Efficacy of smokeless tobacco for smoking cessation: a systematic review and meta-analysis.

OBJECTIVE: Smoking remains prevalent in many countries despite rigorous tobacco control strategies. The use of Swedish snus, a type of low-nitrosamine smokeless tobacco, has been promoted as a tobacco harm reduction strategy. DATA SOURCES AND STUDY SELECTION: Three databases were searched for studies that assessed the effectiveness of snus in promoting smoking abstinence. A total of 28 studies were reviewed (5 randomised controlled trials (RCTs), 7 longitudinal and 16 cross-sectional studies). DATA EXTRACTION: Separate meta-analyses were conducted by study type, pooling effect estimates where outcome measures and design were sufficiently comparable. Study details and quality assessment (Risk of Bias 2 for RCTs, Newcastle-Ottawa Scale for observational studies) are provided for each study. DATA SYNTHESIS: While the meta-analysis of RCTs did not show a significant association between snus use and smoking cessation (risk ratio (RR)=1.33, 95% CI 0.71 to 2.47 and RR=0.62, 95% CI 0.27 to 1.41), the results of the meta-analysis of longitudinal cohort studies (RR=1.38, 95% CI 1.05 to 1.82, p=0.022) and cross-sectional studies (OR=1.87, 95% CI 1.29 to 2.72, p=0.001) indicated that use of snus was associated with an increased likelihood of quitting or having quit smoking. There was significant heterogeneity in the cross-sectional studies, and leave-one-out analysis indicated that the longitudinal cohort results were driven by one study. Most studies examined were subject to an elevated risk of bias. CONCLUSION: There is weak evidence for the use of snus for smoking cessation. Better RCTs and longitudinal studies are needed; meanwhile, existing cessation aids may be better placed than snus to promote abstinence.

Prevalence and self-reported reasons of cannabis use for medical purposes in USA and Canada.

RATIONALE: There has been increasing attention on cannabis use for medical purposes, but there is currently a lack of data on its epidemiology. OBJECTIVES: To examine the epidemiology of self-reported cannabis use for medical purposes by (1) estimating its prevalence, (2) comparing gender and age differences, and (3) investigating what reasons they were used to manage. METHODS: Participants included 27,169 respondents (aged 16-65) who completed Wave 1 of The International Cannabis Policy Study (ICPS) conducted across Canada and the USA in 2018 via online surveys. Cannabis policy conditions were "US legal-recreational" (legal for both recreational and medical uses), "US legal-medical only", "US illegal", and "Canada-medical only". RESULTS: The overall prevalence of self-reported ever cannabis use for medical purposes was 27%, with similar rates by sex and the highest prevalence in young adults. Prevalence was higher in US legal-recreational states (34%) than US illegal states (23%), US legal-medical only states (25%), and Canada (25%). The most common physical health reasons include use to manage pain (53%), sleep (46%), headaches/migraines (35%), appetite (22%), and nausea/vomiting (21%). For mental health reasons, the most common were for anxiety (52%), depression (40%), and PTSD/trauma (17%). There were 11% who reported using cannabis for managing other drug or alcohol use and 4% for psychosis. CONCLUSIONS: A substantial proportion of the North American population self-reported cannabis use for medical purposes for a variety of medical reasons, including those living in jurisdictions without legal markets. Further research is needed to understand the safety and efficacy of these forms of medical cannabis use.

Content analysis of cannabis vaping videos on YouTube.

BACKGROUND AND AIMS: There has been an increase in the potency of cannabis during the last two decades and adoption of a novel method of administration-vaping. YouTube, a social media platform, has become a popular source to access cannabis-related information. This study aimed to identify cannabis vaping YouTube videos from 2016 to 2020 and examine the themes and metrics. DESIGN: Cross-sectional sample of 200 YouTube videos. SETTING: YouTube, an on-line video sharing platform. MEASUREMENTS: Videos related to cannabis vaping were identified using the search terms: 'vaping cannabis', 'vaping weed', 'vaping marijuana' and 'vaping THC' [tetrahydrocannabinol]. Videos were independently coded by two researchers. The number of views, likes, dislikes and comments were also collected. Robust regression was used to analyse the relationship between identified video themes and video metrics. FINDINGS: Six themes were identified: 'advertisement', 'product review', 'celebratory', 'reflective', 'how-to' and 'warning'. The 'how-to' and 'celebratory' videos received the highest number of views and likes. The most popular video was viewed more than 4 000 000 times. Many videos portrayed risky behaviour (e.g. vaping a whole THC cartridge in a single setting). Fifty-two percent of these videos had no age access restrictions. The robust regression model also found that engagement metric was positively associated with 'reflective' videos and negatively associated with 'advertisement' videos. CONCLUSIONS: A large number of videos on cannabis vaping are available on-line without age-restriction. Videos that portrayed risky behaviour appear to be prevalent.

Anxiety and Panic Buying Behaviour during COVID-19 Pandemic-A Qualitative Analysis of Toilet Paper Hoarding Contents on Twitter.

Background: The coronavirus disease 2019 (COVID-19) pandemic had increased population-level anxiety and had elicited panic buying behaviour across the world. The over-hoarding of toilet paper has received a lot of negative public attention. In this work, we used Twitter data to qualitatively analyse tweets related to panic buying of toilet paper during the crisis. Methods: A total of 255,171 tweets were collected. Of these 4081 met our inclusion criteria and 100 tweets were randomly selected to develop a coding scheme in the initial phase. Random samples of tweets in folds of 100 were then qualitatively analysed in the focused coding phase until saturation was met at 500 tweets analysed. Results: Five key themes emerged: (1) humour or sarcasm, (2) marketing or profiteering, (3) opinion and emotions, (4) personal experience, and (5) support or information. About half of the tweets carried negative sentiments, expressing anger or frustration towards the deficiency of toilet paper and the frantic situation of toilet paper hoarding, which were among the most influential tweets. Discussion: Panic buying of toilet paper was seen during the 2020 pandemic period with a mass amount of related content spread across social media. The spontaneous contagion of fear and panic through social media could fuel psychological reactions in midst of crises. The high level of negative social media posts regarding the toilet paper crisis acts as an emotional trigger of public anxiety and panic. Conclusions: Social media data can provide rapid infodemiology of public mental health. In a pandemic or crisis situation, real-time data could be monitored and content-analysed for authorities to promptly address public concerns.

Comorbidity between depressive symptoms and chronic conditions - findings from the Indonesia Family Life Survey.

PURPOSE: To estimate the prevalence of symptoms of depression in the population, and to identify patient groups with a history of chronic conditions with the highest risks of comorbid depression. METHODS: Data were drawn from a population-representative sample of 31,447 participants in The Fifth Wave of the Indonesia Family Life Survey (IFLS5) conducted in 2014-15. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale-Revised (CES-D-R 10) that measures symptoms defined by the Diagnostic and Statistical Manual (DSM). Socio-demographic variables controlled for in the adjusted analysis included age, sex, education, and ethnicity. RESULTS: Weighted prevalence of depressive symptoms, above the CES-D-R 10 cut-off, was 22.6% (females=23.0%, males=22.2%). Among those with a chronic condition, the highest risk of comorbid symptoms of depression was observed in those with a memory-related disease (OR=2.64 [1.49-4.68]) or stroke (OR=2.39 [1.75-3.27]). Depressive symptoms were also more commonly reported among people with hypertension, tuberculosis, asthma, other lung conditions, heart problems, liver diseases, arthritis or rheumatism, kidney diseases, stomach or digestive diseases. CONCLUSIONS: Symptoms of depression are common in the general Indonesian population, and comorbidities are high in those with a history of chronic conditions, supporting the need for mental health care in patients presenting for physical diseases. Future research of clinical and patient samples will provide data in those who may be at increased risks.

How many more young Australians say that they would use cannabis if it were legal?

INTRODUCTION AND AIMS: The potential for increased cannabis use by young people after legalisation remains a key concern of opponents of legalisation. This study used survey data to estimate how many young Australians may be prepared to use cannabis if it became legally available. DESIGN AND METHODS: The study included 3052 youths (adolescents aged 12-17 and young adults aged 18-25 years) in Australia who participated in the 2016 National Drug Strategy Household Survey. Incident cases were estimated by multiplying the prevalence and estimated population sizes from the Australian Bureau of Statistics. RESULTS: It was estimated that 17% of adolescents would try (13%) or use (4%), and 32% of young adults would try (15%) or use (17%) cannabis if it were legal. Among those who reported an intention to try it, 85% of adolescents and 59% of young adults had never used cannabis. These translate to 199 000 and 238 000 potential initiators, respectively. Among those with an intention to use cannabis, 21% of adolescents and 3% of young adults had never used cannabis. These translate to 14 000 adolescents and 12 000 young adults who intended to use cannabis if it were legal. DISCUSSION AND CONCLUSIONS: A substantial minority of young Australians say that they would use cannabis for the first time if it were legalised. A proportion of young people who have used cannabis also expressed an interest in increasing their use. Both would warrant special attention if cannabis were legalised.