uruguay's tobacco single brand presentation regulations, New Zealand's Smokefree Aotearoa 2025 Action Plan proposals and 2010 parliamentary Maori Affairs Select Committee Inquiry into the Tobacco Industry, Australia's plain packaging legislation, Balanga City's (Philippines) tobacco-free generation ordinance, Beverly Hills City Council's (USA) ordinance to ban tobacco sales and the Netherlands' policy plan to phase out online and supermarket tobacco sales. Each case was one strategy within a well-established comprehensive tobacco control and public health approach. Intersectoral and multijurisdiction collaboration, community engagement and public support, a strong theoretical evidence base and lessons learnt from previous tobacco control policies were important supportive factors, as was public support to ensure low political risk for policy makers. CONCLUSIONS: Tobacco control policy audacity is usually an extension of existing measures and typically appears as 'the next logical step' and therefore within the risk appetite of policy makers in settings where it occurs.

Tool to monitor tobacco control policy implementation: the Tobacco Control Scale in Latin America. Adaptation process and pilot study.

BACKGROUND: Monitoring tobacco control policy implementation is one of the keys for tobacco consumption reduction in Latin America (LA). This study reports on the adaptation of the Tobacco Control Scale (TCS) for use in LA countries and the level of tobacco control policy implementation in this region according to the scale. METHODS: Ecological cross-sectional survey. The questionnaire to measure tobacco control policies was a translated (into Spanish and Portuguese) and adapted version of the last TCS as used in Europe. The resulting TCS-LA maintains the same structure as the original TCS, with eight policy domains and 100 points (pts) as maximum score; however, four policy domains were adapted because the exact same rationale could not be applied. At least two non-governmental tobacco control experts were contacted per country to answer the TCS-LA. RESULTS: Informants from 17 out of 18 countries completed the questionnaire. Using the TCS-LA, Panama (70 pts), Uruguay (68 pts) and Ecuador (61 pts) exhibited the strongest tobacco control policies, while Guatemala (32 pts), Bolivia (30 pts) and Dominican Republic (29 pts) have implemented a lower number of tobacco control policies. Eight countries reached 50% of the TCS-LA total possible score, indicating a relatively good implementation level of tobacco control policies. CONCLUSIONS: Panama, Uruguay and Ecuador are the tobacco control policy leaders in LA; however, tobacco control in the region has room for improvement since nine countries have a total score under 50 pts. The TCS is a feasible and adaptable tool to monitor tobacco control in other WHO regions beyond Europe.

Seguir avanzando en las Américas: el control del tabaco fomenta el desarrollo sostenible

es

Progress, challenges and the need to set concrete goals in the global tobacco endgame / Progresos, desafíos y necesidad de establecer objetivos concretos en la fase final para poner fin al consumo tabaco en todo el mundo / Avanços, desafios e a necessidade de estabelecer metas concretas para a erradicação global do tabaco

ABSTRACT The tobacco endgame is rapidly moving from aspirational and theoretical toward a concrete and achievable goal and, in some cases, enacted policy. Endgame policies differ from traditional tobacco control measures by explicitly aiming to permanently end, rather than simply minimize, tobacco use. The purpose of this paper is to outline recent progress made in the tobacco endgame, its relationship to existing tobacco control policies, the challenges and how endgame planning can be adapted to different tobacco control contexts. Examples of implemented policies in three cities in the United States and national policies in the Netherlands and New Zealand are outlined, as well as recent endgame planning developments in Europe. Justifications for integrating endgame targets into tobacco control policy and the need to set concrete time frames are discussed, including planning for ending the sale of tobacco products. Tobacco endgame planning must consider the jurisdiction-specific tobacco control context, including the current prevalence of tobacco use, existing policies, implementation of the World Health Organization's Framework Convention on Tobacco Control, and public support. However, the current tobacco control context should not determine whether endgame planning should happen, but rather how and when different endgame approaches can occur. Potential challenges include legal challenges, the contested role of e-cigarettes and the tobacco industry's attempt to co-opt the rhetoric of smoke-free policies. While acknowledging the different views regarding e-cigarettes and other products, we argue for a contractionary approach to the tobacco product market. The tobacco control community should capitalize on the growing theoretical and empirical evidence, political will and public support for the tobacco endgame, and set concrete goals for finally ending the tobacco epidemic.

RESUMEN La fase final para poner fin al consumo de tabaco está rápidamente dejando de ser una aspiración y una teoría y se está convirtiendo en un objetivo concreto y alcanzable y, en algunos casos, una política promulgada. Las políticas para poner fin al consumo de tabaco difieren de las medidas tradicionales de control porque están dirigidas explícitamente a poner fin al consumo de tabaco de forma permanente, en lugar de solo minimizarlo. El propósito de este artículo es describir los progresos recientes en la fase final para poner fin al consumo de tabaco, su relación con las políticas existentes de control del tabaco, los desafíos que se enfrentan y cómo la planificación de la fase final se puede adaptar a los diferentes contextos de control del tabaco. Se describen ejemplos de políticas implementadas en tres ciudades de los Estados Unidos y de políticas nacionales en los Países Bajos y Nueva Zelanda, así como los progresos recientes en la planificación de la fase final en Europa. Se abordan las justificaciones para integrar los objetivos de fase final en las políticas de control del tabaco y la necesidad de establecer plazos concretos, incluida la planificación para poner fin a la venta de productos de tabaco. La planificación de la fase final para poner fin al consumo de tabaco debe considerar el contexto de control del tabaco específico según la jurisdicción, así como la prevalencia actual del consumo, las políticas existentes, la aplicación del Convenio Marco de la Organización Mundial de la Salud para el Control del Tabaco y el apoyo público. Sin embargo, el contexto actual no debe determinar si se debe realizar la planificación de la fase final, sino más bien cómo y cuándo pueden desarrollarse los diferentes planteamientos de la fase. Entre los posibles desafíos se encuentran los legales, el controvertido papel de los cigarrillos electrónicos y el intento de la industria tabacalera de incorporarse a la retórica de las políticas libres de humo. Si bien reconocemos las diferentes opiniones con respecto a los cigarrillos electrónicos y otros productos, abogamos por un enfoque restrictivo con respecto al mercado de productos de tabaco. La comunidad que trabaja por el control del tabaco debe capitalizar la creciente evidencia teórica y empírica, la voluntad política y el apoyo público para lograr la fase final para poner fin al consumo de tabaco, y establecer objetivos concretos para acabar finalmente con la epidemia de tabaquismo.

RESUMO A erradicação do tabaco está passando rapidamente de uma aspiração teórica para um objetivo concreto e alcançável e, em alguns casos, está se tornando política em vigor. As políticas de erradicação diferem das medidas tradicionais de controle do tabagismo pois visam explicitamente ao fim permanente do consumo de tabaco, ao invés de simplesmente minimizá-lo. O objetivo deste artigo é delinear os avanços recentes rumo à erradicação do tabaco, sua relação com as políticas existentes de controle do tabaco, os desafios e como o planejamento da erradicação pode ser adaptado aos diferentes contextos de controle do tabaco. São apresentados exemplos de políticas implementadas em três cidades nos Estados Unidos e políticas nacionais na Holanda e Nova Zelândia, assim como desdobramentos recentes do planejamento da erradicação na Europa. São discutidas justificativas para integrar metas de erradicação nas políticas de controle do tabaco e a necessidade de estabelecer prazos concretos, incluindo o planejamento para encerrar a venda de produtos de tabaco. O planejamento da erradicação do tabaco deve considerar o contexto do controle do tabaco específico a cada jurisdição, incluindo a prevalência atual do consumo de tabaco, as políticas existentes, a implementação da Convenção-Quadro para o Controle do Tabaco da Organização Mundial da Saúde e o apoio do público. Porém, o contexto atual de controle do tabaco não deve determinar se o planejamento da erradicação deve acontecer, mas sim, como e quando diferentes abordagens à erradicação podem ocorrer. Os desafios potenciais incluem recursos judiciais, o papel polêmico dos cigarros eletrônicos e a tentativa da indústria do tabaco de cooptar a retórica das políticas antitabagistas. Embora reconhecendo os diferentes pontos de vista em relação aos cigarros eletrônicos e outros produtos, defendemos uma abordagem contracionista ao mercado de produtos de tabaco. A comunidade de controle do tabaco deve aproveitar as crescentes evidências teóricas e empíricas, a vontade política e o apoio do público à erradicação do tabaco para estabelecer metas concretas e, finalmente, pôr fim à epidemia de tabagismo.

E-Cigarettes: A New Threat to Cardiovascular Health - A World Heart Federation Policy Brief.

Tobacco is widely recognized as a leading cause of cardiovascular morbidity and mortality, accounting for approximately seventeen percent of all cardiovascular disease deaths globally. Electronic nicotine delivery systems such as e-cigarettes have been developed and advertised as safer alternatives to traditional tobacco cigarettes. Aggressive marketing strategies, as well as misleading claims by manufacturers, have largely contributed to the belief that e-cigarettes are harmless. In reality, e-cigarettes are far from innocuous. E-cigarette solutions and aerosols generally contain harmful substances that are commonly found in tobacco cigarette emissions. A growing body of literature suggests that e-cigarettes are associated with an increased risk of cardiovascular morbidity and mortality. In addition, the effectiveness of e-cigarettes as smoking cessation tools has yet to be determined. Concerningly, most smokers do not give up on tobacco cigarettes and eventually become dual users. Unregulated, e-cigarettes constitute a serious threat to established tobacco control policies. Fortunately, many countries have demonstrated that strong regulations were effective in protecting their populations from the dangers of e-cigarettes. The World Heart Federation recommends applying the precautionary principle and a set of measures to protect vulnerable populations, prevent exposure to second-hand smoking, and address misleading claims. In this regard, we recommend that governments, policymakers, and other relevant stakeholders enact or support the following measures, among others: Prohibit the sale and distribution of e-cigarettes to minors, as well as the use of flavouring agents.Prohibit the use of e-cigarettes anywhere tobacco cigarettes have been banned.Prohibit marketing, advertising, and misleading claims regarding e-cigarettes.Apply excise taxes on e-cigarettes.Conduct more research regarding the long-term effects of e-cigarettes on cardiovascular health. Lastly, countries that have banned the commercialization of e-cigarettes should maintain these measures.

¡Activate Ya! Co-learning about school-based tobacco prevention and physical activity promotion in secondary school students in Uruguay.

PURPOSE: ¡Activate Ya! was a group-randomized controlled intervention trial aimed at developing and evaluating the impact of a school-based intervention on preventing cigarette smoking and promoting physical activity (PA) in secondary school students in Uruguay. Secondary aims were to evaluate the program's impact on students' smoking- and PA-related psychosocial risk and protective factors. METHODS: Sixteen schools and n = 654 students participated in the study. The one-year intervention included a classroom-based curriculum, an afterschool program, activity breaks, and final showcase event. A self-administered questionnaire measured outcomes at three time points. Fixed effects regression models tested for differences in outcomes by study condition. RESULTS: While positive intervention effects were found for selected psychosocial-related smoking outcomes, no impact on past-year smoking or smoking susceptibility was detected. Past 7-day PA, measured by the PAQ-C, was significantly higher among intervention school students overall (p = .048) and for girls (p = .03) at posttest, and intervention girls reported significantly higher athletic identity PA competence, friend and teacher PA support at posttest, and PA enjoyment at follow-up (p < .05). CONCLUSION: The positive short-term effects of ¡Activate Ya! on PA and related outcomes for girls support the utility of school-based health promotion in Uruguay. Additional research is needed to determine the most effective strategies to prevent tobacco use among students and promote PA among boys in this setting.