Tobacco Induced Diseases最新文献

Introduction: The effect of smoking cessation during pregnancy on preventing adverse birth outcomes has been shown in studies of US birth certificate data, and in other nations. There is a paucity of data to optimize community-based maternal tobacco cessation programs to improve birth outcomes. Our objective is to evaluate the real-world effectiveness of a multi-component, community-based maternal smoking cessation program in preventing adverse infant outcomes using components of known efficacy.

Methods: The Comprehensive Tobacco Treatment Program (CTTP) was a state-funded maternal tobacco smoking cessation program serving pregnant women in San Bernardino County, California, the largest county in the contiguous US. CTTP used a six-to-eight-week behavioral intervention with components of known efficacy (i.e. incentives, biomarker testing, feedback, and motivational interviewing). We conducted a retrospective cohort study of the 1402 pregnant women enrolled in CTTP during 2012-2019. We conducted a multivariable logistic regression analysis with adverse infant outcomes [premature birth (PTB), low birthweight (LBW), and NICU admission] as the dependent variables, abstinence achieved during [prolonged abstinence (PA) through weekly urinary cotinine tests] or after the program [self-reported point prevalence abstinence (PPA)] as the main effect exposures, and pertinent confounders.

Results: We found that PA during the program significantly decreased the odds of LBW (OR=0.67; 95% CI: 0.47-0.96, p=0.03), and this association remained for self-report of PPA at 2-4 months after the program (OR=0.70; 95% CI: 0.54-0.90, p=0.006), and six months after the program (OR=0.65; 95% CI: 0.47-0.90, p=0.01). Similar, albeit weaker, trends were found for PTB (OR=0.80). In these models, older age, early trimester at enrollment, and African American/Black ethnicity also trended toward higher rates of LBW and PTB.

Conclusions: Abstinence achieved during a multi-component behavioral smoking cessation intervention program using components of known efficacy, significantly reduced low birthweight deliveries in a multi-ethnic population.

Introduction: This study examines how prevalence and behaviors of smoking differ by ethnicity and their associations with chronic obstructive pulmonary disease (COPD) among elderly people of four ethnicities in rural southwest China.

Methods: A cross-sectional survey of 5642 adults aged ≥60 years was conducted in rural southwest China. Data on the demographics, smoking habits, and post-bronchodilator spirometry were collected.

Results: Among the participants, the prevalence of current smoking (48.8% vs 0.8%) and COPD (12.7% vs 4.5%) was significantly higher in males compared to females (p<0.01). Filtered cigarettes were the most popular form of tobacco used, comprising 76.6% of tobacco consumed. Bai ethnic minority participants had the highest prevalence of current smoking and COPD, and the highest number of cigarettes smoked per day compared to the other three studied ethnicities (p<0.01). Ha Ni ethnic minority participants had the lowest rate of smoking cessation (8.7%) and the highest rate of smoking in public places (66.8%) (p<0.01). The results of multivariable logistic regression indicated that current smokers were more likely to suffer from COPD across all four studied ethnicities (p<0.05). Further, the association of current smoking with COPD in Bai ethnicity elderly participants was stronger compared to other ethnic groups (p<0.01).

Conclusions: The present study shows that ethnicity plays a significant role in influencing both the prevalence and behaviors related to smoking among elderly people in rural southwest China. Future efforts to prevent and reduce tobacco use in rural China should consider ethnicity, as culturally tailored tobacco control strategies could help prevent and manage the COPD epidemic.

Introduction: Adolescent suicidality poses a serious barrier to healthy growth and development. This study examines the association between secondhand smoke (SHS) exposure and suicidality among adolescents from multicultural families in South Korea, using a secondary analysis of the Korea Youth Risk Behavior Webbased Survey (KYRBS).

Methods: This cross-sectional study used pooled secondary data from the 2021 and 2024 waves of the KYRBS, a nationally representative survey of adolescents in South Korea, collected through self-administered questionnaires. This is a secondary dataset analysis of the KYRBS using logit regression models to assess the associations between the duration and setting-specific frequency of SHS exposure and suicidality among adolescents. The mediating role of perceived stress was examined using the Karlson-Holm-Breen (KHB) method.

Results: SHS exposure is significantly associated with increased suicidality likelihood among adolescents, with particularly strong associations observed in those from multicultural families. Among multicultural adolescents, each additional total day of SHS exposure is significantly associated with the likelihood of suicidal ideation (AOR=1.117; 95% CI: 1.084-1.151), suicide planning (AOR=1.095; 95% CI: 1.052-1.139), and suicide attempts (AOR=1.117; 95% CI: 1.069-1.168). SHS exposure showed a stronger association with suicidality in multicultural families versus non-multicultural families. A higher frequency of SHS exposure across multiple settings is significantly associated with elevated odds of suicidal ideation (AOR=1.422; 95% CI: 1.247-1.621), suicide planning (AOR=1.395; 95% CI: 1.153-1.689), and suicide attempts (AOR=1.524; 95% CI: 1.222-1.902). Further analysis reveals that perceived stress partially mediates the association between SHS exposure and suicidality among multicultural adolescents. Perceived stress indirectly mediated 23.19% of the effect of SHS exposure on suicide attempts. It also mediated 30.67% and 34.18% of the effects on suicidal ideation and planning, respectively.

Conclusions: SHS exposure was associated with a higher likelihood of suicidality among adolescents, with this association observed in greater magnitude in adolescents from multicultural families. Moreover, perceived stress partially mediates the association between SHS exposure and suicide attempts among multicultural adolescents.

Introduction: The health implications of electronic cigarette (e-cigarette) use remain uncertain despite their increasing global prevalence. This study evaluates the health hazards of e-cigarettes on railway workers by comparing the differences in clinical and biochemical health indicators resulting from exposure to different smoking methods.

Methods: Using a retrospective cohort design, this study analyzed 7719 routine physical examinations and clinical health records from male railway workers in Shanghai (March 2022). Participants were stratified into four smoking subgroups: non-users, e-cigarette users, cigarette smokers, and dual users (concurrent e-cigarette and cigarette use). A multinomial logistic regression analysis evaluated the potential health impacts associated with each type of cigarette use, while a linear regression analyzed the impact of accumulated smoking years on these health indicators.

Results: E-cigarette use was associated with increased odds of elevated systolic blood pressure (AOR=1.12; 95% CI: 1.01-1.24; AOR=1.18; 95% CI: 1.06-1.31) and heart rate (AOR=1.18; 95% CI: 1.06-1.33) per 10-unit increase, as well as reduced urine pH (AOR=0.64; 95% CI: 0.52-0.80; AOR=0.70; 95% CI: 0.56-0.88) compared to non-users and cigarette smokers. Compared to cigarette use, e-cigarette use was associated with higher hemoglobin levels (AOR=1.22; 95% CI: 1.05-1.42) and increased aspartate aminotransferase levels for every 10-unit increment (AOR=1.23; 95% CI: 1.01-1.51). Furthermore, relative to non-users, e-cigarette users showed higher levels of white blood cells and carcinoembryonic antigen, with the largest effect sizes observed among e-cigarette users compared to other subgroups. In addition, the number of accumulated smoking years significantly impacted clinical and biochemical health indicators in both cigarette and e-cigarette users.

Conclusions: E-cigarette use was associated with adverse alterations in several clinical and biochemical health indicators, some of which were comparable to or more pronounced than those observed in cigarette smokers. Public health policies are necessary to regulate their use, particularly in occupational settings.

Introduction: In Bangladesh, a significantly lower minimum retail price and preferential ad valorem tax rate for low-price cigarettes incentivized manufacturers to avoid tax by expanding the low-price cigarettes market. The effect of this industry response on government tax revenue has not been quantified yet. This study aims to fill this gap.

Methods: Using cigarette sales data (2019-2020) of British American Tobacco (BAT) Bangladesh in the WHO Tobacco Tax Simulation Model, we estimated the gap of actual from potential revenue by simulating four counterfactual scenarios involving government tax interventions and cigarette manufacturers' decision to expand low-price cigarette sales. We analyzed optimal government policy response vis-à-vis manufacturers' actions in a game theoretic framework based on a payoff matrix of tax revenue and industry revenue.

Results: The revenue gap due to expansion of low-price cigarette sales (scenario 1) was BDT 22.1 billion (US$ 0.26 billion; US$ 1≈ BDT85 in Year 2020), equivalent to around 10% of the collected revenue in 2019-2020. Due to lower minimum price of low-price cigarettes (scenario 2), the revenue gap was BDT 14.7 billion (US$ 0.17 billion). The revenue gap was BDT 30.5 billion (US$ 0.36 billion) for the lower minimum price and lower excise tax rate of low-price cigarettes (scenario 3). The revenue gap due to lower minimum price, lower excise tax rate of low-price cigarettes and low-price cigarette sales expansion (scenario 4) was BDT 49.4 billion (US$ 0.58 billion).

Conclusions: In Bangladesh, revising the tiered excise tax structure by raising prices in the low-tier and unifying tax rates across tiers can curb tax avoidance, boost government revenue, and promote public health.

Tobacco use is a major risk factor for any surgical intervention. Offering patients help with giving up smoking before surgery increases cessation rates and lowers the risk of complications. The aim of this clinical trial is to evaluate the efficacy of an intensive presurgical intervention for promoting smoking cessation in smokers undergoing either orthopedic surgery with implants or general/urological surgery. We will conduct a stratified randomized clinical trial [intervention group (IG) and control group (CG), 1:1 allocation] at the Vall d'Hebron University Hospital, Barcelona, Spain. The IG will receive intensive help to quit smoking (psychoeducational and behavioral support, nicotine replacement therapy with follow-up, and an information leaflet). The CG will receive brief advice and the same information leaflet in a single session. Sample size was calculated to include four equal groups (IG and CG in both types of surgery) with an estimated difference of 15 points in abstinence between IG and CG; assuming a loss to follow-up of 10%, a total of 232 subjects will be needed (58 per group). The primary dependent variables are self-reported and verified abstinence from tobacco consumption (expired CO) and surgical complications. We will conduct descriptive and bivariate statistical analysis for independent data. Logistic regression will be performed to assess the efficacy of the intervention. The relative risk of surgical complications will be calculated using Cox regression models. Patient recruitment began in May 2023. This trial will be the first to evaluate an intervention of this nature in Spain. If its efficacy is demonstrated, the results will support the design of a protocol for a smoking cessation program aimed at smokers who are scheduled for surgery.

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

Identifier: ID NCT05961813.

Introduction: Chronic obstructive pulmonary disease (COPD) affects 390 million people globally, with oxidative stress playing a key pathogenic role. Smoking and other forms of tobacco exposure are major COPD drivers and important sources of systemic oxidative stress, and potentially interact with metal homeostasis. Copper exhibits dual effects in lung homeostasis, as a cofactor for antioxidant enzymes and a potential catalyst for reactive oxygen species. However, the causal relationship between serum copper levels and COPD remains unclear. This study aimed to assess their association using a combination of observational and genetic approaches.

Methods: In stage one, we used multivariate regression to analyze the association between serum copper and COPD in 3166 participants in the National Health and Nutrition Examination Survey (NHANES), 2011-2016. Models adjusted for demographic and clinical covariates including smoking-related variables, and stratified analyses by smoking status. Stage two utilized Mendelian randomization (MR) analysis to explore a potential cause-and-effect link between copper levels in serum determined by genetics and COPD.

Results: Observational analysis showed increased COPD risk in the highest serum copper tertile (T3 vs T1, OR=1.65; 95% CI: 1.09-2.49; p-trend=0.0245). The association remained after adjustment for smoking-related covariates. However, MR analyses using both FinnGen and UK Biobank data suggested no causal effect (FinnGen IVW, OR=1.01; 95% CI: 0.98-1.04, p=0.37; UK Biobank IVW, OR=1.00; 95% CI: 1.00-1.00, p=0.55), with sensitivity analyses confirming result robustness.

Conclusions: While elevated serum copper is associated with COPD prevalence observationally, the null MR finding suggests it may reflect tobacco-related systemic oxidative stress or reverse causation rather than being a direct causal driver. Therefore, serum copper may be more useful as a biomarker of smoking-induced redox disturbance than as a therapeutic target. These results underscore the importance of integrating tobacco exposure metrics in future studies examining metal biology in COPD.

Introduction: This study aimed to examine the relationship between smoking and delirium in patients with sepsis and identify potential mediating mechanisms, utilizing data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database.

Methods: A retrospective cohort analysis was conducted involving 10855 adult patients with sepsis. Multivariable logistic regression, propensity score matching (PSM), and inverse probability treatment weighting (IPTW) were applied to assess associations while controlling for confounders such as demographics, comorbidities, vital signs, and laboratory parameters. Causal mediation analysis (CMA) was employed to explore the mediating role of partial pressure of carbon dioxide (PaCO2). Subgroup and sensitivity analyses were performed to assess result robustness.

Results: The incidence of delirium was significantly higher among smokers compared to non-smokers (34.8% vs 25.7%). Adjusted models identified smoking as an independent risk factor (OR=1.44; 95% CI: 1.28-1.61). These findings were validated through PSM (OR=1.35; 95% CI: 1.20-1.53) and IPTW (OR: 1.25, 95% CI: 1.18-1.32). Subgroup analyses affirmed associations across most strata. CMA indicated that 7.876% (95% CI: 4.433-13) of the effect of smoking on delirium was mediated by elevated PaCO2, with direct and indirect effects quantified at 0.0625 (95% CI: 0.0428-0.0800) and 0.0050 (95% CI: 0.0027-0.0081), respectively. Sensitivity analyses among ICU survivors yielded consistent results (OR=1.52; 95% CI: 1.34-1.72).

Conclusions: Smoking is independently linked to an increased risk of delirium in patients with sepsis, with hypercapnia partially mediating this relationship. These findings emphasize the importance of smoking cessation and targeted respiratory management in preventing delirium.

Introduction: The use of electronic cigarettes (e-cigarettes) is spreading among adolescents, especially at higher education institutions, and it may have effects on health and learning. The objectives of this cross-sectional study were to examine the decision to use e-cigarettes and identify the associated factors among students of a university in northern Thailand.

Methods: Data were collected by using a developed questionnaire via an online system with 430 undergraduate students from a university in northern Thailand. Samples were selected by stratified random sampling. Data were analyzed using frequencies and percentages, means and standard deviations, and logistic regression at a confidence level of 0.05.

Results: In a sample group, the decision to use e-cigarettes was found to be 18.6%. Factors significantly associated with the decision to use e-cigarettes included receiving information about the dangers of e-cigarettes from loved ones (AOR=2.84; 95% CI: 1.20-6.71), having friends who use e-cigarettes (AOR=8.53; 95% CI: 3.41-21.37), attitudes toward e-cigarettes (AOR=3.10; 95% CI: 1.61-5.95), perceived risk of e-cigarette use (AOR=2.51; 95% CI: 1.22-5.13), and perceived benefit of avoiding e-cigarette use (AOR=2.38; 95% CI: 1.23-4.57).

Conclusions: The factors associated with the decision to use e-cigarettes were found to be directly related to the students themselves, as well as their friends, acquaintances, and partners. Therefore, universities should have a policy to prevent the use of e-cigarettes by focusing on the individual level with all students. Further, activities should be organized in groups, especially among friends and partners, with a focus on changing attitudes, providing accurate information, and increasing the perceptions of e-cigarette risks as well as the benefits of avoiding e-cigarette use.

Introduction: In China, health warning labels (HWLs) on cigarette packs are text-only with two messages in rotation. We examined China's HWLs as they appear on packs, focusing on elements of design and branding that may undermine their effectiveness.

Methods: We used a systematic protocol to purchase 488 unique cigarette packs in 2023 from five major Chinese cities. The study sample consisted of the 471 packs that displayed the current HWLs mandated by China. A detailed codebook was developed to assess design elements in the HWL area (color/pattern schemes, text to background contrast, branding, etc.) and pack characteristics (brand family). Two trained coders who were native Chinese speakers independently double-coded the packs. We examined the prevalence of identified design elements and compared differences across brand families.

Results: Colors/patterns that appeared on the pack overlapped with the HWL area on almost all packs (90%). About one-quarter (27%) of packs featured branding directly below the HWLs; significant differences were observed across brand families (p<0.05). On 11% of packs, the HWL text lacked contrast against its background. Other concerning design elements included the use of multiple colors in HWL text and background, and split HWLs.

Conclusions: The prevalence of appealing branding and design elements that overlap the HWL on cigarette packs, potentially diminishes the effectiveness of HWLs and makes the Chinese HWLs less prominent compared to best practices. To enhance the effectiveness of HWLs and align with FCTC Article 11, China could implement stricter HWL regulations prohibiting branding within HWLs.