IntroductionIndonesia has a high smoking prevalence that has not diminished significantly since 1990. Considering this, we aim to summarise the existing national tobacco-related policy mix and ...explore markers of policy incoherence in tobacco control between 2014 and 2020.MethodsWe conducted (1) a review and synthesis of Indonesian tobacco-related legislation and regulations; (2) a systematic search and synthesis of related literature and news reporting; and (3) interviews with tobacco control activists and academics to understand political will towards tobacco control regulations and the tobacco industry.ResultsIndonesia’s existing tobacco-related policy mix lies across the president’s office, six national ministries and one independent agency. However, current responsibility lies primarily with four government ministries: Ministries of Health, Finance, Communication and Information, and Trade and Industry, with the Ministry of Finance most active. Evidence demonstrates that official interministerial collaboration was lacking from 2014 to 2020 and suggests that institutional will to introduce more effective tobacco control varies considerably between different arms of government.DiscussionPolitical will differs according to ministerial mandates and priorities, fostering a fragmented policy approach and undermining the development of a coherent response. Without political will from the president or national parliament to create an overarching framework for tobacco control, either via ratification of the Framework Convention on Tobacco Control or another mechanism, there remains no formal impetus for intragovernmental cooperation. Nonetheless, this analysis reveals some government progress and ‘pressure points’ that advocates can focus on to promote tobacco control policies within the current policy mix.
The use of electronic cigarettes (e-cigarettes) has rapidly increased among youth and young adults, but knowledge gaps exist on the potential health effects of using recently introduced pod-based ...e-cigarettes.
To conduct a systematic review of recent peer-reviewed scientific literature on pod-based e-cigarettes.
A search of online databases, including PubMed, Web of Science, Embase, and EBSCO HOST, was conducted to identify pod-based e-cigarette-associated articles from June 2015 (the time when JUUL JUUL Labs was introduced) to June 2019. We included English-language articles that presented primary data on pod-based e-cigarettes.
Pod-based e-cigarettes represent a substantial evolution in design by increasing the efficient delivery of nicotine. While these products may contain less harmful constituents than other types of e-cigarettes and cigarettes, there is no evidence that the levels found are safe among youth. There is evidence for higher nicotine dependence associated with their use. Pod-based e-cigarette brands, compared with other e-cigarette brands, have targeted youth and young adults with social media marketing. There was less discussion about the use of these products as smoking cessation devices or their health risks on social media. The social acceptability and favorable perceptions of pod-based e-cigarettes may underlie the use of these products.
The appeal and dependence potential of pod-based e-cigarettes for youth emphasize the need for stronger regulations on product design, social media, marketing channels, and youth access together with health communications that emphasize the risks of nicotine dependence.
Meta-analyses have concluded that positive emotions do not reduce appetitive risk behaviors (risky behaviors that fulfill appetitive or craving states, such as smoking and excessive alcohol use). We ...propose that this conclusion is premature. Drawing on the Appraisal Tendency Framework and related theories of emotion and decision-making, we hypothesized that gratitude (a positive emotion) can decrease cigarette smoking, a leading cause of premature death globally. A series of multimethod studies provided evidence supporting our hypothesis (collective N = 34,222). Using nationally representative US samples and an international sample drawn from 87 countries, Studies 1 and 2 revealed that gratitude was inversely associated with likelihood of smoking, even after accounting for numerous covariates. Other positive emotions (e.g., compassion) lacked such consistent associations, as expected. Study 3, and its replication, provided further support for emotion specificity: Experimental induction of gratitude, unlike compassion or sadness, reduced cigarette craving compared to a neutral state. Study 4, and its replication, showed that inducing gratitude causally increased smoking cessation behavior, as evidenced by enrollment in a web-based cessation intervention. Self-reported gratitude mediated the effects in both experimental studies. Finally, Study 5 found that current antismoking messaging campaigns by the US Centers for Disease Control and Prevention primarily evoked sadness and compassion, but seldom gratitude. Together, our studies advance understanding of positive emotion effects on appetitive risk behaviors; they also offer practical implications for the design of public health campaigns.
ABSTRACT
Background and aims
The availability of alcohol through retail outlets is associated with alcohol‐related harms, but few studies have demonstrated a causal relationship. We investigated the ...association between alcohol availability and alcohol‐attributable emergency department (ED) visits in the province of Ontario during a period of deregulation of controls on the number of alcohol outlets.
Design
Cross‐sectional and pre–post design
Setting and participants
The study used data from two time‐periods: pre‐deregulation (2013–14) and post‐deregulation (2016–17), to compare rates of ED visits for 513 defined geographic regions in Ontario Canada, called Forward Sortation Areas (FSAs).
Measurements
The primary outcome was the age‐standardized rates of alcohol‐attributable ED visits. We compiled a list of all alcohol retail outlets in Ontario during 2014 and 2017 and matched them to their corresponding FSA. We fitted mixed‐effects Poisson regression models to assess: (a) the cross‐sectional association between number of outlets and hours of operation and ED visits; and (b) the impact of deregulation on ED visits using a difference‐in‐difference approach.
Findings
Alcohol‐attributed ED visits increased 17.8% over the study period: more than twice the rate of increase for all ED visits. Increased hours of operation and numbers of alcohol outlets within an FSA were positively associated with higher rates of alcohol‐attributable ED visits. The increase in ED visits attributable to alcohol was 6% (incident rate ratio = 1.06; 95% confidence interval = 1.04–1.08) greater in FSAs that introduced alcohol sales in grocery stores following deregulation compared with FSAs that did not.
Conclusions
Deregulation of alcohol sales in Ontario, Canada in 2015 was associated with increased emergency department visits attributable to alcohol.
Reddit is a popular hub for discussing vaping. A deeper understanding of the factors that influence this online discourse could inform public health messaging efforts targeting this platform. Using a ...network analysis framework, we sought to investigate the role of opinion leaders and online communities in facilitating vaping discussions on Reddit. We collected Reddit submissions about vaping posted in May 2021 and used these submissions to generate subreddit-level (N=261) and thread-level (N=8,377) data sets. We coded subreddits into four community categories: 1) Vaping, 2) Substance use, 3) Cessation, and 4) Non-specific. We used sociometric in-degree centrality statistics to identify subreddit opinion leaders. We computed non-parametric ANOVAs and negative binomial regressions to test associations between opinion leadership and subreddit community category variables on subreddit network composition (comprised of subreddit-level network nodes and edges) and the number of commenters on Reddit threads about vaping (thread-level). Subreddit network composition was largely dependent on opinion leaders in Non-specific communities, and less so in Vaping and Substance use communities. At the thread-level, the rate of commenters was higher among threads initiated by opinion leaders than non-opinion leaders (adjusted rate ratio aRR=4.84). Furthermore, threads posted in Vaping (aRR=1.64), Substance use (aRR=1.92), and Cessation (aRR=1.21) communities had higher commenter rates than those posted in Non-specific communities. Communities and opinion leaders play a key role in the composition and reach of vaping discussions on Reddit. These findings provide a foundation for public health campaigns and interventions targeting Reddit and perhaps other social media platforms.
Do negative feelings in general trigger addictive behavior, or do specific emotions play a stronger role? Testing these alternative accounts of emotion and decision making, we drew on the Appraisal ...Tendency Framework to predict that sadness, specifically, rather than negative mood, generally, would 1) increase craving, impatience, and actual addictive substance use and 2) do so through mechanisms selectively heightened by sadness. Using a nationally representative, longitudinal survey, study 1 (n = 10,685) revealed that sadness, but not other negative emotions (i.e., fear, anger, shame), reliably predicted current smoking as well as relapsing 20 years later. Study 2 (n = 425) used an experimental design, and found further support for emotion specificity: Sadness, but not disgust, increased self-reported craving relative to a neutral state. Studies 3 and 4 (n = 918) introduced choice behavior as outcome variables, revealing that sadness causally increased impatience for cigarette puffs. Moreover, study 4 revealed that the effect of sadness on impatience was more fully explained by concomitant appraisals of self-focus, which are specific to sadness, than by concomitant appraisals of negative valence, which are general to all negative emotions. Importantly, study 4 also examined the topography of actual smoking behavior, finding that experimentally induced sadness (as compared to neutral emotion) causally increased the volume and duration of cigarette puffs inhaled. Together, the present studies provide support for a more nuanced model regarding the effects of emotion on tobacco use, in particular, as well as on addictive behavior, in general.
•A substantial proportion (17.2%) of adolescents reported dual-use of e-cigarettes and cannabis.•Sole combusted tobacco use was rare (0.8%).•Mental health correlated with dual- (e-cigarettes and ...cannabis) and poly-use (combusted tobacco, e-cigarettes and cannabis).•Findings can inform approaches to protect adolescents likely to engage in multiple substance use.
Compared to single substance use, adolescents’ use of multiple substances is associated with more severe dependence, cessation outcomes, and health risks. This study examined correlates of use and co-use of e-cigarettes, combusted tobacco, and cannabis among high school-aged (9th-12th grade, approximately aged 14–18) adolescents.
We analyzed the 2019 Massachusetts Youth Health Survey (MYHS) data to calculate the weighted means of any past 30-day sole-use of e-cigarettes, sole-use of combusted tobacco, sole-use of cannabis, dual-use of two of the above substances, and poly-use of all three substances. We then used weighted multinomial logistic regression to examine the associations between demographic, social and behavioral factors and sole-, dual-, and poly-use (vs. no use) of these substances.
Among N = 1614 respondents, any past 30-day dual-use of e-cigarettes and cannabis was the most prevalent (17.2%, SE: 1.3%). Sole-use of combusted tobacco was less than 1%, whereas 4.5% (SE: 0.7%) of respondents reported poly-use of e-cigarettes, cannabis, and combusted tobacco. Lower academic grades and self-reported depression (1 item on persistent feelings of sadness or hopelessness) were associated with increased odds of dual-use of e-cigarettes and cannabis and poly-use (vs. sole-use of any substance). Adolescents who self-reported having “any long-term emotional problems or learning disabilities” had greater odds of poly-use.
Different sets of correlates were associated with sole-, dual-, and poly-use, suggesting that certain adolescents may be more vulnerable than others to multiple substance use. Future research should examine potentially modifiable upstream influences, such as the home environment and socioeconomic factors that may affect the relationship between adolescent mental health, school performance, and multiple addictive substance use.
BackgroundTobacco taxes, as with other ‘sin taxes’, are generally regarded as a highly cost-effective mechanism to reduce consumption but are often considered by policymakers to be regressive, ...undermining efforts to fully implement them at levels recommended by the WHO due to concerns of fairness. We aim to demonstrate whether there are circumstances in which the impacts of additional tobacco taxes are not regressive, using a standard income-share accounting definition of tax burden.Methods and findingsWe apply mathematical modelling and explore the hypothetical distributions in the net change in tobacco taxes and cigarette expenditures by income group, following an increase in tobacco taxation. The hypothetical distribution per income group of additional taxes and cigarette expenditures borne by individuals following tobacco tax hikes was calculated with respect to a selection of parameters including: the change in the retail price of cigarettes, the price elasticity of demand for tobacco, smoking prevalence, cigarette consumption and individual income. We determine the range of hypothetical parameter values for which increased tobacco taxation should not be considered to penalise the poorest income groups when examining marginal cigarette consumption expenditures and using an accounting definition of tax burden.ConclusionsOur findings question the doctrine that tobacco taxes are uniformly regressive from a standard income-share accounting view and point to the importance of the specific features of tax policy to shape a progressive approach to tobacco taxation: tobacco tax increases are less likely to be regressive when accompanied by a broad framework of demand-side measures that enhance the capacity of low-income smokers to quit tobacco use.
To examine the association between neighborhood socioeconomic status (SES) and alcohol availability before and after deregulation in 2015 of the alcohol market in Ontario, Canada.
We quantified ...alcohol access by number of alcohol outlets and hours of retail for all 19 964 neighborhoods in Ontario. We used mixed effects regression models to examine the associations between alcohol access and a validated SES index between 2013 and 2017.
Following deregulation, the number of alcohol outlets in Ontario increased by 15.0%. Low neighborhood SES was positively associated with increased alcohol access: lower-SES neighborhoods had more alcohol outlets within 1000 meters and were closer to the nearest alcohol outlets. Outlets located in low-SES neighborhoods kept longer hours of operation.
We observed a substantial increase in alcohol access in Ontario following deregulation. Access to alcohol was greatest in low-SES neighborhoods and may contribute to established inequities in alcohol harms.
Placing limits on number of alcohol outlets and the hours of operation in low-SES neighborhoods offers an opportunity to reduce alcohol-related health inequities.
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