Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

Disease burden of ischemic heart disease attributable to lead exposure in China from 1990 to 2019, and projections until 2030

The burden of ischemic heart disease (IHD) attributable to lead exposure in China remains poorly understood. Using data from the Global Burden of Disease 2019, we aim to explore the epidemiological trends and specific burdens, providing insights into environmental health. In 2019, the number of deaths and disability-adjusted life years of IHD attributable to lead exposure in China reached 105,857 and 1,899,139, respectively. The age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) were 6.46 and 101.29 per 100,000 population, respectively. The burden was higher in males than in females. The estimated ASMR is projected to decrease to 7.08 and 3.37 per 100,000 for males and females by 2030, while the ASDR is expected to decline to 100.57 and 45.30 per 100,000 for males and females. The burden of IHD attributable to lead exposure is substantial in China, highlighting the grave public health concern posed by lead pollution.

Trends in the Incidence and Mortality of Tobacco-Related Cancers Among Adults in the United States

BACKGROUND

Tobacco use remains a global challenge to public health, accounting for almost eight million deaths per year worldwide, with a significant portion attributable to tobacco-related cancers. Examining the epidemiology of tobacco-related cancers and assessing the trends in the incidence and mortality will allow for more effective prevention, treatment, and targeted strategies.

METHODS

We assessed the trends in the incidence and mortality of tobacco-related cancers among adults in the United States using data from United States Cancer Statistics (USCS) 2001-2021 and mortality data 1975-2022 from the National Center for Health Statistics (NCHS). The incidence and mortality rates of tobacco-related cancers were calculated as cases per 1,000,000 persons and age-adjusted to the 2000 United States standard population.

RESULTS

There was a recent overall decreasing trend in both the incidence (2001-2021) and mortality rate (2001-2022). Among adults 20-49 years old, there was an increasing trend from 2001 to 2021 in the incidence among non-Hispanic American Indians/Alaska Natives (APC 2.6, 95% CI 2.1-3.0) and those in the West (APC 0.2, 95% CI 0.0-0.4); in Hispanics, the incidence rate increased most recently from 2013 to 2021 (APC 1.7, 95% CI 1.0-3.0). The mortality rate first increased from 1975 to 1990 among females 50-64 years old and males 65+ years old and from 1975 to 2000 among females 65+ years old, and then decreased thereafter.

CONCLUSIONS

The rising incidence in some younger groups highlights the need for targeted public health interventions to address disparities and improve cancer prevention in these vulnerable populations.

Multi-ancestral genome-wide association study of clinically defined nicotine dependence reveals strong genetic correlations with other substance use disorders and health-related traits

Genetic research on nicotine dependence has utilized multiple assessments that are in weak agreement. We conducted a genome-wide association study of nicotine dependence defined using the Diagnostic and Statistical Manual of Mental Disorders (DSM-NicDep) in 61,861 individuals (47,884 of European ancestry, 10,231 of African ancestry, 3,746 of East Asian ancestry) and compared the results to other nicotine-related phenotypes. We replicated the well-known association at the CHRNA5 locus (lead SNP: rs147144681, p =1.27E-11 in European ancestry; lead SNP = rs2036527, p = 6.49e-13 in cross-ancestry analysis). DSM-NicDep showed strong positive genetic correlations with cannabis use disorder, opioid use disorder, problematic alcohol use, lung cancer, material deprivation, and several psychiatric disorders, and negative correlations with respiratory function and educational attainment. A polygenic score of DSM-NicDep predicted DSM-5 tobacco use disorder and 6 of 11 individual diagnostic criteria, but none of the Fagerström Test for Nicotine Dependence (FTND) items, in the independent NESARC-III sample. In genomic structural equation models, DSM-NicDep loaded more strongly on a previously identified factor of general addiction liability than did a "problematic tobacco use" factor (a combination of cigarettes per day and nicotine dependence defined by the FTND). Finally, DSM-NicDep was strongly genetically correlated with a GWAS of tobacco use disorder as defined in electronic health records, suggesting that combining the wide availability of diagnostic EHR data with nuanced criterion-level analyses of DSM tobacco use disorder may produce new insights into the genetics of this disorder.

Relationship between parental smoking and adolescent smoking: gender differences and mediation of resilience

BACKGROUND

Though the relationship between parental smoking and adolescent smoking has been established, gender differences, and mediation of resilience in this relationship are poorly understood. This research aims to investigate the prevalence of adolescent smoking, and to understand how consequences may differ for boys and girls, as well as to explore what role resilience played in this relationship.

METHODS

Through the school-based cross-sectional survey, a total of 65,898 adolescents were involved in this study, and information were collected by self-reported questionnaire. Participants' smoking status and their parental smoking status were collected by self-made questionnaire, and resilience was assessed by the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). The multivariate logistic regression was conducted to explore the relationship between parental smoking and adolescent smoking. After that, the path analysis was applied to explore the mediation of resilience in this relationship.

RESULTS

Of all participants, the rate of self-report current smoking and biologically verified smoking was 1.4% and 2.0%, respectively. Both self-reported and biologically verified prevalence of smoking among boys were higher than that in girls. There were gender differences in the impact of parental smoking on adolescent smoking: mother smoking had a negative effect on adolescent smoking, and resilience could mitigate this negative effect. Father smoking had no association with girl smoking, while father smoking was positively associated with boy smoking, and resilience was mediated in this association.

CONCLUSIONS

Our findings suggested smoking prevention in adolescents can be done differently for different genders. Besides, results indicated resilience was important in preventing adolescent smoking. Furthermore, parents quitting smoking can play an important role in preventing adolescent smoking to a certain extent.

The economic burden of smoking in Belgium: incremental healthcare costs and lost productivity

Tobacco use is among the leading behavioural risk factors for morbidity and mortality. These high rates result in a high cost to society. Therefore, the aim of the current study was to provide a contemporary overview of the direct medical and indirect costs attributable to smoking tobacco in Belgium. Data from the Belgian Health Interview Survey (BHIS) was combined with health insurance claims data. Healthcare costs were calculated on individuals' cigarette smoking patterns (daily, former, and never smokers). Lost productivity costs were calculated by multiplying the number of absence days by the national average wage cost per day. Univariate and multivariable regression analyses with negative binomial distribution and log link were performed to evaluate the average healthcare costs and indirect costs in relation to tobacco use, socio-demographic characteristics, and (behavioural) risk factors. A total of 10 829 individuals were included in the analyses, of which 47.7% were men, with 15% being smokers. Men were more likely to be smokers than women (56.8% vs. 43.2%; P < 0.001). Compared to never smokers, significantly higher direct medical costs were found for daily (20%; P = 0.03) and former smokers (27%; P < 0.001). No significant differences were observed for the indirect costs for the smoking population compared to never smokers. Taking into account that 15% of the Belgian population were daily smokers in 2018, the national cost for daily smokers equates to €533.861.010. Results of our study show that cigarette smoking has higher direct medical costs compared with never smokers.

Association between smoking status and sarcopenia among middle-aged and older adults: finding from the CHARLS study

PURPOSE

There is limited information on the association between smoking/smoking cessation and sarcopenia in Chinese populations. We conducted a retrospective cohort study to investigate the association between smoking/smoking cessation and its duration with the risk of sarcopenia.

METHODS

This cohort included 6,719 adults over 45 from the CHARLS between 2011 and 2015. Smoking status was categorized into smokers (current smokers/quitters) and non-smokers. Duration of smoking was defined as < 20, 20-29, 30-39, and ≥ 40 years. Duration of smoking cessation was defined as ≤ 1, 2-4, and > 4 years. Sarcopenia was defined according to AWGS 2019. Cox proportional hazards regression models were used to estimate the hazard ratio for the risk of developing sarcopenia.

RESULTS

The median age of the cohort was 57.0 years, and 47.0% were male. Over a 3.7-year follow-up period, 9.7% of participants developed sarcopenia. Compared to non-smokers, smokers had a higher risk of developing sarcopenia (HR: 1.27, 95% CI 1.02-1.59). Among individuals with a smoking duration exceeding 40 years, the likelihood of developing sarcopenia was 39.0% higher (HR: 1.39, 95% CI 1.08-1.79). The elevated risk persists regardless of alcohol consumption. Quitters had a lower risk of sarcopenia compared to current smokers (HR: 0.67, 95% CI 0.47-0.97). Individuals who had quit smoking for > 4 years had a lower risk of sarcopenia compared to current smokers (HR: 0.43, 95% CI 0.24-0.78).

CONCLUSION

Current smokers face a higher risk of sarcopenia, especially those with a prolonged smoking history. Promoting smoking cessation is an essential strategy for lowering the risk of sarcopenia and mitigating its burden among smokers.

Association of low employment quality with cigarette smoking, smoking initiation, and smoking cessation: A 16-year longitudinal study in South Korea

This study explored the association between multidimensional aspects of employment quality and smoking habits. This study included the wage workers in the Korean Labour and Income Panel Study, 2005-2021 (n = 16,188; observations = 92,954). The employment quality was constructed using a multidimensional approach encompassing three dimensions: employment insecurity, income inadequacy, and a lack of rights and protection. The outcome was current smoking in the same year as exposure to employment quality, as well as the incidence of smoking initiation and cessation in the subsequent year. A generalized estimating equation was used for repeated measures analysis to estimate the odds ratio (OR) and 95% confidence intervals (CIs). Compared with those with the highest employment quality, the odds of smoking cessation were lower among those with the low employment quality (OR: 0.81, 95% CI: 0.68-0.95) and those with the lowest employment quality (OR: 0.76, 95% CI: 0.61-0.95). While a comparable relationship was found among males, the correlation in the female sample was unclear. Concurrent smoking status and smoking initiation exhibited no clear associations with overall employment quality in both male and female samples. For individual employment quality indicators, daily employment showed a negative association with the odds of smoking cessation. Therefore, this study suggests that policy interventions aimed at enhancing the employment quality of workers are warranted to reduce smoking rates.

Assessing the 53-Year Epidemiological Trends of Oral Squamous Cell Carcinoma (OSCC) in Northeastern Iran

OBJECTIVES

This study aimed to assess the epidemiological trends of oral squamous cell carcinoma (OSCC) in Northeast Iran over a 53-year period.

MATERIAL AND METHODS

In this retrospective study, we obtained data on OSCC cases in Northeast Iran spanning 53 years (1970-2022), including demographic details, such as age, sex, site, and histopathological grade. Descriptive analysis was conducted, and frequencies were compared using the chi-squared test to evaluate differences between sexes, age groups, cancer sites, and histopathological grades. Additionally, we assessed the associations of each OSCC site with age, sex, and histopathological grade. Statistical significance was set at p < 0.05, with a confidence interval of 95%.

RESULTS

This study examined 13,769 cases, among which 507 were diagnosed with OSCC, accounting for 3.68% of the total cases. The mean age was 59.27 ± 14.94 years, with a significantly higher prevalence of OSCC among individuals older than 50 years (p < 0.001). There were nearly equal proportions of males and females, with the tongue being the most common site (28.4%), followed by the gingiva (26.4%) and buccal mucosa (19.5%). Grade 1 (well differentiated) OSCC was significantly more prevalent (54%) than other grades. There was a significant association between sex and tongue SCC in females (p = 0.006) and between sex and lip SCC in males (p = 0.008). Prevalence in individuals above 50 was significant for the tongue, buccal mucosa, gingiva, and lip (p = 0.001, < 0.001, < 0.001, 0.028, respectively). In the tongue, buccal mucosa, gingiva, and floor of the mouth, grade 1 was significantly more prevalent (p < 0.001).

CONCLUSIONS

Our study revealed that OSCC predominantly affects individuals older than 50 years, with nearly equal prevalence between sexes. The most commonly affected sites are the tongue and gingiva, often exhibiting grade 1 histopathological findings. Enhanced community awareness of risk factors and regular oral examinations are essential for reducing the incidence of OSCC.

miRNA Signatures in Alveolar Macrophages Related to Cigarette Smoke: Assessment and Bioinformatics Analysis

Cigarette smoke (CS) is a driver of many respiratory diseases, including chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer (NSCLC). Tobacco causes oxidative stress, impaired phagocytosis of alveolar macrophages (AMs), and alterations in gene expression in the lungs of smokers. MicroRNAs (miRNAs) are small non-coding RNAs that influence several regulatory pathways. Previously, we monitored the expressions of hsa-miR-223-5p, 16-5p, 20a-5p, -17-5p, 34a-5p, and 106a-5p in AMs derived from the bronchoalveolar lavage (BAL) of subjects with NSCLC, COPD, and smoker and non-smoker control groups. Here, we investigated the capability of CS conditionate media to modulate the abovementioned miRNAs in primary AMs obtained in the same 43 sex-matched subjects. The expressions of has-miR-34a-5p, 17-5p, 16-5p, 106a-5p, 223-5p, and 20a-5p were assessed before and after in vitro CS exposure by RT-PCR. In addition, a comprehensive bioinformatic analysis of miRNAs KEGGS and PPI linked to inflammation was performed. Distinct and common miRNA expression profiles were identified in response to CS, suggesting their possible role in smoking-related diseases. It is worth noting that, following exposure to CS, the expression levels of hsa-miR-34a-5p and 17-5p in both smokers and non-smokers, 106a-5p in non-smokers, and 20a-5p in smokers, shifted towards those found in individuals with COPD, suggesting them as a risk factor in developing this lung condition. Moreover, CS-focused sub-analysis identified miRNA which exhibited CS-dependent pattern and modulated mRNA involved in the immune system or AMs property regulation. In conclusion, our study uncovered miRNA signatures in AMs exposed to CS, indicating that CS might modify epigenetic patterns that contribute to macrophage activation and lung disease onset and progression.

Understanding the mechanisms of change in social norms around tobacco use: A systematic review and meta-analysis of interventions

BACKGROUND AND AIMS

Tobacco use spreads through social networks influencing social norms around tobacco use. However, the social norms scholarship is extremely diverse and occasionally conflicting, complicating efforts to understand how best to leverage social norms to reduce tobacco use. This study systematically reviewed and meta-analyzed this vast terrain by focusing on social norms measurement and mechanism, and intervention effectiveness and modality aimed at changing social norms around tobacco use and actual tobacco use.

METHODS

We searched Scopus, PubMed, PsycInfo, Clinicaltrials.gov, ProQuest Dissertations, the Cochrane Trial Registry, as well as the websites of the Society for Research on Nicotine and Tobacco, the Open Science Framework, medrXiv and the Truth Initiative for experimental and quasi-experimental evaluation studies of interventions designed to shift tobacco use. We included studies written in English from inception to 30 May 2024. We only included studies which noted social norms or social influence as part of the intervention design or set of measured variables. We excluded studies with only one time point, without an intervention being evaluated and those not published in English. Study screening followed the PRISMA 2020 guidelines, and was conducted by at least two independent reviewers who resolved discrepancies through discussion and consensus. All included studies were analyzed in a narrative synthesis, and those providing sufficient statistics for tobacco and social norms outcomes were included in meta-analyses, which were performed separately for tobacco outcomes and social norms outcomes. Study outcomes were transformed into a standardized mean difference (Hedges' g) and several meta-regressions were fit to explore sources of heterogeneity using a robust variance estimation specification to handle effect size dependency.

RESULTS

A total of 95 studies met inclusion criteria for the narrative synthesis, 200 effect sizes from 86 studies were included in the tobacco outcomes meta-analysis, and 66 effect sizes from 29 studies were included in the social norms outcomes meta-analysis. Nearly 90% of included studies were conducted in high-income settings, with the remainder conducted in middle-income settings. No studies were conducted in Latin America or on the African continent. Social norms change interventions had a statistically significant effect on reducing tobacco use and pro-tobacco social normative perceptions [g = 0.233, 95% confidence interval (CI) = 0.166, 0.301, P < 0.001 and g = 0.292, 95% CI = 0.090, 0.494, P = 0.007, respectively]. Interventions were commonly conducted among schoolchildren in classrooms through multicomponent education sessions, often coupled with regular 'booster' sessions over time. Among adult populations, motivational interviewing and other counselling approaches were used in some cases, and few interventions leveraged digital technologies to change social norms.

CONCLUSIONS

Social norms change interventions appear to be effective for reducing tobacco use and pro-tobacco social normative perceptions. In particular, leveraging role models appears to be the most effective social norms change mechanisms for tobacco control.

Cardiovascular disease in the Americas: the epidemiology of cardiovascular disease and its risk factors

This first article of the Series about Cardiovascular Disease in the Americas summarizes the epidemiology of CVD and its risk factors, and population-level strategies in place aimed at CVD prevention. While age-standardized CVD incidence and CV mortality rates have been decreasing across in the Americas since 1990, the annual number of CVD cases and related deaths have increased due to population growth and ageing. The burden of CVD is also slowly transitioning from high-income countries in North America to middle-income countries in Latin America and the Caribbean. Trends in CV risk factor levels have been mixed, with declines in smoking and mean cholesterol counterbalanced by higher prevalence of obesity and diabetes. Population-wide strategies aimed at controlling cardiometabolic risk factors and tobacco use have been implemented with varying degrees of success. There is a need to better implement existing CVD prevention strategies in the region.

Sex differences in atrial fibrillation in India: Insights from the Kerala-AF registry

Background

Much data informing sex differences in atrial fibrillation (AF) comes from Western cohorts. In this analysis, we describe sex differences in Kerala, India, using the Kerala-AF registry-the largest AF registry from the Indian subcontinent.

Methods

Patients aged ≥18 years were recruited from 53 hospitals across Kerala. Patients were compared for demographics, treatments, and 12-month outcomes, including major adverse cardiovascular events (MACE) and bleeding.

Results

Male patients were more likely to have a smoking and/or alcohol history and had more ischaemic heart disease (46.2% vs. 25.5%; p < 0.001). Female patients had more valvular AF (35.1% vs. 18.0%; p < 0.001), and more use of calcium-channel blockers (23.3% vs. 16.5%; p < 0.001) or digoxin (39.6% vs. 28.5%; p < 0.001). Almost one in four patients were not anticoagulated despite raised CHA2DS2-VASc scores. 12-month MACE outcomes did not differ by sex (male: 30.2% vs. female: 29.4%; p = 0.685), though bleeding events were more common in male patients (2.4% vs. 1.3%; p = -0.038), driven by minor bleeding (1.2% vs. 0.5%).

Conclusion

In this large AF cohort from India, male patients had a higher prevalence of ischaemic heart disease, smoking, and alcohol use, while female patients had a higher prevalence of valvular heart disease. MACE did not differ by sex, though bleeding was more common in males. Almost a quarter of patients were not anticoagulated despite raised thromboembolic risk.

Exposure to Bupropion-SR vs. Placebo is associated with reductions in smoking among persons receiving methadone with no stated interest in smoking cessation

Smoking is prevalent among individuals receiving methadone treatment. Reducing smoking among this population is needed as smoking is a leading cause of morbidity and preventable death. Smoking cessation interventions for persons receiving medication for opioid use disorder have yielded small changes in abstinence. Bupropion-SR was developed as an anti-depressant medication and is a first-line medication for smoking cessation. There is limited research on the effectiveness of bupropion-SR on smoking cessation among individuals receiving medication for opioid use disorder. This study is a secondary analysis of N = 72 adults enrolled in methadone treatment who endorsed smoking cigarettes. Participants were randomized to receive bupropion-SR 150 mg twice-daily (n = 35) or placebo (n = 37) in the primary study that examined bupropion-SR on cocaine use outcomes over a 30-weeks. Mixed model analyses examined secondary changes in self-reported cigarettes smoked, a self-reported measure of nicotine dependence, and quantitative urinary cotinine values. The longitudinal analysis of self-reported daily cigarettes identified no main effects of group and week however a significant interaction between group and week revealed that persons receiving bupropion-SR group reported less smoking early in the intervention. Longitudinal evaluation of changes in urinary cotinine revealed a significant main effect of week but no main effect of group or group x week interaction. Data suggest that bupropion-SR significantly decreased the number of self-reported cigarettes smoked relative to placebo and reduced nicotine dependence severity by the end of the study. Follow-up studies are needed as these decreases were not identified throughout the full study period or at termination.

Global, regional, and national cardiovascular disease burden attributable to smoking from 1990 to 2021: Findings from the GBD 2021 Study

INTRODUCTION

Smoking poses a serious threat to cardiovascular health. The aim of the study is to evaluate the global, regional, and national burden of smoking-attributable cardiovascular disease (CVD) and set priorities for future tobacco control.

METHODS

Data on deaths and years lived with disability (YLDs) for smoking-related CVD from 1990 to 2021, including age-standardized rates (ASRs), were sourced from the Global Burden of Disease (GBD) 2021. This study is a secondary descriptive analysis of the GBD 2021 data. We used the estimated annual percentage change (EAPC) to reflect temporal trends in disease burden and conducted a sensitivity analysis using the average annual percentage change (AAPC) to corroborate the findings. We also analyzed the relationship between disease burden and the Sociodemographic Index (SDI).

RESULTS

In 2021, smoking-related CVD caused 2.25 million deaths and 3.09 million YLDs globally, marking increases of 26.16% and 59.73% from 1990, respectively. However, from 1990 to 2021, the global age-standardized mortality rate (ASMR) and age-standardized years lived with disability rate (ASYR) for smoking-related CVDs decreased, with EAPCs of -1.94 and -0.92, respectively. Between 1990 and 2021, Australasia and Tropical Latin America experienced the largest declines in ASMR and ASYR, with EAPCs of -5.54 and -2.63, respectively, while Lesotho and Mali had the largest increases, with EAPCs of 2.68 and 1.67, respectively. Throughout the period, the burden of smoking-related CVD was consistently higher in men. Moreover, the trend of decline in disease burden was slower in men compared to women (EAPC for ASMR: -1.78 for men vs -3.25 for women). In 2021, countries with higher SDI also had higher ASYR.

CONCLUSIONS

Although the global burden of smoking-related CVD has declined over the past three decades, the challenge remains severe, particularly in less developed countries and regions. More proactive and effective tobacco control measures should be urgently implemented in countries where the burden of smoking-related CVD is severe.

Effects of Chronic Alcohol Intake on the Composition of the Ensemble of Drug-Metabolizing Enzymes and Transporters in the Human Liver

In this study, to better understand the mechanisms of the profound impact of alcohol consumption on drug pharmacokinetics, efficacy, and toxicity, we characterized the alcohol-induced changes in the ensemble of drug-metabolizing enzymes and transporters (DMETs) in the human liver by performing global proteomic analysis of human liver microsomes from 94 donors. DMET protein levels were analyzed concerning alcohol consumption, smoking history, and sex using non-parametric tests, which were further strengthened by correlational analysis. To this end, we used a provisional index of alcohol exposure formulated based on the relative abundances of four marker proteins best correlating with the level of alcohol consumption. Alcohol-induced changes in the cytochrome P450 pool include significant increases in CYP2E1, CYP2B6, CYP2J2, and NADPH-cytochrome P450 reductase levels and the lowering of CYP1A2, CYP2C8, CYP2C9, CYP4A11, and cytochrome b5. Changes in UDP-glucuronosyltransferase (UGT) abundances comprise elevated UGT1A6, UGT1A9, and UGT2A1, and reduced UGT1A3, UGT1A4, UGT2B7, UGT2B10, and UGT2B15 levels. Tobacco smokers showed elevated CYP1A2, UGT1A6, and UGT2B4 and reduced FMO3, FMO4, and FMO5 levels, while in females, CYP1A2, UGT2B17, and UGT2B15 levels were lower, and UGT2A3 and STS were higher compared to males. The alcohol-induced changes in the DMET ensemble at the protein level reported herein provide deep insights into how alcohol impacts drug and xenobiotic metabolism.

Delphi consensus methodology to gauge expert perspectives on smoking prevention, cessation and harm reduction in Italy

The role of smoke-free alternatives to cigarettes for tobacco harm reduction remains controversial. This study was conducted to understand the perspectives of a panel of Italian experts on this topic. Using Delphi consensus methodology, expert opinions on the use of smoke-free alternatives, tobacco harm reduction and anti-smoking legislation were gathered and analyzed. In July 2022, a Scientific Committee, including five members, proposed 38 statements spanning three areas: (1) harm from tobacco smoking and strategies for harm reduction; (2) smoke-free alternatives to cigarettes; and (3) anti-smoking legislation. Between August and November 2022, the Expert Panel, including members of the Scientific Committee and 15 other key opinion leaders, voted on the statements in two rounds. Consensus was achieved on 24 of 38 statements. The results emphasized the persistent national health threat posed by tobacco smoking in Italy, with a smoking prevalence of 20-24% between 2007 and 2022. Emphasizing harm reduction as a pivotal public healthcare strategy, the Expert Panel agreed on 10 statements related to smoke-free alternatives, but underlined the need for further research despite promising initial findings. The Expert Panel also reached consensus on six statements regarding anti-smoking legislation, stressing the importance of crafting and upholding rigorous anti-smoking laws that are consistent with World Health Organization guidelines. This pioneering Delphi consensus statement illuminates the complicated debate regarding the role of smoke-free alternatives for tobacco harm reduction in Italy. The findings highlight the evolving nature and advocate the need for ongoing discussions and further research on this important issue.

Prevalence and associated factors of diabetes among adult populations of Hawassa town, southern Ethiopia: A community based cross-sectional study

INTRODUCTION

Knowing the magnitude and preventable risk factors of diabetes has a significant contribution in targeted prevention intervention which ultimately ensures the existence of healthier and productive individuals in a country. Diabetes has untoward impact on health, social and economic consequences. Exploring preventable risk factors are extremely important because of their potential association and interaction with diabetes. Therefore, the aim of this study was to investigate the magnitude and modifiable risk factors of diabetes among adult populations in Hawassa town, southern Ethiopia.

METHODS

A community based cross-sectional study was conducted from September, 2023 to November, 2023 among adult populations. A multi-stage sampling technique was employed to select 1,113 study participants between the ages of 20-69 years. An interviewer-administered questionnaire was used to collect data. Additionally, participants were also instructed to fast overnight, after which the standard fasting blood glucose test was conducted. A binary logistic regression model was fitted to identify independent predictors of diabetes.

RESULTS

The overall prevalence of diabetes was 14.4% (95% Confidence Interval (CI): 12.4%, 16.4%). Being male (Adjusted Odds Ratio (AOR):2.10; 95% CI: 1.34, 3.29), being unable to read and write (AOR: 3.38; 95% CI: 1.09, 10.47), read and write (AOR: 3.38; 95% CI: 1.09, 10.47) and medium cycle (AOR 2.79; 95% CI: 1.02, 7.63) compared to college and above, consume less than 5 servings of fruits on daily base (AOR: 2.80; 95% CI: 1.18, 6.62), having ever chewed khat (AOR 6.50; 95% CI: 4.07, 10.39) and being overweight and obese (AOR: 2.43; 95% CI: 1.54, 3.83) were independently associated with diabetes mellitus (DM).

CONCLUSION

This study identified a high prevalence of diabetes among adults in Hawassa, driven by various risk factors. This presents an opportunity to mitigate diabetes risk through public health measures, including avoiding khat chewing, promoting healthy diets, managing overweight and obesity, implementing community-based screening, enhancing health literacy, and integrating health information into daily life.

Global trends in the burden of ischemic heart disease attributable to smoking from 1990 to 2021: A systematic analysis of the Global Burden of Disease Study 2021

INTRODUCTION

Ischemic heart disease (IHD) remains a leading cause of death and disability worldwide. This study evaluates the trends in IHD burden attributable to smoking, utilizing Global Burden of Disease Study 2021 (GBD 2021) data, across 204 countries and territories from 1990 to 2021. By examining age-standardized death rates (ASDR) and disability-adjusted life years (ASRDALYs), the study provides insights into the spatiotemporal variations associated with smokingattributable IHD in different sociodemographic regions.

METHODS

Data on smoking-attributable IHD mortality and DALYs were obtained from the GBD 2021 database. This secondary analysis examined ASDR and ASRDALYs for IHD as primary outcomes, with active smoking as the primary exposure. Temporal trends were analyzed using estimated annual percentage changes (EAPCs). The burden was stratified by age, sex, and sociodemographic index (SDI) to identify disparities across regions.

RESULTS

Over the last three decades, global ASDR and ASRDALYs for smokingrelated IHD have generally declined. High-SDI regions had the largest reductions, with EAPCs of -4.31 (95% CI: -5.73 - -2.87) and -4.02 (95% CI: -5.40 - -2.62), respectively. In contrast, low-SDI regions experienced slower declines, with EAPCs of -0.54 (95% CI: -1.41-0.33) and -0.80 (95% CI: -1.52 - -0.08), respectively. Older age groups and males consistently had a higher burden across all regions. Global death rates for populations aged 15-49, 50-74, and ≥75 years were 4.31, 46.57, and 142.52 per 100000, respectively. The global ASDR for males (30.24) was 8.54 times higher than that for females (3.54). Regional disparities were most pronounced in low- and middle-income areas, particularly in Eastern Europe and Central Asia, where smoking related IHD burden remains high.

CONCLUSIONS

While global reductions in smoking-related IHD burden are encouraging, sustained disparities remain, particularly in low-SDI regions. Males and older populations continue to have a disproportionately higher burden, emphasizing the need for targeted interventions and sustained efforts to address these inequities.

Literacy among tobacco users and healthcare professionals about tobacco harm reduction strategies: a scoping review protocol

Objective

The proposed review identifies and describes the extent of Tobacco Harm Reduction (THR) strategies in Pakistan. It also examines the awareness and understanding of these strategies among healthcare professionals and tobacco users in Pakistan.

Introduction

Tobacco consumption poses a significant threat to human health and is a leading cause of non-communicable diseases. Over the last two decades, the prevalence of tobacco use has increased in low-and middle-income countries (LMICs), which has considerably contributed to the increasing prevalence of Non-Communicable Diseases (NCDs). Tobacco is consumed in various forms, including manufactured cigarettes, hookah/shisha, chewing tobacco, and dipping tobacco. Tobacco use can be reduced and prevented through various strategies adopted by many countries worldwide. One prominent strategy is THR. THR involves the use of safer nicotine products in recommended doses to cope with the symptoms of withdrawal and increase tobacco users' chances of quitting smoking. In Pakistan, the concept of tobacco harm reduction (THR) is not widely recognized by healthcare professionals and tobacco users.

Inclusion and exclusion criteria

Literature available on Pakistani adults and adolescents (aged 13 years and above) will be included. Literature available as free full text will be included regardless of the publication date. Furthermore, literature available in English or Urdu will be considered eligible. Also, literature available in any form of publication, such as research studies, reviews, organizational websites or blogs, will be considered eligible. Literature that includes Pakistani data mixed with data from any other country will be excluded.

Methods

The literature search will use PubMed, CINAHL, ProQuest Theses & Dissertations, EBSCO Dentistry and Oral Sciences, and PsycInfo databases for online and gray literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram will record the included and excluded literature. Two independent reviewers will screen all the retrieved literature. After confirming the eligibility criteria, data from included records will be extracted on an Excel sheet that will record the important characteristics of the literature source and the main findings. Meta-synthesis of collated data will be performed, and the results will be presented as narrative summaries and frequency tables.

Systematic review registration

https://osf.io/dashboard.

Risk of all-cause mortality by various cigarette smoking indices: A longitudinal study using the Korea National Health Examination Baseline Cohort in South Korea

INTRODUCTION

Smoking behaviors can be quantified using various indices. Previous studies have shown that these indices measure and predict health risks differently. Additionally, the choice of measure differs depending on the health outcome of interest. We compared how each smoking index predicted all-cause mortality and assessed the goodness-of-fit of each model.

METHODS

A population-based retrospective cohort, the Korea National Health Examination Baseline Cohort, was used (N=6001607). Data from 2009 were utilized, and the participants were followed until 2021. Cox proportional hazards regression analyses were performed among all participants and ever smokers, respectively, to estimate all-cause mortality. Model fit was assessed by the Akaike Information Criterion.

RESULTS

For men, smoking intensity showed the strongest effect size (hazard ratio HR=1.16; 95% CI: 1.14-1.18), while pack-years provided the best model fit for all-cause mortality. Among women, smoking intensity showed both the strongest effect size (HR=1.49; 95% CI: 1.28-1.74) and the best model fit. Smoking status (never/former/current) also showed comparable effect sizes (men, HR=1.14; 95% CI: 1.13-1.15; women, HR=1.14; 95% CI: 1.11- 1.18) with fair model fit. Analyses of people who ever smoked indicated that a model incorporating smoking status, duration, and intensity best described the mortality data.

CONCLUSIONS

The smoking indices showed varying effect sizes and model fits by sex, making it challenging to recommend a single optimal measure. Smoking intensity may be preferred for capturing cumulative exposure, whereas smoking status is notable for its simplicity, comparable effect size, and model fit. Further research that includes biochemical measurements, additional health outcomes, and longer follow-up periods is needed to refine these findings.

Comparative Assessment of Acute Pulmonary Effects Induced by Heat-Not-Burn Tobacco Aerosol Inhalation in a Murine Model

Tobacco smoking remains a major global health concern, causing preventable deaths and economic strain. Although new tobacco products such as heat-not-burn (HnB) are safer alternatives to traditional cigarettes, research on their associated risks remains limited. This study aimed to investigate the effects of HnB smoke exposure on the lungs compared to those of traditional cigarettes and the combined use of HnB and cigarettes using experiments with a mouse model. We quantitatively analyzed changes in the levels of 92 blood plasma proteins using the proximity extension assay method and observed significant changes in their levels in mice exposed to different smoke conditions; specifically, the levels of certain proteins, including Ccl20, Cxcl1, and Pdgfb, increased in the HnB smoke-exposed group, suggesting activation of nicotine pathways. Comparative analysis with traditional cigarette smoke-exposed mice further highlighted similarities and differences in their protein expression profiles. This study contributes to an improved understanding of the biological mechanisms underlying the harmful effects of alternative nicotine delivery systems and identifies potential biomarkers associated with the harmful effects of HnB smoke exposure. However, the precise impact of nicotine on the immune system may be influenced by various factors, necessitating further research.

Psychological, social and cultural influences on smoking among lesbian, bisexual and queer women

BACKGROUND

Smoking rates have declined markedly in Australia over time; however, lesbian, bisexual and queer (LBQ) women continue to smoke at higher rates than heterosexual women. Understanding the factors influencing smoking in this population is crucial for developing targeted cessation interventions and other supports.

METHODS

Experiences of and motivations for smoking among 42 LBQ cisgender and transgender women and non-binary people in Australia who currently or previously smoked were explored through semi-structured interviews. Participants were primarily white Australian cisgender women in their 30s-40s. Thematic analysis was used to identify common psychological, social and cultural influences on smoking.

RESULTS

While coping with minority stress was a common factor influencing some participants' smoking behaviours, participants also described how smoking offered pleasurable opportunities for gender expression, affirmation and rebellion. Smoking also enabled participants to experience 'marginalised connectivity', a form of social solidarity fostered through the sharing of a stigmatised practice by an oppressed or stigmatised community.

CONCLUSION

This article identifies factors contributing to the ongoing socio-cultural relevance of smoking for some LBQ women in Australia. These specific psychological, social and cultural contexts remain salient for LBQ women's smoking and must be factored into smoking cessation campaigns and programme designs for this population. Tailored messaging that emphasises alternative self-care strategies and the benefits of quitting in the context of supportive communities may be more effective in engaging LBQ women than long-term health risk messages.

Trends and Association between Smoking and the Socio-Demographic Index Among 11 South American Countries, 1990-2019

OBJECTIVES

To examine prevalence trends in the use of smoked tobacco products in 11 South American (SA) countries (i.e., Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru, Suriname, Uruguay, and Venezuela) and their association with country-specific socio-demographic index (SDI) over 30 years.

DATA AND METHODS

The estimates of SDI and smoked tobacco prevalence stratified by age, sex, and country were extracted from the Global Burden of Disease Study (1990-2019) on individuals aged 15+. The annual percentage changes (APCs) of trends in country-specific prevalence of smoked tobacco were evaluated using Joinpoint regression. Correlation analysis was also used to explore the association between country-specific prevalence of smoked tobacco and their SDIs, a measure of developmental status considering income per capita, educational attainment, and total fertility rate.

RESULTS

While all SA countries showed an overall decline in smoked tobacco use prevalence between 1990 and 2019 (APCs between -0.52%-and -4.73%; p < 0.05), Bolivia and Ecuador showed a significant increasing trend (APCs of 0.34% and 0.20%). Country-specific SDI was strongly and significantly correlated (rs = -0.99 to -0.85) with smoking prevalence in SA countries, except for Ecuador and Bolivia (rs = 0.16 and 0.36, respectively).

CONCLUSION

In recent decades, most SA countries have experienced a significant reduction in the prevalence of smoked tobacco use, except Ecuador and Bolivia, where smoking rates have risen, showing a direct correlation with SDI. These findings can contribute to the design and implementation of strategies and policies for tobacco prevention and control in the SA region especially within the two affected countries - Ecuador and Bolivia.

Global, regional, and national burden of low back pain for adults aged 55 and older 1990-2021: an analysis for the global burden of disease study 2021

BACKGROUND

Low back pain (LBP) is a widespread condition that increasingly affects the older adults, highlighting the need for a detailed examination of its global impact. Our research aimed to evaluate the LBP's burden and trends in individuals over 55 years of age across 204 countries and territories from 1990 to 2021.

METHODS

We analyzed the data from the Global Burden of Disease 2021, focusing on LBP prevalence, incidence, and years lived with disability (YLDs), along with associated risk factors.

RESULTS

In 2021, a total of 271,680,057 individuals aged 55 and older globally suffered from LBP. The age-standardized prevalence rate was 18,282.8 per 100,000 population, marking a 10.4% decrease since 1990. The age-standardized incidence and YLD rates had decreased by 9.4% and 11.0%, respectively. Central and Eastern Europe and Australasia had the highest burden, while Andean Latin America, Caribbean, and East Asia had the lowest. Notably, there were significant gender differences, with males experiencing lower rates than females. Occupational ergonomic factors, smoking, and high body mass index were identified as major contributors to the LBP burden.

CONCLUSION

This study analyzed the global burden of LBP in adults aged 55 and older, noting a decrease in age-standardized rates but an increase in total cases and regional disparities. It stressed the need to tackle modifiable risk factors like occupational ergonomics, smoking, and obesity to lessen LBP's impact. The study also called for region-specific, gender-sensitive healthcare policies to ensure fair health outcomes for all adults aged 55 and older.

Impact of maternal and offspring smoking and breastfeeding on oesophageal cancer in adult offspring

Numerous risk factors for oesophageal cancer are linked to lifestyle habits, but the role of early-life factors in its incidence and mortality is unclear. Using UK Biobank data, we explore the association among breastfeeding, maternal smoking, smoking in offspring, and oesophageal cancer risk in adult offspring via multivariable Cox regression. Here, we show that being breastfed, compared with not being breastfed, is associated with a lower risk of oesophageal cancer incidence (HR: 0.83, 95% CI: 0.70-0.98) and mortality (HR: 0.74, 95% CI: 0.61-0.89) in adult offspring. Additionally, it is associated with a reduced impact of smoking in offspring on oesophageal cancer incidence (HR: 0.79, 95% CI: 0.64-0.96) and mortality (HR: 0.73, 95% CI: 0.59-0.91). We subsequently construct a polygenic risk score for oesophageal cancer to explore the influence of genetic factors. Our findings emphasize the importance of breastfeeding, and smoking cessation to prevent oesophageal cancer.

The global, regional, and national burden of colorectal cancer attributable to smoking from 1990 to 2021: a population-based study

Colorectal cancer (CRC) is the third leading cause of cancer-related deaths worldwide, with smoking being a significant risk factor. Understanding the temporal and spatial patterns of the CRC burden attributable to smoking is crucial for global public health strategies. Data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 were used to calculate the number of deaths, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR) per 100 000 population, and age-standardized disability-adjusted life year rate (ASDR). The average annual percentage change (AAPC) was calculated from 1990 to 2021 to analyze disease burden trends. Frontier analysis was conducted to assess efficiency, and predictions were made for the next decade. In 2021, the global death toll and DALYs attributable to smoking were 47 613 and 1 235 667, respectively. From 1990 to 2021, the absolute number of deaths and DALYs increased, while ASMR (AAPC: -1.20) and ASDR (AAPC: -1.22) showed a significant decline. The disease burden was notably higher in males than females. Analysis by the Social Development Index revealed that more developed regions had a higher burden than less developed areas. China ranked first in the number of deaths and DALYs, while Greenland had the highest ASMR and ASDR. From 1990 to 2021, the age-standardized burden of CRC attributable to smoking decreased globally. However, the absolute burden remains a significant public health challenge, requiring sustained and targeted interventions.

Engagement With Stop Smoking Services After Referral or Signposting: A Mixed-Methods Study

INTRODUCTION

Screening for smoking when people interact with healthcare services and referral of those who smoke to stop smoking services (SSSs) is a key component of efforts to tackle tobacco use. However, little is known about what happens after someone is referred or signposted to SSSs.

METHODS

As part of the Cessation of Smoking Trial in the Emergency Department (NCT04854616), those randomized to intervention (n = 505) were referred to local SSSs (along with receiving brief advice and an e-cigarette starter kit) and those randomized to control (n = 502) were given contact details for the same services (signposted). SSS engagement data were collected: (1) directly from participants and (2) from SSS, additional qualitative data came from 33 participant interviews.

RESULTS

Engagement with SSSs was very low. 3.2% (n = 16) of those in the intervention group and 2.4% (n = 12) in the control group reported attending a one-to-one support session. From SSS data, engagement was also low with 8.9% (n = 43) of those referred engaging and 3.1% (n = 15) going on to quit with SSS support. The majority of the 24 intervention participants interviewed did not recall being contacted by an SSS.

CONCLUSIONS

Referral or signposting to SSSs within an Emergency Department-based trial resulted in very low levels of engagement. Barriers to engagement identified included participants not being contacted by SSSs and the support offered not meeting their needs.

IMPLICATIONS

Referral or signposting of those who smoke to SSSs from the Emergency Department resulted in low rates of engagement in this large multicenter randomized controlled trial. To better support those who smoke, it may be more effective for smoking cessation advice to be offered "in the moment" within clinical settings, and follow-up to be proactively offered rather than relying on people being motivated to contact the services themselves or engaging when contacted.

Tobacco Use and Second-Hand Smoke Exposure Among Athletes; Assessment by Urine Cotinine Level and Exhaled Carbon Monoxide: A Cross-Sectional Study

Background and Objectives: Tobacco use and exposure to tobacco products remain a major public health challenge, even among athletes. This study aimed to evaluate tobacco use and second-hand smoke exposure in athletes through urinary cotinine levels and exhaled air carbon monoxide (CO) measurements. Materials and Methods: This cross-sectional study included licensed athletes who visited the sports medicine outpatient clinic of a tertiary hospital. Participants completed an electronic questionnaire on smoking habits and second-hand smoke exposure. Urine samples were analysed for cotinine levels, while CO levels were measured in exhaled breath. Results: A total of 421 athletes participated (57.8% male, median age: 18 years). Tobacco use was reported by 29.9% (n = 126) of participants. Median urinary cotinine levels were 22.9 ng/mL among daily tobacco users and 17.4 ng/mL among athletes exposed daily to second-hand smoke, with a statistically significant difference between exposure levels (p < 0.05). The optimal cut-off value for detecting second-hand smoke exposure was identified as 12.5 ng/mL. Median exhaled air CO levels were 5 ppm in daily tobacco users. Conclusions: This study demonstrates that tobacco use prevalence among athletes mirrors Türkiye's national rates. Despite legal measures to curb tobacco use, direct use and second-hand smoke exposure remain pressing issues among athletes.

Global, regional, and national trends in colorectal cancer burden from 1990 to 2021 and projections to 2040

BACKGROUND

Colorectal cancer (CRC) is a common malignancy with notable recent shifts in its burden distribution. Current data on CRC burden can guide screening, early detection, and treatment strategies for efficient resource allocation.

METHODS

This study utilized data from the latest Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study. Initially, a series of descriptive statistics were performed on the incident cases, deaths, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) of CRC. Percentage changes and average annual percentage changes (AAPC) were then calculated to understand the trends in CRC disease burden. Decomposition and frontier analyses were conducted, and finally, the Bayesian age-period-cohort (BAPC) model was used to predict changes in ASRs up to 2040.

RESULTS

The GBD 2021 estimates indicate a significant increase in the global incident cases, deaths, and DALYs of CRC from 1990 to 2021. The age-standardized incidence rate (ASIR) increased (AAPC: 0.2), while the age-standardized mortality rate (ASMR) (AAPC: -0.72) and age-standardized DALYs rate (AAPC: -0.73) decreased. Males bore a higher disease burden than females, though the trends in disease burden changes were similar for both sexes. Although developed regions had higher incident cases, deaths, and DALYs, they showed more significant declines in ASRs. Decomposition analysis revealed that population growth and aging were the primary drivers of the increased disease burden. Frontier analysis showed that as the Socio-demographic Index increased, the disparity in CRC ASRs among countries widened, with developed regions having greater potential to reduce these rates. The By 2040, the BAPC model projects significant declines in global ASMR and age-standardized DALYs rates, while ASIR is expected to decrease in females but increase in males and across both sexes.

CONCLUSION

CRC remains a significant public health issue with regional and gender differences, necessitating region- and population-specific prevention strategies.

Exploring public support for novel tobacco and alcohol control policies in Great Britain 2021-2023: A population-based cross-sectional survey

Objective and rationale

This study assessed support for novel tobacco compared with alcohol control policies among adults in Great Britain in 2021-2023. Objectives were to assess 1) overall level of support for tobacco compared to alcohol control policies; 2) level of support for tobacco compared to alcohol control policies among people who smoke tobacco or who consume alcohol at increasing and higher risk levels, or who do both; 3) level of support for tobacco compared to alcohol control policies among different sociodemographic groups?

Methods

Data were collected in September/October 2021-2023 in a monthly population-based survey on smoking and drinking behaviour of adults across Great Britain (N = 6311), weighted to match the overall population. Outcome measure was level of support for each seven tobacco and alcohol control policies.

Results

More people were in support of tobacco than alcohol control policies (e.g., 57 % vs. 51 % for tax-related policies). This trend was apparent across all sociodemographic subgroups. With one exception, the policies included in this study were supported by more than half of the participants. The exception was decreasing the visibility of alcohol products in shops, which received 41 % of support. People who engaged in the behaviour targeted by policies (tobacco more so than alcohol use) were generally less supportive.

Conclusion

Overall, public support for tobacco and alcohol control policies is high in Great Britain. With one exception, the policies were supported by over half of participants, suggesting that the public is in favour of government regulations to reduce smoking and drinking prevalence in Great Britain.

Global, regional and national burden of pancreatic cancer and its attributable risk factors from 2019 to 2021, with projection to 2044

Background

To estimate the global burden of pancreatic cancer in 2019 and 2021 including incidence, mortality, and disability-adjusted-life-years (DALYs).

Methods

Data on pancreatic cancer incidence, mortality and DALYs were downloaded from the Global Health Data Exchange. The 95% uncertainty intervals (UIs) were reported for annual numbers and rates (per 100,000 populations).

Results

In 2021, there were 508,532 (95% UI: 462,09 to 547,208) incident cases of pancreatic cancer globally, of which 273,617 (250,808 to 299,347; 53.8%) were in males. The age-standardized incidence rate was 6.0 (5.5 to 6.5) per 100,000 people in 2019 and decreased to 5.9 (5.4 to 6.4) per 100,000 people in 2021. There was a 3.9% increase in the number of deaths from pancreatic cancer from 486,869 (446,272 to 517,185) in 2019 to 505,752 (461,224 to 543,899) in 2021. There was a 3.5% increase in DALYs due to pancreatic cancer, increasing from 10.9 million (10.1 to 11.7) in 2019 to 11.3 million (10.5 to 12.2) in 2021. In 2021, the highest age-standardized death rates were observed in Greenland and Monaco, and the highest age-standardized DALY rates were observed in Greenland and Uruguay. The numbers of incident cases and deaths peaked at the ages of 70 to 74 years. The pancreatic cancer burden increased as the socio-demographic index increased. To 2044, the number of incident cases and deaths will be more than 875 thousand and 879 thousand, respectively.

Conclusion

The disease burden of pancreatic cancer remains high, especially in high-income regions. More cancer prevention measures are needed in the future to reduce the burden of pancreatic cancer.

Tobacco Smoking in Early Adulthood and Labor Market Performance: The Cardiovascular Risk in Young Finns Study

INTRODUCTION

Tobacco smoking has been associated with reduced success in the labor market, potentially due to its negative impact on labor productivity, especially in physically demanding jobs, as it affects physical fitness and performance adversely.

METHODS

This prospective study used data from the Cardiovascular Risk in Young Finns Study survey, linked to register information on labor market outcomes and education attainment, to examine the association between tobacco smoking and long-term labor market outcomes (earnings and employment, N = 1953). Smoking levels were determined by cigarette pack-years in 2001, as reported in the survey, whereas annual earnings and employment status were tracked from 2001 to 2019.

RESULTS

A one-unit increase in pack-year of smoking was associated with a 1.8% decrease in earnings (95% confidence interval [CI]: -2.6% to -0.9%) and a 0.5% reduction in years employed (95% CI: -0.6% to -0.3%). This association was pronounced among participants with lower education levels. The earnings difference was evident among younger cohorts, whereas a negative correlation with employment was observed most strongly in older cohorts among individuals with lower education.

CONCLUSIONS

Our findings suggest that smoking had a negative effect on earnings among the younger generation, particularly among the less well-educated. The finding of greater impacts on years of employment among the older age group, particularly among groups with low education levels, is consistent with the delayed onset of most health impacts, which may particularly affect productivity in physically demanding jobs that are more common among people with less education.

IMPLICATIONS

Adverse consequences of smoking include reduced earnings and labor market participation, particularly among less well-educated groups. Tobacco control advocates should draw attention to these consequences in arguing for effective measures to reduce smoking initiation and increase cessation in order to achieve socially optimal outcomes.

Global Burden of Otitis Media Attributable to Secondhand Smoke in 204 Countries and Territories from 1990 to 2019: The Analysis of the Global Burden of Disease Study

OBJECTIVE

Secondhand smoke (SHS) is a major public health concern. In this study, we evaluated the global burden of otitis media (OM) due to SHS exposure during 1990-2019 and explored the impact of socioeconomic factors on it.

METHODS

With reference to the 2019 Global Burden of Disease (GBD) data, we assessed the OM burden linked to SHS during 1990-2019, stratified by gender, GBD region, and country. Join-point regression models analyzed trends in OM burden by calculating the average annual percent change (AAPC). Spearman's correlation examined the relationship between the Socio-demographic Index (SDI), Healthcare Access and Quality (HAQ) index, and SHS-related OM burden.

RESULTS

During 1990-2019, age-standardized disability-adjusted life years (ASDRs) and age-standardized mortality rates (ASMRs) for OM due to SHS declined globally, with AAPCs of -1.45 for ASDR and -7.97 for ASMR. Significant declines in ASMR were noted in low-to-middle SDI regions. Regionally, Eastern Sub-Saharan Africa had the highest OM-related deaths, while South Asia had the highest disability-adjusted life years. OM burden decreased with higher SDI and HAQ.

CONCLUSION

Despite global declines, significant regional and national disparities remained, which emphasizes the need for targeted interventions.

Boredom and affective temperaments as factors hindering smoking cessation: An exploration within an Italian sample

Background

Smoking cessation presents challenges influenced by neurological adaptations and psychological factors, potentially exacerbated by susceptibility to boredom and affective temperaments.

Methods

This study enrolled 409 participants via an online survey distributed among the Italian population through mailing lists, social networks, and messaging apps. Specific questions assessed cigarette smoking, while the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A) and Boredom Proneness Scale (BPS) explored affective temperaments and susceptibility to boredom, respectively.

Results

Results indicated smokers exhibited higher cyclothymic temperament scores compared to no-smokers and ex-smokers, suggesting a connection between this temperament and smoking behavior. Furthermore, the analysis demonstrated variable influences of specific temperaments on boredom proneness.

Conclusions

These findings emphasize the significance of incorporating affective temperaments and boredom proneness into smoking cessation interventions. Understanding the interplay between affective temperaments and boredom proneness can guide the development of innovative and personalized cessation strategies. Further research is warranted to delve deeper into these relationships and their implications for intervention approaches.

Protocol for a Cluster Randomized Controlled Trial to Reduce Susceptibility to Tobacco Use Among School Going Adolescents in a South-Indian District-(Project TEACH)

Background

Adolescents are susceptible to using tobacco because of early exposure to tobacco through family members, easy access, or peer pressure. School-based educational programs are crucial for raising awareness of the harms of tobacco, thus preventing its uptake among adolescents. Studies conducted recently have recognized the need to bring change and reinforce ongoing school-based anti-tobacco education programs. Our study protocol aims to evaluate the effectiveness of a revised school-based anti-tobacco education on susceptibility to tobacco use among school-going adolescents.

Method

Project TEACH (Tobacco Education and Awareness for Creating Healthier Adolescents) is an educational intervention that will comprise an animated video on the effects of tobacco on physical and mental health, along with dispelling myths about tobacco, which will be delivered along with a standard education program. The control group will only receive the standard school-based anti-tobacco education program. It will be conducted among students between 6th to 10th grade, with a sample size of 3,310 students.

Results

Bivariate relations between the main socio-demographic characteristics and susceptibility to tobacco use will be tested using Pearson or Spearman's correlation coefficients. For multivariable analyses, the binary logistic regression analysis is used to establish a risk model to correlate the socio-demographic factors with susceptibility to tobacco use and awareness of the harms of tobacco.

Conclusion

Project TEACH aims to provide a sustainable school-based anti-tobacco education intervention. It will help test the effectiveness of the revised intervention, which could be incorporated into the current school education program being conducted in the district.

Tales of hope and hesitation: Smoking cessation experts' views on the opportunities and risks of digital behaviour change interventions

Objective

Smoking remains a global health challenge, with 1.14 billion active smokers worldwide. Many of these smokers seek cessation support. The rise of mHealth offers novel intervention methods, providing monitoring and tailored feedback. This study aimed to map the opportunities and challenges of integrating digital behaviour change interventions (mHealth) into smoking cessation practices by understanding professionals' perceptions of these tools.

Methods

A qualitative study was conducted involving semi-structured interviews with 11 experienced smoking cessation professionals in Flanders, Belgium. Data collection occurred between January and April 2023. Inductive thematic analysis was performed to identify key patterns and themes in the experts' views regarding mHealth interventions.

Results

The analysis revealed four primary themes: (1) The Inexorable March of Technology - experts acknowledged the inevitability of technology in smoking cessation but varied in enthusiasm; (2) The Shimmering Mirage of Possibility - technology was viewed as supplementary, offering efficiency and support but limited in depth; (3) The Footnotes to Enthusiasm - experts expressed concerns over privacy, inclusivity, and the potential for technology to displace human care; and (4) The Human Anchor - the irreplaceable role of human connection and therapeutic alliance, which digital tools might not be able to replicate.

Conclusion

Experts believe mHealth interventions can augment smoking cessation support but should not replace human-driven care. A blended approach, integrating digital tools with traditional therapeutic relationships, offers the most promise. Addressing concerns about privacy, inclusivity, and most importantly the limits of digital therapeutic alliances is essential for successful mHealth implementation in smoking cessation.

Impact of smoking status on incident hypertension in a Japanese occupational population

Hypertension and tobacco smoking pose independent risks for cardiovascular diseases, but their association is unclear especially in Japanese. We investigated the impact of smoking status on the risk of new-onset hypertension in male and female Japanese workers. We evaluated 5439 subjects without hypertension who participated in medical check-ups in 2007-2018. The outcome was the development of hypertension (blood pressure ≥140/90 mmHg or initiation of antihypertensive drugs). Cox's proportional hazards models were used to assess the association between smoking status and the hypertension incidence. During the average 6.0-year follow-up, 1395 individuals (25.6%) developed hypertension. The crude incidence rates of hypertension (per 100 person-years) were: current non-smokers (n = 3033), 3.4; quitters (n = 445), 4.2; and sustained smokers (n = 1961), 5.7. The multivariable-adjusted hazard ratio was 1.34 (1.20-1.50) for sustained smokers and 1.03 (0.86-1.24) for quitters compared to current non-smokers (P for trend <0.01). In stratified analyses, the risk of incident hypertension was significantly higher in the sustained smokers with lower blood pressure or without diabetes at baseline versus the current non-smokers. A significant risk reduction of hypertension development due to smoking cessation was revealed in the subjects with higher blood pressure levels at baseline or without body weight gain after smoking cessation. Smoking was an independent risk factor for incident hypertension. Smoking cessation reduced the risk of hypertension development compared to sustained smoking, especially among the subjects with higher blood pressure levels. Maintaining one's body weight after smoking cessation would also help prevent hypertension development.

Has the impact of cigarette smoking on mortality been underestimated by overlooking second-hand smoke? Tohoku medical megabank community-based cohort study

Objectives

Previous studies have assessed the impact of active smoking on mortality using the population-attributable fraction (PAF). However, these studies have not included second-hand smoking (SHS), potentially underestimating smoking's impact. We compared the PAF from active smoking alone with the PAF, including SHS exposure.

Design

Prospective cohort study.

Setting

A community-based cohort study in Japan.

Participants

40 796 participants aged ≥20 years.

Main outcome measures

SHS was defined as inhaling someone else's cigarette smoke at the workplace or home in the past year. We classified smoking status and SHS into ten categories: never-smoker without SHS, never-smoker with SHS, past smoker without SHS, past smoker with SHS, current smoker 1-9 cigarettes/day without SHS, current smoker 1-9 cigarettes/day with SHS, 10-19 cigarettes/day without SHS, 10-19 cigarettes/day with SHS, ≥20 cigarettes/day without SHS and ≥20 cigarettes/day with SHS. The main outcome was all-cause mortality.

Results

During the median follow-up period of 6.5 (5.7-7.5) years, 788 men and 328 women died. For men, compared with never-smokers without SHS, past smokers without SHS (HR, 1.39 [95% CI, 1.11 to 1.73]) and past smokers with SHS (HR, 1.48 (95% CI, 1.10 to 2.00)) were associated with all-cause mortality. For women, never-smokers with SHS had a significantly higher risk of all-cause mortality (HR, 1.36 (95% CI, 1.00 to 1.84)). Without considering SHS, 28.0% and 2.3% of all-cause mortality in men and women, respectively, were attributable to past and current smoking. Including SHS, PAF increased to 31.3% in men and 8.4% in women.

Conclusions

We clarified that smoking's impact was underestimated by not accounting for SHS, especially in women. Information on SHS is crucial for understanding smoking's health impact. This study supports the importance of avoiding smoking and preventing SHS.

The Prevalence and Determinants of Waterpipe and Cigarette Smoking Among Medical Sciences Students Living in Dormitories in Southern Iran

Background and Aims

Tobacco use among students is one of the most alarming problems throughout the world. This study was carried out to investigate the prevalence of cigarette and waterpipe smoking as well as their determinants among students in dormitories of Jahrom University of Medical Sciences.

Methods

This cross-sectional study was conducted on 293 students living in the dormitories of Jahrom University of Medical Sciences using random sampling method. A researcher-made questionnaire was used, which included demographic characteristics and patterns of cigarette and waterpipe smoking. Multivariable logistic regression was used to determine factors related to cigarette and waterpipe smoking.

Results

The mean age of the participants was 20.99 ± 1.74 years and 49.8% of them were male. The mean age at the initiation of cigarette and waterpipe smoking was 15.53 ± 4.33 and 16.60 ± 3.01 years, respectively. The prevalence of current cigarette smoking was 6.48% and that of waterpipe smoking was 8.53%. In addition, 10.24% and 17.06% of the participants reported ever use of cigarette and waterpipe smoking, respectively. Moreover, the prevalence of tobacco smoking was higher in male students than in females (8.22% vs. 4.76% for cigarette smokers and 11% vs. 6.12% for waterpipe smokers). The results showed that there was a significant relationship between having cigarette-smoker family members and having cigarette-smoker friends with cigarette smoking. Also, waterpipe smoking was associated with having cigarette-smoker family members and having waterpipe smoker friends (p < 0.05).

Conclusion

Tobacco use is relatively high among medical students. Since the family and social factors are related to cigarette and waterpipe smoking, the family and society should be informed about the dangers of cigarettes and waterpipe smoking. It is also emphasized that students with risk factors be identified.

Systematic Review on Hypnotherapy and Smoking Cessation

The main objective of this systematic review is to comprehensively describe and evaluate the evidence on hypnotherapy for smoking cessation. Included studies were comprised of adults, had measurable objective/subjective data reflecting smoking cessation, hypnosis or hypnotherapy studied alone or as part of a multicomponent intervention, and at least ten participants. A total of 745 nonduplicate publications were screened, and 63 papers were included for analysis. Based on 33 of these studies, 66.7% reported a positive impact of the hypnosis intervention for smoking cessation. Positive impact studies had longer average treatment duration, greater number of hypnotherapy sessions, and utilized both self-report and objective measures of smoking cessation outcome (40.9% of positive studies using both vs 20% of no impact studies). The efficacy of hypnotherapy for smoking cessation is positive; however, more studies using biologically confirmed abstinence and reduction in the number of cigarettes smoked are needed. Hypnotherapy is a useful approach for smoking cessation that warrants additional inquiry. Future studies are needed that assess treatment fidelity and hypnotizability, provide information on race/ethnicity, and report on side effects and adverse events.

Vascular Stress Markers Following Inhalation of Heated Tobacco Products: A Study on Extracellular Vesicles

The advent of heated tobacco products (HTPs) has introduced new variables in the study of nicotine delivery systems and their health implications. Amidst concerns over cardiovascular effects, this study aims to elucidate the acute impact of HTP inhalation on extracellular vesicles (EV) levels in young, healthy individuals. In this controlled, acute exposure study, 23 young, healthy volunteers were subjected to HTP inhalation. EV levels of endothelial and platelet origin were quantified through flow cytometry before and after exposure. Data analysis was performed using multiple measures ANOVA to assess changes in EV concentrations. Our findings reveal a significant increase in EVs of endothelial and platelet origin following short-term HTP inhalation with nicotine. Notably, no significant change was observed in leukocyte- and neutrophil-derived EVs. This increase in EVs suggests acute vascular stress, with peak levels observed 4 h post-exposure. The rise in endothelial and platelet-derived EVs aligns with documented responses to acute vascular injury, paralleling the effects seen with traditional cigarette and e-cigarette use. Despite HTPs being marketed as safer alternatives, our results indicate that nicotine-containing HTPs may still pose significant vascular risks. These findings contribute to the growing body of evidence cautioning against the perceived safety of HTPs and reinforce the importance of regulatory oversight and public health initiatives targeting nicotine delivery technologies. Trial Registrations: ClinicalTrials.gov ID: NCT04824495, registered 2021-01-07.

Prevalence and social determinants of smoking among men in Mauritius: a cross-sectional study

BACKGROUND

Mauritius has implemented a range of stringent policies to control smoking and promote public health. Regular monitoring focuses on the prevalence of tobacco use, yet there is a gap in understanding its socio-economic patterns.

OBJECTIVE

The aim of this study was to estimate the prevalence of tobacco smoking and to identify the social determinants associated with smoking among men in Mauritius in 2021.

METHODS

This is a cross-sectional population-based study conducted by the Ministry of Health and Wellness during 2021. In total, 3622 individuals participated (response rate of 84.1%), of which 1663 were men (45.9%). The study mainly focused on men given the low prevalence of smoking among women. Daily smoking was the outcome and a series of sociodemographic and socioeconomic factors were included as independent variables. Prevalence ratios (PR) and their 95% confidence intervals (95% CI) were estimated to fulfill the study objective.

RESULTS

The prevalence of smoking among men was 30.4%. People in the 25-34 age group (PR = 1.65; 95% CI: 1.12-2.41), those separated, divorced or widowed (PR = 1.57; 95% CI: 1.16-2.11), the ethnic groups Muslim-Mauritians (PR = 1.70; 95% CI: 1.00-2.89) and Creoles (PR = 1.97; 95% CI: 1.16-3.35), and those with secondary (PR = 1.29; 95% CI: 1.00-1.67) and primary education (PR = 1.47; 95% CI: 1.10-1.98) were statistically significantly associated with daily smoking.

CONCLUSIONS

Although a gradual decline in smoking prevalence was observed compared with the previous 2015 survey, the Ministry of Health and Wellness should persist in fortifying its anti-smoking measures and concentrate on crafting tailored interventions aimed at the vulnerable groups identified in this study.

Investigation of Smoking Cessation Status and Its Influencing Factors in Patients with Chronic Obstructive Pulmonary Disease

Purpose

Chronic obstructive pulmonary disease (COPD) is a common disease with high prevalence, high mortality and high costs across the globe. Small airways are major sites contributing to airway resistance and the small airway disorder (SAD) is frequently implicated in early-stage COPD. Smoking is recognized as the leading cause of COPD and SAD. This study aimed to investigate the status quo and influencing factors of smoking cessation in patients with SAD or COPD, which is crucial for improving prevention and treatment of chronic airway diseases.

Patients and Methods

In this multicenter, prospective cohort investigation, questionnaire survey and one-year follow-up study were conducted in SAD and COPD patients with smoking history. The rate of quitting intention, quitting attempt and recent smoking cessation of SAD or different stages of COPD and their influencing factors were recorded, compared and analyzed.

Results

A total of 386 valid questionnaires were collected. The rate of quitting intention was 91.7% (95% CI: 88.53-94.07%), and quitting attempt was 73.6% (95% CI: 68.96-77.73%). Regular bronchodilator use, alcohol abstinence, and the lower Fagerstrom Test for Nicotine Dependence (FTND) scores were associated with a higher intention to quit smoking. Further, inpatients with higher mMRC scores, non-smoking parents, engagement in pulmonary rehabilitation exercises, and receipt of medical advice to quit were more likely to attempt quitting smoking. In the one-year follow-up survey, the overall recent smoking cessation rate was 23.9%. The multivariate logistic regression analysis revealed that higher mMRC grade, carrying out pulmonary rehabilitation exercise and the quitting intention were positive factors for quitting smoking, while outpatients with lower educational level, higher FTND score and Tobacco Craving Questionnaire-Short Form (TCQ-SF) scores were negative influencing factors for recent smoking cessation.

Conclusion

Patients with SAD and COPD generally had a high willingness to quit smoking, but a significant reduction in the success rate of smoking cessation. Factors influencing smoking cessation included the severity of the illness, nicotine dependence, patient self-control, lifestyle and environment.

Implementation and impact of NHS-funded tobacco dependence services in England: a mixed-method evaluation protocol

INTRODUCTION

Tobacco smoking remains a leading cause of ill-health, premature mortality and a driver of health inequalities. To support smokers in England, a comprehensive approach to treating tobacco dependence is being implemented. This includes offering support to all people admitted to hospitals, as well as women and pregnant people within NHS settings. We aim to describe the protocol for an evaluation of this tobacco-dependence service.

METHODS AND ANALYSIS

This is a national evaluation across five regions in England (i.e., South West, West Midlands, Greater Manchester, North East and North Cumbria, Yorkshire and Humber) including 11 NHS Foundation Trusts. It is funded from September 2021 to September 2025. Evaluation settings are acute hospital, maternity and inpatient mental health.Work package (WP) 1 involves qualitative key informant interviews to characterise the policy implementation context. WP 2 involves an online survey to assess the routinisation of the service in practice and staff attitudes regarding tobacco dependence, plus in-depth interviews with relevant practitioners to explore survey findings and interviews with smokers to investigate its usefulness and impact. WP 3 involves descriptive statistical analysis of routinely collected data to assess service uptake and impact on health and care outcomes (e.g., smoking status). WP 4 involves an economic analysis of routinely collected data to determine the financial impact of the service. Qualitative data (WP 1, WP 2) will be analysed using Thematic Analysis and Framework Analysis, respectively. WP 2 survey data will be analysed using descriptive statistics.

ETHICS AND DISSEMINATION

This evaluation received favourable ethical opinion from Newcastle University (17756/2021) and NHS Wales Research Ethics Committee (22/WA/0203). It has also received Confidentiality Advisory Group support (22CAG0103).

Behavioral Activation mHealth Application for Smoking Cessation: A Randomized Controlled Pilot Trial

INTRODUCTION

Behavioral activation (BA) is an effective intervention for both depression and substance use disorders. Combining BA with a standard smoking cessation intervention may improve quit rates by addressing depressive symptoms, a key barrier to quitting. This study preliminarily evaluated the acceptability and efficacy of the BA-based Actify! mobile health application (mHealth app) for smoking cessation.

AIMS AND METHODS

We conducted a pilot randomized controlled trial (n = 242) comparing Actify! with the National Cancer Institute's (NCI) app for smoking cessation (QuitGuide) on acceptability (user satisfaction, app openings), smoking abstinence, and mechanisms of change (BA and depressive symptoms) at 8 weeks and 6 months postrandomization. Participants were US adults recruited online who smoked daily.

RESULTS

Treatment satisfaction was uniformly higher in the Actify! arm. Number of app openings was similar across arms (M = 34.3 openings over 8 weeks in both arms). Self-reported 30-day point prevalence abstinence (PPA) at 8 weeks was 12.6% for Actify! versus 7.3% for QuitGuide. Differences in 30-day PPA continued through 6 months (18.5% for Actify! vs. 12.2% for QuitGuide). Changes between baseline and 8 weeks in depressive symptoms and BA favored Actify!. Planned subgroup analyses suggested greater benefit of Actify! among participants with pretreatment mild-to-moderate depression symptom severity compared to those with no depression symptoms.

CONCLUSIONS

Actify! showed considerable promise as a novel mHealth treatment, as evidenced by its high usage and higher user satisfaction and quit rates than QuitGuide at both short- and long-term follow-up. The next step is to evaluate Actify! in a fully powered efficacy trial.

IMPLICATIONS

Study findings demonstrate the promise of a BA-based mobile health app (Actify!) for smoking cessation as a population-level intervention that can effectively address depressive symptoms as a risk factor for worse smoking treatment outcomes. The Actify! app is the first standalone BA-based app to demonstrate potential for improved acceptability and efficacy relative to a standard care comparison app, with user satisfaction and smoking quit rates descriptively exceeding those of the NCI's QuitGuide app.

A comparative perception and impact of pictorial warnings on cigarette packaging among Malaysian smokers and non-smokers

Introduction

In 2003, the World Health Organization (WHO) recommended that pictorial warnings on tobacco products be used to educate consumers on the negative health impacts associated with tobacco use. This study aimed to assess the effectiveness of pictorial warnings on cigarette packaging among smokers and non-smokers.

Methods

A cross-sectional study using a self-administered questionnaire was conducted in Kuala Lumpur. Four components assessed the respondents' socio-demographics, smoking status, perceptions, and impact of pictorial warnings. Six standard cigarette pictorial warning images were included in the questionnaire. Data collected were analysed using SPSS version 29.0. Frequencies and percentages were used for categorical data, while means and standard deviations were used for continuous data. Statistically significant results were set at p-value < 0.05. Non-parametric tests, the Chi-square test and the One-Way ANOVA test were used to calculate the differences between the variables, as the data was not normally distributed.

Results

Three hundred seventy-eight respondents participated in this study, with smokers and non-smokers divided equally, 189. Most respondents were 20-29 years old (n = 223, 59.0%) and had tertiary education (n = 207, 54.8%). Most smokers were male (n = 172, 91.0%), and most non-smokers were female (n = 119, 63.0%). Most respondents (n = 364, 96.3%, p = 0.276) noticed the pictorial warnings on cigarette packs. Nevertheless, significantly (p < 0.001) more smokers (n = 73, 38.6%) seldomly read the content compared to non-smokers (n = 57, 30.2%). Most smokers (n = 48, 12.7%) sometimes consider quitting smoking upon exposure to pictorial warnings on cigarette packs. However, most non-smokers (n = 161, 42.6%) never had the urge to smoke upon looking at the pictorial warnings. The most impactful image on cigarette packs among smokers was 'Lung cancer' (n = 74, 39.2%), while for non-smokers was 'Mouth cancer' (n = 59, 31.2%) with p < 0.001.

Conclusion

While non-smokers demonstrated greater engagement with and emotional responses to the warnings, smokers showed less frequent interaction and a tendency toward desensitisation. Although pictorial warnings play a vital role in raising awareness of the health risks of smoking, particularly lung and mouth cancer, their effectiveness in encouraging smoking cessation among smokers remains limited.

Smoking-attributable peptic ulcer disease mortality worldwide: trends from 1990 to 2021 and projections to 2046 based on the global burden of disease study

Objective

Smoking is a major risk factor for peptic ulcer disease (PUD) mortality. This study aims to analyze global trends in smoking-attributable PUD mortality from 1990 to 2021 and project future trends to 2046.

Methods

Data were obtained from the Global Burden of Disease Study 2021. We calculated age-standardized mortality rates (ASMR) and estimated annual percentage changes (EAPC) for smoking-attributable PUD mortality. Bayesian Age-Period-Cohort models were used to project future trends.

Results

From 1990 to 2021, global smoking-attributable PUD deaths decreased from 48,900 to 29,400, with the ASMR declining from 1.2 to 0.3 per 100,000 (EAPC: -4.25%). High-income regions showed faster declines, while some low- and middle-income countries experienced slower progress or even increases. Projections suggest a continued global decline in smoking-attributable PUD mortality to 2046, with persistent regional disparities. By 2046, the global ASMR is expected to decrease to approximately 0.1 per 100,000, with higher rates persisting in certain regions such as the Solomon Islands (3.7 per 100,000) and Cambodia (1.6 per 100,000).

Conclusion

While global smoking-attributable PUD mortality has significantly decreased and is projected to continue declining, substantial regional disparities persist. These findings underscore the need for targeted tobacco control interventions, particularly in high-risk regions, to further reduce the global burden of smoking-attributable PUD mortality.

[Cannabis and nicotine in German music videos]

BACKGROUND

Smoking of tobacco and cannabis is widespread in Germany. Preventing children and adolescents from starting to use these products is an important goal of prevention. The aim of the present study was to examine how often depiction or mention of cannabis and nicotine use occurs in German-language music videos, which can be seen as advertising for smoking.

METHOD

The sample, which comprised the population of all German-language music videos listed in the YouTube Top 100 Charts in 2023, included 600 music videos. Using a coding scheme, the music videos were categorised as 'smoke-free' or 'not smoke-free' and the depiction or mention of consumption was counted.

RESULTS

Of the videos examined, 54.7% (n=328) contained at least one depiction or mention of cannabis or tobacco use; 31.7% of the videos (n=190) were exclusively about tobacco use, 12.5% of the videos (n=75) were exclusively about cannabis use, and 10.5% (n=63) were about both. While tobacco or cannabis use was shown or mentioned in 67.0% of the videos from the 'German rap' genre, the average for the other genres was 20.6% (OR=7.83; p<0.001). When considering cannabis use alone, the difference between the genres was even more pronounced. The proportion of videos in which cannabis was shown or mentioned was 29.7% in the 'German rap' genre and 4.4% in the other genres (OR=9.27; p<0.001). The 328 videos in which tobacco or cannabis use was shown received 3.2 billion clicks (64.5% of clicks). This means that these 328 videos generated a total of 9.7 trillion impressions. Of these, 5.8 trillion impressions were about nicotine use and 3.9 trillion about cannabis use.

DISCUSSION

Music videos expose children and adolescents to a wide range of scenes of nicotine and cannabis use, which remains largely unregulated.

Sex-specific associations of serum cotinine levels with depressive symptoms and sleep disorders in American adults: NHANES 2007-2014

Background

Accumulating evidence have demonstrated that tobacco smoke exposure (TSE) causes damage to human mental issues. However, previous studies almost focus on the individual smoking exposure patterns and some inconsistent results are reported. Serum cotinine is a reliable and quantitative biomarker of TSE. This study aims to explore the association of serum cotinine with depression and sleep disorders and the potential gender differences.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) 2007-2014 was used. Weighted multiple logistic regression methods, generalized additive models (GAM), and restricted cubic spline (RCS) models were used for association analyses. Moreover, gender-stratified analyses were conducted.

Results

Of 12,599 individuals included in the final analysis, 1,295 had depression, 3245 had trouble sleeping and 1152 had diagnostic sleep disorders. After adjusting for potential covariates, linear relationship suggested higher serum cotinine levels were positively associated with risk of depression and sleep disorders, including self-reported trouble sleeping and diagnostic sleep disorders in the total sample and female participants, and serum cotinine levels were positively correlated with depression and trouble sleeping in male participants. Additionally, inverted L-shaped associations between serum cotinine and depression and sleep disorders were detected, and at the same cotinine level, females have a higher risk of experiencing depression and sleep disorders.

Conclusions

In this study, higher serum cotinine increased the risk of depression and sleep disorders and there was stronger association in females than males. These findings provided novel evidence about how TSE affected the mental condition of the general US population.

Estrogen administration enhances the adverse effects of cigarette smoking on the heart in cycling female mice

Smoking, particularly chronic smoking (CS), is a threat to global health, contributing to increased mortality and morbidity associated with cardiovascular disease (CVD). CS induces oxidative stress and endothelial dysfunction, which has a profound impact on cardiac structure and function. While the protective effects of estrogen, particularly 17β-estradiol (E2), on cardiovascular health are well-documented in premenopausal women, the interaction between estrogen and CS remains poorly understood. The aim of this study is to investigate the impact of chronic cigarette smoking on cardiac health in relation to ethinylestradiol (EE) oral contraceptive (OC) usage in premenopausal females. Female mice were exposed to chronic cigarette smoke and co-administered EE. Cardiac structural and functional parameters were assessed alongside inflammatory markers, oxidative stress indicators, and histological changes. Results revealed that the combination of EE and CS led to adverse cardiac remodeling characterized by increased left ventricular end-diastolic volume and elevated left ventricular mass. In addition, an inflammatory state was evident, marked by increased expression of IL-4, IL-1β, IL-13, IL-10, and PARP-1, as well as increased interstitial collagen deposition. These findings suggest a progression towards adverse cardiac remodeling resembling dilated cardiomyopathy. Furthermore, our observations highlight the complexity of the inflammatory response triggered by smoking, potentially exacerbated by estrogen supplementation. The main finding of this study is that the combination of CS and EE enhanced adverse cardiac remodeling, which was shown structurally, histologically, and biochemically.