Tobacco Induced Diseases最新文献

Introduction: Scotland introduced comprehensive smoke-free legislation covering most enclosed public spaces in 2006. Twenty years on, this study examines changes in markers of population level exposure to secondhand tobacco smoke (SHS).

Methods: A secondary analysis of Scottish Health Survey data between 1998 and 2024 to examine trends in population exposure to SHS and household rules about smoking indoors. The proportions of non-smoking adults who had measurable cotinine in their saliva were calculated for the period 1998-2024. The geometric mean (GM) concentrations of cotinine levels were calculated using Tobit regression. Data from 2012-2024 on self-reported smoking rules for the home were analyzed.

Results: Salivary cotinine expressed as a GM fell from 0.464 ng/mL (95% CI: 0.444-0.485) in 1998 to 0.020 ng/mL (95% CI: 0.015-0.028) in 2024: a reduction of 95.7%. The percentage of non-smoking adults who had no measurable cotinine in their saliva increased by six-fold between 1998 (12.5%) and 2024 (77.6%). Most of the change occurred in the immediate aftermath of smoke-free legislation, with both metrics of population exposure to SHS demonstrating little evidence of change between 2011 and 2024. The proportion of households that are smoke-free has increased from 75.2% in 2012 to 90.2% in 2024 but is now ten times more common in the most deprived areas compared to the least deprived.

Conclusions: Scotland has sustained large reductions in SHS exposure since smoke-free legislation was introduced twenty years ago in 2006. However, progress evident in the years between 2006 and 2011 has not been maintained: there are still nearly one-quarter of non-smoking adults having measurable exposure to SHS on any given day. Smoking in the home has also reduced, but the level of inequality of this measure has doubled between 2012 and 2024. Public health interventions should consider the remaining workplace and home settings where people experience exposure to SHS.

Brief verbal intervention for smoking cessation (BISC) is an evidence-based practice proven to be effective and cost-efficient, yet its implementation in primary healthcare (PHC) clinics in China is currently inadequate. Developing and evaluating multifaceted implementation strategies are crucial to translating such evidence-based practices into routine clinical care. This study protocol outlines a rigorous, multi-phase approach to identifying and testing the most effective strategies for BISC implementation. This is a two-phase study utilizing the Multiphase Optimization Strategy (MOST). The first phase, which has been completed, involved using a scoping review, stakeholder consultations, and a Best-Worst Scaling (BWS) online survey to systematically identify and define four key implementation strategies. The second phase is a cluster-randomized 2×2×2 factorial trial conducted in primary healthcare institutions in Guangdong province, China, from January 2026 to December 2026. Eligible participants are clinicians providing primary healthcare services. Clusters will be randomly assigned, and outcome assessors and data analysts will be blinded to allocation. Data collection includes unannounced standardized patient (USP) visits, questionnaires, interviews, and telephone follow-ups, with outcomes assessed six months after the endline. The study's outcomes are categorized into a primary aim (implementation outcomes) and a secondary aim (effectiveness outcomes). This protocol outlines the utilization of the MOST framework to customize the optimized combination of implementation techniques for BISC within the local context. By using a factorial design, the study could unpack the black box of multi-component interventions and identify which specific components are most effective and efficient. This approach is expected to provide a valuable methodological paradigm for advancing implementation science in low- and middle-income countries.

Clinical trial registration: The study is registered on the official website of Chinese Clinical Trials.

Identifier: ChiCTR2600115994.

Abbreviations: BISC: brief verbal intervention for smoking cessation, PHC: primary healthcare, CFIR: Consolidated Framework for Implementation Research, BWS: best-worst scaling, MOST: Multiphase Optimization Strategy, USP: unannounced standardized patient, PSU: primary sampling unit, SSU: secondary sampling unit, PPS: probability proportional to size, DSMB: Data and Safety Monitoring Board, IOF: Implementation Outcomes Framework, PSAT: Program Sustainability Assessment Tool, PRESS: Provider Report of Sustainment Scale, NPT: Normalization Process Theory, EBP: evidence-based practice.

Introduction: E-cigarette use among young adolescents in Guam, and potentially other regions of the US-Affiliated Pacific Islands (USAPI), is markedly higher than among similarly aged adolescents in the general US population. The objective was to test the pilot version of a school-based e-cigarette and other tobacco product curriculum, named Fuetsan Manhoben, on outcomes related to e-cigarette use among Guam middle school students.

Methods: The intervention involved 4 video-based, culturally tailored lessons delivered in the classroom by health educators. A stratified cluster-randomized design was used to assign 8 public middle schools to either the intervention or the control condition. Six classrooms in each school participated in the study. Participants (n=269) in the intervention condition received the 4-lesson curriculum, whereas participants (n=269) in the control condition did not receive any intervention. Participants in both conditions provided data at pretest, post-test (4 weeks later), and at follow-up at 3 months. The current analyses pertain only to e-cigarette-related outcomes. Wald tests were utilized to determine the statistical significance of fixed effects within the negative binomial and logistic regression frameworks.

Results: At immediate post-test, the intervention did not have statistically significant effects on openness to using e-cigarettes (incidence rate ratio, IRR=0.79; 95% CI: 0.42-1.49, p>0.05), e-cigarette use initiation (OR=O.96; 95% CI: 0.42-2.19, p>0.05), or past-30-day e-cigarette use (IRR=0.90; 95% CI: 0.77-1.06, p>0.05). At follow-up at 3 months, the intervention also did not have statistically significant effects on e-cigarette use initiation (OR=0.70; 95% CI: 0.34-1.45, p>0.05) or past-30-day e-cigarette use (IRR=0.94; 95% CI: 0.82-1.08, p>0.05). However, findings indicated that the intervention reduced openness to using e-cigarettes at follow-up at 3 months (IRR=0.49; 95% CI: 0.28-0.86, p<0.01). That is, being assigned to the intervention condition was associated with 51% decrease in openness to using e-cigarettes at follow-up at 3 months.

Conclusions: Four lessons delivered over 4 weeks may not produce immediate short-term preventive effects, except potentially reducing e-cigarette use susceptibility at follow-up at 3 months. Further research is warranted to examine whether expanding the content and duration of the curriculum may result in stronger, more durable effects. Also, future studies should examine whether increasing the follow-up to 6-12 months might capture delayed preventive effects that were not detectable within the shortened, follow-up at 3 months in the current study.

Clinical trial registration: The study is registered on the official website of ClinicalTrials.gov.

Identifier: ID NCT05037656.

Introduction: Although the WHO Framework Convention on Tobacco Control (FCTC) mandates a comprehensive ban, tobacco sponsorship persists as a significant challenge in China. Focusing on this issue, this study aims to describe, identify, and understand the amounts, publicity, and influencing mechanism of tobacco sponsorship in China.

Methods: This multi-method quantitative study collected data from the China Tobacco Yearbooks for provincial tobacco sponsorship and production data, the Chinalawinfo Open Platform for anti-smoking regulations, and four tobacco industry websites for publicity materials, covering 2015 to 2022. Using ArcMap, STATA, and Python, we integrated spatial autocorrelation analysis, topic modeling, content analysis, and statistical modeling.

Results: Tobacco sponsorship amounts nationwide plummeted in 2017, followed by a gradual recovery until another decline in 2021. Spatial analysis revealed significant positive spatial autocorrelation from 2016-2020 and in 2022 (Global Moran's I>0.1, p<0.05). Sponsorship publicity predominantly centered on four topics: natural and health disaster response, tobacco product production and manufacturing, poverty alleviation and policy response, and customer service and brand building. OLS regression indicated that smoke-free law efficacy was negatively associated with sponsorship amounts (β= -0.149; 95% CI: -0.238 - -0.060; p<0.01), while cigarette production showed a positive association (β=0.001; 95% CI: 0.001-0.002; p<0.01). These associations remained robust after controlled for government-industry connection and production chain linkage. Mediation analysis further suggested that 'Mentioning tobacco farmers' served as a significant negative mediator for the impact of SLE (indirect effect= -0.351; 95% CI: -0.603 - -0.099; p<0.01) and a significant positive mediator for cigarette production (indirect effect=0.001; 95% CI: 0.000-0.001; p<0.05), government-industry connection (indirect effect=0.138; 95% CI: 0.084-0.192; p<0.01), and production chain linkage (indirect effect=0.338; 95% CI: 0.255-0.420; p<0.01). Robustness checks using heteroscedasticity-consistent and province-clustered standard errors confirmed the stability of these findings.

Conclusions: Tobacco sponsorship is fundamentally profit-driven because it mainly funds and publicizes components of the production chain, particularly tobacco farmers. As its severity may be constrained by anti-tobacco legislation, future studies are needed to continuously monitor these evolving strategies, thereby accumulating sufficient evidence to support the introduction and implementation of comprehensive, nationwide legislation that clearly defines and penalizes all sponsorship activities in China.

Introduction: Smoking is a major public health issue with undeniable adverse effects on human health. It is associated with a wide range of diseases, including cancer, cardiovascular conditions, pulmonary disorders, and neurological diseases. Among these, sleep disturbances and respiratory tract disorders, particularly Obstructive Sleep Apnea Syndrome (OSAS), are of particular concern. This study aims to investigate the relationship between smoking cessation and the OSAS risk scores.

Methods: Our study is a prospective, pre-post, single-arm observational study with repeated measures, conducted on patients who successfully quit smoking (n=117). The Epworth Sleepiness Scale, Berlin Questionnaire, and STOP-BANG Questionnaire were utilized to assess the risk of OSAS. OSAS risk scores were obtained from patients at their initial visit to the smoking cessation clinic and again six months after smoking cessation.

Results: Our study was completed with 117 patients. According to the Epworth Sleepiness Scale, high daytime sleepiness was reported in 36 patients, while quitting smoking reduced this number to 30 patients. According to the Berlin Questionnaire, the number of high-risk patients, which was 47, decreased to 28 after smoking cessation. According to the STOP-BANG Questionnaire, the rate of patients considered to be at high risk for OSAS was 45.3%, but it decreased to 35.9% after smoking cessation.

Conclusions: Our study demonstrated that the number of high-risk patients, as determined by OSAS risk scales, decreased after smoking cessation. Our study provides indications that the risk of OSAS may decrease with smoking cessation.

Introduction: Ischemic heart disease (IHD) remains a leading global health challenge, with smoking identified as a key modifiable risk factor. China, with its high smoking prevalence and aging population, faces a growing burden of smoking-related IHD. This study evaluates the disease burden of smoking-related IHD in China from 1990 to 2021 and projects future trends to inform targeted interventions.

Methods: Using data from the Global Burden of Disease (GBD) 2021 (1990-2021) and the cross-sectional baseline survey of the China Health and Retirement Longitudinal Study (CHARLS, Wave 1, 2011-2012), we analyzed trends in mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Joinpoint regression identified temporal trends, and an autoregressive integrated moving average (ARIMA) model forecast disease burden up to 2036. The CHARLS analysis included participants aged ≥45 years with complete smoking and health records. Multivariable logistic regression assessed the association between smoking status and heart disease likelihood in CHARLS participants.

Results: CHARLS data revealed that former smokers had an 84% higher likelihood of heart disease than never smokers (adjusted odds ratio, AOR=1.84; 95% CI: 1.50-2.25). GBD analysis showed that China's age-standardized mortality rate (ASMR) for smoking-related IHD surpassed global and US levels after 2005, with males bearing a significantly higher burden than females. Joinpoint regression identified key turning points, with male ASMR rising until 2010 before declining slightly, while female indicators consistently improved. ARIMA projections suggest male ASMR will remain high (39.01; 95% UI: 22.69-55.33) by 2036, indicating persistent challenges.

Conclusions: The burden of smoking-related IHD in China exceeds the global average and reveals significant gender disparities, with a worsening burden for males and improvement for females. There is a critical need for more effective smoking control measures aimed at the male population to tackle this major public health issue.

Introduction: Obesity, smoking, and atherosclerosis increase the risk of developing various cardiometabolic diseases. The estimated pulse wave velocity (ePWV) is a new indicator of arterial stiffness. However, the relationship between ePWV, waist-to-height ratio (WHtR), smoking, and cardiometabolic multimorbidity (CMM) remains unclear.

Methods: The study is a secondary dataset analysis of CHARLS, which included 8414 participants from the China Health and Retirement Longitudinal Study conducted between 2011 and 2018. The ePWV was calculated using the mean blood pressure and age. Cox proportional hazards models were used to explore the relationship between ePWV, WHtR, and CMM in both smoking and non-smoking populations. Additionally, we also employed restricted cubic spline (RCS) analysis and mediation analysis to investigate the relationship between ePWV, WHtR, and CMM. A p<0.05 was considered statistically significant.

Results: During the 7-year follow-up period, 1545 participants (18.36%) developed new-onset CMM. The RCS model exhibited a U-shaped relationship between WHtR and CMM incidence, with a positive correlation when WHtR exceeded 0.5. Cox regression analysis revealed that ePWV and WHtR were independent predictors of CMM in both smoking and non-smoking populations. Additionally, ePWV significantly mediated the association between WHtR and CMM risk.

Conclusions: Our findings indicate that ePWV and WHtR are associated with increased CMM risk. Early detection of ePWV and WHtR, combined with smoking cessation, may help identify high-risk individuals and provide a basis for future preventive research.

Introduction: Smoking is a major preventable risk factor for cardiovascular disease and is strongly associated with sudden cardiac death (SCD). This study investigated the relationship between the heart rate recovery index (HRR-I), T peak-end recovery index (Tp-eR-I), and QT interval recovery index (QTR-I) in smokers compared with non-smokers.

Methods: This cross-sectional study, conducted in Bilkent City Hospital, Ankara, Turkey, between May 2017 and June 2025, included 150 healthy smokers (120 males, 30 females) and 123 healthy non-smokers (97 males, 26 females). Smoking data are self-reported. All participants underwent symptom-limited treadmill exercise testing using the Bruce protocol. Heart rate (HR), QT, and Tp-e intervals were measured at baseline, peak exercise, and during recovery periods. HRR-I was calculated as the difference between peak HR and HR at the 1st, 2nd, and 3rd minutes of recovery. Tp-eR-I and QTR-I were calculated as the differences between baseline values and those obtained during peak, 1st, 2nd and 3rd minutes recovery times.

Results: Smokers exhibited significantly lower HRR-I values at the 1st [18.6 ± 7.1 vs 24.2 ± 6.9, p<0.001; 17.9 (95% CI: 12.9-22.9)], 2nd [27.4 ± 7.3 vs 33.1 ± 7.1, p<0.001; 10.7 (95% CI 7.3-14.1)], and 3rd minutes [33.8 ± 7.9 vs 39.5 ± 8.3, p<0.001; 13.4 (95% CI: 9.6-17.2)] of recovery compared with non-smokers. Tp-eR-I and QTR-I values were significantly higher in smokers [Tp-eR-I: 7.8 ± 2.6 vs 5.2 ± 2.1, p<0.001; 18 (95% CI: 12-24)] [QTR-I: 24.5 ± 6.3 vs 18.9 ± 5.8, p<0.001; 12 (95% CI: 6-18)]. Smoking intensity was positively associated with Tp-eR-I (r=0.41, p<0.001) and QTR-I (r=0.36, p<0.001), and negatively associated with HRR-I (r= -0.39, p<0.001).

Conclusions: Cigarette smoking impairs autonomic regulation as reflected by reduced HRR-I and abnormal ventricular repolarization recovery, shown by increased Tp-eR-I and QTR-I. These findings suggest that smoking disrupts sympathetic-parasympathetic balance and myocardial repolarization, potentially explaining the higher incidence of arrhythmias and sudden cardiac death among smokers.

Introduction: Previous studies have reported conflicting results on the relationship of smoking with gout and hyperuricemia. This study aimed to investigate the associations of smoking with serum uric acid levels, hyperuricemia, and gout.

Methods: This study was a pooled analysis of secondary data from the 7th to 9th Korea National Health and Nutrition Examination Survey (2016-2022). We analyzed 29516 participants (12626 for gout analysis) aged ≥19 years. Smoking status (exposure) and doctor-diagnosed gout (primary outcome) were assessed through self-reported questionnaires, while serum uric acid levels (secondary outcome) were measured from blood samples. Multiple linear and logistic regression analyses were performed to assess the associations, adjusting for potential confounders.

Results: In females, current smokers had significantly higher serum uric acid levels than never smokers (adjusted mean difference=0.16 mg/dL; 95% CI: 0.08-0.24; p<0.001). Current smoking in females was also significantly associated with increased odds of both hyperuricemia (adjusted odds ratio, AOR=1.49; 95% CI: 1.11-2.00; p=0.008) and self-reported doctor-diagnosed gout (AOR=22.07; 95% CI: 6.66-73.09; p<0.001) compared with never smoking. In contrast, no significant associations were observed in males; the adjusted mean difference in serum uric acid levels between current and never smokers was -0.01 mg/dL (95% CI: -0.08-0.05; p=0.668), and the AOR for gout was 1.00 (95% CI: 0.62-1.59; p=0.984).

Conclusions: The results suggest that smoking is associated with elevated serum uric acid levels and an increased prevalence of hyperuricemia and gout in women but not in men.

Introduction: Atrial fibrillation and atrial flutter (AF/AFL) are major contributors to the cardiovascular disease burden in G20 countries. However, comprehensive assessments of smoking-attributable AF/AFL burden across the G20 remain limited. The objective of this study was to evaluate temporal trends in the AF/AFL burden attributable to smoking in G20 countries from 1990 to 2021 and to project future trends through 2050.

Methods: This secondary analysis used data from the Global Burden of Disease (GBD) 2021 study. Smoking-attributable disability-adjusted life years (DALYs), deaths, years lived with disability (YLDs), and years of life lost (YLLs) for AF/AFL were extracted for G20 countries between 1990 and 2021. Trends were analyzed by age, sex, and country, and estimated annual percentage changes (EAPCs) were calculated. Autoregressive integrated moving average (ARIMA) and exponential smoothing (ES) models were applied to project the disease burden from 2022 to 2050.

Results: In 2021, smoking-attributable AF/AFL accounted for 321761.89 DALYs (95% UI: 187788.89-476327.05) in the G20. Overall age-standardized rates remained relatively stable from 1990 to 2021. Japan showed a declining trend, whereas Saudi Arabia and Indonesia exhibited increasing burdens. Males consistently experienced higher burdens than females, and the highest absolute burden occurred in individuals aged 65-89 years. Projections indicate that from 2022 to 2050, absolute numbers of deaths, YLDs, YLLs, and DALYs attributable to smoking-related AF/AFL will continue to rise, particularly among males, despite stable or slightly declining age-standardized rates.

Conclusions: Although age-standardized smoking-attributable AF/AFL rates in G20 countries have remained largely stable, absolute burdens are expected to increase substantially due to population growth and ageing. Pronounced sex- and country-level heterogeneity highlights the need for sustained and targeted tobacco control and cardiovascular prevention strategies.