Tobacco Induced Diseases最新文献

Introduction: Tobacco smoking continues to pose a major global public health challenge. Medical students play a crucial role in shaping future smoking cessation practices. Nicotine pouches have recently emerged as a tobacco-free alternative with a potentially reduced harm profile. However, little is known about their use and perception among medical students in Saudi Arabia. This study aimed to assess medical students' knowledge and perceptions of nicotine pouches and to examine usage patterns among those who consume these products.

Methods: A cross-sectional study was conducted between April and July 2024 among 295 medical students from three universities in Saudi Arabia. Data were collected through a self-administered electronic questionnaire covering demographics, smoking history, knowledge, perceptions, and usage behaviors. Statistical analyses, including chi-squared tests and logistic regression, were used to identify factors associated with knowledge and usage.

Results: Smoking prevalence among participants was 16.3%, with significantly higher rates among males. Overall, 58.6% of students demonstrated good knowledge of nicotine pouches. Higher knowledge scores were associated with male gender, senior academic year, and higher grade point average (GPA). Among users, 62.9% reported quitting smoking, and more than half noted health improvements. The 10 mg nicotine strength was the most commonly used. Social influence, particularly peer pressure, was the primary reason for use. Despite noting harm reduction potential, students expressed concern about nicotine dependence and the need for stronger regulation.

Conclusions: Saudi medical students show moderate knowledge of nicotine pouches, influenced by academic and demographic factors. However, concerns about dependence and regulation highlight the need for targeted education and policy development. Integrating this topic into medical curricula may better prepare future physicians to address nicotine use in clinical practice.

Introduction: The association between electronic cigarettes (e-cigarettes) and the risk of cardiovascular disease (CVD) remains inconclusive. This study aims to compare CVD risk from the use of e-cigarettes, cigarettes, combined cigarette and e-cigarette use, and non-use.

Methods: This study is a systematic review and network meta-analysis (NMA). MEDLINE and Scopus databases (through February 2024) were used to identify eligible studies. Observational studies that investigated the effect of e-cigarettes on the risk of composite CVD, myocardial infarction (MI), or stroke, compared to cigarette, dual use, or non-use, were included. NMA was applied to estimate relative effects (i.e. adjusted odds ratio, AOR) of e-cigarette, cigarette, and dual use, on composite CVD, MI, and stroke outcomes. Risk of bias was assessed using the Joanna Briggs Institute tool for surveys and the Newcastle-Ottawa scale for cohort studies.

Results: Eleven adult population studies were eligible for review. E-cigarette, cigarette, and dual use were significantly associated with composite CVD outcomes. Pooled AORs (95% CI) were 1.31 (1.05-1.62) for e-cigarette, 1.57 (1.30-1.88) for cigarette, and 1.67 (1.37-2.03) for dual use. Additionally, former cigarette and former dual use significantly increased the risk of composite CVD outcomes, compared to non-use. The pooled AORs (95% CI) were 1.29 (1.05-1.59) for former cigarette, and 1.46 (1.03-2.08) for former dual use, while former e-cigarette use was not significantly associated with composite CVD endpoints. For MI and stroke outcomes, only cigarette and dual use were significantly associated with these events.

Conclusions: Current e-cigarette, cigarette, and dual use were significantly associated with increased risk of composite CVD outcomes, while only cigarette and dual use significantly increased the risk of MI and stroke, compared to non-use. However, these findings were primarily based on cross-sectional data limiting the temporality of effect; additional prospective cohort studies are needed to confirm our findings.

Introduction: Smoking after a cancer diagnosis is associated with poor outcomes whereas smoking cessation improves survival and other outcomes. Although professional societies and practice guidelines call for equitable tobacco treatment delivery in healthcare, disparities in tobacco-related disease burden persist.

Methods: In the context of an outpatient US cancer center's population-based tobacco treatment program, this study examines associations between cancer survivors' rural and Appalachian residence status and: 1) current tobacco use status, 2) decision to decline tobacco treatment, and 3) reason for declining assistance. A cross-sectional, retrospective analysis was conducted using electronic health record data from 16839 adults: 64.04% female, 88.49% non-Hispanic White, mean age 59.19 ± 14.52 years, 35.97% rural residence, 53.14% Appalachian residence, who sought cancer care in 2019. Descriptive statistics and logistic regression models were applied.

Results: The portion of patients that reported current tobacco use was 21.75%. Rural patients had higher odds of tobacco use than urban (OR=1.22; 95% CI: 1.12- 1.34), as did Appalachian patients compared to non-Appalachian (OR=1.41; 95% CI: 1.28-1.54). Neither rural nor Appalachian residence status was significantly associated with responses to tobacco treatment offers (76.65% declined the offer) or reason for declining (65.19% declined because they were 'not ready to quit').

Conclusions: Findings highlight continued need for population-level tobacco use screening and proactive tobacco treatment offers, given elevated tobacco use in some minority groups and overall low rates of tobacco treatment acceptance. This large study helps shed light on the association between geographical residence and tobacco-related outcomes among patients with cancer, and underscores room for improvement in tobacco treatment uptake in cancer care.

Introduction: Young-onset stroke represents a growing public health crisis globally along with rapid lifestyle changes. This study investigated the mortality and disability burden of young-onset stroke attributable to modifiable lifestyle factors in China compared with global trends, aiming to identify critical intervention targets.

Methods: Utilizing Global Burden of Disease 1990-2021 data, we analyzed age-stratified mortality and disability-adjusted life years for four lifestyle risk factors (tobacco, high alcohol use, dietary risk, and low physical activity). Temporal trends were assessed through joinpoint regression and age-period-cohort modeling, with population-attributable fractions compared between Chinese and global populations over three decades.

Results: China demonstrated persistently greater burdens from tobacco and high alcohol use than global averages did, particularly among males, where alcohol-attributable disability-adjusted life years (DALYs) increased 21% faster than mortality rates did. Gender disparities were prominent, with male population attributable fractions (PAFs) for alcohol exceeding female levels by 9.3-fold. Paradoxically, Chinese females presented rising low physical activity-related DALYs despite declining mortality. Midlife adults (aged ≥40 years) showed accelerated risk accumulation, whereas dietary risk reductions in China outpaced global declines by 2.4-fold. Age effects for all risks were weaker than global estimates, although period and cohort patterns aligned closely.

Conclusions: The diverging trajectories of mortality and disability burdens underscore China's dual challenge: curbing substance-related mortality in young males while containing midlife disability escalation. Culturally tailored strategies addressing gender-specific risk profiles and alcohol-DALY decoupling are urgently needed. These findings provide pivotal evidence for global stroke prevention in transitioning societies.

Introduction: The existing evidence regarding the relationship between secondhand smoke (SHS) exposure and depression symptoms in non-smoking adults remains inconclusive. This cross-sectional study aims to further investigate this relationship using data from the National Health and Nutrition Examination Survey (NHANES).

Methods: SHS exposure was assessed through self-reported passive exposure to indoor tobacco products, such as those encountered at work or in vehicles. Depression symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9) scale. Logistic regression and stratified analyses were conducted to evaluate the association between exposure to seven different indoor sources of SHS and depression symptoms.

Results: This study included 6272 never smoker adults from the US. Compared to individuals not exposed to any indoor SHS, exposure to specific types of SHS was positively associated with depression symptoms: exposure to cars (AOR=1.64; 95% CI: 1.17-2.31), exposure to other indoor areas (AOR=2.03; 95% CI: 1.33-3.10), and exposure to e-cigarettes (AOR=1.78; 95% CI: 1.14-2.77). When cumulative SHS exposure was calculated based on the number of SHS environments to which participants were exposed, those exposed to 1-2 sources of SHS were 1.47 times more likely (AOR=1.47; 95% CI: 1.13-1.91) and those exposed to ≥3 sources were 1.96 times more likely (AOR=1.96; 95% CI: 1.17-3.28) than unexposed individuals to experience depression symptoms.

Conclusions: Exposure to specific SHS environments, particularly simultaneous exposure to multiple SHS environments, seems to be significantly associated with depression symptoms among US adults. Establishing causality and understanding the health implications of this connection will require future longitudinal investigations.

Introduction: Some manufacturers of electronic nicotine delivery systems (ENDS) and liquids sell products with flavor names that use ambiguous terminology rather than explicitly characterize the product's flavor. These are often referred to as 'concept flavors'. This article presents a sample of ENDS concept flavor names to identify naming conventions the industry uses.

Methods: We reviewed 4546 English-language ENDS advertisements that ran in a variety of outlets including magazines, TV, radio, and direct-to-consumer emails, during the period 2015-2020. ENDS flavors in ads were identified and classified as 'concept' if the name contained no explicit characterizing flavor information. All concept flavor names were then reviewed by two coders to identify themes and practices used by ENDS manufacturers.

Results: The sample identified 215 unique concept flavor names. We found examples of flavor names that were suggestive of food or drink such as 'Citra Zing', as well as flavor names suggestive of sensations associated with drug use, such as 'Blurred Vision'. Some other concept flavor themes identified included the use of colors ('Red Venom'), numbers ('No 42.'), words associated with mythology ('God Nectar'), tropical imagery (Hawaiian Rainbow), and pop culture ('Miami Vice'). Some naming practices included the creation of flavor names using a portmanteau ('Grappleberry'), flavor names that used intentional misspelling or satiric misspelling, ('Gritz', and 'Cap'n Crunk'), and the use of malapropisms ('ohm sweet ohm').

Conclusions: The tobacco industry uses concept flavor names, and these names are presented in advertising in the US. This article identified themes and naming practices for concept flavors. Future work may continue to monitor the use of concept flavors and if concept flavor names are used in response to flavor restrictions. Additionally, future research may explore if concept flavors themes are associated with perceived risk, use intentions and behavior.

Introduction: It is well-established that smoking adversely affects the skin. This study aimed to compare skin properties, skin care product usage patterns, and the status of minimally invasive cosmetic procedures and self-evaluated skin quality in active smokers, ex-smokers, and non-smokers.

Methods: This cross-sectional study was conducted in Department of Dermatology, Faculty of Medicine, Ordu University, Türkiye in 2024, with participants aged 18-65 years. Data were collected through a validated self-administered questionnaire. Categorical data were analyzed using chi-squared or Fisher's exact tests. Intergroup differences were examined using one-way analysis of variance with post hoc Bonferroni tests. Correlations between smoking duration, daily cigarette consumption, and total skin quality scores were assessed using Pearson and Spearman correlation analyses and modeled with linear regression. Receiver Operating Characteristic (ROC) analysis was used to assess the skin quality score's ability to distinguish smokers from non-smokers. Logistic regression analysis was conducted to examine the association between smoking and skin quality. Structural Equation Modeling (SEM) was used to explore the relationships between smoking, age, gender, and skin quality.

Results: The study included 286 men and 393 women. Active smokers had worse skin quality, with more wrinkles, spots, and pigmentation (p<0.001). E-cigarette users showed poorer skin in the forehead, around the eyes, mustache, mouth, neck, and back (p=0.007-0.034). Hookah use was linked to worse skin and more spots on the back (p=0.004 and 0.009). Average skin quality scores were 25.47 for active smokers, 27.35 for ex-smokers, and 32.1 for non-smokers. Skin quality declined as smoking duration and daily cigarette count increased (p=0.00). Active smokers more frequently received neurotoxin injections and mesotherapy for skin spots (p=0.006 and 0.026).

Conclusions: This study confirms the detrimental effects of smoking - including e-cigarette and hookah use - on skin. These findings may serve as motivation for smoking cessation efforts.

Introduction: Smoking tobacco negatively affects fracture healing, increasing the risk of delayed union, malunion, and nonunion, as well as healthcare expenses. Although smoking is common in Saudi Arabia, the literature on public awareness of the negative impact of smoking on fractures is limited. Our study aimed to address this gap and assess the population's knowledge on the effects of smoking on fracture healing.

Methods: An analytical cross-sectional study, involving 1033 Saudi adults, was conducted between June and September 2024 in Saudi Arabia. A validated and reliable self-created Smoking and Fracture Knowledge Assessment tool (SFKAT) was used in an online questionnaire to collect the participants' responses. Participants were categorized into good- or poor-knowledge groups based on the median SFKAT score. Binary logistic regression was used to adjust for confounding variables.

Results: The participants included 54.4% men. The median age of the participants was 39 years and 24.1% of them were smokers. Most smokers were men (87%). The median SFKAT score was 16 (interquartile range, IQR=12-19) and 53% of the respondents demonstrated good knowledge on the effects of smoking on fracture healing. The likelihood of good-knowledge scoring was considerably lower for men than women (adjusted odds ratio, AOR=0.48: 95% CI: 0.36-0.65; p<0.001). Healthcare workers were more likely to have a good-knowledge scoring (AOR=2.78; 95% CI: 1.90-4.08; p<0.001). Smokers had lower odds of having a good-knowledge scoring (AOR=0.54; 95% CI: 0.38-0.75; p<0.001).

Conclusions: The awareness of the detrimental effects of smoking on fracture healing is suboptimal, particularly among men and smokers. Sex, healthcare work, and smoking were significantly associated with knowledge levels after adjusting for confounders. These findings may encourage educational strategies and direct counseling for populations with an observed knowledge gap to help lower the burden and treatment costs.

Introduction: We aimed to explore the association between exposure to prenatal tobacco exposure (PTE) in pregnant women and the neurodevelopment of infants and toddlers. We conducted a study using the Environmental Influences on Child Health Outcomes (ECHO)-wide cohort dataset.

Methods: We included 1970 mother-child dyads with children aged 1-42 months from the ECHO-wide cohorts. PTE was measured via self-reported active maternal smoking and secondhand smoke (SHS) exposure. Neurodevelopment was assessed using the Bayley-III, focusing on cognitive, motor, and language domains. Delay was defined as a composite score ≤85. We used Stata-18 for logistic regression to estimate the adjusted odds ratio (AOR) of the association between PTE and neurodevelopmental delay, adjusting for socioeconomic status, maternal age, and prenatal alcohol exposure. Additionally, we explored the mediation effects of birthweight.

Results: Active maternal smoking during pregnancy was associated with 84% higher odds of cognitive delay (AOR=1.84; 95% CI 1.25-2.7), 2-fold higher odds of language delay (AOR=2.04; 95% CI 1.49-2.8), and 16% higher odds of motor delay (OR=1.16; 95% CI 0.76-1.78) compared to children whose mothers did not smoke during pregnancy. However, adjusted models showed that SHS exposure did not affect the three domains. Additionally, mediation analysis revealed that birthweight partially mediated the negative effect of maternal smoking on cognitive function, with a natural indirect effect of -0.08 (95% CI: -0.16 - -0.01; p=0.028) and a marginal total effect of -0.81 (95% CI: -1.20 - -0.43; p=0.0001), indicating both direct and indirect pathways of influence.

Conclusions: Our study supports the growing evidence linking PTE to cognitive delay. Moreover, our findings underscore the importance of optimizing prenatal smoking cessation interventions during pregnancy to mitigate the risk of neurodevelopmental delay in early childhood.

Introduction: As electronic cigarettes (e-cigarettes) gain global popularity, healthcare providers (HCPs) play a critical role in shaping public health responses. In Saudi Arabia, little is known about HCPs' perspectives on e-cigarettes. Hence, this study aimed to evaluate HCPs' knowledge and attitudes toward e-cigarette use and examine differences based on their personal usage patterns.

Methods: This is an observational, cross-sectional study. An online questionnaire was distributed from February to May 2024 among HCPs in Saudi Arabia. The survey, which was previously validated, collected data on sociodemographic, smoking characteristics, and 17 items designed to assess HCPs' knowledge and attitudes about e-cigarette use.

Results: A total of 301 HCPs participated in the study. Among the participants, 19.3% were nurses, 18.9% were PharmDs, 13.2% were dentists, 24.3% were respiratory therapists (RTs), and 24.3% were medical doctors (MDs). Approximately 64% of the respondents were male, and the median age was 32 years (IQR: 22-55). E-cigarette users comprised 22.9% of the respondents. The prevalence of e-cigarette use was highest among dentists (20.0%), with lower rates observed among respiratory therapists (11.0%), nurses (8.6%), pharmacists (7.0%), and medical doctors (6.8%). The majority of respondents (68.1%) recognized that e-cigarettes contain nicotine, 64.5% believed that e-cigarettes are addictive, and 48.9% were unsure whether e-cigarettes are FDA-approved products. Additionally, 33.3% of HCPs relied primarily on social media for information about e-cigarettes. HCPs strongly agreed [median score: 5 (IQR: 4-5)] that HCPs should be educated about e-cigarettes. HCPs who used e-cigarettes exhibited significantly more favorable attitudes toward e-cigarettes compared to non-users, based on the total score (p=0.020).

Conclusions: HCPs' knowledge and attitudes regarding e-cigarettes vary widely in Saudi Arabia. Specific, targeted, and regularly updated educational initiatives are needed to ensure that healthcare professionals are confident and well informed regarding the use, risks, and guidelines related to e-cigarettes.