Alcohol and Cigarette Use among Adolescents and Young Adults in Austria from 2004–2020: Patterns of Change and Associations with Socioeconomic Variables

Background: Adolescents and young adults are a crucial target group for preventing harm related to substance use. Recently, declining alcohol and tobacco consumption in young people has been observed in many countries. Based on survey data from 2004 to 2020, we describe time trends for several subgroups of adolescents and young adults (based on consumption levels and socioeconomic variables) and analyze associations between the level of alcohol per capita consumption or daily smoking and socioeconomic variables. Methods: Time trends for males and females are analyzed by a two-way ANOVA and predictors of use by using multivariate regression and logistic regression. Results: Alcohol per capita consumption decreased significantly for both sexes in the 16-year period, with male and female consumption levels converging. Daily smoking was equally prevalent for young males and females and decreased to a similar degree for both sexes. Being male and living in rural areas are associated with a higher level of alcohol consumption. Daily smoking is associated with a low level of education and is more prevalent among young adults who have already started to work. Conclusions: The decline in alcohol use and daily smoking among adolescents and young adults is taking place simultaneously. However, higher levels of alcohol consumption and daily smoking occur in different groups of adolescents and young adults, which should be considered in prevention strategies.

Risk perceptions and continued smoking as a function of cigarette filter ventilation level among US youth and young adults who smoke

BackgroundWhile evidence demonstrates that the industry’s marketing of cigarettes with higher filter ventilation (FV) misleads adults about their health risks, there is no research on the relationships between FV, risk perceptions and smoking trajectories among youth (ages 12–17) and young adults (ages 18–24).MethodsData on FV levels of major US cigarette brands/sub-brands were merged with the Population Assessment of Tobacco and Health Study to examine whether FV level in cigarettes used by wave 1 youth/young adults (n=1970) predicted continued smoking at waves 2–4, and whether those relationships were mediated by perceived risk of their cigarette brand. FV was modelled based on tertiles (0.2%–11.8%, low; 11.9%–23.2%, moderate; 23.3%–61.1%, high) to predict daily smoking, past 30-day smoking and change in number of days smoking at successive waves.ResultsThe odds of perceiving one’s brand as less harmful than other cigarette brands was 2.21 times higher in the high versus low FV group (p=0.0146). Relationships between FV and smoking outcomes at successive waves were non-significant (all p>0.05).ConclusionYouth and young adults who use higher FV cigarettes perceived their brand as less harmful compared with other brands. However, level of FV was not associated with continued smoking.

Factors Related to Adolescent Smoking: A Nationally Representative Cross-Sectional Study in Thailand

Objective: This study aimed to explore the individual, familial, and social factors associated with different smoking status in Thai adolescents from the 2017 Cigarette Smoking and Alcohol Drinking Behavior Survey (CSAD) Methods: The nationally representative sample of 6046 adolescents aged 15-19 years who took part in the 2017 CSAD in Thailand. Multinomial logistic regression analysis was conducted to explore the associations between the individual, familial, and social factors and different smoking status. Results: The daily smoking and occasional smoking was 6.4% and 3.3%, respectively. Gender, alcohol use, substance use, attitudes toward smoking, exposure to secondhand smoke at home, anti-smoking social media campaign, and graphic warning labels were related to both daily and occasional smoking. Daily smoking was associated with exposure to secondhand smoke at school, restaurant, and public transport, and exposure to tobacco advertising. Conclusion: These findings suggest that smoking prevention intervention should particularly focus on these factors and also need to develop the anti-smoking policies for smoking prevention among adolescents.

Evolution of Tobacco and E-cigarette Experimentation and Use Among French Adolescents Aged 15-16 Years From 2018 to 2020: A Cross-sectional Observational Study

BackgroundWe assessed and compared the evolution of tobacco and e-cigarette experimentation and use among French adolescents aged 15-16 years.MethodsA descriptive, cross-sectional, observational study conducted in 2018-2020 among 7,883 Year 11 pupils attending 27 public secondary schools of the Loire department, France. ResultsFrom 2018 to 2020, 66.18% of adolescents were “non-vapers and non-smokers”, 19.76% were “vapers and smokers”, 7.90% were “non-vapers and smokers” and 6.15% were “vapers and non-smokers”. E-cigarette experimentation was more prevalent than tobacco experimentation (44.92% vs 41.67%), and daily vaping was less prevalent than daily smoking (5.40% vs 10.24%). More boys than girls were daily vapers or daily smokers. A decrease was observed in tobacco experimentation (from 41.22% in 2018 to 39.73% in 2020) and e-cigarette experimentation (from 50.28% in 2018 to 41.25% in 2020). Current vaping remained stable, with an increase in daily vaping. French adolescent vapers frequently use e-liquids with little or no nicotine or with fruit or sweet flavours.ConclusionsAdolescents used e-cigarettes mainly for experimental and/or recreational purposes. The proportion of “non-vapers and non-smokers” tended to increase. “Non-vapers and smokers” tended to progress to the dual use of vaping and smoked tobacco products, with the likely intention to reduce or quit smoking.

Smoking Behaviors, Mental Health, and Risk Perceptions during the Beginning of the COVID-19 Pandemic among Mexican Adult Smokers

Mexico is one of the countries most affected by COVID-19. Studies have found that smoking behaviors have been impacted by the pandemic as well; however, results have varied across studies, and it remains unclear what is causing the changes. This study of an open cohort of smokers recruited from a consumer panel (n = 2753) examined changes in cigarettes per day (CPD), daily vs. non-daily smoking, recent quit attempts, perceived stress, depression, and perceived severity of COVID-19 at two points during the pandemic: March and July 2020. Differences in CPD between waves were estimated with Poisson regression using generalized estimating equations (GEE). Differences in perceived stress were estimated with linear regression using GEE, and differences in recent quit attempts, depression, and perceived severity of COVID-19 were estimated using separate logistic regression GEE models. Rates of depression were higher in July compared to March (AOR = 1.55, 95% C.I. 1.31–1.85), and the likelihood of recent quit attempt was lower in July compared to March (AOR = 0.85, 95% C.I. 0.75–0.98). There was no statistically significant change in CPD, daily smoking, or perceived stress. Perceived COVID-19 severity for oneself increased significantly (AOR: 1.24, 95% C.I. 1.02–1.52); however, the perceived COVID-19 severity for smokers remained constant. Our study suggests that as the COVID-19 pandemic expanded in Mexico, smoking frequency remained stable, and quit attempts decreased, even as adult smokers increasingly perceived infection with COVID-19 for themselves as severe. These results can aid in the development of health communication strategies to educate smokers about their risk for COVID-19, potentially capitalizing on concerns that stem from this syndemic of communicable and smoking-related non-communicable disease.

Effectiveness of a Dyadic Buddy App for Smoking Cessation: Randomized Controlled Trial

Background Tobacco smoking is one of the biggest public health threats. Smartphone apps offer new promising opportunities for supporting smoking cessation in real time. This randomized controlled trial investigated the effectiveness of an app that encourages individuals to quit smoking with the help of a social network member (buddy) in daily life. Objective The objective of this study is to test the effectiveness of the SmokeFree buddy app compared with a control group with self-reported smoking abstinence and carbon monoxide (CO)–verified smoking abstinence as primary outcomes and self-reports of smoked cigarettes per day (CPD) as a secondary outcome. Methods A total of 162 adults who smoked participated in this single-blind, two-arm, parallel-group, intensive longitudinal randomized controlled trial. Around a self-set quit date (ie, 7 days before the self-set quit date and 20 days after) and 6 months later, participants of the intervention and control groups reported on daily smoking abstinence and CPD in end-of-day diaries. Daily smoking abstinence was verified via daily exhaled CO assessments. This assessment was administered via an app displaying results of exhaled CO, thus addressing self-monitoring in both groups. In addition, participants in the intervention group used the SmokeFree buddy app, a multicomponent app that facilitates social support from a buddy of choice. Results A significant reduction in CPD from baseline to the 6-month follow-up was observed among participants in both groups. Multilevel analyses revealed no significant intervention effect on self-reported and CO-verified daily smoking abstinence at the quit date and 3 weeks later. However, CPD was lower at the quit date and 3 weeks later in the intervention group than in the control group. No significant differences between groups were found for any outcome measures 6 months after the quit date. Overall, low app engagement and low perceived usefulness were observed. Conclusions Despite some encouraging short-term findings on the amount of smoking, the SmokeFree buddy app did not have beneficial effects on smoking abstinence over and above the self-monitoring control condition. Future studies should examine whether and what support processes can be effectively stimulated and how app use can be improved to better achieve this goal. Trial Registration ISRCTN Registry 11154315; https://www.isrctn.com/ISRCTN11154315 International Registered Report Identifier (IRRID) RR2-10.1186/s12889-019-7723-z

909Testing ‘hardening hypotheses’ in 30 Global Adult Tobacco Survey countries: an ecological study

Background Evidence from high-income countries suggests “softening” but not “hardening” occurs when smoking prevalence decreases; however, evidence is lacking from developing countries. Methods We constructed heaviness of smoking index (HIS) based on cigarettes smoked per day (CPD) and time-to-first-cigarette (TTFC) and a score of 4-6 was high nicotine dependence; Hardcore smokers (HCS) are daily smokers who smoked within 30 minutes after waking up, smoke ≥10 cigarettes per day, have not made any quit attempts in 12 months, and have no intention to quit at all or during next 12 months; light smokers (<10 CPD or occasional smokers). We plotted two-way linear prediction graphs using country-level data and estimated Spearmańs rank-correlation coefficient. On pooled data multi-level binary logistic regression analyses for HCS, high dependence and light smoker. Results Among men and women range (lowest vs. highest) of rates varied between countries and were lower among women. Daily smoking prevalence was moderately and positively correlated with hard-core smoking (Rsp=0.473), and high dependence (Rsp=0.384) but negatively correlated with light smoking (Rsp=-0.677). HCS and high dependence were associated with socio-economic factors but effect sizes were higher for women. Among GDP and tobacco control score showed protective effect for HCS and high dependence but increased risk for light smoking. Conclusions Positive relationship of daily smoking with HCS and high dependence and its negative relationship with light smoking is contrary to “hardening hypothesis”. Key messages Hardening may not happen in developing countries as well.

Consumption of Alcohol, Cannabis, and Tobacco in a Cohort of Adolescents before and during COVID-19 Confinement

The aim of this study was to identify changes in the hazardous consumption of alcohol, tobacco, and cannabis, due to the COVID-19 lockdown in 2020 in a cohort of schooled adolescents from Central Catalonia. We also analyzed the effect of the individual and social factors on risky consumption during confinement. This longitudinal study involved a subsample of 303 adolescents aged 14–18 years, who were attending 4th year of compulsory secondary education (ESO), 2nd year of college preparation (baccalaureate), or Vocational and Educational Training (VET). We collected data before COVID-19 lockdown (October 2019–February 2020) and 2 months after the lockdown ended. We estimated the prevalence of risky substance use in the sample at baseline for each independent variable. We used Poisson regression models with robust variance to compute the Cumulative Incidence (CI) and Relative Risk (RR), with their respective 95% confidence interval. We found that VET students had a significantly (p < 0.05) higher risk of substance use: binge drinking (RR = 3.21 (95%CI: 1.00–10.34)); hazardous drinking of alcohol (RR = 3.75 (95%CI: 1.12–12.54)), hazardous consumption of cannabis (RR = 3.75 (95%CI: 0.65–21.59)) and daily smoking of tobacco (RR = 4.82 (95%CI: 1.74–13.39)). The results showed a general trend of reduction of consumption during COVID-19 confinement period. This study suggests that VET students were more likely to engage in hazardous drinking of alcohol and daily smoking of tobacco. No statistically significant differences were found for the other age groups and variables.

Exploring How Exposure to Truth and State-Sponsored Anti-Tobacco Media Campaigns Affect Smoking Disparities among Young Adults Using a National Longitudinal Dataset, 2002–2017

Background. Little is known regarding long-term impacts of anti-tobacco media campaigns on youth smoking and related disparities in the United States. Methods. We examined longitudinal cohort data from Monitoring the Future (MTF) between 2000 and 2017 in modified Poisson regression models to understand the long-term impacts of televised Truth and state-sponsored ad campaign exposure at baseline (age 18) on first cigarette and daily smoking initiation 1 to 2 years later (at modal ages 19/20). We also used additive interactions to test for potential effect modification between campaign exposure and smoking outcomes by sex, race/ethnicity, and parental educational attainment. Results. We found no evidence for baseline media campaign exposure to be associated with first cigarette or daily smoking initiation at modal age 19/20. Further, results showed no evidence for effect modification between campaign exposure and first cigarette or daily smoking initiation. Conclusions. We found no evidence that baseline Truth and state-sponsored ad exposure was associated with first cigarette or daily smoking initiation at follow up, nor did we find any evidence for effect modification by sex, race/ethnicity, or parental education. We hypothesize that anti-tobacco media campaigns might have had a short-term impact on smoking behaviors, though these effects were not sustained long term.