Tobacco Induced Diseases最新文献

Introduction: Adolescent e-cigarette use remains an important public health challenge, and evidence on its neurocognitive effects at an early age is limited. This study examined associations between exclusive e-cigarette use and cognitive performance in adolescents.

Methods: This study is a propensity score modeling cohort study. This study performed a secondary data analysis on data collected from 21 US sites in the Adolescent Brain Cognitive Development (ABCD) Study between 1 October 2016 and 31 October 2018, with one year of follow-up data. Adolescents reported substance use at ages 12-13 years and completed National Institute of Health (NIH) Toolbox Cognition Batteries one year later, which consists of the following scores: Picture Vocabulary, Flanker Inhibitory Control and Attention, List Sorting Working Memory, Dimensional Change Card Sort, Pattern Comparison Processing Speed, Picture Sequence Memory, and Oral Reading Recognition. Propensity score models incorporating 12 confounders assessed associations between baseline exclusive e-cigarette use (vs no tobacco use) and follow-up cognitive performance at one year.

Results: The cohort included 4574 participants (55.7% White, 25.3% Hispanic, 8.9% Black). Propensity score matching substantially improved covariate balance between e-cigarette users and non-users. Adolescents who exclusively used e-cigarettes in the past six months at baseline (n=35) had lower scores in Oral Reading Recognition (b[Standard Error (SE)]= -4.5 [1.3]; 95% CI: -7.3 - -1.7; p=0.003) and similar associations were observed in multivariable regression models adjusting for demographic, socioeconomic, and behavioral covariates.

Conclusions: Exclusive e-cigarette use among early adolescents was associated with poorer performance in specific cognitive domains. These preliminary findings raise concerns about potential neurocognitive implications of e-cigarette use and warrant confirmation in larger, longitudinal studies with longer follow-up.

Introduction: Tobacco use remains a critical global public health challenge, particularly in developing countries. As future healthcare providers, medical students and physicians play important roles in smoking cessation interventions. This study evaluates how systematic tobacco medicine training impacts medical graduate students' smoking cessation knowledge and attitudes.

Methods: This prospective intervention study was conducted at Chongqing Medical University, China, from 2022 to 2024. A total of 540 graduate students were enrolled and randomly assigned (1:1) to an untrained group (n=270) or a trained group (n=270). The untrained group received no training, while the trained group underwent a 6-week blended tobacco medicine training, comprising 12 online and six offline courses. Post-intervention, an online questionnaire and test were used to assess attitudes and knowledge. Data were analyzed using independent t-tests, Mann-Whitney U tests, chi-squared tests, or Fisher's exact tests for group comparisons; multivariable linear regression models were employed to adjust for baseline characteristics and evaluate the intervention's impact.

Results: The trained group achieved significantly higher cognitive scores regarding smoking cessation compared to the untrained group (mean difference=1.03; 95% CI: 0.73-1.33, p<0.001). Multivariable regression analysis indicated that training was positively associated with cognitive scores (B=0.92; 95% CI: 0.64-1.20, p<0.001), whereas current smoking status, longer smoking duration, and male gender were negatively associated. Regarding knowledge, the trained group demonstrated higher accuracy rates in most items (p<0.001).

Conclusions: Systematic blended tobacco medicine training effectively improves medical graduate students' knowledge and attitudes toward smoking cessation. Integrating such training into medical education is essential for preparing future professionals to support tobacco control.

Introduction: Tobacco use is a key modifiable risk factor for atrial fibrillation/flutter (AF/AFL). We assessed global, regional, and national burdens attributable to smoking from 1990 to 2021 and projected future trends.

Methods: Data on deaths and DALYs were extracted from the GBD 2021 study. Main statistical analyses included the calculation of ASMR and ASDR. Trends were quantified using the estimated annual percentage change (EAPC). An age-period-cohort (APC) model was employed to decompose the effects of age, period, and birth cohort. Furthermore, a Bayesian age-period-cohort (BAPC) model was utilized to project the disease burden through 2045.

Results: In 2021, AF/AFL related to tobacco caused around 396000 cases, more than 10000 deaths, and 400000 disability-adjusted life years (DALYs). Compared with 1990, absolute cases and DALYs increased, while ASDR and ASR DALY declined (20%). High SDI regions improved most; low SDI regions lagged. Men and older adults bore disproportionate burdens. By 2045, deaths are projected to reach 14500 and 4200, respectively. Despite rising absolute DALYs, ASMR and ASDR are expected to decline in both sexes.

Conclusions: Although standardized rates declined, the absolute burden of tobacco-related AF/AFL continues to rise, highlighting the urgent need for stronger tobacco control and targeted interventions in vulnerable populations.

Introduction: This study aimed to explore the differences in knowledge and cognitive perceptions of traditional tobacco and e-cigarettes among college students in Zhejiang Province, China, and to provide evidence-based insights for future prevention and control strategies.

Methods: A cross-sectional survey was conducted in September 2020 among students from nine undergraduate institutions in Zhejiang Province, selected through a combination of typical and convenience sampling. An anonymous online questionnaire was used to collect data on tobacco-related knowledge, usage behavior, and cognitive perceptions. Statistical analyses included chi-squared tests, rank-sum tests, logistic regression, McNemar's tests, and Cohen's kappa (κ) to assess differences and consistency in knowledge regarding traditional tobacco and e-cigarettes.

Results: A total of 728 valid responses were obtained. Among the respondents, 9.20% were current smokers and 6.73% were current e-cigarette users, of whom 1.37 % used e-cigarettes exclusively. Only 42.72% of respondents showed high knowledge of e-cigarettes, significantly lower than the 80.36% for traditional tobacco (χ²=128.410, p<0.001). Consistency in knowledge and risk perception between the two product types was also poor (κ<0.6). Among college students, 75.19% learned about e-cigarettes through the internet, and only 20.37% of those who had never used e-cigarettes correctly identified e-cigarette packaging.

Conclusions: College students demonstrated significantly lower awareness of e-cigarettes compared to traditional tobacco, with notable cognitive inconsistency regarding health risks. The prevalence of misinformation, especially from online sources, underscores the urgent need for targeted education and control measures to address cognitive confusion and improve awareness of e-cigarette risks.

Introduction: Smoking is a major risk factor for death, but the impact of behavioral patterns such as time to first cigarette (TTFC) on this risk has been little studied in the US population. To address this, we investigated the association between smoking status and TTFC with all-cause, cardiovascular disease, and cancer mortality based on a national sample.

Methods: We conducted a pooled secondary data analysis of the National Health and Nutrition Examination Survey data from the United States, covering nine continuous cycles between 2001 and 2018. The initial pooled sample comprised 91355 participants. After applying a series of exclusion criteria, the final analytical cohort consisted of 39084 adult subjects. TTFC was investigated by means of a touch-screen questionnaire. Outcomes included all-cause mortality, cardiovascular disease mortality, and malignancy-related mortality. Mortality information was obtained from the National Death Index (NDI) using death certificates (https://www.cdc.gov/nchs/linked-data/mortality-files/?CDC_AAref_Val=https://www.cdc.gov/nchs/data-linkage/mortality-public.htm).

Results: After full adjustment, former smokers had a significantly elevated risk of mortality compared to never smokers. A U-shaped association was observed between TTFC and both all-cause and CVD mortality. For all-cause mortality, the risk was highest in smokers with TTFC <30 min (hazard ratio, HR=4.47; 95% CI: 2.23-8.98, p<0.001). Similarly, for CVD mortality, the highest risk was also found in the TTFC <30 min group (HR=5.53; 95% CI: 2.32-13.14, p<0.001). In contrast, TTFC showed an inverse relationship with cancer mortality, with the risk being highest for TTFC <30 min (HR=3.23; 95% CI: 1.25-8.31, p=0.020) and decreasing with a later TTFC.

Conclusions: Former and current smokers showed elevated all-cause, CVD, and cancer mortality risks versus never smokers. TTFC exhibited a U-shaped association with all-cause and CVD mortality, but not with cancer mortality.

Abbreviations: TTFC: time to first cigarette, NHANES: National Health and Nutrition Examination Survey, NDI: National Death Index, NCHS: National Center for Health Statistics, CDC: Centers for Disease Control and Prevention, HEI-2020: Healthy Eating Index, GED: General Educational Development, PIR: poverty-to-income ratio, BMI: body mass index, CVD: cardiovascular disease, TC: total cholesterol, ALT: alanine aminotransferase, AST: aspartate aminotransferase, HbA1C: glycated hemoglobin, WTDR1D: dietary one-day sample weight.

Introduction: The mechanisms underlying the association between insulin resistance and nicotine dependence remain incompletely understood. This study aimed to examine the association between insulin resistance, assessed by the triglyceride-glucose (TyG) index, and nicotine dependence, measured by the Fagerström test for nicotine dependence (FTND), among adult exclusive combustible cigarette smokers.

Methods: This cross-sectional study was conducted between February and June 2025 in a tertiary care setting and included 169 adult exclusive combustible cigarette smokers aged 18-80 years. Individuals with diabetes mellitus or those receiving lipid-lowering therapy were excluded. Nicotine dependence was assessed using the Fagerström test for nicotine dependence (FTND), and insulin resistance was estimated using the triglyceride-glucose (TyG) index. Correlation analyses and multivariable linear regression were performed to examine factors associated with the TyG index.

Results: The mean age of the participants was 40.23 ± 12.95 years, and 55.6% were male. The mean TyG index was 8.51 ± 0.56, and the mean FTND score was 4.86 ± 2.32. The TyG index showed positive correlations with FTND score (r=0.280; p<0.001), age (r=0.261; p=0.001), and pack-years (r=0.218; p=0.004), and was significantly higher in males than in females (p<0.001). In multivariable linear regression analysis, older age, male sex, and higher FTND scores were independently associated with higher TyG index values.

Conclusions: The findings suggest a potential association between nicotine dependence and insulin resistance among adult exclusive combustible cigarette smokers. Prospective studies are needed to clarify the direction and clinical significance of this association.

Introduction: Tobacco cessation is crucial to reducing morbidity and mortality in India. Through a secondary analysis of the Tobacco Control Policy (TCP) India Wave 3 (2018-2019) survey data, we examined cessation outcomes, including successful quitting, quit attempts, use of cessation services, and healthcare provider (HCP) advice to quit, among combustible, smokeless, and mixed (combustible and smokeless tobacco) users.

Methods: We conducted a cross-sectional analysis of the TCP India Wave 3 (2018-2019) survey data. The survey captured self-reported data on tobacco use and cessation using structured questionnaires. Participants included combustible tobacco (cigarette/bidi) users (n=977), smokeless tobacco users (n=5806), and mixed users (i.e. combustible and smokeless tobacco users, n=1157). Weighted prevalence estimates were calculated, and multivariable analysis evaluated factors associated with cessation outcomes.

Results: Successful quitting among lifetime tobacco users ranged from 6.3% to 12.4%. Among current users, past quit attempts ranged from 4.8% to 20.9%, and cessation services use in the latest quit attempt ranged from 5.8% to 9.3%. More combustible tobacco users (67.5%) reported receiving HCP advice to quit than smokeless tobacco users (40.5%). Combustible tobacco users aged ≥55 years (adjusted odds ratio, AOR=3.82; 95% CI: 2.06-7.07) reported higher odds of quitting compared to individuals aged 15-39 years. Smokeless tobacco users who reported that their 'partner thinks a lot that they should quit tobacco use' (AOR=2.21; 95% CI: 1.85-2.64) and who received HCP advice to quit (AOR=2.07; 95% CI: 1.65-2.59) had higher odds of attempting to quit than their respective counterparts. Mixed users who perceived tobacco 'caused a lot of damage to their health' had higher odds of receiving HCP advice to quit (AOR=2.47; 95% CI:1.16-5.29) compared to those reporting 'not at all'.

Conclusions: Cessation outcomes and HCP advice to quit are suboptimal across tobacco users. Longitudinal studies are needed to understand the role of anti-tobacco advertising campaigns and spousal support on cessation outcomes.

Introduction: China has over 300 million smokers, yet overall willingness to quit remains low. Moreover, more than 90% of Chinese smokers who attempt to quit have no professional support, underscoring the need for effective self-directed cessation interventions.

Methods: We conducted a pretest-posttest quasi-experimental study in Hangzhou, China (March-June 2023). A total of 1082 eligible adult male smokers were allocated to receive gain-framed (n=546) or loss-framed (n=536) cessation messages after baseline assessments. Quit intention was measured with a 5-point Likert scale immediately before and after exposure to the allocated message. The primary outcome was an increase in quit intention post-exposure. Logistic regression was used to compare framing effects between groups, adjusting for occupation, annual household income, baseline quit intention, self-exempt beliefs, self-efficacy, and nicotine dependence (FTND). Subgroup analyses explored effect modification by these psychological factors.

Results: All participants received the allocated intervention and 1081 were included in the final analysis. Increased quit intention was observed in 34.6% of the gain-framed group versus 30.7% of the loss-framed group (adjusted odds ratio, AOR=0.73; 95% CI: 0.55-0.98; p=0.038). Subgroup analyses showed consistent benefits of gain-framed messages, with stronger associations among participants with low self-exempt beliefs (AOR=0.66; 95% CI: 0.45-0.96; p=0.031) and low self-efficacy (AOR=0.48; 95% CI: 0.28-0.83; p=0.008).

Conclusions: Gain-framed messages were associated with higher quit intentions than loss-framed messages among Chinese male smokers. Tailoring message framing to smokers' psychological profiles may yield more favorable responses. Given the quasi-experimental design, further studies are needed to obtain sufficient evidence for culturally sensitive tobacco control strategies in China.

Introduction: Smoking is a key driver of esophageal, stomach, liver, pancreatic, and colorectal cancers, and its impact is stronger in adults aged ≥60 years due to cumulative exposure and population aging. A comprehensive analysis of temporal trends and sociodemographic drivers for major digestive cancers in this population is lacking. This study quantified smoking-attributable deaths and disability-adjusted life years (DALYs) from digestive cancers in adults aged ≥60 years globally from 1990 to 2021. It also projected future burdens to 2036 to inform age-focused tobacco control and cancer prevention.

Methods: This study is a secondary dataset analysis of data from GBD 2021. We analyzed smoking-attributable deaths and DALYs for esophageal, stomach, liver, pancreatic, and colorectal cancers among adults aged ≥60 years across 204 countries and territories (1990-2021). We decomposed temporal changes into contributions from population growth, aging, and changes in age-specific rates. Associations with the sociodemographic index (SDI) were assessed, and future burdens (2022-2036) were projected using a Bayesian age-period-cohort model.

Results: From 1990 to 2021, global smoking-attributable deaths increased by 27.5% (398426 to 508147) and DALYs by 14.6% (8.9 to 10.2 million). Decomposition attributed the increase primarily to population growth (41-43%), partially offset by declining age-specific rates (-30% to -35%). Regional disparities were stark: high-SDI regions stabilized burdens through epidemiological improvements, while low-SDI regions saw population-driven escalations. SDI was positively correlated with burden at the country level (ρ=0.20-0.48; p<0.001), peaking at mid-high SDI.

Conclusions: Despite falling age-specific rates, the absolute burden of smoking-attributable digestive cancers in older adults is rising in parallel with demographic growth. Projections to 2036 suggest that, if current demographic trends continue, absolute deaths and DALYs are expected to continue increasing as populations age and grow.

Introduction: Smoking is a major risk factor for aortic aneurysm (AA). This cross-sectional study used Global Burden of Disease (GBD) data to examine trends in smoking-related AA and project future trends.

Methods: We conducted a secondary analysis on the GBD 2021 dataset. Data on mortality, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) associated with AA attributable to smoking from GBD. The estimated annual percentage change (EAPC) was employed to assess burden trends from 1990 to 2021. The autoregressive integrated sliding average (ARIMA) model was utilized to project disease trends from 2022 to 2036. Decomposition analysis and frontier analysis were employed to comprehensively examine the data.

Results: Globally in 2021, there were 47538 deaths (95% UI: 39480-56008) from smoking-attributable AA, with an ASMR of 0.56 per 100000 (95% UI: 0.46-0.66) and 1157488 DALYs (95% UI: 989966-1325831). The ASMR showed a decreasing trend from 1990 to 2021 (EAPC= -2.17; 95% CI: -2.30 - -2.04). However, there were significant differences between regions, with the burden of deaths in high sociodemographic index (SDI) areas accounting for 40.3% of the global total, while ASMR in low-middle SDI areas rose (EAPC=0.99; 95% CI: 0.94-1.03). The point estimates for ASMR and ASDR were consistently greater in males compared to females throughout the study period. Projections indicate a continued global decline in ASMR and ASDR over the next 15 years, but the burden would gradually rise in Central Asia, East Asia, and South Asia.

Conclusions: Smoking remains a significant preventable risk factor for AA, with substantial sex and regional disparities. Targeted public health strategies are urgently needed to address rising burdens in specific regions and reduce health inequalities.