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AbstractSudan is one of the Islamic countries where extramarital sex is religiously forbidden and socially unacceptable. However, increasing numbers of university students become engaged in premarital sex practices, which increases their risk of contracting STIs, including HIV, and puts them into conflicts with their religious beliefs. As little is known about the motivations for abstinence from premarital sex, this study aimed to identify these psychosocial determinants. Using a cross-sectional design, a sample of 257 students between18 and 27 years old was recruited from randomly selected public and private universities in Khartoum. The participants filled out an online questionnaire based on the Integrated Change Model (ICM) to assess their beliefs and practices about abstinence from premarital sex. The analysis of variances (MANOVA) showed that the students who reported being sexually active differed significantly from abstainers in having more knowledge about HIV/AIDS, higher perception of susceptibility to HIV, more exposure to cues that made them think about sex and a more positive attitude towards premarital sex. The abstainers had a significantly more negative attitude towards premarital sex, higher self-efficacy to abstain from sex until marriage and perceived more peer support and norms favouring abstinence from sex until marriage. These findings suggest that promoting abstinence from sex until marriage among university students in Sudan, which aligns with the Sudanese religious values and social norms, requires health communication messages addressing these potential determinants. However, given that sexual encounters still may occur, health communication messages may profit from a more comprehensive approach by also addressing the need for condom use for those unwilling to refrain from sex.

This paper reviews data published between 1990 and 2006 regarding smoking prevalence as well as individual and contextual influences on the smoking behavior among Romanian young adults. Highlights include a consideration of multiple levels of influence, from intra-individual factors, such as demographic and cognitive factors, to social influences, such as families and peers, to the more macro, societal/cultural levels of influence, including advertising and tobacco-related policies The source of data is represented by articles and short information published in journals or in electronic format, legislation, statistics and are illustrated with pictures. Based on these data, recommendations for future smoking prevention and reduction actions for Romanian youth are taken.

Aims To study the impact of implementing smoke-free workplace and hospitality industry legislation on smoking behaviour. Design, setting and participants A cross-sectional population survey from 2001 to 2008 (n approximate to 18 000 per year) was used to assess trends and seasonal patterns in smoking and quitting, and to examine whether changes could be observed after the workplace smoking ban in the Netherlands in 2004 and the hospitality industry ban in 2008. Measurements Outcome measures were smoking prevalence, quit attempts and successful quit attempts. Interactions with educational level (socio-economic status) and bar visiting (exposure to the hospitality industry ban) were tested. Findings The workplace ban was followed by a decrease in smoking prevalence (OR = 0.91, P <0.001), but the hospitality industry ban was not (OR = 0.96, P = 0.127). Both bans, especially the workplace ban, were followed by an increase in quit attempts and successful quit attempts: workplace ban, OR = 1.31, P <0.001; OR = 1.49, P <0.001; hospitality industry ban, OR = 1.13, P = 0.013; OR = 1.44, P <0.001. The workplace ban had a larger effect on successful quitting among higher-educated (OR = 0.35, P <0.001) than on lower-educated respondents (OR = 0.74, P = 0.052). The hospitality industry ban had a larger effect on quit attempts among frequent bar visitors (OR = 1.48, P = 0.003) than on non-bar visitors (OR = 0.71, P = 0.014). Conclusions A workplace smoking ban in the Netherlands was followed by more changes in smoking and quitting than a hospitality industry ban. The hospitality industry ban only appeared to have an impact on quit attempts, and not on smoking prevalence.

Purpose: To investigate the direct and indirect effects of sociodemographic/health factors on diet quality through practical nutrition knowledge (PNK) about how to compose a balanced meal. Design: A cross-sectional study using data from an online survey of the 10 000 Steps cohort (data collected November-December 2016). Setting: Australia. Participants: Adults (n = 8161). Response rate was 16.7%. Measures: Self-reported lifestyle, health, and sociodemographic characteristics, including diet quality and PNK. Analysis: The PROCESS macro for SPSS was used to conduct the mediation analyses. Results: Better diet quality was associated with being female, older, more highly educated, and having a lower body mass index. Mediation analysis showed that PNK significantly mediated the associations between sex (a*b = 0.54, 95% confidence interval [CI] = 0.39-0.70) and education (vocational education: a*b = 0.22, 95% CI = 0.12-0.35, university: a*b = 0.48, 95% CI = 0.35-0.64), and diet quality. Practical nutrition knowledge suppressed the association between age and diet quality (a*b = −0.03, 95% CI = −0.04 to −0.03). Conclusion: Variations in diet quality between sociodemographic groups were partially explained by differences in PNK, suggesting that focusing public health efforts on increasing this specific knowledge type might be promising.

Background As a legal obligation, the Dutch government publishes online information about tobacco additives to make sure that it is publicly available. Little is known about the influence this website (tabakinfo) has on visitors and how the website is evaluated by them. Objective This study assesses how visitors use the website and its effect on their knowledge, risk perception, attitude, and smoking behavior. The study will also assess how the website is evaluated by visitors using a sample of the Dutch general population, including smokers and nonsmokers. Methods A randomized controlled trial was conducted, recruiting participants from an online panel. At baseline, participants (N=672) were asked to fill out an online questionnaire about tobacco additives. Next, participants were randomly allocated to either one of two experimental groups and invited to visit the website providing information about tobacco additives (either with or without a database containing product-specific information) or to a control group that had no access to the website. After 3 months, follow-up measurements took place. Results At follow-up (n=492), no statistically significant differences were found for knowledge, risk perception, attitude, or smoking behavior between the intervention and control groups. Website visits were positively related to younger participants (B=-0.07, 95% CI -0.12 to -0.01; t(11)=-2.43, P=.02) and having a low risk perception toward tobacco additives (B=-0.32, 95% CI -0.63 to -0.02; t(11)=-2.07, P=.04). In comparison, having a lower education (B=-0.67, 95% CI -1.14 to -0.17; t(11)=-2.65, P=.01) was a significant predictor for making less use of the website. Furthermore, the website was evaluated less positively by smokers compared to nonsmokers (t(324)=-3.55, P<.001), and males compared to females (t(324)=-2.21, P=.02). Conclusions The website did not change perceptions of tobacco additives or smoking behavior. Further research is necessary to find out how online information can be used to effectively communication about the risks of tobacco additives.

Introduction: Little is known about the extent to which smoking restrictions are socially accepted in a country such as the Netherlands where smoking restrictions have been implemented and reversed several times. The current study assessed trends as well as factors associated with two indicators of social acceptance of smoking restrictions in the Netherlands: acceptance of smoking in public places and implementation of home smoking bans. Methods: We used data from the Dutch Continuous Survey of Smoking Habits (DCSSH) between 2005 and 2014 (n = 182 826). The DCSSH is a national population survey with a cross-sectional design in which respondents aged 15 years and older are surveyed weekly. Results: Acceptance of smoking in public places decreased for six out of eight included venues, with the largest decrease for smoking in restaurants. The decrease in acceptance was larger among younger respondents and smokers. Smoking on terraces was an exception: decrease in acceptance there was larger among older respondents and ex-smokers. Implementation of home smoking bans increased over time. Having implemented a home smoking ban was associated with being male, being younger, having a high socioeconomic status, and being ex-or never smoker. Conclusions: Social acceptance of smoking restrictions has increased in the Netherlands, despite a suboptimal implementation process of smoking restrictions. However, there is still potential for improvement as acceptance of smoking is still quite high for some public venues like bars. It is important to strengthen smoking restrictions in order to further denormalize smoking in the Netherlands. Implications: We examined the extent to which smoking restrictions are socially accepted in the Netherlands where smoking restrictions have been implemented and reversed several times. Acceptance of smoking in public places decreased and implementation of home smoking bans increased between 2005 and 2014. Social acceptance of smoking restrictions increased in the Netherlands despite a suboptimal ...

The objectives of this study are assessing of internet use among Romanian patients from general practitioners as well as their intention to use or recommend the first computer tailored program for smoking cessation from Romania. The study involved 200 patients from general practitioners from Cluj-Napoca, Romania. A cross-sectional study was performed in 2014 through anonymous questionnaires. More than 80% of the patients declared using internet, while half were searching on internet in the last month information regarding healthy lifestyle. The prevalence of smoking was 29.5%. One out of two smokers declared intention to try the program for smoking cessation, this intention being higher among smokers with a stronger intention to quit smoking in the next 6 months, having email-address and searching healthy lifestyle information on internet in the last month. Two thirds of the participants agreed that they would inform other persons about the smoking cessation program; this intention was higher among women and among those interested in healthy lifestyle information on internet. Information technology could be use for healthy lifestyle promotion among patients from big cities of Romania, where internet access and interest for computer tailored programs for health promotion look promising.

BACKGROUND: As of May 2016, pictorial health warnings (PHWs) showing the harms of smoking were implemented in the European Union. After one year they had to be fully implemented. We studied changes in awareness of the health risks of smoking after implementation of PHWs among smokers from the Netherlands, whether the trend before the implementation changed after the implementation, and whether there were differences between subgroups. METHODS: We used survey data from six yearly waves of the International Tobacco Control (ITC) Netherlands Survey from 2012 to 2017. The number of participating smokers ranged between 1236 and 1604 per wave. Data were analyzed using Generalized Estimating Equations (GEE) analyses. RESULTS: Indicators of awareness of the health risks of smoking that did not change between 2015 and 2017 were perceived susceptibility (β = 0.043, p = 0.059) and perceived severity (β = − 0.006, p = 0.679) regarding lung problems. Perceived susceptibility, however, was more pronounced between 2015 and 2017 than between 2012 and 2015(p value of interaction: p = 0.044). Noticing information about the dangers of smoking (β = 0.119, p < 0.001) and knowledge about the health risks of smoking (β = 0.184, p < 0.001) increased between 2015 and 2017. These increases were both more pronounced when compared to 2012–2015 (p values of interactions: p = 0.002 and p < 0.001 respectively). Compared to high educated smokers, low educated smokers (β = − 1.137, p < 0.001) and moderate educated smokers (β = − 0.894, p < 0.001) were less knowledgeable about the health risks of smoking in 2016 and 2017. CONCLUSIONS: Introducing PHWs coincided with an increase in smokers' knowledge about the health risks of smoking. Dutch tobacco control policy and campaigns should focus on improving Dutch smokers' awareness of the health risks of smoking even more, especially among low educated smokers.

Background As of May 2016, pictorial health warnings (PHWs) showing the harms of smoking were implemented in the European Union. After one year they had to be fully implemented. We studied changes in awareness of the health risks of smoking after implementation of PHWs among smokers from the Netherlands, whether the trend before the implementation changed after the implementation, and whether there were differences between subgroups. Methods We used survey data from six yearly waves of the International Tobacco Control (ITC) Netherlands Survey from 2012 to 2017. The number of participating smokers ranged between 1236 and 1604 per wave. Data were analyzed using Generalized Estimating Equations (GEE) analyses. Results Indicators of awareness of the health risks of smoking that did not change between 2015 and 2017 were perceived susceptibility (beta = 0.043, p = 0.059) and perceived severity (beta = - 0.006, p = 0.679) regarding lung problems. Perceived susceptibility, however, was more pronounced between 2015 and 2017 than between 2012 and 2015(p value of interaction: p = 0.044). Noticing information about the dangers of smoking (beta = 0.119, p <0.001) and knowledge about the health risks of smoking (beta = 0.184, p <0.001) increased between 2015 and 2017. These increases were both more pronounced when compared to 2012-2015 (p values of interactions: p = 0.002 and p <0.001 respectively). Compared to high educated smokers, low educated smokers (beta = - 1.137, p <0.001) and moderate educated smokers (beta = - 0.894, p <0.001) were less knowledgeable about the health risks of smoking in 2016 and 2017. Conclusions Introducing PHWs coincided with an increase in smokers' knowledge about the health risks of smoking. Dutch tobacco control policy and campaigns should focus on improving Dutch smokers' awareness of the health risks of smoking even more, especially among low educated smokers.