Tobacco Induced Diseases最新文献

Introduction: Tobacco use remains a major preventable cause of morbidity and mortality worldwide. Despite economic development and growing health system capacity, countries in the Gulf Cooperation Council (GCC) region face rising tobacco use and a shifting burden of smoking-attributed diseases. This study systematically analyzes age-specific and age-standardized smoking-related mortality trends across six Gulf countries Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates over a 30-year period.

Methods: We extracted and analyzed smoking-attributed mortality data from the Global Burden of Disease 2021 dataset (1990-2019), including death rates per 100000 population for age groups 15-49, 50-69, and ≥70 years, and the age-standardized percentage of deaths due to smoking. We conducted descriptive trend analysis, heatmap visualization, correlation assessment, and linear projections to 2030.

Results: Bahrain and Kuwait exhibited the highest smoking-attributed mortality rates with 14.3% of all deaths in 2019, particularly among those aged ≥70 years, with death rates exceeding 1300 per 100000. In contrast, Saudi Arabia and Oman maintained relatively lower and stable rates. Strong correlations were observed between mid-life and elderly smoking mortality (r about 0.97), while slightly lower in the ≥70 years group (r about 0.85). Projections indicate a highest burden increase in Bahrain (about 13.5%) and slight increases in Qatar and UAE (about 9%, each) by 2030 without policy intensification.

Conclusions: Despite regional advances in tobacco control, the burden of smoking-related mortality remains high in parts of the Gulf, especially among older adults. Immediate, targeted interventions particularly for middle-aged smokers are necessary to prevent further escalation. These findings support prioritizing tobacco cessation and surveillance as part of GCC public health strategies.

Introduction: The ongoing assessment of smoking rates and their related factors is a crucial component of anti-smoking initiatives and is essential for evaluating the success of anti-smoking strategies and policies. This research aimed to ascertain the prevalence of smoking and to identify the sociodemographic factors linked to smoking among adults in Malaysia aged ≥15 years.

Methods: We analyzed the secondary data of GATS-M 2023, which employed a cross-sectional design with a representative sample of 4269 adults in Malaysia aged ≥15 years, selected through a stratified, two-stage proportionate-to-size sampling technique. The research team collected the GATS-M data through face-to-face interviews conducted by trained research assistants, using a standardized, validated questionnaire. A multivariable logistic regression analysis was performed to identify sociodemographic factors associated with smoking among Malaysians.

Results: The overall smoking prevalence was found to be 19.0% (95% CI: 17.1-21.1), with males exhibiting a significantly higher prevalence than females (35.7%; 95% CI: 32.0-39.5 vs 1.5%; 95% CI: 0.8-3.1). The highest rates of smoking were noted among individuals of other ethnic backgrounds (39.1%), those aged 25-44 years (24.9%), and individuals who completed primary school but less than secondary school 95% CI: 2.60-5.91 (23.6%). Multivariable analysis revealed that Males from Malay (AOR=3.92; 95% CI: 2.60-5.91), Indian (AOR=3.17; 95% CI: 1.50-3.74), Other Bumiputra (AOR=3.14; 95% CI: 1.83-0.33), and other ethnic groups (AOR=4.77; 95% CI: 2.36-9.65) (Chinese ethnic as reference), and individuals with primary (AOR=2.98; 95% CI: 1.81-4.90) and secondary education level, showed a higher risk of being current smokers (AOR=1.81; 95% CI: 1.17-2.80, tertiary education level as reference) whilst no similar trends were found among female adults.

Conclusions: The smoking prevalence among Malaysian adults aged ≥15 years showed a slight decrease. There is a need for more anti-smoking policies or interventions, particularly aimed at males, Malays, younger adults, and those with lower levels of education, to further reduce the smoking prevalence in Malaysia.

Introduction: In 2024, Canada became the first country to implement warning messages on cigarette sticks. Warnings were required on king-size cigarettes in April 2024 at the manufacturer level and July 2024 at the retail level. The purpose of this study was to evaluate responses to cigarette stick warnings among adults who smoke in Canada using a standard survey and a daily diary study.

Methods: We used two separate online survey (i.e. questionnaire) methods with Canadian adults who smoke daily and use king-size cigarettes, with data collected in February, May, and August 2024. The first method was a standard cohort survey (observations=1724; participants=999), with one survey each data collection period. Participants were followed up in subsequent waves. Participants reported noticing health information on cigarette sticks 'any' vs 'none', and ≥ 'almost all' vs 'fewer cigarettes' in last month. The second method was a daily diary study (observations=10572; participants=527), with brief surveys every evening for two weeks during each data collection period. Participants reported noticing health information on cigarette sticks ('any' vs 'none' in last 24 hours). Samples for the two studies were distinct. In both studies, we also assessed feelings about the look of cigarette sticks (1=very bad to 5=very good), forgoing cigarettes normally smoked (no vs yes), and quit motivation (continuous). Generalized estimating equations regressed outcomes on survey period, adjusting for sociodemographic and smoking-related covariates.

Results: Noticing stick warnings increased in both surveys [standard 'any': May=58%, August=73%, OR=2.29 (95% CI: 1.81-2.91); standard ≥ 'almost all': May=27%, August=44%, OR=2.56 (95% CI: 1.99-3.30); daily diary: February=6%, May=10%, OR=1.77 (95% CI: 1.29-2.44), August=16%, OR=2.92 (95% CI: 1.73-4.93), all p<0.001]. Over time, negative feelings toward sticks [February=4.10, August=3.91, mean diff= -0.19 (95% CI: -0.32 - -0.05), p=0.006], forgoing cigarettes [February=56%, August=63%, OR=1.44 (95% CI: 1.12-1.86), p=0.004] and quit motivation [February=4.74, August=5.03, mean diff=0.30 (95% CI: 0.06-0.53), p=0.014] increased in the standard surveys, but not the daily diary study.

Conclusions: Canadian adults who smoke king-size cigarettes increasingly noticed cigarette stick warnings over the early implementation period. The standard survey also found increases in cessation-related responses to stick warnings. Future research should assess long-term impacts of this policy and validate standard and daily diary survey methods for evaluating labeling policies.

Introduction: Low- and middle-income countries (LMICs) face a disproportionate exposure and disease burden from secondhand smoke (SHS). Creating completely smoke-free indoor public places is effective in protecting people from SHS. This study examines how online news outlets in LMICs discuss existing smoke-free policies and their implementation.

Methods: In September 2023, we used Tobacco Watcher (www.tobaccowatcher.org), a tobacco news surveillance platform, to identify articles using the built-in topic 'Air' (i.e. smoke-free policy) and search terms 'implementation' or 'compliance' in 10 LMICs from 2022 to 2023. Two trained coders independently assessed all articles for their relevance (either substantially discussing in multiple paragraphs or holding a clear position on smoke-free policy implementation). A content analysis was conducted, with the coders independently coding each article for argument position, content, evaluation of current implementation efforts, and argument presenters until reaching 80% agreement or higher. Discrepancies in coding were resolved through discussion.

Results: Among 634 articles retrieved, 345 met the inclusion criteria. Most of these articles (81%, n=276) supported implementation of existing smoke-free policies; 31% (n=107) considered current smoke-free policy implementation efforts unsuccessful, citing lack of enforcement, signage, and other violations, while 20% (n=70) considered implementation to be successful; 21% (n=74) suggested a need for stronger smoke-free policies, including the elimination of designated smoking areas. Common argument presenters included government agencies (84%, n=291), civil society organizations (e.g. civil society: 40%, n=139), WHO (19%, n=67), and researchers or experts (18%, n=62).

Conclusions: Discourse around smoke-free policy implementation in online news media of LMICs was generally supportive, praising complete bans and active implementation. However, coverage highlights that enforcement remained a challenge and pointed to a need for stronger policies. News media can be utilized as avenues for raising awareness surrounding tobacco control challenges, building support for policy, and countering tobacco industry narratives.

Introduction: Practicing smoking cessation counseling with real patients is often limited in pharmacy education. To address this gap, artificial intelligence (AI) was employed to simulate patient interactions for role-playing, providing a flexible and pressure-free learning experience. This study aimed to evaluate the use of an AI-simulated patient (ChatGPT) for smoking cessation counseling in pharmacy education by assessing students' satisfaction, perceived learning impact, benefits, and difficulties encountered.

Methods: A quasi-experimental one-group post-test design was conducted with fourth-year pharmacy students enrolled in the smoking-cessation skills course at the Faculty of Pharmacy, Chiang Mai University, during the first semester of 2024 academic year. All students registered and attending the course were eligible and invited to participate. Case scenarios based on the 5As framework were developed and implemented in ChatGPT to simulate real-time counseling. After completing the AI session, students completed a self-administered questionnaire.

Results: Among 145 fourth-year pharmacy students, 66% reported satisfaction with the AI activity, and 84.4% indicated improved understanding of smoking cessation. Reported benefits included enhanced self-assessment and adaptability in the learning process, while common challenges involved technical limitations and limited understanding of how AI functions.

Conclusions: Overall, students expressed satisfaction with the AI-based activity, reported improved learning, and identified both benefits and areas for improvement. These findings support the integration of AI tools like ChatGPT as a student-centered, scalable approach in smoking cessation education, aligned with SDG 4: Quality Education.

Introduction: Given the shared risk profiles and interdependence of smoking and drinking behaviors, this study aimed to examine factors associated with smoking and alcohol consumption among older adult Korean men.

Methods: This was a secondary cross-sectional analysis of data pooled from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted between 2007 and 2019, encompassing 7259 men aged ≥65 years. The participants were divided into the non-smoking/non-drinking, smoking/non-drinking, non-smoking/drinking, and smoking/drinking groups, and the sociodemographic and various health-related data collected via questionnaires and blood tests were used for multinomial logistic regression.

Results: When examining factors associated with each group using the non-smoking/non-drinking group as the reference group, several associated factors were identified. For example, not participating in regular exercise (AOR=1.31; 95% CI: 1.06-1.61; p=0.011), perceived health status as poor/very poor (AOR=1.56; 95% CI: 1.21-2.00; p<0.001), and skipping breakfast (AOR=1.90; 95% CI: 1.22-2.98; p=0.005) were some of the factors positively associated with the smoking/non-drinking group. Conversely BMI ≥25 (AOR=1.44; 95% CI: 1.12-1.83; p=0.004), elevated triglyceride levels (AOR=1.03; 95% CI: 1.03-1.05; p<0.001), and more daily fat intake (AOR=1.20; 95% CI: 1.03-1.40; p=0.019) were positively associated with the non-smoking/drinking group. Higher triglyceride levels (AOR=1.03; 95% CI: 1.01-1.05; p<0.001), depressive mood (AOR=2.10; 95% CI: 1.20-3.67; p=0.009), and more daily fat intake (AOR=1. 27; 95% CI: 1.07-1.51; p=0.007) were positively associated with the smoking/drinking group.

Conclusions: Metabolic changes, such as higher triglyceride levels, were more common in the drinking groups, whereas negative emotions were more prevalent among smokers. These findings may highlight the need for targeted interventions to promote healthier lifestyles among older adults; however, further research is necessary to revalidate our study findings.

Introduction: Preserved ratio impaired spirometry (PRISm) is a new and variable phenotype of spirometry impairment that was first defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 2023. The identification of high-risk factors for the progression from PRISm to COPD remains insufficient at present.

Methods: Mendelian randomization (MR) analysis was conducted using genome-wide association study (GWAS) summary statistics. Genetic instruments for smoking behavior were derived from the GWAS & Sequencing Consortium of Alcohol and Nicotine use (GSCAN) (n=607291), while PRISm case-control data were sourced from the UK Biobank (n=296282). The inverse-variance weighted (IVW) method served as the primary analytical approach, supplemented by heterogeneity assessment, pleiotropy evaluation, and sensitivity analyses. For the meta-analysis, PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from inception to 31 December 2024, to identify relevant studies that followed up on the changes in spirometry among individuals with PRISm or studies that reported the possible factors related to the changes in spirometry among individuals with PRISm. The risk of bias and the quality of the included studies were assessed using the Newcastle-Ottawa Scale (NOS).

Results: The MR analysis identified 85 SNPs as genetic instruments, revealing a modest causal link between cigarette smoking and PRISm prevalence (IVW: OR=1.01-1.02, p=0.048). The meta-analysis of 14 studies (n=7336 PRISm cases) shows 20.8% (95% CI: 15.6-25.9) progress to COPD at follow-up, with no significant difference by follow-up duration (<5 vs ≥5 years). Persistent PRISm occurs in 41.5% (95% CI: 35.8-47.2), more frequently in long-term follow-up subgroups. Baseline 'chest distress/dyspnea' (OR=3.81; 95% CI: 1.47-9.84) and 'current smoking' (OR=2.18; 95% CI: 1.14-4.15) significantly predict progression, while respiratory symptoms, FEV₁/FVC ratio, TLC%, and FVC% show no association.

Conclusions: Our findings suggest a modest causal link between cigarette smoking and PRISm prevalence. The progression of PRISm to COPD within 5 years is approximately 20.8%. Among individuals with PRISm at the first visit, 'chest distress or dyspnea' and 'current smoking' are potential clinical risk factors for the progression of PRISm to COPD.

Introduction: Smoking is well-established as the primary risk factor for laryngeal cancer, yet high-quality clinical randomized controlled trials are lacking. To address this gap, we utilized Mendelian randomization (MR), a novel research approach that offers an alternative to traditional randomized controlled trials. Our study aimed to reaffirm the connection between smoking and laryngeal cancer, while also contributing new insights for global public health prevention.

Methods: We performed a two-sample MR analysis using publicly released genome-wide association studies (GWAS) statistics. Smoking as exposure and laryngeal cancer as outcome. The inverse-variance weighted (IVW) method was used to analyze the genetic causal association between smoking and laryngeal cancer. We applied four complementary methods, including weighted median, weighted mode, MR-Egger regression, and MR pleiotropy residual sum and outlier (MR-PRESSO) to detect and correct for the effect of horizontal pleiotropy.

Results: Based on IVW, we found a causal association between smoking (cigarettes per day) and laryngeal cancer (OR=9.55; 95% CI: 1.26-72.27; p=0.03). There was a potential genetic causal association between smoking and laryngeal cancer. No heterogeneity (Q=34.06, p=0.89) or horizontal pleiotropy (Egger intercept, p=0.69) was found in any of the analyses. Sensitivity analyses confirmed robustness (MR-PRESSO global test, p=0.96). None of the leave-one-out tests in the analyses found any SNP that could affect the results of MR.

Conclusions: Genetic liability to smoking is associated with a higher risk of laryngeal cancer. Our findings support a genetic link between smoking and laryngeal cancer, underscoring the importance of smoking prevention in public health strategies.

Introduction: There are growing concerns that advertising and promotion on social media are driving youth use of tobacco and e-cigarettes. The UK provides an instructive example as it has high levels of e-cigarette use, high levels of social media use and a restrictive tobacco control environment. Existing evidence in the UK, however, has not focused on children, and has not been updated to reflect changes in patterns of social media use and in the use of these products. The aim of this study is to assess the associations of social media use with smoking and vaping.

Methods: Using data from the United Kingdom Household Longitudinal Study on adolescents aged 10-17 years between 2015-2023, we employed generalized estimating equation (GEE) models to estimate the relationships between time spent on social media and likelihood of smoking tobacco and using e-cigarettes. Models were controlled for possible confounders including sociodemographics and whether children lived in a home with e-cigarette use or tobacco smoking. We included data from 9359 participants with 25704 observations.

Results: Current cigarette smoking was reported by 4.9% of the sample and current e-cigarette use by 3.1%. Our adjusted models found strong relationships between time spent on social media and both smoking and vaping (p for trend <0.001). For example, use of social media for ≥7 hours/day was linked to greater odds of tobacco (adjusted odds ratio, AOR=5.13; 95% CI: 3.32-7.95) and e-cigarette use (AOR=4.26; CI: 2.25-8.08).

Conclusions: This study finds associations between time spent on social media and both smoking and vaping among children. Enforcing regulations on content and restricting the duration of social media use may be warranted to protect children's health.

Introduction: In this review, we aimed to explore whether nicotine e-cigarette or vaping product use impact respiratory health.

Methods: We searched CINAHL, Embase, MEDLINE, PsycINFO, PubMed and Cochrane library databases initially in January 2023 and updated the search in January 2024. We included peer-reviewed human, animal, cell/in vitro original studies published between July 2021 and December 2023 but excluded qualitative studies. Three types of e-cigarette exposure were examined: acute, short-to-medium term, and long-term.

Results: We included 119 studies in the main analysis, and 5 in meta-analysis. Over half of the studies had low risk of bias. Non-smoker current vapers had higher incident risk of respiratory symptoms (relative risk, RR=1.90; 95% CI: 1.28-2.83) but statistically non-significant risk of chronic obstructive pulmonary disease (COPD) (RR=2.53; 95% CI: 0.96-6.67) compared to never users. They also had lower incident risk of respiratory symptoms compared to non-vaper current smokers (RR=0.75; 95% CI: 0.64-0.89) and dual users (dual use vs vaping, RR=1.26; 95% CI: 1.03-1.55). Dual users had higher risk of incidence of respiratory symptoms and prevalence of COPD compared to never users (RR=2.53; 95% CI: 1.44-4.45 and RR=3.86; 95% CI: 1.49-10.02, respectively), and the risk was statistically similar to non-vaper current smokers (RR=0.97; 95% CI: 0.84-1.14 and RR=1.15; 95% CI: 1.00-1.33, respectively). All meta-analysis findings were of 'very low' to 'low' certainty evidence. Of the studies not included in meta-analysis, we found 'moderate' certainty evidence of higher risk of respiratory symptoms, COPD, asthma, lung inflammation and damage in non-smoker current vapers compared to non-users, inconsistent findings on the risk of COVID-19 and other respiratory infections, and no significant association with e-cigarette associated lung injury.

Conclusions: E-cigarettes are associated with harms to the respiratory system. Further longitudinal research with special attention to measuring effects in different e-cigarette user populations are warranted.