Jean-François Etter

Background: Cannabis use is widespread and driven by diverse motives, ranging from recreational purposes to coping with psychological distress. Understanding the underlying reasons for cannabis use, their distribution across different subgroups of people who use cannabis, and how they relate to possible behavior change is essential for developing effective prevention and intervention strategies such as smartphone apps designed to support change. Objective: The primary objective of the study was to determine whether analyzing profiles on the “Stop-cannabis” app (Institute of Global Health, University of Geneva, Switzerland) could reveal subgroups based on motives for cannabis use and readiness to change. A secondary objective was to explore differences among these subgroups in terms of problematic use and other indicators of change readiness. Methods: This study analyzed data from 2578 individuals using the ”Stop-cannabis app”, a mobile app developed in Switzerland to support those seeking to manage their cannabis use. Participants completed validated questionnaires assessing motives for use (Marijuana Motives Measure [MMM]), readiness to change (Stages of Change Readiness and Treatment Eagerness Scale [SOCRATES]), and risk of problematic use (Alcohol, Smoking, and Substance Involvement Screening Test [ASSIST]). They also self-rated their “readiness for action,” the “importance of change,” and their “confidence in their ability to change.” These assessments were part of the app’s intervention model, with personalized feedback delivered based on participants’ responses; no external incentives were offered. Cluster analysis was conducted to identify subgroups based on MMM and SOCRATES scores. Results: In total, 3 distinct profiles emerged: the “individually coping users” (ICU), the “social and coping users” (SCU), and the “enhancement-seeking users” (ESU). ICU and SCU scored higher on coping motives compared with ESU, along with greater ambivalence and stronger recognition of problematic use, as measured by SOCRATES. They also scored higher on the ASSIST (indicating greater risk of problematic cannabis use), placed more importance on making behavioral changes, yet reported lower confidence in their ability to enact those changes. By contrast, ESU primarily used cannabis for recreational reasons and had low recognition of problematic use, despite being at moderate risk. Conclusions: This research highlights that while motives for cannabis use are varied and individually nuanced, distinct subgroups can be identified, each with specific challenges. The findings align with previous research emphasizing the importance of coping motives in behavior change. Tailoring app content to reflect the unique profiles and needs of each subgroup may improve intervention outcomes. For instance, SCU and ICU may benefit from strategies targeting emotion regulation and alternative coping mechanisms, whereas ESU may respond better to brief motivational feedback and harm reduction strategies. Such tailored approaches can enhance the effectiveness of digital tools in promoting meaningful and long-term behavior change.

Introduction: Despite the important role that healthcare professionals play in smoking cessation strategies, recent reports from several countries show misperceptions about nicotine, pharmacotherapy for smoking cessation and novel nicotine products, but little is known about such knowledge gaps...

Aims: Transnational alcohol and tobacco corporations are expanding operations in Southeast Asia. This study has two objectives: to examine the power of the tobacco and alcohol industries in shaping tobacco and alcohol policies in the Philippines and Singapore, and to identify key lessons and challenges for alcohol and tobacco control. Methods:  We developed a conceptual framework from the literature on power and political, commercial, and legal determinants of health. We conducted a literature review and content analysis of official government documents, corporate documents, and news articles on the tactics of the alcohol and tobacco industries. To triangulate findings, we also conducted a thematic analysis of 30 interviews that we conducted in the Philippines and Singapore. Findings:  Transnational and national alcohol and tobacco corporations used various tactics to influence the policy process for alcohol and tobacco control in the Philippines and Singapore. These industries utilised lobbying, litigation or threat of litigation, revolving doors, and marketing to exercise their instrumental power. They exercised their structural power by exploiting their market dominance and promoting public-private partnerships and alcohol marketing self-regulation. In the Philippines, the tobacco industry benefitted from regulatory capture. Both industries tapped framing tactics, corporate social responsibility, and public-private partnerships to exert their discursive power. Conclusions: Our study detailed how the alcohol and tobacco industries have exercised their instrumental, structural, and discursive power to influence and interfere in alcohol and tobacco control policies in the Philippines and Singapore. Less regulated, the alcohol industry retains an advantage over the tobacco industry in both countries.

Introduction: Studies of the users’ engagement with smoking cessation application (apps) can help understand how these apps are used by smokers, in order to improve their reach and efficacy. Objective: The present study aimed at identifying the best predictors of the users’ level of engagement with a smartphone app for smoking cessation and at examining the relationships between predictors and outcomes related to the users’ level of engagement with the app. Methods: A secondary analysis of data from a randomized trial testing the efficacy of the Stop-Tabac smartphone app was used. The experimental group used the “full” app and the control group used a “dressed down” app. The study included a baseline and 1-month and 6-month follow-up questionnaires. A total of 5,293 participants answered at least the baseline questionnaires; however, in the current study, only the 1,861 participants who answered at least the baseline and the 1-month follow-up questionnaire were included. Predictors were measured at baseline and after 1 month and outcomes after 6 months. Data were analyzed using machine learning algorithms. Results: The best predictors of the outcomes were, in decreasing order of importance, intention to stop smoking, dependence level, perceived helpfulness of the app, having quit smoking after 1 month, self-reported usage of the app after 1 month, belonging to the experimental group (vs. control group), age, and years of smoking. Most of these predictors were also significantly associated with the participants’ level of engagement with the app. Conclusions: This information can be used to further target the app to specific groups of users, to develop strategies to enroll more smokers, and to better adapt the app’s content to the users’ needs.

This paper critically analyses a statement by Australia's National Health and Medical Research Council (NHMRC) on e‐cigarettes in May 2022 that will be used to guide national policy. We reviewed the evidence and the conclusions drawn in the NHMRC Statement. In our view, the Statement is not a balanced reflection of the benefits and risks of vaping because it exaggerates the risks of vaping and fails to compare them to the far greater risks of smoking; it uncritically accepts evidence of harms from e‐cigarettes while adopting a highly sceptical attitude towards evidence of their benefits; it incorrectly claims that the association between adolescent vaping and subsequent smoking is causal; and it understates the evidence of the benefits of e‐cigarettes in assisting smokers to quit. The Statement dismisses the evidence that vaping is probably already having a positive net public health effect and misapplies the precautionary principle. Several sources of evidence supporting our assessment were published after the NHMRC Statement's publication and are also referenced. The NHMRC Statement on e‐cigarettes does not present a balanced assessment of the available scientific literature and fails to meet the standard expected of a leading national scientific body.

The COVID-19 pandemic exposed a multitude of vulnerabilities in Switzerland’s decentralized healthcare system and highlighted the urgent need to strengthen Switzerland’s capacity to respond to health crises and disease outbreaks. In this article, we draw on three distinct areas of analysis of the current functioning of the Swiss healthcare system to examine its strengths and weaknesses, which can serve as a basis for future considerations and strategic priorities. First, we analyze the different levels of nine non-pharmaceutical interventions (NPIs), as defined by the ETH KOF Stringency Index and implemented in the Swiss cantons of Zurich, Vaud, and Ticino, compared with the rate of positive COVID-19 cases, hospitalizations, and deaths. We find that there was no strong correlation between the severity of the nine non-pharmaceutical interventions implemented and lower rates of positive COVID-19 cases, hospitalizations, and deaths. Second, we examine the challenges of Switzerland’s decentralized healthcare system through a literature review and with empirical data obtained from semi-structured interviews with health professionals in Switzerland. We conclude our analysis with the role of central authorities during the COVID-19 pandemic. The results demonstrate that during a national emergency in Switzerland, taking into account other factors that influence the success of a pandemic strategy, there is an opportunity for a more unified, centralized response to reduce the social and economic toll of the pandemic without necessarily risking greater health damage. We recommend that the Swiss federal government use a combination of decentralized and centralized public health and policy approaches and promote greater private–public collaboration with direct communication channels among policymakers, public health stakeholders, and the public to improve pandemic preparedness and response.