TobaccoFree Research Institute

Anxiety and depressive (A&D) disorders are prevalent in youth and frequently co-occur with smoking and, to a lesser degree, e-cigarette use. Associations between Other mental health disorders (MHD) and tobacco and e-cigarette use are less unidirectional. We examine prevalence of smoking and e-cigarette use in young adults with and without A&D and with and without Other MHD. We use survey data from 5,190, 20 year-olds from Wave 4 of Growing Up in Ireland Child Cohort diagnosed by a doctor, psychologist, or psychiatrist with A&D or with Other MHD: eating disorders; post-traumatic stress disorder (PTSD); obsessive compulsive disorder; bipolar disorder; personality disorder; or schizophrenia. They also reported their ever and current smoking, and e-cigarette use. Frequencies and crosstabulation analyses were performed using SPSS v27. 18.4% (n=948) reported A&D and 4.9% (n=253) reported Other MHD diagnoses. In A & D: ever (79%,n=746 vs 73%,n=3055) and current (48%,n=454 vs 36%,n=1490) smoking were significantly higher in those with than in those without (p<.01). In Other MHD: differences in smoking between those with and without were insignificant (p=0.86, 0.20). E-cigarette use differed to smoking. Compared to those without any MHD, there was significantly higher prevalence of e-cigarette use (p<.01) both for all diagnosed with A&D (Ever 57%,n=541 vs 46%,n=1915; Current 17%,n=160 vs 13%,n=529) and with Other MHD (Ever 63%,n=159 vs 47%,n=2297; Current 18%,n=44 vs 13%,n=644). Young adults with A&D are more at risk of smoking than those with Other MHD. Those with any MHD have increased risk of e-cigarette use. Services for these groups need differentiated focus.

BackgroundSmoking is inversely related to people's Physical Activity Level (PAL). As the behavior of friends may affect the choices and behavior of adolescents, having friends with a high PAL may potentially protect against adolescent smoking. This study aims to assess whether adolescents' smoking is associated with the PAL of their friends. MethodsSILNE-R survey data of 11.918 adolescents from 55 different schools in 7 European cities was used to determine weekly smoking, individual PAL, PAL of friends, school PAL, and smoking of friends. Multilevel, multivariable logistic regression analysis were used to assess the association between the PAL of friends and weekly smoking. Several socio-demographic variables were included as covariates in the analysis. ResultsOur results indicated that 10.8% of the respondents was smoking weekly. Weekly smoking was most common among adolescents whose friends had a PAL of 0–42.0 min per day (14.5%). Respondents were significantly more likely to be smoking weekly if their friends were on average 0–42 min vs. 80–180 min physically active (OR 1.27 [95% CI 1.04–1.55]). This association existed independently of the individual PAL of respondents. Stratification for smoking of friends yielded equal results, although the association appeared to be somewhat stronger for those with smoking friends (OR 1.38 [95% CI 1.06–1.82]). ConclusionAdolescents are less likely to smoke weekly if they associate with friends who spend >80 min per day on physical activity. Initiatives aimed at the prevention of smoking among adolescents may benefit from organizing group-based physical activity programs.

Smokefree laws are intended to protect against second-hand smoke (SHS) in outdoor areas. We examined if exposure to PM2.5 particles in outdoor smoking areas changed breathing rates in 60 patients with asthma (n = 30) or with COPD (n = 30), in an open, non-randomised, interventional study model in Czechia, Ireland and Spain. The patients wore a PM2.5 particle monitor (AirSpeck) and a breath monitor (RESpeck) for 24 h to determine changes in breathing rates (Br) at rest and during a visit to an outside smoking area. Spirometry and breath CO were measured before and the day after visiting an outdoor smoking area. The PM2.5 levels at the 60 venues were highly variable, ranging from ≥2000 µg/m3 (in 4 premises) to ≤10 µg/m3 (in 3 premises, which had only a single wall in the structure). At 39 venues, the mean PM 2.5 levels were ≥25 µg/m3. The breathing rate changed significantly in 57 of the 60 patients, resulting in an increase in some patients and a decrease in others. Comprehensive smokefree laws were ineffective in protecting asthma and COPD patients from exposure to high levels of SHS in outside areas of pubs and terraces, which should be avoided by these patients. These findings also support the extension of smokefree laws to outside areas.

INTRODUCTIONFinancial incentives improve stop-smoking service outcomes. Views on acceptability can influence implementation success. To inform implementation planning in Ireland, public attitudes on financial incentives to stop smoking were measured.METHODSA cross-sectional telephone survey was administered to 1000 people in Ireland aged ≥15 years in 2022, sampled through random digit dialing. The questionnaire included items on support for financial incentives under different conditions. Prevalence of support was calculated with 95% Confidence Intervals (CIs) and multiple logistic regression identified associated factors using adjusted odds ratios (AORs) with 95% CIs.RESULTSAlmost half (47.0%, 95% CI: 43.9–50.1) of the participants supported at least one type of financial incentive to stop smoking, with support more prevalent for shopping vouchers (43.3%, 95% CI: 40.3–46.5) than cash payments (32.1%, 95% CI: 29.2–35.0). Support was similar for universal and income-restricted schemes. Of those who supported financial incentives, the majority (60.6%) believed the maximum amount given on proof of stopping smoking should be under €250 (median=100, range: 1–7000). Compared to their counterparts, those of lower education level (AOR=1.49; 95% CI: 1.10–2.03, p=0.010) and tobacco/e-cigarette users (AOR=1.43; 95% CI: 1.02–2.03, p=0.041) were significantly more likely to support either financial incentive type, as were younger people.CONCLUSIONSWhile views on financial incentives to stop smoking in Ireland were mixed, the intervention is more acceptable in groups experiencing the heaviest burden of smoking-related harm and most capacity to benefit. Engagement and communication must be integral to planning for successful implementation to improve stop-smoking service outcomes.

ABSTRACTINTRODUCTIONFinancial incentives improve stop smoking service outcomes. Views on acceptability can influence implementation success. To inform implementation planning in Ireland, public attitudes to financial incentives in stop smoking services were measured.METHODSA cross-sectional telephone survey was administered to a random digit dialled sample of 1000 people in Ireland aged 15 years and older in 2022. The questionnaire included items on support for financial incentives under different conditions. Prevalence of support was calculated with 95% Confidence Intervals (CIs) and multiple logistic regression identified associated factors using Adjusted Odds Ratios (aORs, with 95% CIs).RESULTSAlmost half (47.0%, 95% CI 43.9%-50.1%) supported at least one type of financial incentive to stop smoking, with support more prevalent for shopping vouchers (43.3%, 95% CI 40.3%-46.5%) than cash payments (32.1%, 95% CI 29.2%-35.0%).Support was similar for universal and income-restricted schemes. Of those who supported financial incentives, the majority (60.6%) believed the maximum amount given on proof of stopping smoking should be under €250 (median=€100, range=€1-€7000). Versus comparative counterparts, those of lower educational attainment (aOR 1.49 95% CI 1.10-2.03, p=0.010) and tobacco/e-cigarette users (aOR 1.43 95% CI 1.02-2.03, p=0.041) were significantly more likely to support either financial incentive type, as were younger people.CONCLUSIONSWhile views on financial incentives to stop smoking in Ireland were mixed, the intervention is more acceptable in groups experiencing the heaviest burden of smoking-related harm and most capacity to benefit. Engagement and communication must be integral to planning for successful implementation to improve stop smoking service outcomes.

Secondhand electronic cigarette (e-cigarette) aerosol (SHA) might impair indoor air quality and expose bystanders. This study aims to investigate exposure to SHA in controlled conditions of enclosed settings simulating real-world scenario. An experiment was performed in a car and in a room, in which SHA was generated during a 30-minute ad libitum use of an e-cigarette. The experiment was replicated on five consecutive days in each setting. We measured PM2.5 , airborne nicotine concentrations, and biomarkers of exposure to SHA, such as nicotine metabolites, tobacco-specific nitrosamines, propylene glycol, and glycerol in bystanders' saliva samples before, during, and after the exposure period. Self-reported health symptoms related to exposure to SHA were also recorded. The results showed that the highest median PM2.5 concentration was recorded during the exposure period, being 21µg/m3 in the room setting and 16µg/m3 in the car setting-about twofold increase compared to the baseline. Most concentrations of the airborne nicotine and all biomarkers were below the limit of quantification in both settings. Bystanders in both settings experienced some short-term irritation symptoms, expressed as dry throat, nose, eyes, and phlegm. In conclusion, short-term use of an e-cigarette in confined spaces increased indoor PM2.5 level and caused some irritation symptoms in bystanders.

BackgroundSmoking during pregnancy is associated with adverse maternal and fetal outcomes. Tobacco tax avoidance and tax evasion undermine the effectiveness of tobacco tax policies, resulting in cheaper prices for smokers and increased tobacco usage.AimsThe purpose of this study was to explore the purchasing habits of pregnant smokers with regard to tobacco expenditure and use of illicit tobacco.MethodsProspective cohort study. Face to face interviews were conducted with 90 attendees (age range 18–42 years; mean age 28 years) of a smoking cessation antenatal clinic in a large Irish tertiary level maternity hospital. Information regarding smoking habits, quantity of tobacco smoked, and location of purchase of tobacco was collected in addition to socioeconomic details. Tobacco products were examined to establish whether these were purchased from legitimate sources.Results76.6% of women smoked 10 or fewer cigarettes per day. The mean weekly spend on tobacco was €39. Seventeen women (18.8%) smoked roll-your-own tobacco. One woman (1.1%) currently possessed a pack of illicit tobacco, while another 5.5% of participants had purchased illicit tobacco in the past. Four women (4.4%) practiced tobacco tax avoidance by purchasing tobacco abroad or in Duty Free.ConclusionsUse of illicit tobacco is low and only a minority of women engaged in tobacco tax avoidance. As the average price of tobacco in Ireland increases, weekly expenditure on tobacco products is a significant financial impact on low-income women. Smoking cessation would deliver significant financial gains in addition to health benefits.

BackgroundSmoking prevalence in Ireland is falling in all age groups, but e-cigarette use is rising among young people. This qualitative study explores young people’s accounts of e-cigarette use in Ireland.MethodsSemi-structured individual (22) and focus group (8) interviews were conducted with 62 young people aged 18–22 years, recruited from a higher-education institution and youth organisations working with early school-leavers across Dublin. All were smokers or ex-smokers; 41 had tried e-cigarettes, 11 continued as dual users. We identified themes using thematic data analysis.ResultsThree broad themes were identified: incentivising features, disincentivising features, and ambivalent and unsuccessful cessation, named putative smoking cessation. Incentivising features included price, pleasing taste/ flavours, and the possibility of indoor use. Disincentivising features related to adverse health effects (pain, discomfort, sore throat, coughing, headache) and unpleasant physical effects (bad taste, problems resulting from device faults). Other disincentives were over-consumption arising from inability to control intake, "greater addictiveness", product taste, and device faults. Putative cessation refers to the conflict between participants' expected use of e-cigarettes as a smoking cessation/reduction aid and their observed reality of e-cigarettes’ failure in this regard, with reported outcomes including: failure to quit or reduce; continued or resumed cigarette and/or roll-your-own smoking; dual use of e-cigarettes and other tobacco products; and inability to quit e-cigarettes.ConclusionsParticipants were sceptical about e-cigarettes’ "purported relative healthiness", concerned about addictiveness and potential long-term health consequences, and critically aware of advertising and industry strategies. E-cigarettes were viewed as being less denormalised, in part because they could be used in indoor spaces where smoking is banned in Ireland. Although price, taste, and perceived renormalisation were important motivators for young people's use of e-cigarettes, they wanted to quit smoking. The regulation of e-cigarettes through age restriction of access, licensing of outlets, pricing, point of sale and advertising restrictions as well as through the banning of indoor use should be considered by legislators and tobacco control policymakers.

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