BACKGROUND:Tobacco use is closely linked to social and health inequalities, including economic vulnerability, morbidity, and premature death. Young adults with disabilities experience significant social and material hardships, which may be exacerbated by tobacco use. Limited research exists on smoking and e-cigarette use in this population. This study examines the prevalence of disability among young adults in Ireland, compares smoking and e-cigarette use between those with and without disabilities, identifies protective and risk factors, explores shared risk factors, and evaluates disability as an independent risk factor for smoking and e-cigarette use. METHODS:We analysed weighted data from 4,729 20-year-olds in the Growing Up in Ireland Cohort '98 study who were present in Waves 1 (2008), 3 (2016), and 4 (2019). Current smoking, e-cigarette use, disability (excluding mental ill-health) and all other variables were assessed at Wave 4, while peer smoking data were drawn from Wave 3. Analyses were conducted using SPSS version 27. RESULTS:18.1% of participants reported a disability, which was associated with significantly higher smoking (41.8% vs. 36.7%) and e-cigarette use (16.1% vs. 12.9%). Protective factors against both behaviours included being female (OR 0.87 for smoking, OR 0.57 for e-cigarettes), later smoking initiation (OR 0.35, OR 0.62), living in two-parent families (OR 0.83, OR 0.70), and physical activity (smoking only). Risk factors included having peers who smoked (OR 3.67 for smoking; OR 2.36 for e-cigarette use) and caregivers who smoked (OR 1.48, OR 1.48), being employed at age 20 (OR 1.58, OR 1.48), and social media engagement (smoking only). Young adults with disabilities were significantly more likely to experience risk factors (e.g., earlier smoking initiation, caregivers who smoked, one-parent families, employment) but were less likely to have peers who smoked or engage with social media. Disability was independently associated with a higher likelihood of smoking (by 54%) and e-cigarette use (by 36%) after adjusting for protective and risk factors. CONCLUSION:Higher smoking and e-cigarette use in 20-year-olds with disabilities adds further inequality to their lives. Increased awareness, targeted surveys and focused prevention and therapeutic interventions are required to reduce inequalities in this population and hasten the tobacco endgame.

Background: Ireland’s Smoking Ban reduced health inequalities known to be associated with smoking but some groups may not have benefitted. Mental ill-health and smoking are known to be associated with health inequalities. Whether similar patterns exist for e-cigarette use is less clear, as few data exist. Objectives: To examine: (1) self-reported doctor-diagnosed mental ill-health in Irish 20-year-olds; (2) smoking, e-cigarette, and dual use in those with and without mental ill-health; and (3) protective and risk factors for smoking and e-cigarette use in these groups. Methods: We use cross-sectional data from 20 year-olds in Wave 4 of Growing Up in Ireland Child Cohort. They were asked to self-report mental ill-health which had been diagnosed by a clinician, and their smoking and e-cigarette use. All analyses were performed using SPSS v27. Results: 19.4% (n = 1008) of the total sample (n = 4729) reported a mental ill-health diagnosis. Comparing those with and without, those with mental ill-health had significantly higher prevalence of current smoking (47%, n = 419 vs 36%, n = 1361; OR 1.57, CI: 1.36, 1.82), e-cigarette use (17%, n = 152 vs 13%, n = 485; OR 1.40, CI:1.15, 1.70), and dual use (12%, n = 109 vs 9%, n = 328; OR 1.46, CI:1.16, 1.84). Risk factors for smoking and e-cigarette use were, earlier smoking initiation, peers or primary caregivers who smoked, being in paid employment, one-parent family background, and social media use. Being female was protective. Most risk factors were significantly higher in young adults with mental ill-health but, after adjusting for these variables, respondents with mental ill-health still have significantly higher adjusted higher odds of smoking (aOR 1.28, CI:1.05, 1.56). Conclusions: Inequalities in smoking and e-cigarette use in young adults with mental ill-health are evident 20 years after Ireland’s National Smoking Ban. Despite extensive Tobacco Control interventions in the past 20 years, there is still need in Ireland for new targeted interventions to reduce health inequalities for left-behind young smokers with mental ill-health.

We analyse parental smoking and cessation (quitting) associations with teenager e-cigarette, alcohol, tobacco smoking and other drug use, and explore parental smoking as a mechanism for social reproduction. We use data from Waves 1–3 of Growing Up in Ireland (Cohort ’98). Our analytic sample consisted of n = 6,039 participants reporting in all 3 Waves. Data were collected in Waves 1 and 2 when the children were 9 and 13 years old and in Wave 3 at age 17/18 years. Generalized Estimating Equations (GEE) models were used to analyse teenage substance use at Wave 3. Parental smoking was associated with significantly increased risk of all teenage substance use, adjusted odds ratios were aOR2.13 (ever e-cigarette use); aOR1.92 (ever alcohol use); aOR1.88 (current alcohol use); aOR1.90 (ever use of other drugs); aOR2.10 (ever-smoking); and aOR1.91 (current smoking). Primary caregiver smoking cessation (quitting) was associated with a lower risk for teenager current smoking aOR0.62, ever e-cigarette use aOR 0.65 and other drug use aOR 0.57. Primary caregiver smoking behaviour had greater associations than secondary, and age13 exposure more than age 9. Habitus seems to play a role and wealth was protective for teenage smoking. The findings suggest that prevention interventions should target both caregivers and their children.

Smokefree laws are intended to protect against second-hand smoke (SHS) in outdoor areas. We examined if exposure to PM2.5 particles in outdoor smoking areas changed breathing rates in 60 patients with asthma (n = 30) or with COPD (n = 30), in an open, non-randomised, interventional study model in Czechia, Ireland and Spain. The patients wore a PM2.5 particle monitor (AirSpeck) and a breath monitor (RESpeck) for 24 h to determine changes in breathing rates (Br) at rest and during a visit to an outside smoking area. Spirometry and breath CO were measured before and the day after visiting an outdoor smoking area. The PM2.5 levels at the 60 venues were highly variable, ranging from ≥2000 µg/m3 (in 4 premises) to ≤10 µg/m3 (in 3 premises, which had only a single wall in the structure). At 39 venues, the mean PM 2.5 levels were ≥25 µg/m3. The breathing rate changed significantly in 57 of the 60 patients, resulting in an increase in some patients and a decrease in others. Comprehensive smokefree laws were ineffective in protecting asthma and COPD patients from exposure to high levels of SHS in outside areas of pubs and terraces, which should be avoided by these patients. These findings also support the extension of smokefree laws to outside areas.

Objective To measure, exposure to PM2.5 particles in outdoor smoking areas and changes in breathing rates in patients with asthma or chronic obstructive pulmonary disease (COPD). Setting Sixty venues in Czechia, Ireland and Spain, in an open, non-randomised, clinical trial. Participants We studied 60 patients-30 asthma patients (Female 63.3%), with a mean age (+/-standard deviation [SD]) of 47.4 (19.0 SD), and 30 COPD patients (Female 51.6%), mean age 63.5 (10.1 SD), smokers, non-smokers or ex-smokers, recruited through medical clinics. Intervention Patients wore a PM2.5 particle monitor (AirSpeck), and a breath monitor (RESpeck) for 24 hours to determine changes in breathing rates (Br) at rest and during a visit to an outside smoking area. Spirometry and breath CO were measured before and the day after visiting an outdoor smoking area. Results PM2.5 levels in the 60 venues were highly variable, in 1 premises levels of PM2.5 were sustained for at least 15 minutes at ≥ 2,000 µg/m3, in 4 premises, ≥ 500 (range 1,933-539) µg/m3, in 8 premises, ≥ 200(range 480-203) µg/m3, in 9 premises, ≥ 100 (range 170-108) µg/m3, in 8 premises, ≥ 40 (range 80.5- 40.1) µg/m3, in 9 premises, ≥ 25 µg/m3, in 10 premises, ≥ 10 µg/m3, in 8 premises, and ≤10 µg/m3 in only 3 premises, with a single wall. The overall breathing rates/minute (Br)did not change significantly but in 28 patients mean Br increased from 21.47 (1.74 SD) to 22.8 (2.29 SD), change of -1.35 (-1.80-0.91 C.I), p value 0.00 and mean in 29 patients Br decreased from 21.95(2.43 SD) to 20.38(2.79 SD), 1.57(1.03-2.12 C.I), p value 0.00. Conclusion Exposure to high levels of PM2.5, and associated alteration of patients’ breathing rates occurred in outdoor smoking areas despite national comprehensive smokefree laws. These exposure levels support the abolition of such areas. (Words 295) ClinicalTrials.gov ID: NCT03074734 Ethics: Approval Number: Ref: 15-103

reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -Articles describing a research protocol of a study.• Methodology Papers -Papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Tobacco Industry Monitoring Letters -brief articles on tobacco industry tactics.

reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -Articles describing a research protocol of a study.• Methodology Papers -Papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Tobacco Industry Monitoring Letters -brief articles on tobacco industry tactics.

The concept 'cultural flashpoint' (CF) has not been fully defined or described. The authors test this concept through the prism of a controversial gender-focused Irish school programme, Exploring Masculinities (EM). Adopting an instrumental case study methodology, they use media content analysis to develop a temporal trajectory of the CF, describe its shape, explicit and implied contentious themes, and its process. They identify characteristic features of a cultural flashpoint: (i) a focal issue, event and/or object; (ii) conflict; (iii) bounded time period; (iv) the involvement of exo- and multi-sectoral individuals and groups; (v) randomness, opaqueness and conflation among its expressions; and (vi) broadly cultural and not confined to its sector of origin. They offer a definition of a CF and suggest it as a conceptual device for identifying, analysing and understanding contestation about educational (and other) change occurring in the context of wider and more long-standing cultural, social and political movements.

BACKGROUND:Gambling among adolescents is associated with gambling disorder in adulthood. This study investigated factors associated with gambling and excessive gambling in adolescents. METHODS:This secondary analysis of the cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) used nationally representative data from the Irish cohort of the 2019 ESPAD wave. Data were collected between March and May 2019. We included 1949 students aged 15-16 years (946 [48·5%] male, 1003 [51·5%] female), with a response rate of 85%. We calculated past year gambling prevalence as the rate of those who had gambled for money on at least one of four games of chance (slot machines, cards or dice, the lottery, betting on sports or animals) in the past 12 months. An adapted version of the three-item Consumption Screen for Problem Gambling was used to identify excessive gambling (score ≥4). We carried out descriptive and logistic regression analyses using binary covariates with Stata v16.1. We included 19 variables in the multivariable analysis. Ethics approval was granted by Dublin Institute of Technology's Ethics Committee. Non-consent forms were issued to all parents to opt out. FINDINGS:Overall, 447 (23%) of 1949 students gambled in the past year, of whom 45 (10%) engaged in excessive gambling. Using a mutually adjusted multivariable logistic regression analysis, past year gambling was associated with alcohol use (adjusted odds ratio [aOR] 1·6, 95% CI 1·1-2·2), experiencing serious arguments (aOR 1·4, 1·1-1·9), and trouble with the police (aOR 1·9, 1·2-2·8). Female gender was a protective factor (aOR 0·6, 0·4-0·9). In the univariable analysis, excessive gambling was associated with gaming (OR 2·3, 1·0-5·1), tobacco use (2·1, 1·1-4·2), e-cigarette use (2·1, 1·1-4·1), heavy episodic drinking (2·7, 1·4-5·1), trouble with the police (2·8, 1·5-5·4, p<0·01), and deliberately hurting themselves (2·8, 1·4-5·6). Female gender (OR 0·3, 0·1-0·6) and social media use (0·4, 0·2-0·8) were protective factors. Excessive gambling was also associated with betting on sports and animals (OR 3·6, 1·6-8·4), slot machines (2·9, 1·5-5·8), card or dice (2·4, 1·2-4·6), and online gambling (4·2, 2·0-8·0). INTERPRETATION:A large proportion of 15-16 year olds in Ireland have gambled for money in the past year, with one in ten of those having engaged in excessive gambling. This number is likely to be underestimated due to recall and social desirability bias. Reducing the availability, access, and appeal of gambling products in Ireland should be addressed through ongoing gambling reform. FUNDING:Institute of Public Health.

Introduction Links between teenage gambling and tobacco and cannabis use have been reported for more than 25 years 1 . Less is known about e-cigarette use and gambling. In Ireland, data about teenage smoking, cannabis use and gambling have been available for some time but analyses are lacking 2 . E-cigarettes have been marketed and sold in Ireland for about a decade but, as in other jurisdictions, little is known about e-cigarette use and gambling. This study fills this gap by examining the links between smoking, e-cigarette and cannabis use, and gambling in Ireland. Material and Methods We use data from the 2019 European School Survey Project on Alcohol and other Drugs (ESPAD), a nationally representative, cross-sectional survey of 1,940 15-16-year-old students. Tobacco, e-cigarette, and cannabis use were measured by asking participants if they had used these substances in the previous 12 months (responses re-coded as yes or no). Gambling prevalence was measured by asking participants, if they gambled money in the previous 12 months, to report which games they had played: playing on slot machines, playing cards or dice, playing the lottery, or betting on sports or animal races (responses re-coded as yes or no). Frequencies and regression analyses were carried out using Stata v16.1. Results As shown in Table 1, prevalence of all 4 behaviours among 15-16 year olds in Ireland was high. Of the 4 behaviours, e-cigarette use in the previous year had the highest prevalence (37.2%, n=723), followed by gambling (22.9%, n=447), cannabis use (19.1%, n=370) and smoking (14.4%, n=281). Smoking (OR 1.84), e-cigarette use (OR 1.79), and cannabis use (OR 1.67) were all significant predictors of past-year gambling. Conclusions This study confirms, for Irish teenagers, previously reported links between smoking, cannabis use, and gambling. It also shows that teenager e-cigarette use, which has a high prevalence in Ireland, has a similar relationship with, and comparable odds for, teenager gambling.

BACKGROUND:Children with a parent who smokes are more likely to become substance users than those who do not have a parent who smokes. In this study, we examined whether childhood or early adolescent exposure to primary parent smoking increased the risk of subsequent teenage alcohol and drug use at ages 17-18 years. METHODS:For this longitudinal observational study, we analysed data from 6039 teenagers and their parents from the waves 1-3 of the Growing up in Ireland Cohort 98' Study. Parental smoking was assessed at baseline (9 years) and wave 2 (13 years) with responses coded as yes or no. The primary parent was defined as the person who provided most care and who knew most about the Study Child, usually the mother or mother figure for 98% of study participants. Teenage alcohol and drug use assessed at ages 17-18 years (wave 3) was determined by responses to the question "Have you ever consumed alcohol?" (answers yes or no), drug use was assessed by questions on ever trying aerosols/gas, cannabis, and non-prescribed drugs, with those answering yes being classified as other-drug ever users. We did a logistic regression analysis to examine the associations between parents' smoking on teenage alcohol and drug use, controlling for covariates: gender, education, income, education, region, and household type. Ethics approval for the GUI project was obtained from the Health Research Board. FINDINGS:Of the 6039 teenagers included in our study, 2968 (49%) were female, 3070 (51%) were male, 5351 (89%) ever used alcohol, 5065 (85%) were current users, and 2098 (35%) used other drugs. Rates of primary parent smoking were 31% (n=1883) in wave 1 and 30% (n=1829) in wave 2. After adjusting for other exposures known to be associated with teenage substance use, primary parent smoking at waves 1 and 2 was associated with higher odds of teenage alcohol ever use (adjusted odds ratios [aORs] 1·89 [95% CI 1·44--2·46] at wave 1 and 1·53 [1·20-1·98] at wave 2), current alcohol use (1·88 [1·50-2·36] and 1·59 [1·28-1·97]) and other-drug ever use (1·699 [1·45-1·95] and 1·71 [1·47-1·98]). INTERPRETATION:Teenagers aged 17-18 years exposed at ages 9 and 13 years to parental smoking were more likely to report significantly higher odds of alcohol and drug use at age 17-18 years. The finding that exposure to parent smoking in childhood increases the risk of teenage alcohol and other drug use suggests a need for interventions aimed at parents who smoke Limitations include potential unmeasured or residual confounders and reliance on self-reported teenage substance use behaviours. FUNDING:Royal City of Dublin Hospital Trust, Irish Research Council Government of Ireland Postgraduate Scholarship Programme.