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In response to a change, individuals may choose to follow the responses of their friends or, alternatively, to change their friends. To model these decisions, consider a game where players choose their behaviors and friendships. In equilibrium, players internalize the need for consensus in forming friendships and choose their optimal strategies on subsets of k players—a form of bounded rationality. The k-player consensual dynamic delivers a probabilistic ranking of a game’s equilibria, and via a varying k, facilitates estimation of such games. Applying the model to adolescents’ smoking suggests that: (a) the response of the friendship network to changes in tobacco price amplifies the intended effect of price changes on smoking, (b) racial desegregation of high schools decreases the overall smoking prevalence, (c) peer effect complementarities are substantially stronger between smokers compared to between nonsmokers.

Abstract Introduction Cigarette brand variant names remain a key marketing tool despite restrictions under Article 13 of the EU Tobacco Products Directive. This study investigates whether variant names of popular cigarette brands evoke associations that violate the Directive's prohibitions on harm and flavour-related claims in the Netherlands Methods 1,354 participants (younger adult and adult daily smokers, younger adult non-daily smokers, and younger adult non-smokers) offered unprompted and prompted associations with 10 variants from three major brands to explore perceptions of harm and taste. Qualitative responses were coded and analysed, and quantitative comparisons assessed differences across variant types. Results Variant names referring to former ‘mild’ variant names (e.g., “Gold”, “Blue\") were perceived as less harmful than full-flavour variants (e.g., “Red\"). Variant names referring to former ‘menthol’ variants (e.g., “Green”, “Alpine\") elicited strong associations with menthol flavour, particularly among younger participants. Findings indicate systematic misperceptions about harm and flavour, contrary to regulatory intent. Conclusions This study highlights the continued influence of brand variant names on consumer perceptions, particularly among young smokers and non-smokers. Subtle linguistic and colour cues in variant names were found to reinforce these perceptions, undermining efforts to convey the universal harms of smoking. Policymakers could consider stricter regulation, such as mandating neutral numerical naming systems, to mitigate misleading associations and further reduce product appeal. Strengthened oversight can further align tobacco control policies with public health goals, advancing efforts to prevent smoking initiation and achieve a smoke-free generation. Key messages • Colour-cued variant names create predictable harm and flavour associations, particularly amongst young adults and non-smokers. • Young adult smokers more often smoke low tar and menthol variants.

Objectives. We explored young adults’ perceptions of snus (spitless moist snuff packed in porous bags), dissolvable tobacco products, and electronic cigarettes and intention to try these products. Methods. We conducted 11 focus group discussions involving a total of 66 young adults (18–26 years old) on these new tobacco products (e.g., harmfulness, potential as quit aids, intention to try) held between July and December 2010. We analyzed discussions using a thematic approach. Results. Participants generally reported positive perceptions of the new products, particularly because they came in flavors. Few negative perceptions were reported. Although some participants believed these products were less harmful than cigarettes and helpful in quitting smoking, others thought the opposite, particularly regarding electronic cigarettes. Participants also commented that these products could be gateways to cigarette smoking. Half of the participants, including a mix of smokers and nonsmokers, admitted they would try these products if offered by a friend. Conclusions. Young adults perceive the new tobacco products positively and are willing to experiment with them. Eliminating flavors in these products may reduce young adults’ intentions to try these products.

Background While discussion continues over the future implementation of lung cancer screening, low participation from higher risk groups could limit the effectiveness of any national screening programme. Objectives To compare smokers’ beliefs about lung cancer screening with those of former and never smokers within a low socioeconomic status (SES) sample, to explore the views of lower SES smokers and ex‐smokers in‐depth, and to provide insights into effective engagement strategies. Design, setting and participants Using proactive, community‐based recruitment methods, we surveyed 175 individuals from socioeconomically deprived communities with high smoking prevalence and subsequently interviewed 21 smokers and ex‐smokers. Participants were approached in community settings or responded to a mail‐out from their housing association. Results Interviewees were supportive of screening in principle, but many were doubtful about its ability to deliver long‐term survival benefit for their generation of “heavy smokers.” Lung cancer was perceived as an uncontrollable disease, and the survey data showed that fatalism, worry and perceived risk of lung cancer were particularly high among smokers compared with non‐smokers. Perceived blame and stigma around lung cancer as a self‐inflicted smokers’ disease were implicated by interviewees as important social deterrents of screening participation. The belief that lungs are not a treatable organ appeared to be a common lay explanation for poor survival and undermined the potential value of screening. Conclusions Attitudes towards screening among this high‐risk group are complex. Invitation strategies need to be carefully devised to achieve equitable participation in screening.

Many public health policies are rooted in findings from medical and epidemiological studies that fail to consider behavioral influences. Using nearly 50 years of data from the Framingham Heart Study's male participants, we evaluate the longevity consequences of different lifetime smoking patterns by jointly estimating smoking behavior and health outcomes over the life cycle, by richly including smoking and health histories, and by flexibly incorporating correlated unobserved heterogeneity. Unconditional difference-in-mean calculations that treat smoking behaviors as random indicate a 9.3-year difference in age of death between lifelong smokers and nonsmokers; our findings suggest the bias-corrected difference is 4.3 years.

Abstract Background Breast cancer screenings decrease mortality from the disease. In Finland, women aged 50-69 receive biennial invitations to the screening. Attendance varies between population groups, but factors related to non-attendance are insufficiently understood. More comprehensive information is needed to improve participation across population groups. This study aimed to determine lifestyle and wellbeing-related factors associated with non-attendance in the screening. Methods Data from the national Healthy Finland 2022-2023 survey were linked to breast cancer screening data from the Finnish Cancer Registry. A total of 5220 women aged 50-72 who participated in the survey and received a screening invitation within five years were included. Non-attendance was defined as not attending the latest screening. Results were presented as population-weighted prevalences (%) and 95% confidence intervals (CI) of non-attendance. Results Of the study sample, 8.8% did not attend the latest screening. Non-attendance was more common in women with low consumption of vegetables and fruit (15.2% (95% CI 8.8-21.5)) vs. high consumption (7.3 (6.0-8.7)), low physical activity (PA) (14.1 (9.7-18.4)) vs. high PA (7.8 (6.2-9.3)), current smokers (15.8 (12.2-19.4)) vs. non-smokers (7.6 (6.6-8.6)), very low social inclusion (Experiences of Social Inclusion Scale (ESIS)<50) (14.4 (10.2-18.6)) vs. ESIS≥50 (8.3 (7.2-9.3)). Conclusions Breast cancer screening attendance is generally high in Finland. As a novelty, this study linked national registry-based screening data to population-based survey data enabling the study of diverse determinants of non-attendance. Unhealthy lifestyle habits and low social inclusion are associated with non-attendance. Understanding the factors associated with it may help to identify and target non-attenders, ultimately improving attendance and early detection, and thus decrease breast cancer mortality. Key messages • Poor lifestyle habits and low social inclusion are associated with lower breast cancer screening attendance. Screening participation should be addressed as part of broader public health strategies. • Identifying factors that are associated with poor breast cancer screening attendance aids in tailoring strategies to promote attendance and decrease cancer mortality.

Cigarette smoking is associated with worse cognition and decreased cortical volume and thickness in healthy cohorts. Chronic cigarette smoking is prevalent in schizophrenia spectrum disorders (SSD), but the effects of smoking status on the brain and cognition in SSD are not clear. This study aimed to understand whether cognitive performance and brain morphology differed between smoking and non-smoking individuals with SSD compared to healthy controls. Data were obtained from the Australian Schizophrenia Research Bank. Cognitive functioning was measured in 299 controls and 455 SSD patients. Cortical volume, thickness and surface area data were analysed from T1-weighted structural scans obtained in a subset of the sample ( = 82 controls, = 201 SSD). Associations between smoking status (cigarette smoker/non-smoker), cognition and brain morphology were tested using analyses of covariance, including diagnosis as a moderator. No smoking by diagnosis interactions were evident, and no significant differences were revealed between smokers and non-smokers across any of the variables measured, with the exception of a significantly thinner left posterior cingulate in smokers compared to non-smokers. Several main effects of smoking in the cognitive, volume and thickness analyses were initially significant but did not survive false discovery rate (FDR) correction. Despite the general absence of significant FDR-corrected findings, trend-level effects suggest the possibility that subtle smoking-related effects exist but were not uncovered due to low statistical power. An investigation of this topic is encouraged to confirm and expand on our findings.

While there has been substantial analysis of social media content deemed to spread misinformation about electronic nicotine delivery systems use, the strategic use of misinformation accusations to undermine opposing views has received limited attention. This study aims to fill this gap by analyzing how social media users discuss the topic of misinformation related to electronic nicotine delivery systems, notably vaping products. Additionally, this study identifies and analyzes the actors commonly blamed for spreading such misinformation and how these claims support both the provaping and antivaping narratives. Using Twitter's (subsequently rebranded as X) academic application programming interface, we collected tweets referencing #vape and #vaping and keywords associated with fake news and misinformation. This study uses systematic content analysis to analyze the tweets and identify common themes and actors who discuss or possibly spread misinformation. This study found that provape users dominate the platform regarding discussions about misinformation about vaping, with provaping tweets being more frequent and having higher overall user engagement. The most common narrative for provape tweets surrounds the conversation of vaping being perceived as safe. On the other hand, the most common topic from the antivape narrative is that vaping is indeed harmful. This study also points to a general distrust in authority figures, with news outlets, public health authorities, and political actors regularly accused of spreading misinformation, with both placing blame. However, specific actors differ depending on their positionalities. The vast number of accusations from provaping advocates is found to shape what is considered misinformation and works to silence other narratives. Additionally, allegations against reliable and proven sources, such as public health authorities, work to discredit assessments about the health impacts, which is detrimental to public health overall for both provaping and antivaping advocates. We conclude that the spread of misinformation and the accusations of misinformation dissemination using terms such as \"fact check,\" \"misinformation,\" \"fake news,\" and \"disinformation\" have become weaponized and co-opted by provaping actors to delegitimize criticisms about vaping and to increase confusion about the potential health risks. The study discusses the mixed types of impact of vaping on public health for both smokers and nonsmokers. Additionally, we discuss the implications for effective health education and communication about vaping and how misinformation claims can affect evidence-based discourse on Twitter as well as informed vaping decisions.

Background Midlife cardiovascular risk factors (CVRF) are associated with late‐life cognitive impairment, but also mortality. We evaluated their association with cognitive decline in a diverse cohort of older adults who survived to age 80 without diagnosis of dementia. Method Three harmonized cohorts of long‐term Kaiser Permanente members were pooled and restricted to those aged 80+. We measured CVRF from Multiphasic Health Check‐ups (MHC; 1964‐1985), which assessed hyperlipidemia, hypertension, overweight/obesity, diabetes, and smoking status. Standardized z‐scores for executive function (EF) and verbal episodic memory (VEM) were measured over up to 8 waves (2017‐2023) using the Spanish and English Neuropsychological Assessment Scales. Linear mixed models with random intercepts and slopes associated CVRF, separately, with cognitive decline adjusting for age at MHC, age at cognitive assessment, race (Asian/Black/Latino/white/multiracial), education (≤high school/some college/≤college), assessment mode (in‐person/telephone), and practice effects. Sensitivity analyses evaluated the count of CVD risk factors stratified by smoking status. Result Participants (n = 935) averaged 40.6(±7.9) years of age at MHC, 88.0(±4.9) years at baseline cognitive assessment, and 61.4% were women (Table 1). At midlife, 47% had hyperlipidemia, 23% hypertension, 34% overweight/obese, 1% diabetes, and 51% ever smoked. Hyperlipidemia was associated with worse baseline EF (β(95% CI):‐0.24(‐0.36,‐0.12)), smoking was associated with better EF (β:0.13(0.01,0.25)), and hypertension was associated with worse EF (β:‐0.14(‐0.25, 0.002)), though the effect was not statistically significant (Table 2). There were no associations between CVRF and EF decline. Hyperlipidemia was the only CVRF associated with worse baseline VEM (β:‐0.18(‐0.31,‐0.05)), and no CVRF was associated with VEM decline (Table 2). Despite smokers having higher baseline EF compared to nonsmokers, having 3+ CVRF was associated with steeper decline in both groups compared to those with fewer CVRF (Figure 1). Baseline VEM was similar between smokers and non‐smokers, and for both smokers and nonsmokers, the steepest declines in VEM were among those with one CVRF. Conclusion In this diverse cohort, midlife hyperlipidemia was associated with worse cognition in late life. A positive association between smoking and EF may be indicative of resilience among midlife smokers who have reached age 80+. Regardless of smoking status, multiple CVD risk factors may be detrimental to cognitive function, particularly EF.

Smoking tobacco is regarded as an epiphenomenon in patients with schizophrenia when it may be causal. We aimed to examine whether smoking status is related to the onset of schizophrenia or the broader diagnosis of non-affective psychosis, including schizophrenia. We used data from The Health Improvement Network primary care database to identify people aged 15-24 between 1 January 2004 and 31 December 2009. We followed them until the earliest of: first diagnosis of schizophrenia (or psychosis), patient left the practice, practice left THIN, patient died or 31 December 2014. In men, incidence rates for schizophrenia per 100 000 person years at risk were higher in smoking initiators (non-smoker who became a smoker during the study) than in non-smokers (adjusted IRR 1.94; 95% CI 1.29-2.91) and higher still in smokers (adjusted IRR 3.32; 95% CI 2.67-4.14). Among women, the incidence rate of schizophrenia was higher in smokers than in non-smokers (adjusted IRR 1.50; 95% CI 1.06-2.12), but no higher in smoking initiators than non-smokers. For non-affective psychosis, the pattern was similar for men but more evident in women where psychosis incidence rates were higher in smoking initiators (adjusted IRR 1.90; 95% CI 1.40-2.56) and in smokers (adjusted IRR 2.13; 95% CI 1.76-2.57) than in non-smokers. We found an important and strong association between smoking and incidence of schizophrenia. Smoking may increase risk through as yet unknown pathways or smoking may share genetic risk with schizophrenia and non-affective psychoses.