Objective: Tennessee’s tobacco use prevalence rate is 20.7%, compared to 16.1% nationally. This is associated with over 11,000 premature deaths and $5 billion annual costs. Over a third of young adults attend colleges/universities, and the use of electronic nicotine products is highest among this age group. This study created a Tennessee-specific best practices policy rating instrument to assist Higher Education Institutions (HEIs) in crafting comprehensive nicotine product policies. Methods: Between August 2017 and October 2018, a Tobacco-Free Generation Campus Initiative-funded team developed the Nicotine Product Policy Index (NPPI) rating instrument, with 50 items within four sections: 1) environment, 2) enforcement, 3) prevention and treatment services, and 4) policy organization. The policies of 84 Tennessee HEIs were scored using the NPPI, and total scores were transformed to ratings from 0-5 for a comprehensive policy. Results: Of Tennessee’s 34 independent colleges/universities, 11.76% were rated at 0 for lack of policy accessible to investigators. Ratings of 1 were given to 44%, 2 to 8.82%, 3 to 14.71%, and 4 to 17.64%. A rating of 4 was given to 17.64% of independent colleges/universities,15.38% of Tennessee’s 13 Community Colleges and 33.33% of Tennessee’s six Locally Governed Institutions. All four University of Tennessee-affiliated institutions earned a 4 rating. Only one institutional tobacco/smoking policy rated a 5: Tusculum College, an independent college/university. Conclusion: The NPPI could guide development of comprehensive nicotine product policies designed to address the high prevalence of tobacco use.

Skolsköterskan som är verksam inom elevhälsan har i uppdrag att arbeta hälsofrämjande på skolan. Tobaksfria nikotinprodukter såsom elektroniska cigaretter och vitt snus har ökat bland ungdomar. Det är angeläget att utforska hur skolsköterskor arbetar med nikotinprevention för att kunna förbättra det hälsofrämjande arbetet för att förhindra att en ny generation blir beroende utav nikotin. Syfte: Syftet med studien var att utforska skolsköterskors erfarenheter av att arbeta med prevention av tobaksfria nikotinprodukter bland ungdomar på högstadiet. Metod: Kvalitativ intervjustudie baserad på tio semistrukturerade intervjuer med skolsköterskor i Halland i Sverige. Manifest kvalitativ innehållsanalys med induktiv ansats. Resultat: Fem kategorier: Skolsköterskans undervisning och information ute i klasserna, skolsköterskans relation till eleverna, skolsköterskans relation till vårdnadshavarna, skolsköterskans hälsofrämjande arbete genom hälsosamtal, skolsköterskans stöd från ledningen samt 11 underkategorier och citat från informanter vilket bekräftar resultatet. Konklusion: Det saknas tydliga riktlinjer för hur skolsköterskorna ska arbeta med nikotinprevention på skolan. Ungdomar bör få kunskap hur skadligt nikotin är för hälsan och vad ett nikotinberoende kan leda till i framtiden. / The school nurse, active in student health services, is required to promote the health of the students at school. Use of tobacco-free nicotine products, such as e-cigarettes and white snuff, has increased among adolescents. In order to promote better health education and work towards the prevention of nicotine addiction in the next generation, it is important to explore the adverse effects of addiction. Aim: The aim of this study was to explore the experiences of various school nurses in working towards the prevention of tobacco-free nicotine product usage among adolescents in secondary school. Method: This is a qualitative study based on ten semi-structured interviews with school nurses in Halland, Sweden, manifesting the analysis using an inductive approach. Results: Results were classified into five categories: Teaching and information, relationship to the students, relationship to the guardians, health promotion through health talks, support from management, as well as 11 subcategories and quotes from participants confirming the result. Conclusion: There are no clear guidelines as to how school nurses currently work with nicotine prevention. However, it should be required that the next generation be taught the harmful effects of nicotine to their health and what nicotine addiction can lead to in the future.

Marknadsföring av hälsofarliga produkter inom områden som till exempel alkohol och tobakhar länge ifrågasatts då det går emot främjandet av folkhälsan. Tidigare forskning tyder på att exponering för marknadsföring av dessa produkter leder till ett ökat konsumtionsbeteende hos unga. Lagar kring regleringar av bland annat åldersgränsen och marknadsföring av dessa produkter har således stiftats, men nya produkter sätter ständigt krav på en granskning av dessa lagar. De relativt nya tobaksfria nikotinprodukterna reglerades inte på flera år under en lag och företag kunde således använda sig av flertalet strategier för att marknadsföra nikotinprodukter, exempelvis vitt snus och e-cigaretter. Fåtalet forskning har gjorts kring exponeringen förmarknadsföringen av nikotinprodukterna och ungas påverkan av denna, men de som har gjorts visar på ett samband mellan exponeringen och en ökad mottaglighet samt en ökad sannolikhet till att börja konsumera produkterna. Studien syftar till att öka förståelsen för hur företags marknadsföring av nikotinprodukten vitt snus uppfattas av generation Z i Sverige och till vilken grad marknadsföringen påverkar dem för att således nyansera problemet. En kvalitativ studie genomfördes där tre fokusgruppsintervjuer med totalt femton deltagare genomfördes. Empirin samlades in genom att spela in samtliga intervjuer vilka sedan transkriberades för att möjliggöra en objektiv analys. Empirin visar att respondenterna upplevde att företags marknadsföring av vitt snus framhäverpositiva attribut hos produkten genom färgglada och tilltalande annonser där produkten marknadsförs likt en essentiell accessoar. Vitt snus ansågs även vara normaliserat och marknadsfördes likt en godis eller ett tuggummi vilket riktade sig mot en ung målgrupp. Det framgick även att deltagare har fått en förändrad attityd gentemot produkten vid en längre tids exponering via dels marknadsföring, dels vänners konsumerande av produkten. Deras negativa och hälsofarliga uppfattning av vitt snus hade minskat till den grad att de till slut konsumeradeprodukten. Vidare visade influencers ha betydelse för ungas konsumtionsbeteende och deras roll som förebild ifrågasattes av respondenterna med tanke på deras stora inflytande på sina följare. Slutligen fanns det även ifrågasättanden gällande influencers verkliga anledning till samarbeten med företag där marknadsföring av hälsofarliga produkter ansågs endast bero på den ekonomiska aspekten då de gör reklam för ett hälsofarligt konsumerande. / Marketing of health-hazardous products in areas such as alcohol and tobacco has long been a discussed topic as it questions the promotion of public health. Previous research indicates that exposure to marketing of these products leads to increased consumption behavior among young people. Laws surrounding the regulation of, for instance, the age limit and marketing of these products have thus been established. However, newly established products on the market constantly require an inspection of these laws. The relatively new tobacco-free nicotine products were not regulated for several years when these entered the market. Therefore,companies were able to use several productive strategies to market nicotine products, for example white nicotine pouches and e-cigarettes. Research on nicotine products marketing exposure and the effect on young people shows an association between the marketing exposure and an increased susceptibility and a behavior change. This study aims to contribute with a profound understanding of how companies' nicotine product marketing of nicotine pouches is perceived by generation Z in Sweden and to what extent themarketing influences them, in order to nuance this questioned topic. A qualitative method was applied where three focus group interviews with fifteen participants were conducted. The interviews were recorded to get a full transcription and enable an objective analysis. The results show that the participants perceived the companies' nicotine pouches marketing to emphasize positive attributes of the product through colorful and appealing advertisements,where the product appeared like an essential accessory. The nicotine pouches were also perceived to be normalized in society and were marketed like candy or chewing gums which targeted a younger audience. It also emerged that participants had a reduced harm perceptionsof nicotine pouches through a longer period of market exposure and exposure of the product through friends. Their reduced harm perceptions resulted in consumption of the product. Furthermore, influencers were shown to have an impact on young people's consumption behavior and their part as a role model was questioned by respondents regarding their influence on their followers. Finally, the results show participants critically question influencers' real reason for collaborations with companies. The marketing of health-hazardous products was considered only a financial manner as the influencers promote a health-hazardous consuming.

The use of modern oral nicotine products (colloquially known as white snus or nicotine pouches) is increasing fast among youth and young women in Sweden. Due to aggressive marketing on social media, the colourful snus cans that contain nicotine pouches have become accessories that could be compared with lifestyle products (such as branded clothing, jewellery, or cosmetics). This collaborative design project aims to explore alternative approaches to education against modern nicotine products and to create a small-scale countermovement for the increasing white snus trend. During the project, we have used methods of human-centred design and visual communication in order to facilitate female snus users in reflecting on their own habits and rethinking the lifestyle around nicotine pouches. The project is done in collaboration with female university students who use white snus and two local tobacco control workers in the Region Kalmar län (Region Kalmar County).