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Tabakkonsum bei Jugendlichen und erwachsenen Risikopopulationen. Einflussfaktoren und Ansätze zu Prävention und Intervention Die vorliegende Arbeit beschäftigt sich mit den Einflussfaktoren des Tabakkonsums bei verschiedenen Zielgruppen sowie möglichen Ansätzen zur nachhaltigen Beeinflussung des Rauchverhaltens. Die Arbeit besteht aus insgesamt sechs Manuskripten, die in nationalen und internationalen Fachzeitschriften publiziert oder zur Publikation angenommen sind. Diese sechs Beiträge lassen sich zwei Schwerpunkten zuordnen, die inhaltlich die zwei wichtigsten Möglichkeiten zur Reduktion des Tabakkonsums in der Bevölkerung widerspiegeln: die Verhinderung des Neueinstiegs in das Rauchen bei Kindern und Jugendlichen (Prävention) sowie die Förderung des Ausstiegs aus dem Rauchen (Intervention). Im ersten Teil wird im Rahmen eines Reviews sowie zweier Studien untersucht, ob sich verhältnispräventive Maßnahmen an Schulen auf das Rauchverhalten der Schüler auswirken. Im zweiten Teil untersuchen drei Studien die Motivation zur Verhaltensänderung, die Inanspruchnahme von Hilfsangeboten bzw. die Effektivität von Tabakentwöhnung bei Rauchern mit einer Alkoholabhängigkeit, Müttern in der Mutter-Kind-Rehabilitation sowie Patienten mit tabakassoziierten körperlichen Erkrankungen. / „Smoking in adolescents and adult risk populations. Factors of influence and approaches concerning prevention and intervention” This dissertation is concerned with factors influencing the smoking behaviour of different target groups and potential approaches for lasting changes of these behaviours. The dissertation consists of six manuscripts that are published or accepted for publication in national and international peer-reviewed journals. These six papers refer to two main emphases that reflect the two most important possibilities to reduce tobacco consumption in the population: Prevention of smoking initiation in children and adolescents (prevention), and support for smoking cessation (intervention). In the first part of the dissertation, a literature review and two empirical studies assess the influence of school tobacco policies on the smoking behaviour of students. In the second part, three empirical papers examine motivation to change, utilisation and effectiveness of smoking cessation in smokers with an alcohol dependence, mothers in mother-child rehabilitation and patients with smoking-related physical diseases.

The study investigated three aspects related to smoking, namely, smoking behaviour, risk perception and attitudes to anti-smoking legislation. The theoretical framework of the study was the Information-Motivation-Behavioural (IMB) skills model. The study was a quantitative one, making use of a cross-sectional survey design to obtain data about the three variables of interest. Responses to statements about risk perception and attitudes to anti-smoking legislation in the questionnaire were arranged on a three-point Likert scale. The inferential statistics used were one-sample ttests and Chi-square analyses. The results showed an overall smoking prevalence of 16%, with twice as many females than males being smokers in the sample. ‘Coloured’ students in both genders had the highest smoking rate compared to all other race groups. The knowledge of the health risks of smoking were very high, however smokers had a lower perception of risk compared to non-smokers. Moreover, while there was a fair amount of support for anti-smoking legislation among smokers, smokers tended to show less support for legislation than non-smokers, especially to those parts of the legislation that affect them more directly. The results of the study indicate a clear connection between smoking behaviour and the effect it has on both risk perception as well as attitudes to anti-smoking legislation in individuals.

The study investigated three aspects related to smoking, namely, smoking behaviour, risk perception and attitudes to anti-smoking legislation. The theoretical framework of the study was the Information-Motivation-Behavioural (IMB) skills model. The study was a quantitative one, making use of a cross-sectional survey design to obtain data about the three variables of interest. Responses to statements about risk perception and attitudes to anti-smoking legislation in the questionnaire were arranged on a three-point Likert scale. The inferential statistics used were one-sample ttests and Chi-square analyses. The results showed an overall smoking prevalence of 16%, with twice as many females than males being smokers in the sample. ‘Coloured’ students in both genders had the highest smoking rate compared to all other race groups. The knowledge of the health risks of smoking were very high, however smokers had a lower perception of risk compared to non-smokers. Moreover, while there was a fair amount of support for anti-smoking legislation among smokers, smokers tended to show less support for legislation than non-smokers, especially to those parts of the legislation that affect them more directly. The results of the study indicate a clear connection between smoking behaviour and the effect it has on both risk perception as well as attitudes to anti-smoking legislation in individuals.

Magister Artium (Psychology) - MA(Psych) / The study investigated three aspects related to smoking, namely, smoking behaviour, risk perception and attitudes to anti-smoking legislation. The theoretical framework of the study was the Information-Motivation-Behavioural (IMB) skills model. The study was a quantitative one, making use of a cross-sectional survey design to obtain data about the three variables of interest. Responses to statements about risk perception and attitudes to anti-smoking legislation in the questionnaire were arranged on a three-point Likert scale. The inferential statistics used were one-sample t-tests and Chi-square analyses. The results showed an overall smoking prevalence of 16%, with twice as many females than males being smokers in the sample. 'Coloured' students in both genders had the highest smoking rate compared to all other race groups. The knowledge of the health risks of smoking were very high, however smokers had a lower perception of risk compared to non-smokers. Moreover, while there was a fair amount of support for anti-smoking legislation among smokers, smokers tended to show less support for legislation than non-smokers, especially to those parts of the legislation that affect them more directly. The results of the study indicate a clear connection between smoking behaviour and the effect it has on both risk perception as well as attitudes to anti-smoking legislation in individuals. / South Africa

Tabakkonsum bei Jugendlichen und erwachsenen Risikopopulationen. Einflussfaktoren und Ansätze zu Prävention und Intervention Die vorliegende Arbeit beschäftigt sich mit den Einflussfaktoren des Tabakkonsums bei verschiedenen Zielgruppen sowie möglichen Ansätzen zur nachhaltigen Beeinflussung des Rauchverhaltens. Die Arbeit besteht aus insgesamt sechs Manuskripten, die in nationalen und internationalen Fachzeitschriften publiziert oder zur Publikation angenommen sind. Diese sechs Beiträge lassen sich zwei Schwerpunkten zuordnen, die inhaltlich die zwei wichtigsten Möglichkeiten zur Reduktion des Tabakkonsums in der Bevölkerung widerspiegeln: die Verhinderung des Neueinstiegs in das Rauchen bei Kindern und Jugendlichen (Prävention) sowie die Förderung des Ausstiegs aus dem Rauchen (Intervention). Im ersten Teil wird im Rahmen eines Reviews sowie zweier Studien untersucht, ob sich verhältnispräventive Maßnahmen an Schulen auf das Rauchverhalten der Schüler auswirken. Im zweiten Teil untersuchen drei Studien die Motivation zur Verhaltensänderung, die Inanspruchnahme von Hilfsangeboten bzw. die Effektivität von Tabakentwöhnung bei Rauchern mit einer Alkoholabhängigkeit, Müttern in der Mutter-Kind-Rehabilitation sowie Patienten mit tabakassoziierten körperlichen Erkrankungen. / „Smoking in adolescents and adult risk populations. Factors of influence and approaches concerning prevention and intervention” This dissertation is concerned with factors influencing the smoking behaviour of different target groups and potential approaches for lasting changes of these behaviours. The dissertation consists of six manuscripts that are published or accepted for publication in national and international peer-reviewed journals. These six papers refer to two main emphases that reflect the two most important possibilities to reduce tobacco consumption in the population: Prevention of smoking initiation in children and adolescents (prevention), and support for smoking cessation (intervention). In the first part of the dissertation, a literature review and two empirical studies assess the influence of school tobacco policies on the smoking behaviour of students. In the second part, three empirical papers examine motivation to change, utilisation and effectiveness of smoking cessation in smokers with an alcohol dependence, mothers in mother-child rehabilitation and patients with smoking-related physical diseases.

La présente étude a comme objectif de comprendre comment les détenus se sont adaptés à l’interdiction complète de fumer dans les établissements carcéraux canadiens. À partir d’entrevues qualitatives menées auprès de dix-sept hommes incarcérés dans divers établissements de détention canadiens, nous avons analysé le vécu des reclus soumis à cette nouvelle réglementation. Il ressort de nos analyses que le tabac permet aux détenus d’amoindrir les souffrances liées à l’emprisonnement, d’où l’adaptation individuelle et collective quant au contournement de la politique antitabac. De plus, la réglementation sur le tabac a des répercussions considérables sur le caractère total des institutions carcérales. La perte d’un droit qui avait été acquis depuis plusieurs décennies a créé une augmentation des mesures de contrôle, des privations et des tensions au sein du milieu carcéral. / The present study aims to understand how inmates have adjusted to a total ban on smoking in Canadian prisons. From qualitative interviews conducted with seventeen men detained in various detention facilities in Canada, we analyzed the experiences of inmates subject to the new regulations. It appears from our analyzes that tobacco allows inmates to lessen the suffering associated with imprisonment, which leads the individual and collective adaptation to circumvent the smoking policy. In addition, the tobacco regulation has a significant impact on the total character of penal institutions. The loss of a right that was acquired over several decades has created an increase in control measures, deprivation and tensions within the prison.

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Snus förbjöds inom EU år 1992, men Sverige erhöll ett undantag från förbudet vid anslutning till EU år 1995. Anledningen till snusförbudet var att vissa medlemsstater redan infört förbud mot snus i nationell lagstiftning, vilket skapade en obalans på den inre marknaden. År 2016 lanserades vitt snus, en produkt som liknar snus men saknar tobak. Tobakssnus och vitt snus har sitt ursprung i Sverige. Vitt snus har nyligen förbjudits i flera medlemsstater, som Belgien, Nederländerna och delar av Tyskland. EU har ännu inte tagit ställning till frågan om vitt snus, vilket gör framtiden för vitt snus oviss. Syftet med EU:s tobakspolitik och regleringar är att tobaksvaror inte ska vara tilltalande och attraktiva för unga. EU har som mål att vara en tobaksfri generation år 2040 enligt Europas plan mot cancer. Denna uppsats undersöker om ett nationellt förbud mot vitt snus strider mot den fria rörligheten för varor och hur en framtida reglering kan se ut.  Genom analys av tobaksvaror, tobaksdirektiv, svensk lagstiftning, ställningstagande från medlemsstater, EU:s inre marknad, fri rörlighet av varor och handelshinder har följande slutsatser framkommit. Eftersom Tobaksdirektivet är från 2014 är det möjligt att ett nytt tobaksdirektiv kommer införas inom en snar framtid. I ett nytt tobaksdirektiv borde vitt snus regleras, såvida inte ett separat direktiv skapas för tobaksfria nikotinprodukter. Tobakspolitiken tar alltmer sikte på nikotin, eftersom nikotin är den beroendeframkallande komponenten. Det är möjligt att vitt snus kategoriseras som snus och därmed omfattas av Sveriges undantag från snusförbudet. En sådan kategorisering kan utlösa diskussioner i andra medlemsstater och äventyra det svenska undantaget. Det är viktigt att identifiera varan vitt snus för att avgöra huruvida det kan regleras enligt befintliga regleringar för tobaksvaror eller om vitt snus är en egen vara som saknar regleringar. Vitt snus saknar harmoniseringsåtgärder, vilket ger medlemsstaterna utrymme att fastställa sina egna skyddsnivåer för vitt snus förutsatt att det inte strider mot den fria rörligheten av varor. Ett nationellt förbud mot vitt snus är ett handelshinder, då det begränsar vitt snus och skapar obalans på den inre marknaden. Dock kan ett sådant handelshinder motiveras av folkhälsoskäl enligt artikel 36 FEUF. Slutsatsen är att ett förbud mot vitt snus i nationell lagstiftning inte strider mot den fria rörligheten av varor, förutsatt att det är ett motiverat handelshinder som godkänns av EU. Framöver kan en reglering av vitt snus förväntas. / Snus was banned in the EU in 1992, However, Sweden was granted an exception from the ban in 1995 when Sweden joined the EU. The reason for the ban on snus was that some Member States had already banned snus in their national legislation, creating an imbalance in the internal market. Nicotine pouches, which are similar to snus, were introduced in 2016. The distinction between snus and nicotine pouches is that nicotine pouches do not contain tobacco. Both snus and nicotine pouches are Swedish products. However, nicotine pouches have recently been banned in Member States such as Belgium, the Netherlands and parts of Germany. The EU has not yet taken a position on the issue of nicotine pouches, making their future unpredictable. The aim of the EU's tobacco policy is to prevent tobacco products from being appealing and attractive to young people, with a target of achieving a tobacco-free generation by 2040. The thesis examines whether a national ban on nicotine pouches conflicts with the free movement of goods and what a future regulation might entail.  This thesis analyses the EU regulation of tobacco products and the Swedish legislation, as well as the position taken by Member States on the free movement of goods and trade barriers within the EU's internal market. It is expected that a new tobacco directive will be introduced in the near future, which will likely include regulations for nicotine pouches, unless a separate directive is created for tobacco-free nicotine products. Tobacco policy increasingly focuses on nicotine, as it is the addictive component. Nicotine pouches may be classified as snus due to their similar features, which means that nicotine pouches will be included in Sweden's exemption from the snus ban. It is possible that snus could then trigger discussions in other Member States and thus jeopardise the Swedish exemption. Classifying nicotine pouches as goods may determine whether banning them in national legislation would conflict with the free movement of goods. Nicotine pouches are not subject to harmonization measures. Therefore, Member States have the opportunity to determine their own levels of protection, as long as it does not conflict with the free movement of goods. A ban on nicotine pouches in national law is a barrier to trade under Article 34 TFEU because it restricts the product and creates an imbalance in the internal market. However, a trade barrier can be justified if it is justified on grounds of public health under Article 36 TFEU. Therefore, a national ban on nicotine pouches may be a justified trade barrier. The burden of proof for a justified trade barrier lies with the Member State, after which the EU approves it. The conclusion is that banning nicotine pouches in national legislation does not conflict with the free movement of goods, because a justified trade barrier should be approved by the EU. In the future, we may have to expect a harmonisation measure for the product nicotine pouches. / Le snus a été interdit dans l'UE en 1992. Cependant, la Suède a obtenu une exception à l'interdiction en 1995, lorsque la Suède a rejoint l'UE. La raison de l'interdiction du snus était que certains États membres l'avaient déjà interdit dans leur législation nationale, créant ainsi un déséquilibre au sein du marché intérieur. Les sachets de nicotine, similaires au snus, ont été introduits en 2016. La distinction entre le snus et les sachets de nicotine est que les sachets de nicotine ne contiennent pas de tabac. Les sachets de nicotine ont récemment été interdits dans des États membres comme la Belgique, les Pays-Bas et certaines parties de l'Allemagne. L'UE n'a pas encore pris position sur la question des sachets de nicotine, ce qui rend leur avenir imprévisible. L'objectif de la politique antitabac de l'UE est d'empêcher les produits du tabac d'être attrayants pour les jeunes, avec pour objectif d'atteindre une génération sans tabac d'ici 2040. La thèse examine si une interdiction nationale des sachets de nicotine est en conflit avec la libre circulation des marchandises et ce que pourrait impliquer une future réglementation.  Cette thèse analyse la réglementation de l'UE, la législation suédoise, la position prise par les États membres sur la libre circulation des marchandises et les barrières commerciales au sein du marché intérieur de l'UE. On s'attend à ce qu'une nouvelle directive sur le tabac soit introduite dans un avenir proche, qui comprendra probablement des réglementations sur les sachets de nicotine, à moins qu'une directive distincte ne soit créée pour les produits à base de nicotine sans tabac. La politique antitabac se concentre de plus en plus sur la nicotine, car c'est elle qui crée la dépendance. Les sachets de nicotine peuvent être classés comme snus en raison de leurs caractéristiques similaires et inclus dans l'exemption suédoise de l'interdiction du snus. Il est possible que le snus déclenche alors des discussions dans d'autres États membres et mette ainsi en péril l'exemption suédoise. Classer les sachets de nicotine comme marchandises peut déterminer si leur interdiction dans la législation nationale serait contraire à la libre circulation des marchandises. Les sachets de nicotine ne sont pas soumis aux mesures d'harmonisation au titre de l'article 114 du TFUE. Les États membres ont donc la possibilité de déterminer leurs propres niveaux de protection, pour autant que cela n'entre pas en conflit avec la libre circulation des marchandises. L'interdiction des sachets de nicotine dans la législation nationale constitue une barrière commerciale au sens de l'article 34 du TFUE, car elle restreint le produit et crée un déséquilibre sur le marché intérieur. Toutefois, une barrière commerciale peut être justifiée s’il est justifié par des raisons de santé publique au titre de l’article 36 du TFUE. Par conséquent, une interdiction nationale sur les sachets de nicotine pourrait constituer une barrière commerciale justifiée. La charge de la preuve d’une barrière commerciale justifiée incombe à l’État membre, après quoi l’UE l’approuve. La conclusion est que l'interdiction des sachets de nicotine dans la législation nationale n'est pas contraire à la libre circulation des marchandises, car une barrière commerciale justifiée devrait être approuvée par l'UE.