Prior Daily Menthol Smokers More Likely to Quit 2 Years After a Menthol Ban Than Non-menthol Smokers: A Population Cohort Study

BACKGROUND AND AIMS: The province of Ontario, Canada, banned the use of menthol-flavored tobacco products as of January 1, 2017. This study aims to assess the longer-term impact of a menthol ban on smoking behavior at 2 years, which is unknown. METHODS: Population cohort study with baseline survey (n = 1821) conducted September–December 2016 and follow-up survey January–August 2019 among current smokers in Ontario (16+) prior to the menthol ban. Poisson regression was used to assess the probability of quitting smoking by pre-ban menthol status, controlling for differences in smoking and demographic characteristics, with multiple imputations used to address missing data. FINDINGS: Menthol smokers were more likely to report having quit smoking (12% [daily menthol] and 10% [occasional menthol] vs. 3% [non-menthol]; p < .001) than non-menthol smokers in the 2 years after a menthol ban. After adjustment for smoking and demographic characteristics, daily menthol smokers had higher likelihood of quitting smoking (adjusted relative risk [ARR] 2.08; 95% confidence interval [CI] 1.20–3.61) and reported more quit attempts (ARR 1.45; 95% CI 1.15–1.82). Among those who attempted to quit, menthol smoking was not associated with relapse (daily ARR = 0.96; 95% CI: 0.86, 1.07; occasional ARR = 0.99; 95% CI: 0.90, 1.08). However, there was a statistically significant interaction among menthol users who reported using other flavored tobacco products 1 year after the ban (ARR = 0.26 [95% CI: 0.08, 0.90]) CONCLUSIONS: The study found increased probability of quitting among daily menthol smokers and more quit attempts among daily and occasional menthol smokers compared with non-menthol smokers in Ontario 2 years after the implementation of a menthol ban. IMPLICATIONS: This study examines quitting behavior 2 years after a menthol ban in Ontario, Canada. Those who were daily menthol smokers prior to the ban were more likely to quit smoking and make more quit attempts in the 2 years after the ban. While there was no difference in the likelihood of relapse between menthol and non-menthol smokers among those who attempt to quit, there were indications that pre-ban daily menthol smokers who used other tobacco products after the ban were likely to quit

Socioeconomic Position and Adolescent Trajectories in Smoking, Drinking, and Psychiatric Distress

Purpose: Smoking, drinking, and psychiatric distress are inter-related and may also be associated with socioeconomic position (SEP). This paper investigates the role of SEP in adolescent development across all three of these outcomes. Methods: Data were self-reported by adolescents in the Twenty-07 Study (N = 1,515) at ages 15, 17, and 18 years. Latent class analysis was used to identify homogeneous subgroups of adolescents with distinct developmental patterns. Associations between developmental patterns and a range of socioeconomic indicators were then tested. Results: Five classes were identified. A Low Risk class had low levels for all outcomes. A High Distress class had persistently high levels of distress, but was otherwise similar to the Low Risk group. A High Drinking class drank alcohol earlier and more heavily but also had higher levels of distress than the Low Risk group. Smokers were grouped in two classes, Early Smokers and Late Smokers, and both also had raised levels of drinking and distress. Early Smokers tended to begin earlier and smoke more heavily than Late Smokers. Relative to the Low Risk class, adolescents in a disadvantaged SEP were more likely to be Early Smokers and somewhat less likely to be in the High Drinking class. SEP was not consistently associated with membership in the High Distress or Late Smokers classes. Conclusions: Associations with SEP are evident in opposing directions or absent depending on the combination and timing of outcomes, suggesting that a disadvantaged SEP is not a simple common cause for all three outcomes. © 2013 Society for Adolescent Health and Medicine. All rights reserved

A systematic review of longitudinal studies on the association between depression and smoking in adolescents

<p>Abstract</p> <p>Background</p> <p>It is well-established that smoking and depression are associated in adolescents, but the temporal ordering of the association is subject to debate.</p> <p>Methods</p> <p>Longitudinal studies in English language which reported the onset of smoking on depression in non clinical populations (age 13-19) published between January 1990 and July 2008 were selected from PubMed, OVID, and PsychInfo databases. Study characteristics were extracted. Meta-analytic pooling procedures with random effects were used.</p> <p>Results</p> <p>Fifteen studies were retained for analysis. The pooled estimate for smoking predicting depression in 6 studies was 1.73 (95% CI: 1.32, 2.40; p < 0.001). The pooled estimate for depression predicting smoking in 12 studies was 1.41 (95% CI: 1.21, 1.63; p < 0.001). Studies that used clinical measures of depression were more likely to report a bidirectional effect, with a stronger effect of depression predicting smoking.</p> <p>Conclusion</p> <p>Evidence from longitudinal studies suggests that the association between smoking and depression is bidirectional. To better estimate these effects, future research should consider the potential utility of: (a) shorter intervals between surveys with longer follow-up time, (b) more accurate measurement of depression, and (c) adequate control of confounding.</p

Reciprocal relationships between trajectories of depressive symptoms and screen media use during adolescence

Adolescents are constantly connected with each other and the digital landscape through a myriad of screen media devices. Unprecedented access to the wider world and hence a variety of activities, particularly since the introduction of mobile technology, has given rise to questions regarding the impact of this changing media environment on the mental health of young people. Depressive symptoms are one of the most common disabling health issues in adolescence and although research has examined associations between screen use and symptoms of depression, longitudinal investigations are rare and fewer still consider trajectories of change in symptoms. Given the plethora of devices and normalisation of their use, understanding potential longitudinal associations with mental health is crucial. A sample of 1,749 (47% female) adolescents (10-17 years) participated in six waves of data collection over two years. Symptoms of depression, time spent on screens, and on separate screen activities (social networking, gaming, web browsing, TV/passive) were self-reported. Latent growth curve modelling revealed three trajectories of depressive symptoms (Low-Stable, High-Decreasing, and Low-Increasing) and there were important differences across these groups on screen use. Some small, positive associations were evident between depressive symptoms and later screen use, and between screen use and later depressive symptoms. However, a Random Intercept Cross Lagged Panel Model revealed no consistent support for a longitudinal association. The study highlights the importance of considering differential trajectories of depressive symptoms and specific forms of screen activity to understand these relationships

A Longitudinal Investigation into the Association of Smoking and Depression among Adolescents: Exposures, Outcomes, and Auxiliary Hypotheses

Introduction: The association between smoking and depression has been well established, but the nature of the relationship has not been determined. A synthesis of longitudinal studies examining the onset of smoking and depression among adolescents demonstrated consistent evidence of both smoking predicting depression and depression predicting smoking in multiple populations; however, more work is needed to develop and test the mechanisms associated with the onset of the co-occurrence of smoking and depression. This thesis examines the role of a broad range of potential confounders on the relationship between smoking and depression, and investigates a potential mechanism of effect. Method: Analyses were conducted using the Nicotine Dependence in Teens (NDIT) cohort which included 1293 students initially aged 12-13 years recruited from all grade seven classes in a convenience sample of ten secondary schools in Montreal, Canada surveyed twenty times over five years. Multiple regressions were performed to examine the temporal relationship of potential confounders on the relationship between smoking and depression and to empirically observe variables that could be intermediate on pathways between smoking and depression. A growth curve model was developed to test the effect of perceived self medication on changes in depression scores over time. Results: A concept map of the smoking and depression relationship in the NDIT cohort was developed according to the results of proportional hazard and fixed effect regressions in which friend smoking, stress, and anxiety-associated variables were identified as intermediate variables. Perceived self-medication was associated with decelerated rates of change of depressive symptoms over times, suggesting that smoking may increase mean levels of stress and depressive symptoms, but may offer the perception of control. Conclusion: In concert, this thesis suggests a model in which stress and the perceived control of psychobiological function using cigarettes lead to the development of increased depressive symptoms and increased cigarette use.Ph

LGBTQ2S+ Youth Perspectives on Mental Healthcare Provider Bias, Standards of Care, and Accountability

This study explores the experiences of LGBTQ2S+ youth while accessing mental health and substance use care services during the COVID-19 pandemic. Through a series of facilitated virtual meetings, 33 LGBTQ2S+ youth from across Ontario participated in collaborative activities to identify barriers they have experienced when accessing mental health services, as well as potential solutions to these barriers. Discussions were recorded, transcribed, and analyzed using thematic analysis. The study revealed that LGBTQ2S+ youth disproportionately experience bias, discrimination, and heteronormative assumptions when accessing mental health services, resulting in negative care experiences. Youth also reported insufficient availability of quality care, little continuity in care, and a lack of educated providers capable of effectively addressing the needs of the community. Potential solutions proposed by youth include training resources for providers, LGBTQ2S+ specific care centers, better continuity of care, and assessments to ensure care providers are culturally competent. These results show the COVID-19 pandemic has exacerbated the disparities LGBTQ2S+ youth experience when accessing mental health services and highlight the urgent need to implement policies and programs that will advance the standards of care for LGBTQ2S+ youth

How many cigarettes a day in an endgame?

Background Around the world, countries are setting endgame targets that look to bring smoking prevalence below a certain rate. Canada, for instance, has set a target of 5% smoking by 2035. However, what numbers of cigarettes smoked per day should countries expect as they approach these scenarios? The information is particularly important for government to understand the impacts of endgames on revenue. Methods A population change model was developed to predict change in cigarettes per day under endgame scenarios for the Province of Ontario, Canada. Population predictions were obtained from Statistics Canada for the period 2014-2035 including expected births, deaths, and immigration by age group (12-19, 20-34, 35-44, 45-64, 65+). Smoking prevalence was obtained from the 2014 Canadian Community Health Survey. Change in cigarettes per day was modelled scenarios assuming that the effects on cigarettes per day was consistent with prevalence change. Results To reach the tobacco endgame by 2035, it would be require for Ontario to go from 2.1 million smokers in 2014 to 700,000 smokers in 2035 with expected prevalence rates ranging from 1.8% among 12-19 year olds to 6.9% among 20-34 year olds. Average number of cigarettes per day was expected to be 4.0 cigarettes smoked per day on average by 2035 down from 13.3 cigarettes a day in 2014. Conclusions In the province of Ontario, it would be expected that the average remaining smoker in an endgame scenario would smoke 4 cigarettes per day. This analysis uses the same assumptions used to estimate the effects of tax on prevalence, but the effect of prevalence change on cigarette consumption may differ with other interventions. However, this analysis presents a challenge to the hardcore hypothesis