Experimentation with smoking during adolescence has been linked to an increased likelihood of nicotine dependence, often persisting in adulthood.To assess students’ susceptibility to smoking and to analyze associated factors.A cross-sectional study was conducted from April to June 2025. A convenience sample of 638 students aged 12-16 years was selected from 6 schools. Data was collected using a structured questionnaire including sociodemographic, social/environmental and personal variables. The Expanded Susceptibility to Smoking Index (ESSI) was utilized for non-smoking students to identify those at risk of starting smoking cigarettes and related products, with higher scores indicating higher susceptibility to smoking. Regression analysis was used to examine the factors associated with smoking susceptibility.Of the 638 participants, 431 (68%) had never tried tobacco, 199 (31%) had tried tobacco products, and 95 (15%) had smoked them in the previous 30 days. Among the non-smokers, 50% and 51% presented medium–high ESSI scores for cigarettes and e-cigarettes, respectively, and 11% presented medium–high ESSI scores for nicotine pouch use. A higher ESSI score for cigarette smoking was associated with older age (OR=1.460,95%CI=1.223-1.742,p<0.001), household exposure to smoking (OR=1.637,95%CI=1.085-2.468,p= 0.019), second hand smoke in public outdoor places (OR=2.019,95%CI=1.285-3.175,p=0.002), having friends who smoke (OR=2.221,95%CI=1.399-3.527,p<0.001) and receiving an offer to smoke within the last 30 days (OR=3.188,95%CI=1.137-8.935,p=0.027). A higher ESSI score for e-cigarettes was associated with older age (OR=1.374,95%CI=1.158-1.629,p<0.001) household exposure to smoking (OR=1.909,95%CI=1.219-2.990, p=0.005), second hand smoke in public indoor places (OR=1.736,95%CI=1.158-2.603,p=0.008), having friends who smoke (OR=2.307,95%CI=1.524-3.493,p<0.001) and receiving an offer to smoke within the last 30 days (OR=2.511,95%CI =1.169-5.396,p=0.018). A higher ESSI score for nicotine pouches was associated with male gender (OR=3.131,95%CI=1.590-6.164,p<0.001) and inversely associated with the perception that nicotine pouches were likely to have an effect on health (OR=0.074,95%CI=0.019-0.280,p<0.001).A significant number of students who have not tried tobacco have some degree of susceptibility to smoking, positively associated with older age, smoking among family members and friends, and exposure to second-hand smoke.Policymakers could utilize our findings to develop more targeted prevention programs by considering the impact of the social environment and intrapersonal factors on smoking susceptibility.

Smoking cessation is often accompanied by withdrawal symptoms, increased perceived stress, and difficulty maintaining abstinence. Non-pharmacological interventions such as breathing exercises are increasingly used to support individuals during this critical transition, yet their contribution to stress reduction and cessation success remains insufficiently studied. Understanding their potential value may strengthen behavioral support strategies used in primary care smoking cessation services.This study aimed to evaluate the effectiveness of structured breathing exercises in reducing perceived stress during the early phase of smoking cessation and to determine whether these exercises contribute to smoking cessation success at one month.This prospective study included adults aged 18–65 years who presented to smoking cessation clinics between April and July 2019. Sociodemographic characteristics, the Fagerström Test for Nicotine Dependence, and baseline Perceived Stress Scale (PSS-14) scores were recorded. PSS was reassessed at the first week, second week, and first month. Participants were categorized into two groups based on whether they regularly practiced the recommended breathing exercises. Within-group changes in stress levels were analyzed using paired statistical tests. Between-group comparisons and one-month cessation outcomes were assessed using chi-square tests.Breathing exercises were particularly effective during the first week, when withdrawal symptoms are most intense. The rapid reduction in perceived stress supports the use of simple, low-cost breathing techniques as an adjunct in early cessation. However, the lack of difference in cessation outcomes suggests that stress reduction alone may not independently determine cessation success. The imbalance in baseline stress levels and short follow-up period may have influenced results.Breathing exercises were particularly effective during the first week, when withdrawal symptoms are most intense. The rapid reduction in perceived stress supports the use of simple, low-cost breathing techniques as an adjunct in early cessation. However, the lack of difference in cessation outcomes suggests that stress reduction alone may not independently determine cessation success. The imbalance in baseline stress levels and short follow-up period may have influenced results.Breathing exercises reduced perceived stress during the early stages of smoking cessation but did not increase one-month cessation success. Larger, longer-term randomized studies are needed to clarify their potential contribution to sustained abstinence.

Smoking cessation services face the challenge of vaping being perceived as “not smoking,” a misconception for which youth lungs pay the price and which drives EVALI (e-cigarette or vaping product use–associated lung injury).To map and synthesize the existing evidence on youth vaping–related EVALI with a primary care and family medicine perspective.A scoping review following PRISMA-ScR guidelines used an AI-based platform to analyze recent, diverse evidence on EVALI. Searches in Scopus, PubMed, and DergiPark yielded 519 records, with 71 English-language studies from 2019 to 2025 included. These studies, comprising observational, clinical, epidemiological, review, and case series reports, focused on EVALI outcomes in adolescents and adults using e-cigarettes or vaping products. Study selection employed systematic Boolean search strategies, and results were synthesized descriptively and thematically.Most studies were conducted in high-income countries, mainly the United States(n = 46), England(n = 12),and Türkiye(n = 4). Publication numbers peaked in 2020(n = 30) and 2021(n = 17) before declining after2022.The evidence base was largely driven by public health institutions, led by the Centers for Disease Control and Prevention (CDC) (n = 11), medicine (n = 7),and pediatrics (n = 7),while general practice was minimally represented(n = 1).The mean number of authors per publication was 8.03 ± 7.47 (IQR: 7),reflecting predominantly large,multi-author research teams.Thematic analysis identified eight major themes.The dominant theme was exposure to ENDS and vaping, including nicotine and THC/cannabis use and inhalational exposure to chemical constituents such as vitamin E acetate.Clinical presentation and disease severity ranged from acute lung injury and ARDS to hypoxia,ICU admission, prolonged hospitalization, and mortality.Diagnostic imaging frequently reported chest CT findings, particularly ground-glass opacities, with bronchoscopy and bronchoalveolar lavage used in selected cases. Additional themes included outbreak-driven epidemiology,adolescents and young adults as key risk groups, diagnostic overlap with COVID-19,psychosocial influences on vaping behaviors,and treatment strategies primarily based on supportive care and corticosteroids.EVALI represents a missed prevention opportunity rather than solely a tertiary-care diagnosis, highlighting the critical role of family medicine in early identification through routine vaping assessment in adolescents.Ask early.Advise clearly.Prevent EVALI in primary care.

Tobacco use remains one of the leading preventable causes of morbidity and mortality worldwide. In recent years, the increasing consumption of new tabaco and nicotine products, such as heated tobacco products, electronic cigarettes and nicotine pouches, has raised particular concern among adolescents and young adults. These products are often perceived as less harmful, contributing to earlier initiation, dual use and sustained nicotine dependence. Primary care, particularly family medicine, plays a central role in prevention, early identification and intervention, requiring a comprehensive and age-adapted approach.To highlight the importance of a comprehensive, multidisciplinary and preventive approach to tobacco and new nicotine product use among adolescents and young adults, emphasizing the role of family medicine in health promotion, risk reduction and behavior change.Narrative review of the literature combined with clinical experience from primary care practice and intensive smoking cessation counseling, focusing on epidemiology, determinants of use, health impacts, and effective preventive and therapeutic interventions targeting adolescents and young adults. Evidence-based strategies implemented in family medicine settings were analyzed, including brief interventions, motivational interviewing, family involvement and community-based actions.The literature demonstrates a growing prevalence of new nicotine product use among young populations, often associated with misinformation, social influence and targeted marketing. Evidence supports that comprehensive interventions — integrating individual counseling, family engagement, school and community involvement, and public health policies — are more effective than isolated actions.In primary care, brief opportunistic interventions, non-judgmental communication, and tailored prevention strategies improve awareness, reduce initiation and support cessation. Addressing psychosocial factors and comorbid risk behaviors is essential for long-term effectiveness.A comprehensive approach to the prevention and control of tobacco and new nicotine product use among adolescents and young adults is essential. Family physicians are uniquely positioned to intervene early, promote health literacy and coordinate preventive strategies across individual, family and community levels. Strengthening training, resources and integrated policies in primary care is crucial to reduce nicotine dependence and its long-term health consequences.

Tobacco use, including cigarette smoking and electronic cigarette use, often begins during adolescence and remains a major preventable cause of morbidity. Despite regular contact with adolescents and their families, primary care settings frequently miss opportunities to identify and address youth smoking and vaping due to communication barriers, confidentiality concerns, and time constraints.To synthesize the literature on communication-based strategies used in primary care to identify, prevent, and address smoking and vaping among adolescents.We conducted a narrative literature review using a structured search of PubMed, including studies published between 2010 and 2025. Search terms combined adolescents, smoking or vaping, primary care, and communication-based interventions. Quantitative, qualitative, and mixed methods studies relevant to family medicine practice were included, while studies conducted exclusively outside primary care settings or without a communication component were excluded. Two reviewers independently screened and synthesized eligible studies, with a third reviewer providing oversight and resolving discrepancies.A total of 17 studies were included. Four key themes emerged. First, routine tobacco screening in primary care often under detects electronic cigarette use, highlighting the need for confidential and adolescent focused approaches. Second, brief communication strategies delivered by primary care clinicians, such as motivational interviewing, were feasible and more consistently implemented than referral-based interventions. Third, family focused communication influenced adolescent smoking behaviours, particularly in households with parental smoking. Fourth, digital and blended interventions linked to primary care visits showed promise in improving adolescent engagement. Findings should be interpreted considering heterogeneity across study designs and potential publication bias.Adolescent smoking and vaping are shaped by communication dynamics between adolescents, caregivers, and primary care clinicians. Strengthening communication within this triad may improve early identification and support timely intervention in primary care.Primary care can support adolescents who smoke or vape through confidential screening, brief counselling delivered by clinicians, family focused communication, and integration of digital tools. Communication based strategies offer practical and scalable opportunities for prevention and early intervention in routine primary care practice.

Tobacco addiction remains a preventable global public health problem. In recent years, growing concern has emerged regarding the increasing use of electronic cigarettes (e-cigarettes) among young people.This study aimed to investigate the prevalence of tobacco and e-cigarette use among university students, their willingness to quit, their awareness of available professional counselling support, and their knowledge related to e-cigarettes.This cross-sectional study was conducted between March and June 2024 at a public university in Turkey with participation of 1144 students. Stratified and cluster sampling methods were used. Data were collected via face-to-face questionnaires assessing sociodemographic characteristics, tobacco use behaviours, attempts to quit, the Fagerstrom Test for Nicotine Dependence, and 14 e-cigarette knowledge statements. Informational leaflets on cessation support and e-cigarette harms were provided to participants following the surveyOverall, 40.6% reported current use of any tobacco product and 24.3% reported e-cigarette use; among cigarette smokers, 74.4% had low/very-low dependence. Although 72.8% wished to quit, only 36.9% knew how to access medical counselling and 22.3% had received quit advice in the past year. In multivariable analyses, higher academic year, male gender, and lower-perceived-economic-status were associated with greater odds of tobacco use, while female gender and studying in the Faculty of Medicine were associated with lower odds of tobacco use. E-cigarette use was primarily motivated by flavour, curiosity, and, to a lesser extent, smoking cessation.This study revealed that, despite the sales ban in Turkey, exposure to e-cigarettes has rapidly increased among university students and multi-product tobacco use is widespread. Although most users were willing to quit, they were unaware of available professional support, highlighting the need to improve access to cessation services. These findings emphasize the importance of campus-based interventions, including expanding smoke-free policies, strengthening access to counselling, and ensuring routine cessation advice in student health clinicsTobacco product use remains widespread among university students, with a growing preference for new-generation products such as e-cigarettes. However, low nicotine dependence levels and high willingness to quit represent a valuable intervention opportunity. Comprehensive university-based programs focused on prevention, awareness, and smoking cessation support are essential to promote healthy lifestyle behaviours in young adults.

Healthcare providers (HCPs) play a central role in supporting smokers to quit through behavioural counselling and pharmacological interventions. Evidence shows that smokers achieve higher quit rates when assisted by trained professionals. However, the level of HCPs’ knowledge, attitudes and counselling skills related to smoking cessation in the study area remains unclear.To assess the knowledge, attitudes and practices (KAP) of HCPs regarding smoking cessation intervention strategies in the Sol Plaatje district, Northern Cape. Setting: Thirteen primary healthcare clinics within the Sol Plaatje Local Municipality, Kimberley, Northern Cape.A descriptive, cross-sectional analytical study was conducted among healthcare workers in these facilities using a structured questionnaire.Of the 165 eligible HCPs invited, 156 completed the questionnaire. Over half (53.9%) were unaware of the South African tobacco cessation guidelines, although 87.2% recognised the importance of counselling patients about smoking and its role in quitting. Most respondents lacked knowledge of the pharmacological treatments recommended for tobacco dependence in South Africa. While 89.7% agreed that smoking cessation counselling is an essential part of their role, fewer than half reported arranging follow-up for patients attempting to quit.Smoking cessation counselling and pharmacological treatment by healthcare providers (HCPs) are essential for helping smokers quit. This study found that many HCPs had limited knowledge of smoking cessation guidelines and pharmacological options, despite recognising the importance of counselling and its effectiveness. While HCPs understood key health risks of smoking, including its impact on pregnancy and tuberculosis, overall knowledge remained poor. Major barriers identified included a lack of training, inadequate access to guidelines, limited community support resources, and insufficient educational materials. Smoking among HCPs further hindered cessation efforts. Strengthening training and guideline implementation is critical to improving smoking cessation support.Significant gaps exist in HCPs’ knowledge, attitudes and practices relating to smoking cessation. These findings highlight the need for strengthened continuing education and improved dissemination of national smoking cessation guidelines.