Cannabis was previously associated with worse memory function in men but not in women. As the hippocampus is crucial in the formation and retrieval of memory, we studied if cumulative exposure to cannabis is associated with differences in the hippocampal tissue volume, fractional anisotropy (FA) and cerebral brain perfusion (CBF) by MRI, overall and by sex, stratified by ever tobacco smoking, in multivariable adjusted linear regression models in both sexes. We included participants of the CARDIA cohort, followed since 1985, with cannabis assessed during each follow up. Categories of self-reported cumulative exposure were never, <0.5, 0.5-<2, and >2 cannabis-years, where 1 cannabis-year=365 days of use. We included 648 participants: 52% were women; mean age was 55 years, 86% reported ever using cannabis and 48% ever smoking tobacco. There was no difference in mean hippocampal volume according to greater cumulative use of cannabis. The coefficient of hippocampal volume in participants never smoking tobacco reporting >2 cannabis-years was -37.99mm(3) (95% CI -201.08-125.09) compared to never users. There was no significant difference when stratifying by sex or ever tobacco exposure, or for FA or CBF. Cumulative cannabis exposure over 30 years was not associated with hippocampal volume, integrity or blood flow in middle age. The differences in memory function in cannabis users are likely not attributable to the hippocampus only. Future studies should assess further neuronal mechanisms and social determinants associated with cognition in cannabis users.

STUDY OBJECTIVES:E-cigarettes can help smokers quit, but how e-cigarettes used for tobacco smoking cessation impact sleep is still unclear. The primary objective was to evaluate the effect of e-cigarettes for smoking abstinence on sleep quality. Secondary objectives included subscales of sleep quality. METHODS:We conducted a secondary analysis of the Efficacy, Safety, and Toxicology of electronic nicotine delivery systems for smoking cessation (ESTxENDS) randomized controlled trial, which included adult smokers in Switzerland (five sites, 7.2018-6.2021). The intervention group received free e-cigarettes and e-liquids over 6 months plus standard-of-care smoking-cessation counseling (SOC); the control group received SOC alone. The primary outcome was overall self-reported sleep quality at 6 months, measured by the Pittsburgh Sleep Quality Index (PSQI). We considered a minimal clinically important difference (MCID) of 2.5-5. Secondary outcomes included PSQI subscales. We used adjusted linear regressions with inverse probability of attrition weights (IPAW). RESULTS:ESTxENDS included 1246 participants. Of these, 831 participants completed the PSQI at follow-up. For the primary outcome, there was no significant difference in PSQI score between groups (b = -0.20, p = .256, adjusted analyses with IPAW). For PSQI subscales, only sleep efficiency was significantly better in the intervention group (b = 1.87, p = .018), below MCID. CONCLUSION:E-cigarettes added to SOC for tobacco smoking abstinence did not significantly alter participant's self-reported sleep quality compared to SOC alone. Clinicians can inform patients willing to quit smoking with e-cigarettes that their use is not likely to disrupt their perceived sleep quality on average.

ObjectivesColorectal cancer (CRC) screening rates are low in Switzerland. This study tested whether a PCP intervention—training sessions and performance feedback within quality circles (QC) increased CRC screening rates.MethodsA pragmatic randomized controlled trial was conducted in Switzerland (2018–2021) with PCP in QC. The intervention included three training sessions, shared decision-making materials, and performance feedback based on 40 consecutive patients per PCP. The primary outcome was the difference in CRC screening rates between the intervention and control group after 12 months.ResultsOf 120 invited QC, nine participated (5 intervention, 4 control). A total of 63 PCPs (32 intervention, 31 control) collected data on 2,112 patients (1,130 intervention, 982 control; mean age 61.5, 53% women). Analysis clustered by PCP and QC showed screening rate was 58% in the intervention group vs. 42% in controls (OR1.98; 95% CI:1.14–3.42). Screening rates in the intervention group increased from 55% to 57.9% (absolute increase: 2.9%; 95% CI:1.1%–6.9%; OR1.29; 95% CI:1.08–1.55, p < 0.01).ConclusionTraining sessions and performance feedback in QC increased screening rates, but few QCs chose to participate.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT03510858.

INTRODUCTION:Tobacco smoking is an insufficiently addressed health burden among people living with HIV. The Reduce tobacco use in people living with HIV in Switzerland (RETUNE) trial tests the effectiveness of offering a menu of nicotine substitute products, including e-cigarettes, nicotine pouches, and nicotine patches, on tobacco smoking cessation rates. This a priori planned internal pilot aims to assess the trial processes, in particular the delivery of the intervention, and its acceptance by participants. METHODS:RETUNE is a pragmatic, randomized, multicenter trial using the 'Trials within Cohorts' (TwiCs) design embedded in the Swiss HIV Cohort Study. Participants are people living with HIV who are part of the cohort and smoke. Following the TwiCs design, participants can accept one of the offered intervention products or refuse all of them, after being randomized to the intervention group. This internal pilot study included the first 200 RETUNE participants randomized between February and September 2025. We report the acceptance rate and participants' experiences with the intervention products, based on trial data and additional questionnaires. RESULTS:Of the 98 participants randomized to the intervention group, 53 accepted a nicotine substitute product while 45 declined the intervention. The majority chose e-cigarettes (31/53; 59%), one-third chose nicotine patches (17/53; 32%), and four participants chose nicotine pouches (4/53; 8%). The most common reason for declining all offered products was no interest in quitting tobacco smoking (34/53; 64%). Overall, 37/53 (70%) intervention participants completed the pilot study survey. Most (27/37; 73%) continued the initially chosen product; the remaining changed the product, the nicotine concentration, or the flavor; however, no one stopped the smoking cessation intervention entirely. CONCLUSIONS:The results of this internal pilot support the feasibility of the RETUNE trial. The observed acceptance rate was similar to our estimate. E-cigarettes were the preferred product. We are continuing recruitment for the RETUNE trial. CLINICAL TRIAL REGISTRATION:The study is registered on the official website of ClinicalTrials.gov. IDENTIFIER:NCT06789692.

IntroductionIn Switzerland, primary care physicians (PCP) prescribe colonoscopy for colorectal cancer (CRC) screening rather than offering a choice between colonoscopy and faecal occult blood test (FOBT). This study evaluated a training program promoting shared decision-making for CRC screening.MethodsPCP from a research network were randomized 1:1 into intervention or control. The intervention group received study materials, patient decision aids, evidence summary, FOBT sample kit, and personalized feedback on CRC screening practices. PCP documented CRC screening decisions of 40 consecutive patients (ages 50-75) four months post-intervention. The control group received no materials before data collection.ResultsOf 110 PCP randomized, 83 (76%) collected data on 3,171 patients (mean age 62, 50% women). PCP in the intervention group were more likely than controls to have at least one patient tested or planning FOBT (84% vs. 56%; unadjusted RR: 1.52; 95% CI: 1.13 to 2.04). In a sensitivity analysis restricted to 62 PCP who participated in a previous data collection, 72% (21/29) already met the primary outcome in the intervention group at baseline and 49% (16/33) in the control group (RR: 1.49; 95% CI: 0.98 to 2.28). When contrasting the change within PCP from the 2017 and 2018 data collection, there was no significant increase in proportion of PCP who met primary outcome between intervention and control group, while it might have increased the proportion of PCP already prescribing FOBT to prescribe it to more of their patients.ConclusionA mailed intervention increased FOBT prescriptions, but selection bias may have influenced results.

INTRODUCTION:Injectable long-acting antiretroviral therapy (iLA-ART) offers a valuable alternative to oral ART (oART). While the efficacy of these treatment strategies is similar, adequate information on their specific characteristics is essential to enable people with HIV (PWH) to decide which option best suits their values and preferences. METHODS:We conducted a multicentric survey of PWH on oART in the Swiss HIV Cohort Study (SHCS). Using a questionnaire co-developed with expert patients, we assessed participants' (1) values and preferences on characteristics of modern oART and treatment satisfaction, (2) knowledge about iLA-ART with cabotegravir/rilpivirine, (3) reasons influencing their interest to switch or not to iLA-ART and (4) perceived burden of treatment (BOT) taking oART. Outcomes were rated on an 11-point (0-10) Likert scale. We explored outcomes' determinants using multivariate analyses. RESULTS:A total of 200 PWH on oART participated (response rate 87%), with a median age of 52 years (Interquartile Range 45-59), 58 (29%) were women, and 90 (45%) were men who have sex with men. Treatment satisfaction was very high (mean 9.3, Standard Deviation [SD] 1.3) and perceived BOT on oART was low (mean 2.5, SD 2.0). The two most valued oART characteristics were effectiveness (mean 9.9, SD 0.3) and absence of side effects (mean 9.5, SD 1.7). Overall, 76 (39%) participants had never heard about iLA-ART, with large differences between the 3 participating centres (60% vs. 3% vs. 50%). In multivariable analysis, women (Odds Ratio 0.35, 95% confidence interval [CI] 0.14-0.85) and PWH ≥60 years (0.27, 0.08-0.94) were less aware about iLA-ART. Reasons influencing PWH's potential interest to switch to iLA-ART varied individually, while the main reason for preferring to stay on oART was the bimonthly dosing interval of iLA-ART. CONCLUSION:In Switzerland, over one-third of PWH were unaware of iLA-ART despite its reimbursed availability. The provider of care appears to be the main driver of these findings, while women and older individuals showed the lowest awareness. As ART characteristics are valued individually, providing systematic information on available treatment options and engaging PWH in shared decision-making could help address identified disparities and empower them to choose the treatment that best aligns with their preferences.

With increased sensitivity of instrumentation, more substances can be analysed using capillary dried blood spots (DBS), and therefore, minimal invasive sample collection can be performed. However, for cannabinoids such as (-)-trans-Δ9-tetrahydrocannabinol (THC), low extraction efficiencies have been reported in previous studies. In this study, a novel extraction method was developed comprising an extraction with dimethyl sulfoxide followed by methanolic extraction, yielding extraction efficiencies > 80% for both THC and its metabolite 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH). The linear ranges of the LC-MS/MS method are 0.5-20 ng/mL for THC and 1.25-100 ng/mL for THC-COOH with good precision and accuracy. Concentrations of THC and THC-COOH in DBS from capillary blood were compared to venous blood concentrations based on 159 blood samples retrieved from a study including recreational cannabis users. THC-COOH concentrations in DBS were in close agreement with venous blood concentrations with a median capillary DBS/venous blood ratio of 1.09 (mean 1.10 ± 0.21), whilst THC concentrations in capillary blood were higher than venous blood concentrations with a median ratio of 2.11 (mean 16.6 ± 87.9) (after exclusion of outliers: 1.84 [mean 2.57 ± 1.93]), and the THC concentration ratio capillary DBS/venous blood showed a larger variability, ranging from 0.75 to 722 (0.75 to 8.18 after exclusion of outliers).

Abstract Background Among people living with HIV, there has been a shift of focus from HIV-related health issues to cardiovascular diseases and cancer. For both, tobacco smoking is a major but insufficiently addressed etiological factor. Evidence from randomized trials suggests that nicotine substitute products such as e-cigarettes and nicotine patches can reduce tobacco smoking and its associated health burden. However, most previous smoking cessation trials primarily included people who are motivated to quit smoking and focused on testing a single nicotine substitute product. The effectiveness of offering a menu of nicotine substitute products to tobacco smokers regardless of their willingness to quit smoking (“opt-out” approach) is unknown. Methods Reduce tobacco use in people living with HIV in Switzerland (RETUNE, NCT06789692) is a pragmatic, 1:1 randomized, multicenter, superiority clinical trial using the Trials within Cohorts (TwiCs) design within the Swiss HIV Cohort Study. RETUNE assesses the effectiveness of offering a menu of different nicotine substitute products, namely electronic cigarettes, nicotine pouches, and nicotine patches, versus usual care. Cohort participants are eligible if they smoke more than one tobacco cigarette per day, do not use any of the substitute products, and have signed the randomization consent following the TwiCs design. Participants randomized to the intervention may choose any of the offered substitutes to be used free of charge for 6 months or decline the offer. Overall, we plan to recruit 972 participants. The primary outcome is tobacco abstinence at 6 months measured as participant-reported past 7-day prevalence abstinence. The primary outcome will be assessed in the intention-to-treat set using a logistic regression model adjusted for region, men having sex with men, current drug users, and number of cigarettes per day at baseline. Secondary outcomes are long-term smoking cessation rates and tobacco-associated health outcomes. Discussion RETUNE started recruitment in February 2025 and is currently ongoing. RETUNE using the TwiCs design will clarify the effectiveness of a preference-based opt-out smoking cessation intervention among people living with HIV. Trial registration Clinicaltrials.gov NCT06789692. Registered on January 17th, 2025. The manuscript is aligned with the registry. https://clinicaltrials.gov/study/NCT06789692?cond=NCT06789692&rank=1

INTRODUCTION:People smoking tobacco cigarettes and switching to e-cigarettes report adverse symptoms attributed to e-cigarettes. We aimed at assessing the proportions and changes over 6 months in self-reported symptoms among participants of a large randomized controlled trial testing e-cigarettes for smoking cessation. METHOD:We included participants from the intervention group of the Efficacy, Safety and Toxicology of ENDS (ESTxENDS) randomized controlled trial. They received e-cigarettes, freebase nicotine e-liquids and smoking cessation counseling, phone follow-up at 1-, 2-, 4-, 8-week, and a visit at 6 months after target quit date. A set of predefined adverse symptoms experienced while vaping or smoking were systematically assessed at each contact. We used descriptive statistics and mixed models to report proportion of symptoms over time in exclusive e-cigarette users. We assessed the effect of symptoms on smoking re-initiation and the effect of duration of exclusive e-cigarette use on the resolution of symptoms in marginal structural models. RESULTS:The intervention group included 622 participants, with a mean age of 40 (SD: 14) and 53% identified as men. After 1 week, the most commonly reported adverse symptoms among the 405 exclusive e-cigarette users were dry mouth (34%, 95 CI: 29%-39%), mouth/throat irritation (23%, 19%-27%), and cough (25%, 21%-29%). After 6 months, 256 exclusive e-cigarette users reported dry mouth (18%, 14%-23%), mouth/throat irritation (11%, 7%-15%), and cough (12%, 8%-16%). Marginal structural model revealed mouth/throat irritation led to smoking re-initiation, but continuing exclusive e-cigarette use resolved dry mouth in many. CONCLUSIONS:Adverse symptoms attributed to e-cigarettes are reported by fewer exclusive e-cigarette users over time. While continued e-cigarette use led to less dry mouth, mouth/throat irritation symptoms seemed to resolve because people experiencing symptoms switched back to smoking tobacco, while continuous exclusive e-cigarette users had less symptoms. IMPLICATIONS:E-cigarette use for smoking cessation can lead to adverse symptoms, such as dry mouth, mouth/throat irritation, and cough. The proportion of these symptoms, especially of dry mouth, was lower in participants still exclusively using e-cigarettes after 6 months than in people after one week of use. These findings are crucial for health care professionals who recommend e-cigarettes for smoking cessation, as they offer practical guidance on how to inform their patients about the possibility of these symptoms when shifting to e-cigarettes.

BACKGROUND:Switzerland has taken a different path to cannabis regulation than other countries. A 2021 law allows regulatory experiments on the production and sale of cannabis for non-medical purposes. The research team planned a randomised controlled trial (RCT) to test how selling cannabis in pharmacies affects users' health and consumption habits. The study intervention also included counselling on risk reduction, such as smoking cessation. The research team aimed to incorporate the perspectives of people who use cannabis into the study design, despite challenges related to stigma and legal constraints. METHODS:When planning the RCT, the research team mandated an external researcher to form an advisory group with regular users of non-medical cannabis. This researcher used convenience sampling (including snowball sampling) to recruit people who use cannabis, considering age, self-reported gender and cannabis use frequency. She conducted an individual interview, followed by iterative group discussions. She summarised the results into reports and sent them to the research group, who considered the results during study planning and formulated topics to be discussed in the next advisory group meeting. RESULTS:In a two- and half-year long process (November 2021 to March 2024), eight people who use cannabis provided iterative feedback that informed the development of the study intervention. Based on their feedback, the research team expanded the product selection to include cannabis resin alongside cannabis flowers. The group's feedback also led the research team to make several changes to the sales process in pharmacies. While the members of the advisory group expressed that much of their feedback had been considered, they noted that some key aspects - such as product pricing - had not been implemented. Legal and political constraints limited the research team's ability to implement advisory group feedback. CONCLUSIONS:This experience showed that gathering user input is feasible, even in highly regulated, stigmatized contexts. Including the perspectives of people who use cannabis in the trial set-up allowed the research team to adapt the study intervention. Where they could not adapt the study intervention, it helped them prepare for possible reactions from future study participants and disseminate their findings to other stakeholders. Future research should test the feasibility and benefits of such activities throughout all research stages.

INTRODUCTION:Affective disorders are common during pregnancy and guidelines recommend continued use of antidepressants during pregnancy. Trajectories of antidepressant treatment during pregnancy and the prevalence of prenatal exposure to antidepressants in Switzerland remains understudied. This study aimed: 1) to estimate the prevalence of prenatal antidepressant dispensation and of four predefined treatment patterns (continuation, switch, discontinuation and restart); 2) to identify trajectories of antidepressant dispensation from 9 months before pregnancy to delivery. METHODS:Using Swiss claims data from 2010 to 2019, we estimated the prevalence of antidepressant dispensation during pregnancy and of the treatment patterns. We identified trajectories of antidepressant medication using group-based trajectory modeling (GBTM). To better characterize the trajectories, we tested their associations with comedications and other covariates. RESULTS:Among 84,317 pregnancies, 1.6 % (95 % CI = [1.5 %, 1.7 %]) were exposed to antidepressants. Prevalence of treatment patterns ranged from 0.02 % to 0.40 %. Discontinuation and restart accounted for 9.6 % and 4.5 % of pregnancies with antidepressant dispensations. GBTM resulted in six trajectories: GBTM-increase over pregnancy (11.3 % of the women using antidepressants), GBTM-discontinuation (11.4 %), GBTM-continuation (4.6 %), GBTM-discontinuation before pregnancy (16.4 %), GBTM-episodic dispensation (44.4 %) and GBTM-decrease over pregnancy (11.9 %). Anxiolytic and antipsychotic use was frequent among GBTM-continuation and GBTM-restart before pregnancy. CONCLUSIONS:The prevalence of antidepressant dispensation during pregnancy was similar to the prevalence in Europe. The most prevalent trajectory was episodic dispensation and a fifth of women stopped antidepressants before pregnancy and another fifth during pregnancy, which is not in line with recommendations. Future studies should investigate patient and clinician level reasons for discontinuation.

Objective: This study aims to assess differences in depressive and anxiety symptoms at 6-month follow-up in a smoking cessation trial using e-cigarettes as quitting aids. Methods: We conducted a secondary analysis of the Swiss multicentre ESTxENDS smoking cessation randomized controlled trial (RCT) assessing differences in depressive (Patient Health Questionnaire-9, PHQ-9, range: 0-27) and anxiety symptoms (General Anxiety Disorder-7, GAD-7, range: 0-21) at 6-month follow-up comparing participants who received e-cigarettes to those who received smoking cessation counseling alone. Results: Of 1244 participants 913 completed the PHQ-9 and 884 the GAD-7 at 6-month follow-up. Mean PHQ-9 scores (SD) at 6 months for the intervention group were 3.7 (3.9), control group: 4.0 (4.2); mean GAD-7 scores (SD) at 6 months for the intervention group were 4.6 (4.3), control group: 4.6 (4.4). Multivariable analyses showed no evidence of a clinically relevant intervention effect on the PHQ-9 [coefficient- 0.101, 95 % CI-0.182 to-0.019, p = .016, corresponding to a 0.9 decrease of the original PHQ-9 score] and the GAD-7 scores [coefficient- 0.056, 95 % CI-0.135 to 0.022, p = .160] in the main adjusted models. Conclusions: Among smokers who participated in the ESTxENDS smoking cessation trial, we found distribution of e-cigarettes for smoking cessation in addition to standard counseling compared to counseling alone had no clinically relevant effect on depressive or anxiety symptoms at 6-month follow-up. Trial Registration: ClinicalTrials NCT03603340

INTRODUCTION:Colorectal cancer (CRC) screening relies primarily on colonoscopy and fecal immunochemical testing (FIT). Aligning utilization of these options with individual CRC risk may optimize benefit with lower risks, individual burden, and societal costs. We studied the effect of communicating personalized CRC risk and corresponding screening recommendations on risk-appropriate screening uptake in an organized screening setting. METHODS:Randomized controlled trial among residents aged 50-69 years not yet invited for screening in Vaud, Switzerland. The intervention was a mailed brochure communicating individual 15-year CRC risk and screening recommendation. The control group received a usual brochure comparing FIT and colonoscopy. The primary outcome was self-reported risk-appropriate screening (FIT if <3% risk, FIT or colonoscopy if ≥3% and <6%, and colonoscopy if ≥6%) at 6 months. A secondary outcome was overall screening uptake. RESULTS:Of 5,396 invitations, 1,059 people responded (19%) of whom 258 were randomized to intervention and 257 to control materials (average 15-year risk 1.4% [SD = 0.5], age 52.2 years [SD = 2.2], 51% women). Risk-appropriate screening completion was 37% in the intervention group and 23% in the control group (absolute difference 14%, 95% confidence interval 6%-22%). Overall screening uptake was 50% in the intervention group and 49% in the control group (absolute difference 1%, 95% confidence interval -7% to 10%). DISCUSSION:In a population not known to be at elevated CRC risk, brochures providing personalized CRC risk and screening recommendations improved risk-appropriate screening without impacting overall screening uptake. This approach could be helpful for aligning screening methods, risks, and benefits with cancer risk and resource allocation.

Introduction: We aimed to characterize current tobacco and nicotine product use and tobacco cessation efforts in Swiss primary care, including the prescription of medications and recommendation of vapes to quit smoking. Methods: Cross-sectional study from pediatricians and primary care physicians (PCPs) in the Swiss Sentinella network (practice-based network to monitor infectious diseases). PCPs collected data from 30 consecutive patients >= 12 years of age between September and December 2021. Patient data included age, gender, nicotine products use, plans to quit, and time discussing smoking cessation. PCP data were their use of medications, follow-up appointments, and vapes for quitting smoking. Results: Eighty-nine of 168 PCPs participated (53 %) and collected data on 2438 patients, of whom 523 (21,5 %) used a nicotine product within seven days, of whom 88 % smoked cigarettes. Among the 106 (20 %) who planned to quit smoking, 16 (15 %) planned to use nicotine replacement therapy, nine (9 %) varenicline, six (6 %) vapes, five (5 %) bupropion, and 57 no treatment (54 %). Moreover, 236 (46 %) of 523 patients using nicotine products received one to five minutes of cessation advice, 80 (16 %) six to ten minutes, and 17 (3 %) >10 min. Half of PCPs offered follow-up and medications to >= 50 % of patients planning to quit, while 52 % never recommended vapes. Conclusion: The use of nicotine products remains common among primary care patients, the majority of whom smoke cigarettes. Nicotine products without tobacco remain relatively rare. After the consultation, one in five patients using nicotine products planned to quit, the majority without any aid.

IntroductionTobacco smoking is associated with adverse health outcomes for both pregnant women and their offspring. Smoking cessation counseling is an effective method to help women quit smoking. Developing a targeted smoking cessation intervention could benefit those who struggle to quit tobacco and potentially reduce the harm due to any co-occurring tobacco use. Assessing the prevalence of tobacco, electronic nicotine delivery systems (ENDS), nicotine replacement therapy (NRT), and cannabinoid use in pregnancy is key to developing such interventions. Thus, we aimed to assess the prevalence and patterns of tobacco, ENDS, NRT, and cannabinoid use in pregnancy. We further aimed to assess the prevalence of smoking cessation counseling intervention.Materials and methodsWe conducted a cross-sectional survey among pregnant women attending regular clinical visits at Spitalzentrum Biel between February and May 2023 (n = 262). Frequency and proportion along with 95% confidence intervals (CI) were reported for tobacco, ENDS, NRT, and cannabinoid use in pregnancy.ResultsTobacco use was reported among 7.6% (20/262, 95% CI: 4.2%-11.1%) of the included pregnant women. Tobacco cigarettes (conventional or roll-on) were used by 7.3% (19/262, 95% CI: 3.8%-10.7%) of the surveyed pregnant women, with 0.8% (2/262, 95% CI: 0.0%-3.4%) of them reporting use of cigarettes along with ENDS and 0.4% (1/262, 95% CI: 0.0%-3.8%) reporting use of the cigarettes with NRT. Cannabinoid use was reported by 3.8% (10/262, 95% CI: 1.1%-7.0%) of pregnant women and all of them used products with Cannabidiol (CBD) only. Additionally, only 25% (5/20, 95% CI: 10.0%-48.3%) of tobacco users had received smoking cessation counseling intervention.ConclusionThe estimated prevalence of tobacco, ENDS, NRT, and cannabinoid use among the pregnant women in this survey was 7.6%, 0.8%, 0.4%, and 3.8% respectively. However, among tobacco users, only one-fourth received smoking cessation counseling intervention.

AIM:Cannabis policy developments worldwide typically follow separate tracks for medical and non-medical use, even in jurisdictions pursuing both forms of legalization. As these parallel regulatory frameworks evolve, understanding how stakeholders negotiate and maintain boundaries between these domains become crucial for effective policy development. Using Swiss cannabis policies as a case study, this study examines how stakeholders engage in boundary work related to medical and non-medical cannabis regulation. METHODS:Thematic content analysis was conducted on qualitative interview data from 18 stakeholders involved in Swiss cannabis policy. RESULTS:Two distinct forms of boundary work emerged. Conceptual boundary work involved using discursive methods to legitimize medical cannabis as scientific while positioning non-medical cannabis in the social/political domain. Structural boundary work manifested through institutional mechanisms, particularly health insurance reimbursement and pharmacy distribution. Insurance reimbursement served as a key structural element distinguishing medical from non-medical cannabis. However, using pharmacies as distribution points in non-medical cannabis regulatory pilot projects was identified as problematic, potentially undermining intended boundaries between domains. CONCLUSIONS:The study reveals that stakeholders engage in boundary work as a strategic tool to navigate the complexity of maintaining boundaries between medical and non-medical cannabis systems. Relying on scientific discourse to legitimize medical cannabis while keeping non-medical cannabis in the social/political sphere may create artificial distinctions that do not reflect the complex reality of cannabis use. Policymakers aiming to reduce blurred boundaries should carefully consider how policy elements may undermine intended separations between domains.

INTRODUCTION:A range of studies suggests that people who smoke tobacco have impaired olfactory function, but few have explored the association between smoking history, such as duration or intensity, and olfactory function. We aimed to determine the prevalence of olfactory dysfunction among adult smokers and to test the association between duration or intensity of smoking and olfactory function. METHODS:For this cross-sectional study we consecutively invited adult smokers, participating in a smoking cessation trial conducted in five Swiss study sites, to undergo olfactory function testing at baseline from September 2020 to June 2021. We tested olfactory function with the Burghart's Sniffin' Sticks 16-item identification test resulting in an olfactory identification score (OIS) of 0-16 points. We defined olfactory dysfunction as an OIS ≤11 points. We fitted multivariable regression models to test the association between the OIS or olfactory dysfunction and self-reported smoking parameters [cigarettes per day (CPD), years of smoking (YOS) and pack-years] adjusted for relevant confounders such as demographics, substance use and comorbidities. RESULTS:Of 388 eligible participants, 375 (96.7%) completed the olfactory testing. Mean age was 39.0 years (SD=13.2), and 44.8% identified as women. The participants smoked on average 15 (SD=7.1) cigarettes per day for a median duration of 18 years (IQR: 11-28). Mean OIS was 13.3 (SD=1.8) and 12.0% had olfactory dysfunction. Olfactory dysfunction was significantly associated with pack-years (OR=1.03; 95% CI: 1.00-1.05) but not with YOS or CPD. OIS was negatively associated with pack-years (coefficient= -11.11; 95% CI: -4.29 - -17.94). OIS was not significantly associated with YOS or CPD. CONCLUSIONS:Among smokers smoking ≥5 cigarettes per day participating in a smoking cessation trial, about one in ten had olfactory dysfunction. Higher number of pack-years were associated with a worse measure of olfactory function and with olfactory dysfunction. CLINICAL TRIAL REGISTRATION:This sub-study of the ESTxENDS trial is pre-registered on the official website of ClinicalTrials.gov. IDENTIFIER:NCT04617444.