Changes in smoking prevalence after the enforcement of smoking control regulations in urban Shanghai, China: Findings from two cross-sectional surveys

The Characteristics of Gut Microbiota and Its Relation with Diet in Postmenopausal Osteoporosis

The gut microbiome is linked to osteoporosis. Previous clinical studies showed inconsistent results. This study aimed to characterize the gut microbiota feature and reveal its relation with diet in postmenopausal osteoporosis. Fifty-five postmenopausal women with osteoporosis (Op group) and forty-four age-matched postmenopausal women (normal bone mineral density, Con group) were included in this study. Fecal microbiota was collected and analyzed by shallow shotgun sequencing. Food frequency questionnaires were collected from both groups, and Spearman analysis was used to clarify its correlation with gut microbiota. A total of 2671 species from 29 phyla, 292 families, 152 orders, 80 classes were detected in the study. The two groups had no significant difference in the α and β diversity (p > 0.05). At the genus level, Anaerostipes was enriched in Op group (p < 0.05). At species level, Methanobrevibacter smithii, Bifidobacterium animalis, Rhodococcus defluvii, Lactobacillus plantarum, and Carnobacterium mobile were enriched in the Op group, while Bacillus luciferensis, Acetivibrio cellulolyticus, Citrobacter amalonaticus, and Bifidobacterium breve were differentially enriched in the Con group. Food frequency questionnaire showed that postmenopausal women with osteoporosis intaked more red meat, beer, white and red wine (p < 0.05), and the Con group had more yogurt, fruit, and tea consumption. Red meat consumption had a significant negative correlation with Streptosporangiales (p < 0.01) and Actinomadura (p < 0.05). Fruits intake negatively correlated with Nocardiaceae, Rhodococcus, and Rhodococcus defluvii (p < 0.05). More yogurt intake was consistently correlated with a greater abundance of Streptosporangiales. This study suggests that gut microbiota is significantly altered in the postmenopausal osteoporosis population at genus and species levels, and specific dietary intake might relate to these changes.

Secondhand smoke exposure can increase the risk of first ischemic stroke: A 10.7-year prospective cohort study in China

INTRODUCTION

Passive smoking is considered a major public health issue in China. Prospective evidence regarding the link between secondhand smoke (SHS) and ischemic stroke in China is scarce.

METHODS

The China Kadoorie Biobank (CKB) study in Liuzhou City recruited 50,174 participants during 2004-2008. Of these 30,456 never-smokers were included in our study. The median follow-up period was 10.7 years. The incidence of ischemic stroke was obtained through the China Disease Surveillance Points (DSP) system and the Health Insurance (HI) database. Cox proportional risk models were used to evaluate the association between SHS exposure and ischemic stroke.

RESULTS

During 320,678 person-years of follow-up, there were 2059 patients with ischemic stroke observed and the incidence of ischemic stroke was 6.42 per thousand person-years. Participants exposed to SHS daily faced a 21 % higher risk of ischemic stroke (HR = 1.21, 95 %CI: 1.09-1.34) compared to those exposed to SHS less than once a week. Subgroup analyses revealed that daily SHS exposure was linked to heightened risk of ischemic stroke among women, non-employed, and non-weekly tea drinkers.

CONCLUSIONS

Daily SHS exposure was associated with higher risks of ischemic stroke. Proactive tobacco control strategies are necessary to decrease the risk of ischemic stroke in never smokers.

Changing profiles of the burden of Alzheimer's disease and other dementias attributable to smoking in the belt and road initiative countries: A secondary analysis of global burden of disease 2019

Objectives

This study was aimed at analyzing the burden and trend of Alzheimer's disease and other dementias attributed to smoking (SADD) in the Belt and Road Initiative (BRI) countries during 1990-2019.

Methods

Data from The 2019 Global Burden of Disease Study was used to extract information on the burden of SADD in terms of the numbers and age-standardized rate of mortality (ASMR) and disability-adjusted life years (ASDALR) in the BRI countries for 1990-2019. The average annual percent change (AAPC) was used to analyze the temporal trends of ASDALR from 1990 to 2019 and in the final decade by Joinpoint regression analysis.

Results

The DALYs of SADD were the highest in China, India, and the Russian Federation in 1990 and in Lebanon, Montenegro and Bosnia, and Herzegovina in 2019. From 1990 to 2019, the ASDALR in China had increased from 55.50/105 to 66.18/105, but decreased from 2010 to 2019, while that of India had declined from 32.84/105 to 29.35/105, but increased from 2010 to 2019. The ASDALR showed the fastest increase in the Russian Federation, with AAPC of 1.97% (95% confidence interval [CI]: 1.77%, 2.16%), and the fastest decline in Sri Lanka, with AAPC of -2.69% (95% CI: 2.79%, -2.59%). ASMR and ASDALR from SADD showed a substantial decline during 1990-2019 both globally and in the different socio-demographic index (SDI) regions (all P < 0.05, except for the high-middle-SDI region). Compared to the rates in males, the AAPC in ASDALR of females was significantly greater in 20 countries(all P < 0.05). In the age group of 20-54 years, the DALYs rate showed a decreasing trend only in 13 members in the low-SDI region (all P < 0.05).

Conclusion

Under the premise of eliminating the differences, mobilizing resources in the country itself, the BRI organization, and globally will help reduce the global SADD burden and achieve healthy and sustainable development.

China's Smoke-free Policies in Public Place and the Smoking Cessation Status of Smokers

INTRODUCTION

Smoking remains a major health risk factor and China is the world's largest consumer of tobacco. Smoke-free policies in public places are a powerful weapon in tobacco control. Therefore, the aim of this study was to assess the association between smoke-free policies in public places and smoking cessation among smokers in China from 2012 to 2020.

METHODS

In this study, we assessed the impact of smoke-free public places policies on smoking cessation situation among smokers aged 16 years and older. We do this by conducting a difference-in-differences analysis using data from the China Family Panel Study (CFPS) 2012-2020.

FINDINGS

By 2020, about 60.2% of the cities were covered by partial smoke-free policies and about 38.5% by comprehensive smoke-free policies. Based on the results of the study, we found that the medium-term effect model (Model 2, 2012:2016; Model 3, 2012:2018) of the impact of partial smoke-free policies on smoking cessation was not statistically significant using 2012 as the study baseline; the short-term effect model (Model 1; 2012:2014; P< .01) and the long-term effect model (Model 4; 2012:2020; P< .05) were statistically significant; the effect of a comprehensive smoke-free policy on smoking cessation (Model 5; 2012:2020; P<.05) was statistically significant.

CONCLUSION

China's existing comprehensive smoke-free policies have had a modest impact on smoking cessation among the smoking population, and a strong, comprehensive national smoke-free law is urgently needed to achieve greater public health outcomes.

IMPLICATIONS

Smoke-free policies are an important intervention to influence smoking behavior. This study demonstrates that comprehensive smoke-free policies in public places in China can effectively influence smoking behavior and show long-term trends in smoke-free behavior, while also reflecting the need to promote comprehensive smoke-free policies. This study provides a basis for the implementation of comprehensive smokefree policies into law and also provides a basis for policy makers.

Oral Cancer Incidence, Mortality, and Mortality-to-Incidence Ratio Are Associated with Human Development Index in China, 1990–2019

The burden of oral cancer (OC) is closely related to economic development. We aimed to evaluate the burden of OC at different stages of economic development in China in terms of incidence, mortality, and mortality-to-incidence ratio (MIR) from 1990 to 2019. Data on cancer in China from 1990 to 2019 were obtained from the Global Burden of Disease 2019. Based on human development index (HDI), Chinese economic development was divided into three stages: low, medium, and high HDI stages. Mann–Whitney U-test was used to evaluate the differences in age-standardised incidence rates (ASIR), age-standardised mortality rates (ASMR), and MIR at various stages of HDI. Correlation and regression tests were conducted to examine the association amongst ASIR, ASMR, MIR, and HDI in OC. The estimated annual percentage changes (EAPCs) were calculated to assess the trend of ASIR, ASMR, and MIR. Significant differences were observed in terms of ASIR, ASMR, and MIR between groups (P < 0.001). The values of both sexes in the low HDI stage were lower than those of the medium and high HDI stages, except for MIR, in which the low HDI stage was the highest (P < 0.05). ASIR and ASMR of OC in males at the medium HDI stage showed the fastest growth rate with EAPC values of 5.64 (95% confidence interval, 95% CI, 5.20 to 6.08) and 4.42 (95% CI, 4.01 to 4.82), respectively. A strong positive correlation exists between HDI and ASIR (r = 0.96) and ASMR (r = 0.91) in both sexes from 1990 to 2019. During the high HDI stage, the ASIR and ASMR of OC were at a high level, but the ASIR halted the uptrend trend and ASMR showed a decreasing trend. Therefore, the HDI index has been positively correlated with the ASIR and ASMR of OC in China in the past 30 years, but this relationship may not be sustained as the economy develops. The health department should continue to allocate additional resources for the prevention and treatment of OC.

Cross-sectional survey on cigarette smoking in Chinese high-income areas

OBJECTIVE

To evaluate smoking status and its influencing factors in high-income areas of China.

DESIGN

Cross-sectional.

SETTING

High-income areas in China.

PARTICIPANTS

4064 persons aged 15 years or older from the survey results in Global Adult Tobacco Survey-China 2018.

METHODS

Gross national income data were used to determine China's high-income economic regions, and the results of the survey in Global Adult Tobacco Survey-China 2018 were used for statistical analysis.

RESULTS

A total of 4064 people were included in our study, including 881 current smokers, 2884 who had never smoked and 299 who had quit smoking. Using the standardised rate method, the standardised smoking rates in high-income and non-high-income areas in China were calculated to be 23.56% and 27.77%, respectively. Men, high school education or below, knowledge of e-cigarette information, permission to smoke at home and people with poor smoking health literacy are the main influencing factors of smokers in high-income areas of China.

CONCLUSION

The smoking rate of people in China's high-income areas is lower than the overall smoking rate in China, and we should increase the public awareness that smoking is harmful to health, encourage the prohibition of smoking at home, increase investment in higher education and improve residents' smoking health literacy level. The purpose of this study was to encourage reduction in the rate of smoking and better control the prevalence of smoking.

Thirdhand smoke beliefs and behaviors among families of primary school children in Shanghai

INTRODUCTION

There are few reports on the beliefs about thirdhand smoke in Chinese families with primary school children. This study aims to understand the beliefs about thirdhand smoke among parents or grandparents of primary school children in Shanghai and to provide an evidence base to incorporate thirdhand smoke preventative action into tobacco control interventions.

METHODS

We performed a cross-sectional survey among parents and grandparents of children aged 6–13 years in the Changjiang Road Primary School and recruited 843 participants to make assessments on the ‘beliefs about thirdhand smoke’ (BATHS) scale. Sociodemographic details including age, gender, marital status, education level, personal income and type of home ownership (new house, secondhand house with or without redecoration) and health status of children (whether they suffered from respiratory diseases or not) were investigated. Scale assessment, univariate and multivariate analyses to explore the factors influencing the BATHS scale and subscale scores, were performed using SPSS version 22.0.

RESULTS

Participants who were aged >65 years were more likely to get lower scores on the BATHS scale (OR=0.476; 95% CI: 0.311–0.728, p=0.001). Undergraduates (OR=1.190; 95% CI: 1.020–1.388, p=0.027) and graduates (OR=1.4490; 95% CI: 1.102–1.906, p=0.008) obtained higher scores. Moreover, the scores of residents living in a secondhand house with redecoration (OR=0.882; 95% CI: 0.782–0.995, p=0.041) and without redecoration (OR=0.801; 95% CI: 0.698–0.919, p=0.002) were lower compared with those of new-house owners. The scores for participants whose children suffered from respiratory diseases in the past six months (OR=1.104; 95% CI: 1.003–1.216, p=0.043) were higher than those whose children had no respiratory diseases.

CONCLUSIONS

This study shows that younger people, females, those with higher incomes, and higher education levels, were more likely to believe the thirdhand smoke impacts on health and its persistence in the environment. Our findings can guide targeted actions for smoke-free home interventions.

Province-specific smoking-attributable cancer mortality in China 2013

INTRODUCTION

Province-specific initiatives are at the forefront of tobacco control but limited studies have provided province-specific assessment of smoking-attributable cancer burden in China.

METHODS

We estimated the fraction of total and site-specific cancer mortality attributable to tobacco smoking in 31 provinces in mainland China. The population attributable fractions (PAFs) for cancer deaths due to smoking were calculated by Levin's formula using province-specific smoking prevalence data around 1998 (assuming a 15-year latency time) and relative risks from cohort studies and meta-analyses. The 95% confidence intervals (CIs) of PAFs were calculated by a Delta method. Cancer deaths were abstracted from cancer registry data of the 31 provinces in mainland China in 2013.

RESULTS

Overall, smoking contributed to a total of 421566 cancer deaths in mainland China in 2013 (19.46% of all cancer deaths), with 400701 of these deaths occurring in men (29.34%) and 20865 (2.61%) in women. The population attributable fractions ranged from 15.56% (95% CI: 9.12-21.82%) in Tibet to 35.09% (95% CI: 25.68-45.83%) in Guizhou among men, and from 0.28% (95% CI: 0.00-0.64%) in Hainan to 10.44% (95% CI: 4.86-16.32%) in Jilin among women. Cancers of lung and liver were the two main smoking-attributable cancers for both men and women.

CONCLUSIONS

Tobacco smoking was responsible for nearly 20% of all cancer deaths in mainland China, but the proportion of cancer deaths attributable to smoking varied substantially across provinces. More effective programs and innovative new strategies for local tobacco control are warranted to reduce the future burden of smoking-related cancers in all provinces of mainland China.