Hardcore Smokers in Norway 1996–2009

In Norway, the prevalence of daily smoking has gradually declined from 50% among men and 30% among women in the early 1970s to 13% in both genders in 2015. The rate of occasional smoking has remained stable at approximately 10% in recent decades. Presumably, this decline in the historically prevalent and socially rooted practice of smoking signals the final stage of the tobacco epidemic, which is characterized by an increasing social gradient within the steadily decreasing segment of smokers. Norway was once a pioneer in tobacco control and introduced a comprehensive governmental program to reduce smoking, including a total ban on tobacco advertising starting in the mid-1970s. Since then, most of the policy instruments recommended by the World Health Organization to combat smoking have been implemented. In addition to a robust infrastructure for tobacco control, there has also been a focus on social denormalization strategies to make cigarettes less desirable and less accessible, and the act of smoking less acceptable. However, given the severe harm associated with smoking, the tobacco control community considers the decline in smoking to be too slow. In particular, there has been a concern for a possible asymptotic plateau in smoking rates. Whether smoking rates will tend to flatten in countries that have reached the last phase of the tobacco epidemic has also been an issue for researchers. One approach has been to investigate the number of “hardcore smokers” to test the much-discussed “hardening hypothesis”. Hardcore smokers are inveterate smokers who do not want to or are not able to quit smoking and therefore are considered a difficult segment to reach by traditional tobacco control measures. The hardening hypothesis postulates that the proportion of hardcore smokers will increase as smoking prevalence declines. The overall aim of this thesis is to increase our understanding of those who continue to smoke, as the normative and socio-material climate tends to facilitate non-smoking. I use various survey data sets to address four main topics in this thesis. The first paper investigates the size of the hardcore smoker group and whether the relative size of the group has changed over time in the population of smokers. We concluded that the size of the hardcore group of smokers remains relatively moderate in Norway, and we found little support for the hardening hypothesis. However, this conclusion depends upon how hardcore smokers are operationalized. Increased knowledge about the mechanisms underlying smokers’ willingness and/or ability to quit is needed. The second paper examines differences between smokers and snus users and their perceptions of their own tobacco use, self-evaluative emotions, perceived moral judgment and social disapproval of their tobacco use. Compared with snus users, we observed that smokers tend to hold more negative emotions about and experience more social disapproval of their tobacco behaviour. Social inequality in smoking behaviour is addressed in the third paper. More precisely, I set out to explore the associations between education, income and the risk of smoking. I conclude that low education is associated with a greater risk of dependence, heavy smoking and having no intention to quit. The last paper in this thesis explored public opinions for 16 novel tobacco control strategies. Smokers opposed all of the proposed strategies except banning smoking in cars carrying children, increasing the age limit for purchasing cigarettes, and banning smoking at transportation stops. The legitimacy of the newly proposed tobacco control measures is discussed within a justification framework. Overall, I conclude that many smokers experience a subjective feeling of stigmatization, they express resistance to increased tobacco control measures and there are some signs of social marginalization processes. In the thesis, these results are discussed in a social inequality and social resistance framework. In addition, smoking is discussed in relation to social stigma and neutralization of risk. The mechanisms underlying the inequality, stigmatization and resistance associated with smoking behaviour need further investigation

A comparison of the Fagerström Test for Nicotine Dependence and smoking prevalence across countries

To examine the correlation between the Fagerström Test for Nicotine Dependence (FTND) score and smoking prevalence across countries

KARAKTERISTIK DAN STATUS KETERGANTUNGAN PEROKOK AKTIF TERHADAP NIKOTIN DI KOTA YOGYAKARTA

AbstrakRokok mengandung unsur-unsur kimia seperti tar, nikotin, benzovrin, metal-kloride, aseton, amino, dan karbon monoksida. Adanya kandungan nikotin dalam rokok dapat menyebabkan ketergantungan. Fagerstrom Test for Nicotine Dependence (FTND) digunakan sebagai kuisioner bagi para perokok di daerah Yogyakarta untuk mengetahui tingkat ketergantungan terhadap nikotin. Penelitian ini merupakan deskriptif dengan pendekatan cross-sectional. Responden sejumlah 70 perokok aktif dengan hasil karakteristik demografis, yaitu (97,1) laki-laki dan (2,9) perempuan, dan awal mula masyarakat merokok yaitu pada usia 17-25 tahun dengan pendidikan terakhir SMA sederajat. Penghasilan perokok melalui penelitian ini didapatkan sebesar Rp 1.000.000,00 hingga Rp 2.000.000,00. Dari 70 perokok terdapat 40% perokok ketergantungan nikotin rendah hingga sedang, 34,3% responden memiliki ketergantungan rendah; 21,4% responden memiliki tingkat ketergantungan sedang, dan 4,3% responden memiliki tingkat ketergantungan tinggi terhadap nikotin. Tujuan dari penelitian ini adalah mengetahui status ketergantungan perokok aktif terhadap nikotin di wilayah Kota Yogyakarta. Status ketergantungan terhadap nikotin dapat dijadikan salah satu kriteria dalam menentukan sasaran promosi kesehatan oleh tenaga kesehatan terkait merokok. Sasaran dan metode promosi kesehatan yang tepat dapat memudahkan informasi tersampaikan guna meningkatkan kesadaran perokok terhadap kesehatan tubuhnya.Kata Kunci: fagerstrom test for nicotine dependence; status perokok; perokok aktif AbstractCigarettes contain chemical elements such as tar, nicotine, benzovrin, metal-chloride, acetone, amino, and carbon monoxide. The presence of nicotine in cigarettes can cause dependence. The Fagerstrom Test for Nicotine Dependence (FTND) was used as a questionnaire for smokers in the Yogyakarta area to determine the level of dependence on nicotine. This research is a descriptive cross-sectional approach. Respondents were 70 active smokers with the results of demographic characteristics, namely male (97.1%) and female (2.9%), and the beginning of the smoking community, namely at the age of 17-25 years with the latest high school education equivalent. The income of smokers through this research is obtained from Rp 1,000,000.00 to Rp 2,000,000.00. Of the 70 smokers, 40% of smokers had low to moderate nicotine dependence; 34.3% of respondents had low dependence; 21.4% of respondents have a moderate level of dependence, and 4.3% of respondents have a high level of dependence on nicotine. The purpose of this study was to determine the nicotine dependence status of smokers in Yogyakarta. Nicotine dependence status can be used as one of the criteria in determining health promotion targets by health workers related to smoking. The right targets and methods of health promotion can make it easier for information to be conveyed in order to increase smokers’ awareness of their health. Keywords:  Fagerstrom test for nicotine dependence; dependence status of smokers; active smoker

Effectiveness of Health Promotion Audiovisual Materials in Reducing Nicotine Dependence Among Young Adults

Nicotine dependence is an addiction to tobacco products caused by drug nicotine. The tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more than 7 million people a year. In spite of all the efforts and interventions made by the government to curb smoking, there seemed to be a steady growth in the number of smokers through the years. The purpose of this study is to determine the effects of health promotion audiovisual material in reducing nicotine dependence among young adults. A quasi-experimental pretest-posttest design was used to know the effectiveness of audiovisuals in decreasing nicotine dependency among young adults. The study population consisted of 50 young adult smokers, 25 in the experimental and 25 in the control group, ages 18-35 years old. Fagerstrom Test for Nicotine Dependence Assessment Toolkit was used for both groups. Experiential videos were presented to the experimental group for 5-10 minutes. Independent T-test was used in comparing the pre-test scores of control and experimental group; however, to analyze the whole collated data, ANCOVA was utilized. There is a significant decrease between the post-test mean scores of the experimental group as compared to their pre-test scores (p=.014) and nicotine dependence of the experimental group significantly reduced after the intervention. Comparatively, there was no significant decrease within the pre-test and posttest scores (p=.104) of the experimental and the control group. The audiovisuals were presented to the experimental group that stated topics about cigarette smoking. There were significant differences between the pretest and posttest scores of the experimental and control groups which indicate that the audiovisuals utilizing the health promotion model were effective in reducing nicotine dependence among young adults. Long-term intervention and research about nicotine dependence may be implemented in future study. There were significant differences between the pretest and posttest scores of the experimental and control groups which indicate that the audiovisuals utilizing the health promotion model were effective in reducing nicotine dependence among young adults. Long-term intervention and research about nicotine dependence may be implemented in future study

Ear acupressure for smoking cessation: a randomised controlled trial

This study investigated the efficacy and safety of ear acupressure (EAP) as a stand-alone intervention for smoking cessation and the feasibility of this study design. Adult smokers were randomised to receive EAP specific for smoking cessation (SSEAP) or a nonspecific EAP (NSEAP) intervention which is not typically used for smoking cessation. Participants received 8 weekly treatments and were requested to press the five pellets taped to one ear at least three times daily. Participants were followed up for three months. Primary outcome measures were a 7-day point-prevalence cessation rate confirmed by exhaled carbon monoxide and relief of nicotine withdrawal symptoms (NWS). Intention-to-treat analysis was applied. Forty-three adult smokers were randomly assigned to SSEAP (n = 20) or NSEAP (n = 23) groups. The dropout rate was high with 19 participants completing the treatments and 12 remaining at followup. One participant from the SSEAP group had confirmed cessation at week 8 and end of followup (5%), but there was no difference between groups for confirmed cessation or NWS. Adverse events were few and minor

Contribuciones de la auriculoterapia al cese del tabaquismo: estudio piloto

Objetivo Avaliar a contribuição da auriculoterapia na cessação do tabagismo. Método Ensaio clínico controlado, randomizado e duplo cego conduzido com 30 tabagistas alocados em dois grupos: Grupo Experimental (21 participantes receberam 10 sessões de auriculoterapia em pontos específicos para o tabagismo) e Grupo Controle (nove participantes receberam a auriculoterapia em pontos que não possuem efeito sobre o foco de investigação). Resultados O tratamento com auriculoterapia contribuiu na redução do número de cigarros fumados em 61,9% dos participantes (p=0,002), na redução da dificuldade de ficar sem fumar em locais proibidos em 38% (p=0,050) e em não fumar quando doente em 23,8% (p=0,025). Conclusão Diante da eficácia apenas em termos de redução do número de cigarros consumidos e dos demais parâmetros avaliados, sugere-se que trabalhos futuros considerem a utilização da auriculoterapia associada a outros métodos de tratamento, com intuito de alcançar melhores resultados de cessação/abstinência.Objetivo Evaluar la contribución de la auriculoterapia al cese del tabaquismo. Método Ensayo clínico aleatorizado, controlado y doble ciego conducido con 30 tabaquistas dispuestos en dos grupos: Grupo Experimental (21 participantes recibieron 10 sesiones de auriculoterapia en puntos específicos para el tabaquismo) y Grupo Control (nueve participantes recibieron auriculoterapia en puntos que no tienen efecto sobre el foco de investigación). Resultados El tratamiento con auriculoterapia contribuyó para la reducción de la cantidad de cigarrillos fumados en el 61,9% de los participantes (p=0,002), la reducción de la dificultad de permanecer sin fumar en sitios prohibidos en el 38% (p=0,050) y en no fumar cuando enfermos en el 23,8% (p=0,025). Conclusión Ante la efectividad solo en términos de reducción de la cantidad de cigarrillos consumidos y los demás parámetros evaluados, se sugiere que trabajos futuros consideren la utilización de la auriculoterapia asociada con otros métodos de tratamiento, a fin de alcanzar mejores resultados de cese/abstinencia.Objective To evaluate the contribution of auriculotherapy in smoking cessation. Method Double-blind randomized controlled trial, conducted with 30 smokers allocated into two groups: Experimental Group (21 participants received 10 sessions of auriculotherapy at specific points for smoking) and Control Group (nine participants received auriculotherapy in points that have no effect on the focus of research). Results Auriculotherapy contributed in reducing the number of cigarettes smoked in 61.9% of participants (p=0.002), in reducing the difficult to abstain from smoking in places where it is forbidden by 38% (p=0.050) and in not smoking when ill 23.8% (p=0.025). Conclusion Given the efficacy only in terms of reducing the number of cigarettes smoked and other parameters, we suggest that future studies consider the use of auriculotherapy combined with other treatment methods, in order to achieve better results in cessation/abstinence