Changing pattern of smoking behavior among Mongolian adolescents: Results from the GYTS (2003-2019)

Background Tobacco use has become a global health concern. Most part of smokers initiate smoking during their adolescence. This study aims to analyze the changing pattern of cigarette smoking among adolescents in Mongolia. Methods The retrospective data analysis is based on four repeated national cross-sectional Global Youth Tobacco Surveys (GYTS) conducted in 2003, 2007, 2014 and 2019. Data were collected by self-administered questionnaires. The sample represented the students aged 12-16 years. Pearson's chi-squared tests and logistic regression analyses were performed by using IBM SPSS version 24 software. Results Altogether, 17,458 students participated in the four surveys. There was an overall decrease in the prevalence of ever smokers (40.4% in 2003, 21.2% in 2019; p < 0.001), current smokers (9.2% in 2003, 4.4% in 2019), and planning of cessation (84.0% in 2003, 62.9% in 2019; p < 0.001). Smoking related knowledge has been changed, e.g., the prevalence of students who thought smoking helps people feel more comfortable decreased from 28.3% to 7.2%. From the point of the media effects the percentage of students who saw anti-tobacco message in the media significantly decreased (from 84.0% to 62.9%, p < 0.001). Additionally, the percentage of participants who were exposed to tobacco smoke at home decreased from 64.1% to 42.6% (p < 0.001) between 2003 and 2019. The multivariate logistic regression analyses by years showed that males, those who were exposed by smoke at home, who thought that smoking makes people more comfortable were more likely to be current smokers; no association was found with anti-tobacco messages. Conclusions Despite of the implementation of tobacco control policies, smoking is a major problem in the Mongolian population. The findings of GYTSs provide information to the development of an adolescent specific national tobacco control program, which will help to combat the tobacco epidemic. Key messages A positive trend of smoking behavior among adolescents has been demonstrated in Mongolia. The findings help to develop a comprehensive adolescent specific school-based tobacco control program.

US Tobacco 21 is Paving the Way for a Tobacco Endgame

The battle against tobacco usage is being fought on all fronts. On December 19, 2019, a measure to raise the minimum age to buy tobacco products to 21 from 18 was passed by the United States Congress and signed by President Donald Trump. This instated banning the sale of all tobacco products and electronic cigarettes to anyone in the US under the age of 21. This follows the raising of the age to buy tobacco in California to 21 in 2016. According to the California Tobacco Control Program: in 2016, roughly 10% of high-school students were smoking cigarettes, but by 2018, only 2%. The percentage of retailers selling tobacco to underaged youth dropped dramatically. These data show that the CA Tobacco 21 law was effective in decreasing the obtainability and usage of tobacco by youth. We expect that US Tobacco 21 will be similarly effective in reducing tobacco use by youth leading to less tobacco addiction in the US.

Clinician Training in the Adaptation of a Comprehensive Tobacco-Free Workplace Program in Agencies Serving the Homeless and Vulnerably Housed

Tobacco use is exceedingly high among those who are homeless or at risk of homelessness but not commonly addressed by clinicians. Taking Texas Tobacco Free (TTTF) is a tobacco control program that addresses known clinician barriers to intervention (e.g., low training receipt, limited resources). Here, we examine the process and outcomes of TTTF’s adaptation within four agencies that provide housing or other services to individuals who are homeless or vulnerably housed. Pre- and post-implementation data were collected from clinicians (N = 68) to assess changes in training receipt, knowledge, and intervention behaviors, relative to program goals. Results indicated significant gains in clinicians’ receipt of training in 9 (of 9) target areas (p’s ≤ 0.0042) and a 53% knowledge gain (p < 0.0001). From pre- to post-implementation, there were mean increases in the use of the 5As (ask, advise, assess, assist, and arrange) and other evidence-based interventions for tobacco cessation, with significant gains seen in assisting residents/clients to quit, arranging follow-ups, and providing or referring for non-nicotine medications (p’s ≤ 0.0491). All program goals, except gains related to advising smokers to quit and the use of specific interventions (behavioral counseling), were met. Overall, TTTF improved clinicians’ capacity to address tobacco use among homeless and vulnerably housed individuals and can serve as a model for tobacco control efforts in similar agencies.

Awareness and Perceptions on Health Warning Labels on Cigarette Packs among Smokers: A Cross-Sectional Study

Backgrounds. Tobacco use is the leading preventable cause of premature deaths. Tobacco control remains a top priority, and health warning labels (HWLs) are one of the recommended methods. This study is aimed at examining the awareness and perceptions of HWLs on cigarette packs among smokers. Methods. A cross-sectional study was conducted among 240 smokers who were randomly recruited from three townships in Mandalay in 2018. A face-to-face interview was done using a questionnaire. Multivariate logistic regression was used to analyse the data. Results. About half were 18-40 years old; the majority were males (96.3%) and smokers (93.4%). Nearly all respondents noticed both pictorial warning and text messages, and about half could identify the current size of HWLs. Most of the smokers generally had positive perceptions and opinions on HWLS, and they strongly supported it. About 75% intended to reduce the number of cigarettes, and 18% were willing to quit within 6 months. Those who desired to reduce the number of cigarettes were more likely to quit within 6 months (aOR=7.6, 95% CI 1.6-35.9 and aOR=19.6, 95% CI 13.0-294.7 for those who had a little and strong desire, respectively). Conclusion. Awareness status and perceptions of the respondents were acceptable, and HWLs have motivated smokers to quit smoking. The Tobacco Control Program needs to strengthen the tobacco control law that prohibits selling loosies in order to maximize the benefits of HWLs.

The Attitudes About Law Number 4207 Among Health Administration Students

Aim: ‘National Tobacco Control Program’ had developed in Turkey by the Ministry of Health in 2009 with amendment of Law 4207 and all closed places became smoke-free. The National Media Campaign has been initiated with the “Smoke Free Air-Zone” slogan for raising public awareness. The aim of our study is to determine the smoking status and attitude of Health Management students about Law 4207 in a university in Turkey, four years after the application of Smoke Free Air-Zone. Methods: In this study we used a questionnaire with 33 questions, which was developed by researchers and Fagerstrom Nicotine Dependent Test to obtain the addiction level of the smokers. Results: Sixty-two percent of 244 students were female. 3.3% were ex-smokers and 10.7% were active smokers. 5.2% of females and 19.3% of males were smoking. 87.5% of smokers think smoking habbit is harmful. 41.4% of the students thought that Law 4207 was generally accepted by the society. Conclusion: Reducing the smoking prevalence and increasing the awareness about the Law 4207 among health administrators is very important for the imlementation of health policy. So our research has an importance to highlight this subject and increase the awareness of the campaign. Keywords: administrators, Law 4207, smoking cessation, tobacco use cessation

Organizational and Financial Analysis of Polish Tobacco Control Program in 2000–2018

In accordance with the provisions of the WHO Framework Convention on Tobacco Control (FCTC), each country shall promote and strengthen public awareness of tobacco control issues (Article 12). Many parties to the FCTC have adopted national tobacco control programs to organize their tobacco control activities. The aim of our study was to analyze the organization and funding of the Polish Tobacco Control Program in years 2000–2018. Document analysis of The Program and reports from its implementation were performed in accordance to the Agency for Health Technology Assessment in Poland (AHTAPol) recommendations and the WHO FCTC guidelines for Article 12 implementation. Spending was also analyzed. The study showed both inadequate planning of and funding for Polish Tobacco Control Program. The Program was developed without use of best practices detailed in the WHO FCTC guidelines as well as in national guidelines prepared by AHTAPol. The experience of Poland shows that although earmarking tobacco taxes has existed in the law, it has been largely ineffective due to the poor Tobacco Control Program design and insufficient funding resulting from a poor execution of the earmarking law. This may be a warning to other countries to strive to create law, compliance with which can be verified and controlled.