Tobacco Induced Diseases最新文献

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.

Introduction: Bipolar disorder is a periodic episode of extreme fluctuations in emotion that has been shown to be associated with smoking and irritability, but the relationship between the three has not been studied, especially in terms of genetic causality. This study aimed to obtain potential causal estimates of the association between irritability and bipolar disorder while quantifying the mediating effects of the modifiable risk factor, smoking.

Methods: This study used a two-step Mendelian randomization (MR) method and employed the inverse variance weighted method for the two-sample MR, utilizing SNPs as genetic instruments. Sensitivity analyses were conducted to detect heterogeneity and horizontal pleiotropy.

Results: Irritability (OR=3.13; 95% CI: 1.23-7.93; p=0.016) and smoking (OR=2.00; 95% CI: 1.47-2.37; p<0.001) were significantly associated with bipolar disorder from a genetic perspective. Irritability was associated with a higher risk of smoking (OR=1.21; 95% CI: 1.07-1.37; p=0.002). Sensitivity analyses confirmed the robustness of these results. Mediation analysis indicated that smoking partially mediated the potential pathway from irritability and bipolar disorder, with the proportion of the effect of irritability on bipolar disorder mediated by smoking being 11.76% (95% CI: 2-21; p=0.012).

Conclusions: Smoking plays a mediating role in the potential causal pathway linking irritability and bipolar disorder, suggesting that smoking cessation interventions may possibly help mitigate the risk of bipolar disorder among individuals with heightened irritability.

Introduction: The tobacco 'endgame' concept proposes moving beyond traditional tobacco control measures towards a tobacco-free future. The aim of this study is to investigate the perceptions of tobacco control stakeholders in Africa on their agreement with what endgame approaches are suited for the region to achieve a tobacco-free society.

Methods: Data were collected using a web-based cross-sectional survey hosted on Redcap. A total of 146 stakeholders from 28 African countries took the survey. Participants rated agreement with 11 proposed endgame approaches drawn from the literature and the qualitative phase of this study. Descriptive analysis was used to summarize stakeholders' level of agreement while bivariate (chi-squared and Fisher's exact tests) and adjusted modified Poisson regression analyses examined association between agreement/disagreement to endgame approaches and demographic factors. Data were analyzed using STATA v17.

Results: All participants agreed to an integrated endgame approach while over 90% agreed with six measures (having non-addictive cigarettes, making cigarette unappealing, tobacco-free generation, regulated market model, quota/sinking lid and specific approaches for Africa). Agreements ranged from 70-85% for price caps, performance-based regulation, and non-combustible nicotine products, while only 35% supported government takeover of tobacco companies. Adjusted Poisson regression analyses showed that female stakeholders were less likely to support restricting tobacco sales by year of birth (relative risk ratio, RRR=0.89) and price caps (RRR=0.78), while PhD holders were more likely to support restricting tobacco sales by year of birth (RRR=1.29) and price caps (RRR=1.27). Stakeholders from Southern Africa were less likely to support a state takeover of tobacco companies (RRR=0.40) and performance-based regulation (RRR=0.76). Having more than 20 years of tobacco control experience lowered the support of price caps endgame measures (RRR=0.45).

Conclusions: Policymakers are encouraged to use insights from this study to consider multifaceted approaches aimed at addressing the problem of commercial tobacco in the African region and pave the way for a tobacco-free Africa.

Introduction: In China, cigarettes function as both consumer goods and 'social currency'. Despite increased awareness of smoking risks, cigarette gifting persists. This study examines whether graphic warning images and price increases can reduce the social value of cigarettes in gifting contexts.

Methods: A survey experiment was conducted (n=744), randomly assigning participants to a control group (n=189), a price treatment group (n=285), and an image warning group (n=270). Eligible participants were adults with stable incomes. Participants in the price treatment group viewed the same cigarette brands as in the control condition but with retail prices doubled relative to the market price, whereas those in the image treatment group viewed cigarette packs with added graphic warning images while prices remained unchanged. The primary outcomes were willingness to gift or receive cigarettes in strong and weak relationships (1=very unwilling to 5=very willing) and brand tier preference (1=low, 2=mid, 3=high), and logistic regressions were applied to assess treatment effects. All comparisons were made against the control group, and logistic regression results are presented as coefficients (β) with 95% confidence intervals (CI).

Results: Graphic warning images significantly reduced willingness to gift cigarettes (β= -0.88; 95% CI: -1.33 - -0.42, p<0.001) and expectations to receive cigarettes (β= -0.62; 95% CI: -1.08 - -0.16, p<0.01) in weak relationships but had no significant effect in strong relationships. Price increases did not affect gifting willingness but reduced brand preference in weak relationships (β= -0.67; 95% CI: -1.11 - -0.23, p<0.01).

Conclusions: Graphic warnings effectively weaken the symbolic value of cigarettes in non-intimate relationships, while price increases alone are insufficient. Tobacco control strategies should prioritize altering symbolic meanings rather than relying solely on economic measures.

Introduction: Smoking is the leading, preventable factor which significantly increases the likelihood of household relative poverty in China. This study aimed to explore the association between smoking and relative poverty across different households and provide evidence for targeted tobacco control measures and poverty reduction policies.

Methods: This study adopted a longitudinal design using two waves of unbalanced panel data from the China Family Panel Studies (CFPS) conducted in 2018 and 2020. Data were collected through structured questionnaires and self-reported responses. Smoking status of household members was considered the exposure factor, while household relative poverty status, measured by the Foster-Greer-Thorbecke indices, served as the outcome variable. A panel logit random effects model was employed to estimate the determinants of relative poverty across households with varying smoking status.

Results: At the 50% median income poverty line, China's relative poverty headcount ratio was 22.15% in 2018 and 22.54% in 2020, with the poverty gap index declining from 11.08% to 10.82% and the squared poverty gap index increasing slightly from 7.13% to 7.17%. Former-smoking households showed the highest poverty incidence (26.3% in 2018; 26.24% in 2020), followed by current-smoking (24.94%; 23.28%) and non-smoking households (22.75%; 22.37%). The panel logit model revealed significantly higher likelihood for current-smoking (adjusted odds ratio, AOR=1.63; 95% CI: 1.44-1.86, p<0.01) and former-smoking households (AOR=1.95; 95% CI: 1.60-2.36, p<0.01) compared to non-smoking households. Additional factors associated with increased odds of poverty included having ≥65 years members, members with chronic disease, and members reporting a two-week illness (all p<0.01).

Conclusions: We conclude that China faces a substantial challenge of relative poverty, with tobacco use significantly increasing the likelihood of household poverty. Potential policy directions may include evaluating the effects of adjusting tobacco excise taxes and reforming tax collection mechanisms, exploring rural smokers' preferences for smoking cessation information to inform the development of targeted interventions and so on.

Introduction: Tobacco use is a major public health crisis in Kenya, leading to over 6000 deaths annually. With a significant number of young people and adults using tobacco, the nation faces a rising health burden. The Kenyan government has implemented educational programs to curb consumption. This study analyzes data from the 2022 Kenya Demographic and Health Survey (KDHS) to assess changes in tobacco use from 2014 to 2022 and identify key demographic and socioeconomic determinants.

Methods: This study is a secondary data analysis of the 2022 Kenya Demographic and Health Survey (KDHS), a nationally representative survey of 46609 adults (aged 15-54 years). Data access was through the MEASURE DHS platform, ensuring ethical handling. A logistic regression model was used to estimate odds ratios of tobacco use, adjusting for socioeconomic and demographic factors. The analysis accounted for the survey's complex design using survey weights and clustering and was conducted in Stata 17 software.

Results: Between 2014 and 2022, overall tobacco use declined. Among men, prevalence dropped from 17.3% to 12.81% (25.95% decrease), and among women from 3.10% to 2.64% (14.84% decrease). While women's smoking slightly increased (0.18-0.35%), their smokeless use decreased (0.93-0.77%). Tobacco use was linked to age, marital status, residence, region, education level, and gender. Men's tobacco use odds increased with age, with those aged 20-24 years nearly five times more likely to use tobacco than those aged 15-19 years (AOR=4.44; 95% CI: 4.44-4.44). Married men were less likely to use tobacco than divorced, separated, or widowed men.

Conclusions: The observed declines in tobacco use, especially among males, suggest that current tobacco control efforts are positively impacting public health. Given the financial strain of health costs, preventive interventions are crucial. Research on socioeconomic and demographic factors can guide targeted behavioral change strategies. Continued policy measures like increased tobacco taxation, raising the legal sale age, and enforcing advertising bans and smoke-free policies remain essential to further reduce tobacco's health burden in Kenya.

Introduction: Adolescent tobacco use has become a serious global public health problem, and effective tobacco control public service advertisements (PSAs) are crucial for reducing adolescent smoking rates. The study aims to employ a mixed-methods approach combining quantitative surveys and qualitative focus groups to evaluate the effectiveness of different types of tobacco control PSAs among Chinese adolescents, identify effective advertising characteristics and content elements, and provide empirical evidence for optimizing youth tobacco control communication strategies.

Methods: A total of 125 students aged 10-18 years were recruited from six primary and secondary schools in Beijing and Kunming from November 2020 to April 2021. Participants completed Likert-scale ratings measuring advertisement effectiveness after viewing eight tobacco control PSAs and participated in focus group interviews. Quantitative data were analyzed using independent samples t-tests, Spearman correlation analysis, and multivariable logistic regression analysis, while qualitative data were analyzed using thematic analysis. All statistical tests were two-tailed with significance set at p<0.05.

Results: Quantitative analysis revealed that PSAs employing 'testimonials' and 'disease' frameworks were most strongly associated with prevention intentions, while those using 'celebrity endorsement', 'humor' and 'appearance damage' frameworks showed the weakest associations. Kunming adolescents showed significantly higher advertisement acceptance scores than Beijing adolescents (mean difference=0.21; 95% CI: 0.04-0.38, p<0.05). The 10-item effectiveness scale demonstrated good internal consistency (Cronbach's α=0.82). Qualitative analysis identified effective characteristics including presentation of specific health hazards, use of testimonials, and fear appeals; ineffective characteristics included non-specific harm presentation, use of humorous elements, and appearance damage content.

Conclusions: Tobacco control PSA design should consider strategies combining disease warnings with real-life testimonials, avoid humorous advertisements and industry-sponsored messaging, and consider regional cultural differences. Distribution through online and social media platforms frequently used by adolescents may enhance reach. Future longitudinal research with broader geographical sampling is needed to confirm these findings.