Tobacco Induced Diseases[JOURNAL]
Sun
200 papers
Association between smoking and physical attractiveness: A longitudinal panel study from the China Family Panel Studies.
Zhou J, Liu Q, Hua F
Tob Induc Dis · 2026 · PMID 42254600 · Full text
INTRODUCTION: Physical attractiveness constitutes a form of human capital, which shapes social interactions and life-course outcomes. This study investigated the association between smoking and physical attractiveness. M...
INTRODUCTION: Physical attractiveness constitutes a form of human capital, which shapes social interactions and life-course outcomes. This study investigated the association between smoking and physical attractiveness. METHODS: This longitudinal panel study conducted a secondary analysis of data from the China Family Panel Studies (CFPS) from 2010 to 2022, linking seven survey waves through unique individual and family identifiers. After restricting the analysis to respondents aged 16-85 years and applying additional data quality criteria, the final sample consisted of 33632 respondents and 119071 observations. The independent variables included smoking status and daily cigarette consumption. The dependent variable was the physical attractiveness evaluated by the interviewer, scored 1 to 7. To examine the association between smoking and physical attractiveness, we employed a two-way fixed-effects model that accounts for time-invariant individual characteristics and common time trends. Furthermore, we investigated the heterogeneity of this association with respect to gender, age, and marital status. RESULTS: A significant negative association existed between smoking and physical attractiveness in the analysis of 119071 observations. After adjusting for confounding variables, the average score for physical attractiveness of current smokers was 0.04 points lower than that of non-smokers (β= -0.04; 95% CI: -0.07 - -0.02). For every unit increase in the natural logarithm of daily cigarette consumption, physical attractiveness decreased by 0.02 points (β= -0.02; 95% CI: -0.03 - -0.01). Heterogeneity analyses indicated that this negative association was more pronounced among males, married individuals, and middle-aged and elderly adults (35-59 and ≥60 years), whereas it did not reach statistical significance among females, unmarried individuals, or young people (16-34 years). CONCLUSIONS: Smoking was negatively associated with physical attractiveness, which is more pronounced in certain populations. Further studies are needed to verify these findings and to explore whether appearance-based messaging could be used in tobacco control campaigns.
Impact of smoking on the treatment cycle and health economics of acute exacerbations of chronic obstructive pulmonary disease.
Li S, Yin L, Lan M … +1 more , Huang G
Tob Induc Dis · 2026 · PMID 42254599 · Full text
INTRODUCTION: Acute exacerbations of chronic obstructive pulmonary disease (COPD) increase disease progression and mortality. Smoking influences treatment and health economics. This study examines how smoking status affe...
INTRODUCTION: Acute exacerbations of chronic obstructive pulmonary disease (COPD) increase disease progression and mortality. Smoking influences treatment and health economics. This study examines how smoking status affects medical costs, hospital stays, and outcomes in acute COPD exacerbations. METHODS: We included 658 patients with acute COPD exacerbations, excluding those with asthma, allergic diseases, bronchiectasis, or tuberculosis. Participants were divided into never smokers (n=218) and smokers (n=440). Smokers were further classified as early smokers (age ≤24 years, n=70) or late smokers (age >24 years, n=370), and as current (n=164) or former smokers (n=276). We used Mann-Whitney U tests, chi-squared tests, and univariate logistic regression (p<0.05). RESULTS: Median hospital stay was 11 days (IQR: 8-16) for smokers versus 10 days (IQR: 7-15) for never smokers (p=0.179). Median daily cost was 1280.63 versus 1182.01 RMB (1000 Chinese Renminbi about US$151.4, mean exchange rate 2018) (p=0.217). However, total treatment costs were higher for smokers (median=13477.81 [IQR: 9096.81-22651.91] vs 12296.95 RMB [7954.42-20392.61]; Hodges-Lehmann difference: 1068.87 RMB, p=0.045). Medicare (government health insurance program in China) payments were higher (12389.82 [7528.24-20366.10] vs 10216.77 RMB [4691.43-17742.65]; difference: 2349.09 RMB, p<0.001), while out-of-pocket payments were lower for smokers (1005.00 [100.00-2500.00] vs 1527.03 RMB [960.00-4686.97]; difference: -600 RMB, p<0.001). Early smokers had higher costs, longer stays (difference: 1.0 day, p=0.019), higher daily costs (difference: 173.2 RMB, p=0.001), and greater out-of-pocket payments (difference: 328.5 RMB, p=0.008) than late smokers. Current smokers had higher Medicare and total expenditures than former smokers (p=0.011 and p=0.010, respectively). CONCLUSIONS: Smoking, especially early smoking, significantly increases the economic burden of acute COPD exacerbations without affecting hospital stay duration.
The mediating role of nicotine dependence in the relationship between marital satisfaction and willingness to quit smoking: A cross-sectional study.
Zhang Y, Huo L, Wang Y … +6 more , Huang Y, Wang R, Jiang N, Guo Y, Qi F, Li S
Tob Induc Dis · 2026 · PMID 42221057 · Full text
INTRODUCTION: Previous studies have established a link between marital relationship quality and smoking cessation behavior, but the mediating role of nicotine dependence has not been fully explored. The purpose of this s...
INTRODUCTION: Previous studies have established a link between marital relationship quality and smoking cessation behavior, but the mediating role of nicotine dependence has not been fully explored. The purpose of this study was to explore the association between marital satisfaction and willingness to quit smoking, and to test the mediating role of nicotine dependence in this association. METHODS: This study was conducted among students in grades 1 to 5 at 17 pilot elementary schools in Qingdao, China. It is a cross-sectional analysis study that collected data in July 2022. The sample consisted of families in which the father smoked and the mother did not. Researchers underwent standardized training before data collection. Parents were screened, and both spouses completed corresponding questionnaires, ultimately yielding 950 valid matched questionnaires. Structural equation modeling using AMOS was employed to test the mediating effect of nicotine dependence. RESULTS: Path analysis revealed that marital satisfaction was negatively associated with nicotine dependence (β= -0.091; 95% CI: -0.172 - -0.014). Willingness to quit smoking was positively related to marital satisfaction (β=0.063; 95% CI: 0.001-0.129) and negatively associated with nicotine dependence (β= -0.394; 95% CI: -0.469 - -0.314). Moreover, the indirect effect of willingness to quit smoking on marital satisfaction via nicotine dependence was positive and statistically significant (β=0.036; 95% CI: 0.006-0.072). Bootstrap mediation tests revealed statistically significant direct and mediating effects, with the mediating effect accounting for 36.36% of the variance. CONCLUSIONS: The results supported that nicotine dependence had a mediating effect between marital satisfaction and willingness to quit smoking.
Exploring the psychological determinants of smoking behavior among immigrant university students in Italy: A convergent mixed-methods cross-sectional study.
Zarifkar M, Maturo AF, Kochackpour F
Tob Induc Dis · 2026 · PMID 42221056 · Full text
INTRODUCTION: Although smoking is not an effective coping mechanism, it is a common behavior among university students experiencing psychological distress, but limited research has examined its psychological determinants...
INTRODUCTION: Although smoking is not an effective coping mechanism, it is a common behavior among university students experiencing psychological distress, but limited research has examined its psychological determinants in multicultural university settings. This mixed-methods study investigated the relationship between smoking behavior and the mental toughness scale. METHODS: A convergent mixed-methods cross-sectional study design was conducted between March and June 2025 among 280 immigrant students at the University of Bologna. Eligible participants were students aged 18-30 years, currently enrolled in a study program, able to communicate in English or Italian, and without chronic conditions affecting smoking behavior. Quantitative data assessed demographic characteristics, smoking patterns, and mental toughness, assessed using the Mental Toughness Questionnaire (MTQ-18), which evaluates control, commitment, challenge, self-confidence, and underlying psychological and migration-related stressors. Qualitative data were obtained through semi-structured interviews exploring emotional coping, cultural adaptation, and smoking motivations. Data were analyzed separately and integrated during interpretation. RESULTS: Among the 280 participants, 42.86% were smokers and 57.14% were nonsmokers. No statistically significant associations were found between smoking status and demographic variables, including gender (χ=0.66, p=0.417), age (χ=6.70, p=0.152), parental smoking (χ=0.00, p=1.000), and sibling smoking (χ=0.07, p=0.789). Most smokers reported low to moderate cigarette consumption (1-10 cigarettes per day). Across all mental toughness dimensions, smokers demonstrated lower mean scores compared to non-smokers. For instance, overall mental toughness scores were lower among smokers (males: 2.57; females: 2.31) compared to non-smokers (males: 3.84; females: 3.74). Qualitative findings highlighted key psychological stressors, including identity disruption, anxiety, academic pressure, and social isolation, which contributed to smoking behavior as a perceived means of emotional regulation. CONCLUSIONS: Smoking behavior among immigrant students is shaped primarily by psychological vulnerability and migration-related stress rather than demographic characteristics. Integrating mental health support, stress-management resources, and culturally responsive interventions into smoking prevention programs may be essential for reducing smoking in immigrant student populations.
PRKN Ser131 phosphorylation promotes cigarette smoke-induced mitophagy impairment and epithelial cell senescence via MKK3/p38 MAPK activation: An in vitro and in vivo study.
Hu Y, Liu J, Zhang M … +6 more , Qu J, Hao W, Zhu X, Wu D, Jiang S, Qu Y
Tob Induc Dis · 2026 · PMID 42212306 · Full text
INTRODUCTION: Cigarette smoke (CS) exposure impairs mitochondrial function and promotes senescence in airway epithelial cells, contributing to the pathogenesis of chronic obstructive pulmonary disease (COPD). However, th...
INTRODUCTION: Cigarette smoke (CS) exposure impairs mitochondrial function and promotes senescence in airway epithelial cells, contributing to the pathogenesis of chronic obstructive pulmonary disease (COPD). However, the molecular mechanisms linking mitophagy dysfunction to cellular senescence remain poorly understood. Parkin (PRKN) is a key regulator of mitophagy, but whether PRKN Ser131 phosphorylation contributes to CS-induced impairment of mitophagy and senescence remains unclear. Therefore, this study aimed to investigate the role of PRKN Ser131 phosphorylation in CS-induced impairment of mitophagy and epithelial cell senescence, and to explore the underlying mechanism. METHODS: This laboratory-based experimental study utilized human bronchial epithelial BEAS-2B cells exposed to cigarette smoke extract (CSE) and a mouse model of CS-induced emphysema. Molecular interventions included mutation of PRKN at Ser131, and knockdown of mitogen-activated protein kinase kinase 3 (MKK3) to modulate the downstream p38 mitogen-activated protein kinase (p38 MAPK) pathway. Mitophagy activity, mitochondrial reactive oxygen species (ROS), and senescence markers were evaluated. RESULTS: Exposure to cigarette smoke extract (CSE) increased MKK3 expression and activated the p38 MAPK pathway, leading to phosphorylation of PRKN at Ser131. This phosphorylation was accompanied by reduced mitophagy-related readouts and increased mitochondrial ROS. Both MKK3 knockdown and modulation of mitochondrial quality-control pathways were associated with improved mitophagy-related readouts and reduced senescence markers under CSE exposure. Moreover, cells expressing the PRKN S131A mutant exhibited significantly improved mitophagy flux, reduced ROS levels, and attenuated senescence compared to wild-type PRKN. , emphysematous lungs showed increased MKK3 and senescence markers alongside decreased PRKN and PTEN-induced kinase 1 (PINK1) expression. CONCLUSIONS: Our findings suggest that the MKK3/p38 MAPK-PRKN Ser131 axis contributes to CS-induced mitophagy impairment and epithelial senescence. Additional studies are needed to strengthen the evidence and evaluate the translational potential of targeting this pathway in COPD.
Infrastructure of tobacco and nicotine cessation services in Finnish healthcare: A cross-sectional study.
Ylitörmänen T, Strand T, Ollila H
Tob Induc Dis · 2026 · PMID 42205977 · Full text
INTRODUCTION: Many countries have made significant progress in implementing effective tobacco control policies. Despite the availability of clinical treatment guidelines for smoking cessation, their integration into rout...
INTRODUCTION: Many countries have made significant progress in implementing effective tobacco control policies. Despite the availability of clinical treatment guidelines for smoking cessation, their integration into routine healthcare systems is less well-known. In Finland, recommendations addressing the infrastructure of tobacco and nicotine cessation, aimed at healthcare service providers, were published in 2024. This study aims to provide a baseline assessment for their evaluation. METHODS: This cross-sectional study collected data in autumn 2024 from twenty-one wellbeing service counties (88%) using an online survey directed at professionals working in healthcare services involved in tobacco and nicotine-related care, including smoking cessation counseling, early identification, and brief interventions. Data were analyzed using descriptive statistics. HHS Framework to Support and Accelerate Smoking Cessation 2024 was utilized to provide a conceptual framework for interpreting the findings. RESULTS: Established structures for cessation services were limited; only 29% (6/21) of counties had appointed a dedicated entity, and 33% (7/21) provided annual training for healthcare professionals in tobacco cessation. Documentation of tobacco and nicotine use in medical records was the most successfully implemented component, reported by 81% (17/21) of counties, followed by the provision of digital services, 71% (15/21). The system includes features for structural documentation, with 62% (13/21) of counties recording early identification and brief interventions in medical records. Cessation services were communicated through multiple channels, including websites, social media, and healthcare centers. CONCLUSIONS: There is a significant variation in the structure and organization of tobacco and nicotine cessation services across wellbeing service counties, with many still in the early stages of development. While documentation of tobacco and nicotine use among patients has been increasingly adopted, the implementation of key components such as early identification, brief interventions, and cessation support remains underemphasized. Strengthening institutional support, organizational structures, professional training, communication, and information flow are associated with more effective implementation.
Associations of cigarette card games engagement with smoking susceptibility and smoking behaviors among Chinese children and adolescents: Findings from the Zhejiang Childhood Behavior and Health Cohort study.
Yu LH, Lu XQ, Yang XJ … +11 more , Yu Z, Jiang W, Pan YS, Yang LP, Hu J, Guan YQ, Xu CX, Yao WY, Wang LX, Zhong JM, Wang M
Tob Induc Dis · 2026 · PMID 42205976 · Full text
INTRODUCTION: Recently, cigarette card games have gained great popularity among Chinese schoolchildren. This study aimed to examine the associations of cigarette card game engagement with smoking susceptibility and smoki...
INTRODUCTION: Recently, cigarette card games have gained great popularity among Chinese schoolchildren. This study aimed to examine the associations of cigarette card game engagement with smoking susceptibility and smoking-related behaviors in students. METHODS: Using data from the Zhejiang Childhood Behavior and Health Cohort, 21526 children and adolescents aged 6-19 years were included, and relevant information on cigarette card games, smoking susceptibility, and several smoking behaviors was collected via self-reported questionnaires. Logistic regression models were used to explore the influence of cigarette card games on smoking susceptibility, as well as the smoking behaviors. Odds ratios (ORs) and their 95% confidence intervals (CIs) are reported. RESULTS: Among the 21526 participants, 861 (4.00%) reported engaging in the cigarette card games within the past 7 days. Never smoking students who engaged in cigarette card games exhibited greater odds of smoking susceptibility than those who did not engage (adjusted odds ratio, AOR=2.05; 95% CI: 1.70-2.46). Similarly, increased odds of ever cigarette smoking, ever and current e-cigarette use were also observed among those participating in such games, with AORs of 3.73 (95% CI: 2.83-4.90), 3.21 (95% CI: 2.31-4.46), and 6.87 (95% CI: 4.87-9.69), respectively. CONCLUSIONS: Findings of the present study confirmed the popularity of cigarette card games among Chinese students. They indicated that engagement in these games was significantly associated with increased odds of smoking susceptibility and various smoking-related behaviors. However, given the limitations of the study, these conclusions should be interpreted with caution.
Association of MiR-27a-5p with chronic obstructive pulmonary disease and its role in human bronchial epithelial cell injury: A case-control and in vitro experimental study.
Wang J, Zhang P, Qin Y
Tob Induc Dis · 2026 · PMID 42205975 · Full text
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) lacks effective early diagnostic biomarkers, and the role of miR-27a-5p in COPD pathogenesis remains unclear. This study aimed to explore its inflammatory regula...
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) lacks effective early diagnostic biomarkers, and the role of miR-27a-5p in COPD pathogenesis remains unclear. This study aimed to explore its inflammatory regulatory mechanism. METHODS: We enrolled COPD patients and healthy controls, measuring miR-27a-5p and inflammatory cytokines (TNF-α, IL-6, IL-1β) in serum and bronchoalveolar lavage fluid. Multivariate logistic regression and ROC curves were used to analyze disease association and diagnostic efficacy. A cigarette smoke extract-induced bronchial epithelial cell model was used with miRNA transfection and dual-luciferase assays to validate the target gene and mechanism. RESULTS: MiR-27a-5p was significantly upregulated in COPD patients (p<0.001), and its expression was associated with COPD alongside smoking status and pulmonary function (adjusted odds ratio, AOR=22.53; 95% CI: 12.31-41.30, p<0.001). It showed strong diagnostic efficacy (AUC=0.96; 95% CI: 0.92-0.99). In vitro, miR-27a-5p overexpression exacerbated inflammation, while inhibition alleviated it. Mechanistically, miR-27a-5p directly targeted ABL2 to regulate inflammatory cytokine release. CONCLUSIONS: MiR-27a-5p within our study was identified as a promising biomarker for COPD susceptibility and modulated airway inflammation via the miR-27a-5p-ABL2 axis.
Association between the use of e-cigarettes and heated tobacco products and asthma prevalence in adolescents: A secondary dataset analysis of the Korea Youth Risk Behavior Survey 2022-2024.
Lee S, Kim J
Tob Induc Dis · 2026 · PMID 42205974 · Full text
INTRODUCTION: Adolescent tobacco use is a major public health concern due to its adverse effects on respiratory health, including asthma. Novel tobacco products such as e-cigarettes (ECs) and heated tobacco products (HTP...
INTRODUCTION: Adolescent tobacco use is a major public health concern due to its adverse effects on respiratory health, including asthma. Novel tobacco products such as e-cigarettes (ECs) and heated tobacco products (HTPs) are increasingly used by youth, yet their respiratory health impacts remain insufficiently understood. This study examined associations between tobacco use patterns and asthma prevalence among Korean adolescents. METHODS: This secondary analysis used cross-sectional data from the nationally representative Korea Youth Risk Behavior Survey (KYRBS, 2022-2024), including 159383 students in grades 7-12. Current tobacco use (past 30 days) was classified into eight groups: non-users; exclusive users of combustible cigarettes (CCs), ECs, or HTPs; dual users; and triple users. Asthma was defined as a self-reported physician diagnosis within the past 12 months. Multivariable logistic regression adjusted for key covariates with survey weights applied. RESULTS: Asthma prevalence was 1.7%. Compared with non-users, adjusted odds ratios (AORs) were 1.34 (95% CI: 1.28-1.39) for CC-only users, 4.34 (95% CI: 4.17-4.51) for EC-only users, 9.16 (95% CI: 8.63-9.72) for HTP-only users, and 13.72 (95% CI: 13.25-14.22) for EC-HTP dual users. Triple users had an AOR of 5.15 (95% CI: 5.02-5.28). Secondhand smoke exposure, alcohol use, stress, and physical activity were also associated with asthma. CONCLUSIONS: Use of ECs and HTPs among Korean adolescents was associated with a higher prevalence of asthma. Concurrent EC and HTP use showed higher odds than single-product use, indicating a graded association across tobacco use patterns. These cross-sectional findings demonstrate robust associations but do not establish causality.
Trends in e-cigarette use among adolescents in Malaysia, 2016-2022: A secondary dataset analysis of national surveys.
Mohd Yusoff MF, Saminathan TA, Robert Lourdes TG … +2 more , Riyadzi MR, Abd Hamid HA
Tob Induc Dis · 2026 · PMID 42205973 · Full text
INTRODUCTION: E-cigarette use among adolescents has increased in recent years, including in Malaysia. Monitoring changes in use is important to inform the prevention of nicotine addiction. This study examines changes in...
INTRODUCTION: E-cigarette use among adolescents has increased in recent years, including in Malaysia. Monitoring changes in use is important to inform the prevention of nicotine addiction. This study examines changes in adolescent e-cigarette use in Malaysia and associated sociodemographic factors from 2016 to 2022. METHODS: This study was a secondary analysis of data from three national school-based health surveys in Malaysia: Tobacco and E-Cigarette Survey among Malaysian Adolescents (TECMA) 2016, and National Health and Morbidity Survey (NHMS) 2017 and 2022. The analysis included school-going adolescents aged 13-17 years. Complex sample analysis was used to estimate prevalence, and multivariable logistic regression using NHMS 2017 and NHMS 2022 examined associated factors. All surveys used a two-stage stratified cluster sampling design and a questionnaire adapted from the Global Youth Tobacco Survey. RESULTS: A total of 13162, 27497, and 33523 respondents participated in TECMA 2016, NHMS 2017, and NHMS 2022. The prevalence of current e-cigarette use among adolescents aged 13-17 years was 12.0% (95% CI: 10.1-14.3), 9.8% (95% CI: 9.0-10.8), and 14.9% (95% CI: 13.7-16.1) in 2016, 2017, and 2022, respectively. Multivariable logistic regression showed that the adjusted odds ratio (AOR) of e-cigarette use increased from 2017 to 2022 among adolescents who smoke from 15.25 (95% CI: 12.62-18.43) to 56.29 (95% CI: 46.76-67.77), among Malays from 1.78 (95% CI: 1.28-2.48) to 3.71 (95% CI: 3.02-4.57), and among students whose parents smoke from 1.0 (95% CI: 0.85-1.19) to 1.32 (95% CI: 1.16-1.49). The association with parental e-cigarette use decreased from 3.78 (95% CI: 3.00-4.77) to 1.64 (95% CI : 1.42-1.89). CONCLUSIONS: E-cigarette use among adolescents has increased in Malaysia. While associated factors remain generally consistent, their strength has changed across survey waves. These findings highlight the need for continued public health efforts and appropriate regulatory strategies to address e-cigarette use among adolescents in Malaysia.
Acceptance and preferences for different nicotine substitute products to reduce tobacco smoking in people living with HIV: Results from an internal pilot study of a randomized trial.
Schönenberger CM, Ochoa SC, Speich B … +25 more , Haerry DH, Cart-Richter E, Jackson-Perry D, Hutter A, Panettieri L, Aggeler S, Chaudron SE, Calmy A, Cavassini M, Abela IA, Kusejko K, Günthard HF, Nemeth J, Rauch A, Wandeler G, Schmid P, Dörr T, Surial B, Berthet A, Auer R, Stoeckle MP, Labhardt N, Chammartin F, Briel M, Amstutz A
Tob Induc Dis · 2026 · PMID 42205972 · Full text
INTRODUCTION: Tobacco smoking is an insufficiently addressed health burden among people living with HIV. The (RETUNE) trial tests the effectiveness of offering a menu of nicotine substitute products, including e-cigaret...
INTRODUCTION: Tobacco smoking is an insufficiently addressed health burden among people living with HIV. The (RETUNE) trial tests the effectiveness of offering a menu of nicotine substitute products, including e-cigarettes, nicotine pouches, and nicotine patches, on tobacco smoking cessation rates. This a priori planned internal pilot aims to assess the trial processes, in particular the delivery of the intervention, and its acceptance by participants. METHODS: RETUNE is a pragmatic, randomized, multicenter trial using the 'Trials within Cohorts' (TwiCs) design embedded in the Swiss HIV Cohort Study. Participants are people living with HIV who are part of the cohort and smoke. Following the TwiCs design, participants can accept one of the offered intervention products or refuse all of them, after being randomized to the intervention group. This internal pilot study included the first 200 RETUNE participants randomized between February and September 2025. We report the acceptance rate and participants' experiences with the intervention products, based on trial data and additional questionnaires. RESULTS: Of the 98 participants randomized to the intervention group, 53 accepted a nicotine substitute product while 45 declined the intervention. The majority chose e-cigarettes (31/53; 59%), one-third chose nicotine patches (17/53; 32%), and four participants chose nicotine pouches (4/53; 8%). The most common reason for declining all offered products was no interest in quitting tobacco smoking (34/53; 64%). Overall, 37/53 (70%) intervention participants completed the pilot study survey. Most (27/37; 73%) continued the initially chosen product; the remaining changed the product, the nicotine concentration, or the flavor; however, no one stopped the smoking cessation intervention entirely. CONCLUSIONS: The results of this internal pilot support the feasibility of the RETUNE trial. The observed acceptance rate was similar to our estimate. E-cigarettes were the preferred product. We are continuing recruitment for the RETUNE trial. CLINICAL TRIAL REGISTRATION: The study is registered on the official website of ClinicalTrials.gov. IDENTIFIER: NCT06789692.
Global, regional, and national burden of lip and oral cavity cancer attributable to smoking, 1990-2021: A secondary dataset analysis of GBD 2021.
Li C, Tang J, Zhang J … +3 more , Tong T, Yang R, Zeng P
Tob Induc Dis · 2026 · PMID 42199517 · Full text
INTRODUCTION: Lip and oral cavity cancer (LOCC) poses a major public health challenge, primarily driven by smoking. This study evaluates the spatiotemporal trends of smoking-attributable LOCC using Global Burden of Disea...
INTRODUCTION: Lip and oral cavity cancer (LOCC) poses a major public health challenge, primarily driven by smoking. This study evaluates the spatiotemporal trends of smoking-attributable LOCC using Global Burden of Disease (GBD) 2021 data, focusing on regional disparities and age-specific stagnations. METHODS: In this secondary dataset analysis of GBD 2021, incidence, mortality, and disability-adjusted life years of smoking-attributable LOCC across 204 countries and territories (1990-2021) were analyzed. Trends were quantified using estimated and average annual percentage changes (EAPC/AAPC) by region, gender, age, and sociodemographic index. RESULTS: In 2021, smoking accounted for 23.41% (95% UI: 20.1-26.5) of global LOCC deaths. Although the global age-standardized mortality rate (ASMR) decreased from 0.77 in 1990 to 0.56 per 100000 population in 2021 (EAPC= -1.09; 95% CI: -1.13 - -1.05), absolute deaths increased by 59.48% to 48773 (95% UI: 33622-63367). Notably, East Asia (EAPC=0.46; 95% CI: 0.19-0.64) and Central Sub-Saharan Africa (EAPC=0.12; 95% CI: 0.04-0.23) uniquely showed increasing ASMRs. Age-specific analysis revealed a plateaued improvement in the elderly, particularly the 75-79 years group (AAPC= -0.1; 95% CI: -0.5-0.3), contrasting with declines in younger groups. Males bore a higher burden, though female mortality declined faster (EAPC= -1.40 vs -1.10). CONCLUSIONS: While the global smoking-attributable LOCC burden is reducing, there are widening regional disparities and a statistical stagnation, specifically in the age group of 75-79 years. These divergent trends generate important hypotheses regarding the limits of uniform prevention. Persistent burdens imply context-specific factors, such as potential gene-environment interactions in East Asia and poly-tobacco use in South Asia, which warrant further investigation to achieve more equitable reductions in disease burden.
Psychological outcomes of smoking cessation supported by telemedicine in real-world clinical practice: A prospective longitudinal cohort study.
Duru S, Kerem B, Demirkaya A … +1 more , Aydın G
Tob Induc Dis · 2026 · PMID 42199516 · Full text
INTRODUCTION: Concerns about possible adverse psychological consequences of smoking cessation - particularly related to depression and anxiety - may act as barriers to quit attempts, reduce adherence to treatment, and ne...
INTRODUCTION: Concerns about possible adverse psychological consequences of smoking cessation - particularly related to depression and anxiety - may act as barriers to quit attempts, reduce adherence to treatment, and negatively affect long-term abstinence. Our objective is to assess changes in depression and anxiety levels over a six-month follow-up period among adults attending a smoking cessation clinic under routine clinical practice conditions and to describe the role of scheduled telemedicine-based follow-up in supporting cessation outcomes. METHODS: This prospective observational cohort study enrolled 500 adult smokers who presented to a specialized smoking cessation outpatient clinic. Symptoms of depression and anxiety were evaluated using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) at baseline and at six months. In addition to face-to-face clinic visits, patients receiving medical treatment were followed through structured telemedicine contacts conducted at two-week intervals throughout the follow-up period. RESULTS: At six months, 180 participants (36.0%) achieved smoking cessation, while 320 (64.0%) continued smoking. Baseline demographic and clinical characteristics were similar between groups. In the overall cohort, median BDI scores declined from 12 (interquartile range, IQR: 8-17) at baseline to 8 (IQR: 5-12) at follow-up, and median BAI scores decreased from 11 (IQR: 7-16) to 7 (IQR: 4-11). Improvements in both depression and anxiety scores were observed in quitters and non-quitters, with greater reductions among individuals who successfully quit smoking. Cytisine was the most frequently prescribed pharmacological treatment (70.6%), and behavioral counseling was provided to all participants. Treatment-related adverse effects were reported by 21.8% of participants, and no serious adverse events occurred. CONCLUSIONS: Under real-world clinical conditions, smoking cessation was accompanied by meaningful reductions in depression and anxiety over a six-month period. Regular telemedicine-based follow-up conducted at two-week intervals appeared to facilitate treatment continuity and may enhance cessation outcomes.
Sources of electronic cigarette acquisition among school-going adolescents: A cross-sectional analysis of the 2022 National Health and Morbidity Survey - Adolescent Health Survey, Malaysia.
Lim KH, Cheong YL, Lim KK … +8 more , Lim JH, Cheong KC, Ghazali SM, Marine AA, Hashim MHM, Heng PP, Teh CH, Lim HL
Tob Induc Dis · 2026 · PMID 42179943 · Full text
INTRODUCTION: The prevalence of youth e-cigarette use has risen markedly, while traditional cigarette smoking rates have declined in recent years. Restricting access to electronic cigarettes (ECs) is regarded as a potent...
INTRODUCTION: The prevalence of youth e-cigarette use has risen markedly, while traditional cigarette smoking rates have declined in recent years. Restricting access to electronic cigarettes (ECs) is regarded as a potential strategy to reduce their use among adolescents. However, there is a paucity of data on the methods by which Malaysian adolescents acquire e-cigarettes. This study seeks to identify the sources through which secondary school students in Malaysia obtain EC. METHODS: Data from the 2022 National Health and Morbidity Survey - Adolescent Health Survey, Malaysia, were analyzed. The survey employed a cross-sectional design and multi-stage sampling to obtain a representative sample of secondary school-going adolescents in Malaysia. The analysis included 4609 students who reported e-cigarette use in the past 30 days. Factors related to access and acquisition locations were examined using multivariable logistic regression and chi-squared tests. RESULTS: Among electronic cigarette (EC) users, 60.4% obtained ECs from commercial sources. Nearly 40% (39.6%) reported acquiring e-cigarettes from friends, while 36.8% purchased them from vape shops. Older age (16-17 years) (AOR=1.52; 95% CI: 1.08-2.14), male gender (AOR=1.72; 95% CI: 1.19-2.49), frequent smoking behavior (AOR=2.49; 95% CI: 1.76-3.52), and having parents who use e-cigarettes (AOR=1.71; 95% CI: 1.29-2.26) were associated with a higher likelihood of obtaining e-cigarettes from commercial sources. CONCLUSIONS: Peer-to-peer sharing was identified as the most prevalent method of e-cigarette acquisition, although a significant proportion of adolescents also purchased these products from commercial outlets. Continued research is necessary to monitor adolescent access to e-cigarettes. Interventions aimed at reducing adolescent e-cigarette use will be more effective if they address the specific sources from which these products are obtained.
Sociodemographic and behavioral factors associated with time to first cigarette upon waking: Findings from the Malaysian national tobacco survey 2023.
Heng PP, Saminathan TA, Robert Lourdes TG … +2 more , Lim JH, Yusoff MFM
Tob Induc Dis · 2026 · PMID 42179942 · Full text
INTRODUCTION: Time to first cigarette (TTFC) upon waking has been recognized as a robust behavioral marker for assessing the severity of nicotine dependence. Given that dependence is a primary driver of sustained tobacco...
INTRODUCTION: Time to first cigarette (TTFC) upon waking has been recognized as a robust behavioral marker for assessing the severity of nicotine dependence. Given that dependence is a primary driver of sustained tobacco use, which significantly impedes successful cessation efforts, this study aimed to determine the prevalence and associated determinants of TTFC within 30 minutes upon waking, among current smokers in Malaysia. METHODS: Data were derived from the Global Adults Tobacco Survey Malaysia (GATS-M) 2023, a cross-sectional study employing multi-stage proportionate-to-size sampling to recruit 4269 represent sample of non-institutionalized populations in Malaysia aged ≥15 years. The dependent variable was 'Time to first cigarette' (TTFC) upon waking up (within or more than 30 minutes); while independent determinants investigated including sociodemographic variables (gender, ethnicity, education level and marital status), and behavioral clues: age of smoking initiation, previous quit attempt, future quit intention, perceived difficulty in quitting, and apprehension about adverse health outcome. Data were analyzed using SPSS version 25, descriptively and with multivariable logistic regression to determine the associated factors of TTFC within 30 minutes of waking up. RESULTS: Approximately 29.2% among the current smokers reported taking the first puff of smoke within 30 minutes upon waking. Multivariable logistic regression substantiated that smoker who initiated smoking before the age of 18 years (AOR=1.60; 95% CI: 1.09-2.76), those without previous quit attempt (AOR=1.59; 95% CI: 1.39-2.01), smokers perceived difficult to quit (AOR=1.48; 95% CI: 1.08-2.54), and those who were not worried about the adverse health outcome of smoking (AOR=2.04; 95% CI: 1.17-3.54) were significantly more susceptible towards TTFC within 30 minutes of waking up. CONCLUSIONS: This finding suggests that highly dependent smokers exhibiting these behavioral characteristics may benefit from targeted behavior-based interventions to address nicotine dependence.
Tobacco dependence severity, cessation legacy and serial mediation in aging China.
Li W, Liu M, Du W
Tob Induc Dis · 2026 · PMID 42179941 · Full text
INTRODUCTION: Most studies on smoking in China operationalize tobacco use as a binary exposure, obscuring clinically meaningful heterogeneity in dependence intensity. Despite China's status as the world's largest tobacco...
INTRODUCTION: Most studies on smoking in China operationalize tobacco use as a binary exposure, obscuring clinically meaningful heterogeneity in dependence intensity. Despite China's status as the world's largest tobacco consumer, limited research has examined gradients in tobacco dependence severity, post-cessation health legacies, or the behavioral-psychological pathways linking nicotine entrenchment to chronic disease in older adults. METHODS: This secondary analysis drew on data from the 2020 China Health and Retirement Longitudinal Study (CHARLS). Tobacco dependence severity was classified: as mild (<10 cigarettes/day), moderate (10-20), or severe (>20) using a consumption-based proxy aligned with the Fagerström test for nicotine dependence (FTND) consumption subscale. Analytic samples included current smokers for dependence-chronic disease associations and serial mediation (n=3637) and former smokers for pre-cessation dependence analyses (n=1935). Multivariable logistic regression estimated direct associations. Serial mediation through reduced physical activity and elevated depressive symptoms to chronic disease was tested using path analysis with bias-corrected bootstrapping. All models adjusted for gender, age, education level, hukou type (household registration status), income, employment, and marital status. RESULTS: Compared with mild dependence, moderate current dependence was associated with higher odds of any chronic disease (AOR=1.22; 95% CI: 1.04-1.42), while severe dependence showed a positive but marginally significant association (AOR=1.24; 95% CI: 0.99-1.54). Among former smokers, moderate and severe pre-cessation dependence predicted elevated hypertension (AOR=1.56 and 1.81) and dyslipidemia (AOR=1.77 and 1.89). Associations appeared more pronounced among agricultural hukou holders, though formal interaction tests were non-significant. Serial mediation identified a statistically significant but substantively trivial indirect pathway through reduced physical activity and elevated depressive symptoms (β=0.001, p<0.05); single-mediator paths were non-significant. CONCLUSIONS: Tobacco dependence severity, as measured by a cigarette consumption-based proxy, shows an overall positive gradient with chronic disease risk among older Chinese adults. Higher pre-cessation dependence is associated with persistent hypertension and dyslipidemia risk after quitting. Descriptive subgroup variation appeared more pronounced among agricultural hukou holders, although interaction tests did not support statistically significant heterogeneity. The findings suggest the value of moving beyond binary smoking classifications toward dependence-stratified screening and post-cessation surveillance. Such considerations may inform tobacco control efforts under Healthy China 2030 for rural populations.
Delivery of a one-week chewing gum for promoting smoking cessation: A pilot randomized controlled trial.
Li MY, Yiu YT, Zhao SZ … +4 more , Cheung YTD, Deng K, Lam TH, Wang MP
Tob Induc Dis · 2026 · PMID 42145985 · Full text
INTRODUCTION: Chewing gum has been used as a self-help strategy for managing smoking cravings, yet its effectiveness has not been evaluated. This pilot trial assessed the feasibility, acceptability, and preliminary effec...
INTRODUCTION: Chewing gum has been used as a self-help strategy for managing smoking cravings, yet its effectiveness has not been evaluated. This pilot trial assessed the feasibility, acceptability, and preliminary effectiveness of delivering 1-week chewing gum for promoting quitting. METHODS: Adult daily smokers were recruited from smoking hotspots in Hong Kong in February 2025. All participants received very brief advice (VBA) and a selfhelp booklet at baseline. The intervention group additionally received 1 week of chewing gum (2 packs) and 2 weeks of instant messaging reminders to promote gum usage, whereas the control group received no placebo or sham intervention beyond VBA and the booklet. Follow-up was conducted at 2 weeks, 3 months, and 6 months post-enrolment. The primary outcome was biochemically validated tobacco abstinence at 6 months. Risk ratios (RRs) were used to estimate the intervention effect using intention-to-treat analysis in Poisson regression. RESULTS: The recruitment rate was 91%, and the retention rate was 86%, 78%, and 74% at 2 weeks, 3 months, and 6 months, respectively. Eighty participants were randomly assigned to the intervention (n=40) and control (n=40) groups using a 1:1 allocation ratio. The intervention group had a higher validated abstinence (10% vs 0%; risk difference, RD=0.53; 95% CI: 0.41-0.64) at 6 months than the control group. Among intervention group participants, 75% (30/40) used chewing gum, and 57% (17/30) rated it as helpful in relieving cravings. Those who used the chewing gum had higher rates of quit attempts (77% vs 40%, p=0.03) and smoking reduction (73% vs 40%, p=0.06) than those who did not. CONCLUSIONS: Delivering chewing gum was feasible and showed preliminary evidence of effectiveness in cessation outcomes. Full trials with an extended intervention period are warranted. CLINICAL TRIAL REGISTRATION: The study is registered on the official website of ClinicalTrials.gov. IDENTIFIER: CT06801860.
The mediating role of relative harm perception in the association between social media marketing exposure-engagement patterns and e-cigarette use behaviors: A cross-sectional study.
Kang N, Kang H, Cho SI … +1 more , Park S
Tob Induc Dis · 2026 · PMID 42145984 · Full text
INTRODUCTION: Social media marketing is a key driver of e-cigarette use. While active engagement facilitates message internalization, research on how specific engagement types influence behaviors via relative harm percep...
INTRODUCTION: Social media marketing is a key driver of e-cigarette use. While active engagement facilitates message internalization, research on how specific engagement types influence behaviors via relative harm perception remains limited. This study investigates the mediating role of relative harm perception in the relationship between social media marketing engagement and e-cigarette curiosity, current use, and quit attempts. METHODS: Data from a cross-sectional web-based survey of 3400 adults aged 19-69 years in the Republic of Korea were analyzed. Participants were recruited in February 2025 from an opt-in online panel using quota-controlled, non-probability sampling designed to balance sex and tobacco-use strata. Respondents were categorized into five groups based on the combination of marketing exposure frequency (high vs low) and behavioral engagement (active vs passive), including a no-exposure group. Weighted multivariable logistic regression and mediation analyses were conducted using a regression-based approach with the survey package in R. RESULTS: Active engagement was significantly associated with lower relative harm perception and increased e-cigarette use. In the 'Low frequency-active engagement' group, harm perception fully mediated the relationship between engagement and use. Conversely, the 'High frequency-active engagement' group demonstrated strong direct effects on use (adjusted odds ratio, AOR=7.23; 95% CI: 2.99-17.48) and curiosity (AOR=5.07; 95% CI: 1.80-14.27), bypassing mediation. In contrast, the 'High frequency-passive engagement' group exhibited an inverse association, showing lower curiosity and higher harm perception. CONCLUSIONS: Active engagement with e-cigarette-related marketing content on social media was associated with lower perceived relative harm and higher odds of e-cigarette curiosity and current use, whereas frequent passive exposure was associated with higher perceived harm and lower curiosity among non-users. These findings underscore the potential importance of incorporating engagement-based metrics when monitoring digital marketing exposure and when evaluating regulatory approaches.
E-cigarette use among female Chinese Indonesian college students in China: A qualitative interpretive phenomenological analysis from an acculturation perspective.
Chen Y, Wang Y, Li Z … +4 more , Zhao X, Yu X, Yue Y, Chan KS
Tob Induc Dis · 2026 · PMID 42145983 · Full text
INTRODUCTION: International students navigate health behaviors across different cultural and regulatory environments, yet their e-cigarette use remains understudied. This qualitative study explores e-cigarette use among...
INTRODUCTION: International students navigate health behaviors across different cultural and regulatory environments, yet their e-cigarette use remains understudied. This qualitative study explores e-cigarette use among female Chinese Indonesian college students in China, examining how acculturation experiences and gendered social norms shape vaping behaviors. METHODS: This qualitative study was conducted at a university in Fujian Province, China, in October 2024, employing Interpretive Phenomenological Analysis (IPA). Three female Chinese Indonesian college students (aged 18-21 years) were purposively selected from a larger survey (n=45) based on Indonesian nationality with Chinese ancestry, female gender, current e-cigarette use, and willingness to participate. Semi-structured interviews were supplemented by questionnaire data assessing acculturation difficulties, psychological well-being (CES-D-10), and social support. Analysis followed Smith's IPA procedures with Berry's acculturation framework as an interpretive lens. RESULTS: Four main themes emerged: 1) Social initiation and peer-embedded use - initiated through peer influence in Indonesian high schools and maintained within co-national networks in China; 2) Acculturation stressors without stress-coping use - participants described e-cigarette use as unrelated to academic pressure, language barriers, and loneliness; 3) Navigating gendered social norms - China was perceived as more permissive, with use concealed from families; and 4) Habituated practice and flavor preferences - use was framed as habit, with fruit flavor preferences driving cross-border sourcing. CONCLUSIONS: E-cigarette use among these students appears to be shaped by peer socialization and habit formation rather than acculturative stress; future longitudinal, multi-site studies with larger samples are needed to examine these patterns among broader international student populations.
Comparison of nicotine dependence between exclusive, dual, and triple tobacco users among Korean adults: A cross-sectional study.
Lee JA, Min Lee C, Cho HJ
Tob Induc Dis · 2026 · PMID 42145982 · Full text
INTRODUCTION: Since the introduction of electronic cigarettes (e-cigarettes, ECs) and heated-tobacco products (heat-not-burn tobacco products, HTPs), the patterns of tobacco product use have shifted from only combustible...
INTRODUCTION: Since the introduction of electronic cigarettes (e-cigarettes, ECs) and heated-tobacco products (heat-not-burn tobacco products, HTPs), the patterns of tobacco product use have shifted from only combustible cigarette (CC) smoking to various combinations of these three products. This study aimed to compare nicotine dependence according to exclusive, dual, and triple use among Korean adults. METHODS: This cross-sectional study used a self-reported online survey to investigate tobacco product use among Korean adults from 7 to 17 November 2022. Participants were recruited from members of an online panel via email invitations based on the 2022 Korean national population registration. Among 13288 respondents, 8000 participants (4000 men and 4000 women) were included in the final analysis. One time of EC use (approximately 15 puffs, lasting around 10 minutes) or one stick of HTP use is considered equivalent to one CC. Nicotine dependence was assessed by time-to-first tobacco use, total amount of use, and the Heaviness Index (HI). RESULTS: The prevalence of CC only users, EC only users, and HTP only users were 13.4%, 1.6%, and 2.0%, respectively. Dual users of CCs + ECs, CCs + HTPs, and ECs + HTPs were 3.4%, 4.4%, and 0.7%, respectively. Triple users were 3.2%. Compared with CC only users, the adjusted odds ratios (AORs) (95% confidence interval, CI) for high HI were 5.52 (3.18-9.57) for CC+EC users, 5.40 (3.20- 9.11) for CC+HTP users, and 4.98 (1.92-12.87) for EC+HTP users. The AOR (95% CI) for high HI was 10.95 (6.48-18.51) for triple users. CONCLUSIONS: In this study, we found that dual or triple users tended to show higher nicotine dependence than CC only users. Further studies are needed to investigate whether dual or triple use of tobacco products leads to greater nicotine dependence.
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