Tobacco Induced Diseases[JOURNAL]
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200 papers
Burden of dementia attributable to smoking among adults aged ≥40 years: A secondary dataset analysis of Global Burden of Disease 1990-2021 with projections to 2035.
Hu X, Li G, Dai K … +4 more , Tang S, Jin X, Yang W, Lu T
Tob Induc Dis · 2026 · PMID 42145981 · Full text
INTRODUCTION: Dementia persists as a critical global health challenge. Smoking is a modifiable behavioral factor associated with dementia, although improvements in healthcare have reduced dementia prevalence and mortalit...
INTRODUCTION: Dementia persists as a critical global health challenge. Smoking is a modifiable behavioral factor associated with dementia, although improvements in healthcare have reduced dementia prevalence and mortality. Evaluating long-term changes in the smoking-attributable dementia burden provides a useful reference for informing and contextualizing dementia prevention efforts. METHODS: This study is a secondary analysis of Global Burden of Disease (GBD) 2021 estimates. We examined smoking-attributable deaths and disability-adjusted life years (DALYs) for dementia among adults aged ≥40 years, across 204 countries and territories from 1990 to 2021. We assessed temporal trends using age-standardized rates and estimated annual percentage changes (EAPC), evaluated inequality across sociodemographic development levels, and projected the burden to 2035 using a Bayesian age-period-cohort (BAPC) model. RESULTS: In 2021, the global burden of dementia attributable to smoking reached 1533214 DALYs (95% UI: 635494-3540712), representing an approximate twofold increase compared with 1990. However, the age-standardized DALY rate (ASDR) declined significantly over the same period, with an EAPC of -0.88 (95% CI: -0.92 - -0.83). Population growth and population ageing were the dominant contributors to the increase in DALYs, accounting for 112.17% and 26.02%, respectively, whereas epidemiological improvements partially offset the burden (-38.19%). In terms of regional variation, East Asia bore the heaviest absolute burden. BAPC projections indicated that despite continued declines in ASDR, smoking-attributable dementia DALYs are expected to keep increasing through 2035. CONCLUSIONS: Despite declining age-standardized rates, the absolute burden of smoking-attributable dementia continues to rise, partly because reductions in smoking exposure are insufficient to counter demographic pressures from population ageing and growth. Persistent disparities across sociodemographic index groups further indicate that gains in tobacco control do not consistently translate into proportional reductions in dementia burden. Aligning tobacco control with ageing-responsive health system strategies will be essential to moderating future burden growth.
Global burden of lower extremity peripheral arterial disease attributable to smoking from 1990 to 2021: A secondary dataset analysis of the Global Burden of Disease Study 2021.
Chen Z, Yuan K, Wan C
Tob Induc Dis · 2026 · PMID 42111955 · Full text
INTRODUCTION: Smoking is the primary modifiable risk factor for lower extremity peripheral arterial disease (LEPAD). This study aimed to assess the global spatiotemporal trends of LEPAD burden attributable to smoking and...
INTRODUCTION: Smoking is the primary modifiable risk factor for lower extremity peripheral arterial disease (LEPAD). This study aimed to assess the global spatiotemporal trends of LEPAD burden attributable to smoking and disentangle the underlying drivers. METHODS: This study is a secondary analysis of publicly available data from the Global Burden of Disease (GBD) 2021 study. We analyzed mortality and disability-adjusted life years (DALYs) across 204 countries and territories from 1990 to 2021. Trends were evaluated using estimated annual percentage change (EAPC), joinpoint regression, and age-period-cohort (APC) models. RESULTS: In 2021, the global number of deaths and disability-adjusted life years (DALYs) due to LEPAD attributable to smoking reached 14130.84 (95% UI: 10300.51-18587.81) and 439653.32 (95% UI: 306683.31-602207.38), respectively, representing increases of 32.25% and 41.01% since 1990, largely driven by population aging. Conversely, the age-standardized mortality rate (ASMR) decreased by 47.25% to 0.16 per 100000, and the age-standardized DALY rate (ASDR) decreased by 40.94% to 5.01 per 100000. Males bore approximately 3.5 times the mortality burden of females (10986.02 vs 3144.82 deaths), and the highest rates were observed in Eastern Europe and Central Asia. EAPC analysis showed a negative correlation with the sociodemographic index (SDI), indicating rising trends in some low SDI regions. The APC analysis revealed that while risk escalated exponentially with age, favorable period and cohort effects drove the decline in rates. CONCLUSIONS: Although age-standardized rates have declined globally due to tobacco control and medical advancements, the absolute burden of smoking-attributable LEPAD continues to rise. Targeted interventions focusing on high-risk regions and aging populations should be considered to mitigate this growing challenge.
Behavioral and psychosocial predictors of e-cigarette use in rural Thailand: A cross-sectional propensity score-matched study.
Sorasit J, Phakdeekul W, Kedthongma W
Tob Induc Dis · 2026 · PMID 42111954 · Full text
INTRODUCTION: E-cigarette use in rural Thailand persists despite legal prohibition since 2014, with inadequate enforcement and misconceptions about safety driving its widespread adoption. Previous studies have documented...
INTRODUCTION: E-cigarette use in rural Thailand persists despite legal prohibition since 2014, with inadequate enforcement and misconceptions about safety driving its widespread adoption. Previous studies have documented usage patterns but have not examined in sufficient detail how demographic and psychosocial factors influence regulatory non-compliance in rural contexts. The aim of this study was to examine the behavioral and psychosocial determinants of e-cigarette use among rural Thai people. METHODS: This cross-sectional study (August-October 2025) examined e-cigarette use determinants among 1020 rural Thai participants aged ≥16 years recruited through multi-stage cluster sampling from rural northeastern Thailand. Data were collected using validated self-administered questionnaires. Multiple analytical approaches were applied (traditional regression, propensity score matching, inverse probability weighting, stratification, doubly robust estimation) to examine associations between exposures and e-cigarette use. E-value analyses were applied to quantify robustness to unmeasured confounding. Statistical significance was set at p<0.05. RESULTS: Males (adjusted odds ratio, AOR=5.29; 95% CI: 3.56-7.89) and females (AOR=4.59; 95% CI: 3.02-6.96) demonstrated substantially higher e-cigarette use likelihood versus LGBTQA+ individuals. Alcohol consumption showed associations (AOR=2.05; 95% CI: 1.53-2.74), with significant gender interaction (p=0.042). Low family support increased likelihood (AOR=1.98; 95% CI: 1.22-3.22), while high social support also showed increased association (AOR=2.05; 95% CI: 1.99-4.23). Knowledge exhibited U-shaped patterns, while perceived lax enforcement increased use (AOR=1.52; 95% CI: 1.10-2.10). Effect estimates demonstrated consistency across all propensity score methods. CONCLUSIONS: Gender, alcohol consumption, family dynamics, and enforcement perceptions significantly determined e-cigarette use in rural Thailand. These findings suggest the need for further research to establish causal relationships and inform the development of gender-stratified, family-based interventions. Methodological triangulation through propensity score approaches strengthened confidence in the observed associations.
Impact of a provider-level incentive on smoking cessation treatment use: A secondary dataset analysis using administrative claims data and a cross-sectional survey in Japanese health check-up settings (N-EQUITY2203).
Yuwaki K, Odawara M, Saito J … +5 more , Fujimori M, Kuchiba A, Inoue M, Kanaoka K, Shimazu T
Tob Induc Dis · 2026 · PMID 42111953 · Full text
INTRODUCTION: Healthcare professionals are recommended to deliver smoking cessation support (SCS) to smokers. However, the effectiveness of provider-level financial incentives on smoker's behaviors, including the use of...
INTRODUCTION: Healthcare professionals are recommended to deliver smoking cessation support (SCS) to smokers. However, the effectiveness of provider-level financial incentives on smoker's behaviors, including the use of smoking cessation treatment (SCT), has been controversial. The aim of this observational study was to explore the association of a provider-level incentive to deliver a general lifestyle intervention, including SCS, with the smoker's use of SCT, and describe the current state of and barriers to delivering SCS at health check-up settings. METHODS: This observational study in a health check-up setting consisted of: 1) a retrospective, quasi-experimental study through secondary use of an administrative claims database between 2018 and 2020; and 2) a cross-sectional questionnaire survey in 2023. Change in the proportion of SCT users pre- and post-introduction of the incentive was analyzed using a claims database, employing a difference-in-difference (DID) approach using adjusted linear regression. To describe SCS at health check-up settings, a cross-sectional survey was sent to 26 health check-up centers that had received the incentives which requested a response from a healthcare professional at each center. Responses were presented as descriptive statistics. RESULTS: DID analysis using data for 126137 smokers revealed no significant change in the proportion of SCT users following introduction of the provider-level incentive (DID= -0.15; 95% CI: -1.09-0.80 per 1000 smokers, p=0.759). The survey, which received responses from 24 health check-up centers, showed that only 27% of these centers provided smokers with contact information for SCT services. Furthermore, 71% and 67% of centers cited a lack of resources and self-efficacy, respectively, as perceived barriers to the delivery of SCS. CONCLUSIONS: The provider-level incentive to deliver the general lifestyle intervention was not associated with SCT use in health check-up settings. Increasing SCT use may require strategies aimed at overcoming barriers to the delivery of SCS.
Prevalence and factors associated with intention to use e-cigarettes among lower secondary school students in Bangkok: A cross-sectional study.
Nakju S, Tanapek S, Assawamaitree S … +1 more , Nitikorn K
Tob Induc Dis · 2026 · PMID 42099463 · Full text
INTRODUCTION: E- cigarettes among youth represent a global public health challenge. The rising prevalence of e-cigarette use among students is a significant public health issue in Thailand. Therefore, this study aimed to...
INTRODUCTION: E- cigarettes among youth represent a global public health challenge. The rising prevalence of e-cigarette use among students is a significant public health issue in Thailand. Therefore, this study aimed to identify the factors associated with the intention to smoke e-cigarettes among lower secondary school students in the Bangkok metropolitan area, using the Theory of Planned Behavior (TPB). METHODS: A cross-sectional study was conducted among 300 students selected via two-stage cluster random sampling. Data were collected via a questionnaire between May and July 2024. Data analysis included descriptive statistics, chi-squared tests, and independent t-tests for bivariate analysis. Multivariable factors associated with intention were identified using binary logistic regression. RESULTS: In all, 90.7% of students had a low level of intention to use e-cigarettes. In the bivariate analysis, gender was significantly associated with the intention to use e-cigarettes (p=0.026). The binary logistic regression model, which adjusted for gender and all three TPB constructs, revealed that attitude towards e-cigarette prevention was the only significant factor associated with the intention to use e-cigarettes. Students with a positive attitude toward prevention were 3.82 times more likely to report a low intention to use e-cigarettes (AOR=3.82; 95% CI: 1.40-10.39). CONCLUSIONS: Attitude toward e-cigarette prevention is the primary factor associated with the intention to use e-cigarettes among lower secondary students. These findings suggest that focusing on a positive attitude and refusal self-efficacy, through school and community collaboration, may effectively support prevention efforts.
Democracy, gender equality, advanced civil rights, economic welfare, and equitable distribution of wealth are related to the success of tobacco control.
Elbek O, Emecen AN, Çetinkaya PD … +2 more , Deniz PP, Kılınç O
Tob Induc Dis · 2026 · PMID 42078792 · Full text
INTRODUCTION: It is well known that there are many social and economic factors influencing tobacco use. There are very few studies addressing these aspects of the issue. Nevertheless, smoking is closely related to social...
INTRODUCTION: It is well known that there are many social and economic factors influencing tobacco use. There are very few studies addressing these aspects of the issue. Nevertheless, smoking is closely related to social, economic, cultural, and political factors. This study aims to present the aspects of the MPOWER application that should be expanded in order to achieve a more effective tobacco control policy. METHODS: Thirty-one countries were included in this secondary data analysis. The smoking prevalence of the countries in 2020 and the changes in smoking prevalence between 2010 and 2020 were taken as dependent variables. Criteria indicating the level of development, democratic standards, gender equality, civil rights, and basic health level of the countries were considered independent variables. Pearson (r) or Spearman (ρ) correlation analyses were conducted based on normality assumptions. RESULTS: There was a positive linear correlation between smoking prevalence and the total unemployment rate (ρ=0.78), income inequality (ρ=0.72), the Global Rights Index (ρ=0.54), and the Gender Inequality Index (ρ=0.45). In contrast, smoking prevalence was negatively correlated with current health expenditures (ρ= -0.55), the Human Development Index (ρ= -0.55), the Corruption Perceptions Index (r= -0.51), the World Justice Index (ρ= -0.47), the share of seats in parliament (r= -0.43), the Democracy Index (ρ= -0.41), and MPOWER (2008) (ρ= -0.38). There was a strong positive correlation between the percent change in smoking prevalence and income inequality (ρ=0.77), the total unemployment rate (ρ=0.64), the Gender Inequality Index (ρ=0.46), and the Global Rights Index (ρ=0.44). Conversely, the percent change in smoking prevalence was negatively correlated with the Freedom Index (ρ= -0.67), the Democracy Index (ρ= -0.67), the Human Development Index (ρ= -0.59), the Corruption Perceptions Index (r= -0.56), current health expenditure (ρ= -0.55), GDP per capita (ρ= -0.53), and MPOWER (2008) (ρ= -0.47). CONCLUSIONS: Besides the MPOWER application, factors correlated with the success of tobacco control are social determinants of health, gender equality, and advanced democracy.
Associations between maternal smoking around birth and hepatocellular carcinoma: A bidirectional two-sample Mendelian randomization study in East Asian populations.
Liu W, Yu W, Zhang K … +1 more , Wang M
Tob Induc Dis · 2026 · PMID 42058183 · Full text
INTRODUCTION: Maternal smoking around birth is known to cause a range of adverse fetal outcomes. This study aimed to investigate the potential relationship between maternal smoking around birth and the susceptibility of...
INTRODUCTION: Maternal smoking around birth is known to cause a range of adverse fetal outcomes. This study aimed to investigate the potential relationship between maternal smoking around birth and the susceptibility of offspring to hepatocellular carcinoma (HCC) in East Asian populations. METHODS: Genome-wide association study (GWAS) summary statistics for maternal smoking around birth, which were obtained from the UK Biobank (ukb-e-1787_EAS, data from 2020), and hepatocellular carcinoma, which were obtained from Biobank Japan (bbj-a-158, data from 2019) in East Asians, were obtained from the Mendelian randomization (MR) database platform. Single-nucleotide polymorphisms (SNPs) strongly associated with maternal smoking around birth were selected as instrumental variables (IVs) for two-sample MR analyses. Three complementary MR approaches were applied: inverse-variance weighting (IVW), weighted median estimation, and MR-Egger regression. RESULTS: A total of 113 SNPs significantly associated with maternal smoking around birth were identified after rigorous selection. Across all MR methods, consistent evidence supported a positive association between maternal smoking around birth and increased HCC risk in offspring (IVW: OR=1.06; 95% CI: 1.05-1.07; weighted median: OR=1.06; 95% CI: 1.05-1.08; MR-Egger: OR=1.05; 95% CI: 1.02-1.08). Conversely, no evidence supported a potential effect of HCC on maternal smoking around birth in reverse MR, reinforcing the directionality of the observed association. CONCLUSIONS: This study provides genetic evidence supporting a possible link between increased maternal smoking around birth and elevated HCC risk in offspring among East Asians.
Prevalence and associated factors of e-cigarette use tendency among adolescents in a rural community, Thailand: A cross-sectional study.
Yinpraphan N, Hansang N, Sukcharoen N … +5 more , Poommin P, Srinithiwat P, Khunlapate C, Charoenpitakporn P, Narindrarangkura P
Tob Induc Dis · 2026 · PMID 42040818 · Full text
INTRODUCTION: Adolescent electronic cigarette (e-cigarette) use has increased globally despite regulatory bans. In Thailand, e-cigarettes have been prohibited since 2014; however, adolescent tendency toward e-cigarette u...
INTRODUCTION: Adolescent electronic cigarette (e-cigarette) use has increased globally despite regulatory bans. In Thailand, e-cigarettes have been prohibited since 2014; however, adolescent tendency toward e-cigarette use remains a concern. This study aimed to determine the prevalence and associated factors of e-cigarette use tendency among secondary school students in Chachoengsao, Thailand. METHODS: A descriptive cross-sectional study was conducted during 18-22 January 2025, among 1848 students aged 13-18 years from 19 secondary schools in Chachoengsao. Participants completed an online self-administered questionnaire on demographics, behaviors, social influences, and e-cigarette knowledge. Tendency was defined as self-reported thoughts about using e-cigarettes. Data were analyzed using descriptive statistics and univariate and multivariate logistic regression, with adjusted odds ratios (AORs), 95% confidence intervals (CIs), and p<0.05 indicating significance. RESULTS: Among 1848 students, 17.6% (n=326) reported a tendency to use e-cigarettes. Being female (AOR=1.66; 95% CI: 1.20-2.30) and low household monthly income (<5000 compared with 20000-29999 THB; AOR=2.81; 95% CI: 1.26-6.25) were associated with a higher tendency. Cigarette smoking was the strongest predictor (AOR=6.71; 95% CI: 4.59-9.82) and alcohol use was also significant (AOR=1.71; 95% CI: 1.16-2.54). Peer influence, including neutral attitudes (AOR=1.42) and prior encouragement (AOR=1.95), increased the likelihood of tendency. Perceived social acceptance (AOR=1.75) and misconceptions - such as believing secondhand vapor is harmless (AOR=3.68) or that e-cigarettes aid smoking cessation (AOR=1.93) - were independently associated with tendency. CONCLUSIONS: Nearly one in six students tended toward e-cigarette use despite the national ban. Female gender, low household monthly income (<5000 THB), risk behaviors, peer influence, and misconceptions were significantly associated factors. Further longitudinal studies are warranted to clarify causal relationships and provide stronger evidence for targeted interventions.
Correlation between the color stability and contact profilometry results of different CAD/CAM ceramic materials after staining with black shammah and DZRT smokeless tobacco.
AlWadei MH
Tob Induc Dis · 2026 · PMID 41939695 · Full text
INTRODUCTION: This study investigated the effects of two types of smokeless tobacco (ST), black shammah and DZRT snuff, on the mean color stability (ΔE**) and contact profilometry results (surface roughness [R]) of five...
INTRODUCTION: This study investigated the effects of two types of smokeless tobacco (ST), black shammah and DZRT snuff, on the mean color stability (ΔE**) and contact profilometry results (surface roughness [R]) of five Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) ceramic materials: feldspathic ceramics (VITABLOCS TriLuxe Forte and Mark II), multilayer zirconia (Ceramill Zolid PS), zirconia-reinforced lithium silicate (VITA Suprinity), and lithium disilicate glass ceramic (IPS e.max CAD). METHODS: A total of 100 specimens of VITABLOCS Mark II, Ceramill Zolid Multilayer PS, VITA Triluxe Forte, IPS e.max CAD, and VITA Suprinity were divided into two ST exposure subgroups, the black shammah and DZRT snuff groups. Samples underwent daily tobacco staining, thermocycling (5-55°C), and brushing simulation (10000 cycles). Color parameters (L*, a*, and b*) were measured by using a spectrophotometer (VITA Easyshade Compact) at baseline and at one, two, and four weeks. ΔE** was calculated by employing the CIEDE2000 formula. Assessments with the VITA classical shade guide were employed to record shifts in the lightness/darkness of samples. R (μm) was assessed via contact profilometry at the end of the study. Statistical analyses included the Kruskal-Wallis, Mann-Whitney U, and chi-squared tests, with significance set at p<0.05. RESULTS: After four weeks of immersion in DZRT snuff, IPS e.max CAD showed the highest ΔE** (6.718) among the tested materials, whereas Ceramill Zolid PS and VITABLOCS Mark II exhibited the lowest ΔE** values (0.614-1.075) across ST types and durations. Significant ΔE** differences were observed among ceramics (p<0.05), staining solution types (p<0.001 for IPS e.max CAD at four weeks), and immersion times (p<0.001). Assessments with the VITA classical shade guide showed that shades darkened significantly (p<0.05) after 2-4 weeks (p<0.05), with the prevalence of the A2 shade decreasing from 62% to 42% after exposure to black shammah and from 58% to 50% after immersion in DZRT snuff. Among materials, VITABLOCS Mark II had the lowest Ra (1.61-1.65 μm) and IPS e.max CAD had the highest (2.89-2.92 μm). CONCLUSIONS: Prolonged exposure to ST induced clinically significant color changes in IPS e.max CAD. Meanwhile, Ceramill Zolid PS and VITABLOCS Mark II demonstrated superior color stability over other materials. Material selection for ST users should prioritize zirconia or feldspathic ceramics to minimize aesthetic compromise.
Association between tobacco-related social environment and e-cigarette use among young adults in northern Vietnam: A cross-sectional study with latent class analysis.
Vu MC, Isaranuwatchai W, Chotipanvithayakul R … +1 more , Wichaidit W
Tob Induc Dis · 2026 · PMID 41929403 · Full text
INTRODUCTION: Tobacco and e-cigarette use among cohabitants and friends tends to cluster together, but data are scarce regarding the association between the clustering patterns and e-cigarette use. The objectives of this...
INTRODUCTION: Tobacco and e-cigarette use among cohabitants and friends tends to cluster together, but data are scarce regarding the association between the clustering patterns and e-cigarette use. The objectives of this study are to identify clusters of the tobacco-related environment and assess the extent to which these clusters are associated with e-cigarette use among young adults in Vietnam. METHODS: We carried out a cross-sectional study among Vietnamese undergraduate students in the second year of study or higher at two universities in Hanoi between September and December 2024. We used latent class analysis to identify clusters in a tobacco-related social environment. We performed multivariable logistic regression to assess the association between these clusters and ever e-cigarette use. RESULTS: Among our participants (n=1448 students), three distinct clusters/classes emerged: 1) Low exposure - participants with a low level of exposure to tobacco use in the social environment; 2) Parent smokers - participants who had parents who currently smoked; and 3) Peer smokers and/or e-cigarette users - participants with friends who currently smoked cigarettes and/or used e-cigarettes (64.9%, 24.6% and 11.5% of all participants, respectively). Participants from the parent smokers class (adjusted odds ratio, AOR=2.15; 95% CI: 1.06-4.34) and the peer smokers and/or e-cigarette users class (AOR=6.33; 95% CI: 3.10-13.07) were significantly more likely to be e-cigarette ever users than those from the low exposure class. CONCLUSIONS: The most common smokers in the social environment were parents and peers, whilst the most typical e-cigarette users were peers. The influence of having peers who smoked cigarettes and/or used e-cigarettes was stronger than the influence of having parents who smoked. The study findings provide basic information that may be useful to stakeholders in designing tailored anti-e-cigarette use campaigns. Campaigns should consider focusing on norms and spaces where young people often socialize.
Perceived effectiveness of text-based tobacco control messages among Chinese young people: A mixed-methods study.
Chen Y, Liu H, Li Z … +4 more , Liu S, Xu J, Yue Y, Chan KS
Tob Induc Dis · 2026 · PMID 41929402 · Full text
INTRODUCTION: Tobacco use remains a significant public health challenge among young people in China. This study evaluated the perceived effectiveness of 10 text-based tobacco control messages among Chinese young people a...
INTRODUCTION: Tobacco use remains a significant public health challenge among young people in China. This study evaluated the perceived effectiveness of 10 text-based tobacco control messages among Chinese young people and identified key characteristics of effective messages. METHODS: We recruited 147 young people aged 11-23 years from public schools and universities in Beijing and Kunming during March 2021. Participants completed a structured questionnaire evaluating ten tobacco control messages by selecting the single most and least effective message for preventing smoking initiation. An effectiveness index (EI) was calculated as the percentage rating each message is most effective minus the percentage rating it is least effective. Follow-up focus group interviews explored reasons for effectiveness perceptions. Quantitative data were analyzed using chi-squared tests and binary logistic regression, while qualitative data underwent thematic analysis. RESULTS: Participants had a mean age of 14.6 years (SD=2.7), with 49.0% female and 98.6% never smokers. Messages providing specific information about severe health consequences were associated with the highest perceived effectiveness. The top-ranked message detailed multiple cancer types (EI=0.285), followed by severe lung disease and COPD (EI=0.232). Three commonly used messages showed limited effectiveness: 'No smoking, I'm healthy, I'm fashionable' (EI= -0.470), 'Smoking causes periodontitis' (EI= -0.204), and 'Refuse the first cigarette' (EI= -0.008). Binary logistic regression confirmed that gender was significantly associated with the least effective message selection after adjusting for covariates (adjusted odds ratio, AOR=3.85; 95% CI: 1.97-7.52, p<0.001 for females selecting the 'fashionable' message). Qualitative analysis identified that young people valued specificity, severity, and factual information, while vague language, directive tones, and unfamiliar conditions were associated with lower perceived effectiveness. CONCLUSIONS: Tobacco prevention campaigns targeting Chinese young people may benefit from prioritizing messages providing specific, factual information about severe health risks. Messages using abstract or directive language were associated with lower perceived effectiveness, offering preliminary guidance for more effective campaigns in China.
Real-world effectiveness of cytisine, bupropion, and nicotine replacement therapy in a smoking cessation clinic: A single-center retrospective cohort study.
Aksoy HB
Tob Induc Dis · 2026 · PMID 41907511 · Full text
INTRODUCTION: Pharmacological treatments such as cytisine, bupropion, and nicotine replacement therapy (NRT) are widely used to support smoking cessation. However, evidence comparing their effectiveness in real-world cli...
INTRODUCTION: Pharmacological treatments such as cytisine, bupropion, and nicotine replacement therapy (NRT) are widely used to support smoking cessation. However, evidence comparing their effectiveness in real-world clinical settings, particularly within smoking cessation outpatient clinics, remains limited. METHODS: This retrospective cohort study evaluated smoking cessation outcomes among patients attending a tertiary smoking cessation outpatient clinic, with follow-up assessments conducted at approximately the first, third, and sixth months. The study was conducted between 1 January 2024 and 28 March 2025. Participants received cytisine, bupropion, or NRT in combination with standardized behavioral counseling. Demographic variables, smoking-related characteristics, treatment adherence, adverse effects, and cessation outcomes were assessed. Smoking cessation was defined as self-reported abstinence during follow-up. Adult patients aged ≥18 years who received smoking cessation treatment were included in the study. RESULTS: A total of 113 patients were included, of whom 67 (59.3%) successfully quit smoking. Completion of pharmacological treatment was significantly higher among patients who quit smoking compared with those who did not (77.6% vs 30.4%, p<0.001). Cytisine use was more frequent among patients who achieved smoking cessation (58.2% vs 39.1%, p=0.046), whereas bupropion use was higher among those who failed to quit smoking (41.3% vs 20.9%, p=0.019). Nicotine replacement therapy use was not significantly associated with cessation outcomes (p=0.983). Among patients who achieved abstinence, relapse occurred in approximately one-third during follow-up. Improvement in dyspnea was reported more frequently among cytisine users. CONCLUSIONS: In this real-world outpatient setting, cytisine was associated with higher smoking cessation success compared with bupropion and NRT. Treatment adherence emerged as a key determinant of cessation outcomes.
Twenty years on from smoke-free legislation in Scotland: A secondary analysis of the Scottish Health Survey dataset (1998-2024) examining changes in household smoking rules, and salivary cotinine concentrations among non-smokers.
Semple S, Best C, Riches E … +4 more , Morton L, Reid G, Howell R, O'Donnell R
Tob Induc Dis · 2026 · PMID 41891109 · Full text
INTRODUCTION: Scotland introduced comprehensive smoke-free legislation covering most enclosed public spaces in 2006. Twenty years on, this study examines changes in markers of population level exposure to secondhand toba...
INTRODUCTION: Scotland introduced comprehensive smoke-free legislation covering most enclosed public spaces in 2006. Twenty years on, this study examines changes in markers of population level exposure to secondhand tobacco smoke (SHS). METHODS: A secondary analysis of Scottish Health Survey data between 1998 and 2024 to examine trends in population exposure to SHS and household rules about smoking indoors. The proportions of non-smoking adults who had measurable cotinine in their saliva were calculated for the period 1998-2024. The geometric mean (GM) concentrations of cotinine levels were calculated using Tobit regression. Data from 2012-2024 on self-reported smoking rules for the home were analyzed. RESULTS: Salivary cotinine expressed as a GM fell from 0.464 ng/mL (95% CI: 0.444-0.485) in 1998 to 0.020 ng/mL (95% CI: 0.015-0.028) in 2024: a reduction of 95.7%. The percentage of non-smoking adults who had no measurable cotinine in their saliva increased by six-fold between 1998 (12.5%) and 2024 (77.6%). Most of the change occurred in the immediate aftermath of smoke-free legislation, with both metrics of population exposure to SHS demonstrating little evidence of change between 2011 and 2024. The proportion of households that are smoke-free has increased from 75.2% in 2012 to 90.2% in 2024 but is now ten times more common in the most deprived areas compared to the least deprived. CONCLUSIONS: Scotland has sustained large reductions in SHS exposure since smoke-free legislation was introduced twenty years ago in 2006. However, progress evident in the years between 2006 and 2011 has not been maintained: there are still nearly one-quarter of non-smoking adults having measurable exposure to SHS on any given day. Smoking in the home has also reduced, but the level of inequality of this measure has doubled between 2012 and 2024. Public health interventions should consider the remaining workplace and home settings where people experience exposure to SHS.
Multiphase optimization implementation strategy for tobacco cessation interventions in primary care clinics: A cluster-randomized type 3 hybrid effectiveness-implementation trial.
Chen J, Yang J, Liu S … +8 more , He W, Chen X, Cai Y, Tong G, Zhou H, Luo H, Luo L, Xu D
Tob Induc Dis · 2026 · PMID 41884085 · Full text
UNLABELLED: Brief verbal intervention for smoking cessation (BISC) is an evidence-based practice proven to be effective and cost-efficient, yet its implementation in primary healthcare (PHC) clinics in China is currently...
UNLABELLED: Brief verbal intervention for smoking cessation (BISC) is an evidence-based practice proven to be effective and cost-efficient, yet its implementation in primary healthcare (PHC) clinics in China is currently inadequate. Developing and evaluating multifaceted implementation strategies are crucial to translating such evidence-based practices into routine clinical care. This study protocol outlines a rigorous, multi-phase approach to identifying and testing the most effective strategies for BISC implementation. This is a two-phase study utilizing the Multiphase Optimization Strategy (MOST). The first phase, which has been completed, involved using a scoping review, stakeholder consultations, and a Best-Worst Scaling (BWS) online survey to systematically identify and define four key implementation strategies. The second phase is a cluster-randomized 2×2×2 factorial trial conducted in primary healthcare institutions in Guangdong province, China, from January 2026 to December 2026. Eligible participants are clinicians providing primary healthcare services. Clusters will be randomly assigned, and outcome assessors and data analysts will be blinded to allocation. Data collection includes unannounced standardized patient (USP) visits, questionnaires, interviews, and telephone follow-ups, with outcomes assessed six months after the endline. The study's outcomes are categorized into a primary aim (implementation outcomes) and a secondary aim (effectiveness outcomes). This protocol outlines the utilization of the MOST framework to customize the optimized combination of implementation techniques for BISC within the local context. By using a factorial design, the study could unpack the black box of multi-component interventions and identify which specific components are most effective and efficient. This approach is expected to provide a valuable methodological paradigm for advancing implementation science in low- and middle-income countries. CLINICAL TRIAL REGISTRATION: The study is registered on the official website of Chinese Clinical Trials. IDENTIFIER: ChiCTR2600115994. ABBREVIATIONS: BISC: brief verbal intervention for smoking cessation, PHC: primary healthcare, CFIR: Consolidated Framework for Implementation Research, BWS: best-worst scaling, MOST: Multiphase Optimization Strategy, USP: unannounced standardized patient, PSU: primary sampling unit, SSU: secondary sampling unit, PPS: probability proportional to size, DSMB: Data and Safety Monitoring Board, IOF: Implementation Outcomes Framework, PSAT: Program Sustainability Assessment Tool, PRESS: Provider Report of Sustainment Scale, NPT: Normalization Process Theory, EBP: evidence-based practice.
Evaluation of sleep apnea syndrome risk in patients attending a smoking cessation outpatient clinic.
Betos Koçak M, Aydin D
Tob Induc Dis · 2026 · PMID 41884084 · Full text
INTRODUCTION: Smoking is a major public health issue with undeniable adverse effects on human health. It is associated with a wide range of diseases, including cancer, cardiovascular conditions, pulmonary disorders, and...
INTRODUCTION: Smoking is a major public health issue with undeniable adverse effects on human health. It is associated with a wide range of diseases, including cancer, cardiovascular conditions, pulmonary disorders, and neurological diseases. Among these, sleep disturbances and respiratory tract disorders, particularly Obstructive Sleep Apnea Syndrome (OSAS), are of particular concern. This study aims to investigate the relationship between smoking cessation and the OSAS risk scores. METHODS: Our study is a prospective, pre-post, single-arm observational study with repeated measures, conducted on patients who successfully quit smoking (n=117). The Epworth Sleepiness Scale, Berlin Questionnaire, and STOP-BANG Questionnaire were utilized to assess the risk of OSAS. OSAS risk scores were obtained from patients at their initial visit to the smoking cessation clinic and again six months after smoking cessation. RESULTS: Our study was completed with 117 patients. According to the Epworth Sleepiness Scale, high daytime sleepiness was reported in 36 patients, while quitting smoking reduced this number to 30 patients. According to the Berlin Questionnaire, the number of high-risk patients, which was 47, decreased to 28 after smoking cessation. According to the STOP-BANG Questionnaire, the rate of patients considered to be at high risk for OSAS was 45.3%, but it decreased to 35.9% after smoking cessation. CONCLUSIONS: Our study demonstrated that the number of high-risk patients, as determined by OSAS risk scales, decreased after smoking cessation. Our study provides indications that the risk of OSAS may decrease with smoking cessation.
Improving legislation is a necessity: A multi-method quantitative analysis of tobacco sponsorship and publicity in China.
Sun S, Wu Y, Tang Y … +1 more , Wang F
Tob Induc Dis · 2026 · PMID 41884083 · Full text
INTRODUCTION: Although the WHO Framework Convention on Tobacco Control (FCTC) mandates a comprehensive ban, tobacco sponsorship persists as a significant challenge in China. Focusing on this issue, this study aims to des...
INTRODUCTION: Although the WHO Framework Convention on Tobacco Control (FCTC) mandates a comprehensive ban, tobacco sponsorship persists as a significant challenge in China. Focusing on this issue, this study aims to describe, identify, and understand the amounts, publicity, and influencing mechanism of tobacco sponsorship in China. METHODS: This multi-method quantitative study collected data from the China Tobacco Yearbooks for provincial tobacco sponsorship and production data, the Chinalawinfo Open Platform for anti-smoking regulations, and four tobacco industry websites for publicity materials, covering 2015 to 2022. Using ArcMap, STATA, and Python, we integrated spatial autocorrelation analysis, topic modeling, content analysis, and statistical modeling. RESULTS: Tobacco sponsorship amounts nationwide plummeted in 2017, followed by a gradual recovery until another decline in 2021. Spatial analysis revealed significant positive spatial autocorrelation from 2016-2020 and in 2022 (Global Moran's I>0.1, p<0.05). Sponsorship publicity predominantly centered on four topics: natural and health disaster response, tobacco product production and manufacturing, poverty alleviation and policy response, and customer service and brand building. OLS regression indicated that smoke-free law efficacy was negatively associated with sponsorship amounts (β= -0.149; 95% CI: -0.238 - -0.060; p<0.01), while cigarette production showed a positive association (β=0.001; 95% CI: 0.001-0.002; p<0.01). These associations remained robust after controlled for government-industry connection and production chain linkage. Mediation analysis further suggested that 'Mentioning tobacco farmers' served as a significant negative mediator for the impact of SLE (indirect effect= -0.351; 95% CI: -0.603 - -0.099; p<0.01) and a significant positive mediator for cigarette production (indirect effect=0.001; 95% CI: 0.000-0.001; p<0.05), government-industry connection (indirect effect=0.138; 95% CI: 0.084-0.192; p<0.01), and production chain linkage (indirect effect=0.338; 95% CI: 0.255-0.420; p<0.01). Robustness checks using heteroscedasticity-consistent and province-clustered standard errors confirmed the stability of these findings. CONCLUSIONS: Tobacco sponsorship is fundamentally profit-driven because it mainly funds and publicizes components of the production chain, particularly tobacco farmers. As its severity may be constrained by anti-tobacco legislation, future studies are needed to continuously monitor these evolving strategies, thereby accumulating sufficient evidence to support the introduction and implementation of comprehensive, nationwide legislation that clearly defines and penalizes all sponsorship activities in China.
A pilot stratified cluster randomized trial of school-based e-cigarette and other tobacco product use prevention for Pacific Island youths: An evaluation of the Fuetsan Manhoben curriculum.
Dalisay F, Okamoto SK, Kawabata Y … +2 more , Herzog TA, Pokhrel P
Tob Induc Dis · 2026 · PMID 41884082 · Full text
INTRODUCTION: E-cigarette use among young adolescents in Guam, and potentially other regions of the US-Affiliated Pacific Islands (USAPI), is markedly higher than among similarly aged adolescents in the general US popula...
INTRODUCTION: E-cigarette use among young adolescents in Guam, and potentially other regions of the US-Affiliated Pacific Islands (USAPI), is markedly higher than among similarly aged adolescents in the general US population. The objective was to test the pilot version of a school-based e-cigarette and other tobacco product curriculum, named , on outcomes related to e-cigarette use among Guam middle school students. METHODS: The intervention involved 4 video-based, culturally tailored lessons delivered in the classroom by health educators. A stratified cluster-randomized design was used to assign 8 public middle schools to either the intervention or the control condition. Six classrooms in each school participated in the study. Participants (n=269) in the intervention condition received the 4-lesson curriculum, whereas participants (n=269) in the control condition did not receive any intervention. Participants in both conditions provided data at pretest, post-test (4 weeks later), and at follow-up at 3 months. The current analyses pertain only to e-cigarette-related outcomes. Wald tests were utilized to determine the statistical significance of fixed effects within the negative binomial and logistic regression frameworks. RESULTS: At immediate post-test, the intervention did not have statistically significant effects on openness to using e-cigarettes (incidence rate ratio, IRR=0.79; 95% CI: 0.42-1.49, p>0.05), e-cigarette use initiation (OR=O.96; 95% CI: 0.42-2.19, p>0.05), or past-30-day e-cigarette use (IRR=0.90; 95% CI: 0.77-1.06, p>0.05). At follow-up at 3 months, the intervention also did not have statistically significant effects on e-cigarette use initiation (OR=0.70; 95% CI: 0.34-1.45, p>0.05) or past-30-day e-cigarette use (IRR=0.94; 95% CI: 0.82-1.08, p>0.05). However, findings indicated that the intervention reduced openness to using e-cigarettes at follow-up at 3 months (IRR=0.49; 95% CI: 0.28-0.86, p<0.01). That is, being assigned to the intervention condition was associated with 51% decrease in openness to using e-cigarettes at follow-up at 3 months. CONCLUSIONS: Four lessons delivered over 4 weeks may not produce immediate short-term preventive effects, except potentially reducing e-cigarette use susceptibility at follow-up at 3 months. Further research is warranted to examine whether expanding the content and duration of the curriculum may result in stronger, more durable effects. Also, future studies should examine whether increasing the follow-up to 6-12 months might capture delayed preventive effects that were not detectable within the shortened, follow-up at 3 months in the current study. CLINICAL TRIAL REGISTRATION: The study is registered on the official website of ClinicalTrials.gov. IDENTIFIER: ID NCT05037656.
Burden of atrial fibrillation and atrial flutter attributable to smoking in the G20: Trends from 1990 to 2021 and predictions for 2022 to 2050: A secondary dataset analysis of the Global Burden of Disease (GBD) 2021.
Yang W, Ma G, Wang H … +4 more , Zheng W, Cui X, Wang Z, Liang W
Tob Induc Dis · 2026 · PMID 41867632 · Full text
INTRODUCTION: Atrial fibrillation and atrial flutter (AF/AFL) are major contributors to the cardiovascular disease burden in G20 countries. However, comprehensive assessments of smoking-attributable AF/AFL burden across...
INTRODUCTION: Atrial fibrillation and atrial flutter (AF/AFL) are major contributors to the cardiovascular disease burden in G20 countries. However, comprehensive assessments of smoking-attributable AF/AFL burden across the G20 remain limited. The objective of this study was to evaluate temporal trends in the AF/AFL burden attributable to smoking in G20 countries from 1990 to 2021 and to project future trends through 2050. METHODS: This secondary analysis used data from the Global Burden of Disease (GBD) 2021 study. Smoking-attributable disability-adjusted life years (DALYs), deaths, years lived with disability (YLDs), and years of life lost (YLLs) for AF/AFL were extracted for G20 countries between 1990 and 2021. Trends were analyzed by age, sex, and country, and estimated annual percentage changes (EAPCs) were calculated. Autoregressive integrated moving average (ARIMA) and exponential smoothing (ES) models were applied to project the disease burden from 2022 to 2050. RESULTS: In 2021, smoking-attributable AF/AFL accounted for 321761.89 DALYs (95% UI: 187788.89-476327.05) in the G20. Overall age-standardized rates remained relatively stable from 1990 to 2021. Japan showed a declining trend, whereas Saudi Arabia and Indonesia exhibited increasing burdens. Males consistently experienced higher burdens than females, and the highest absolute burden occurred in individuals aged 65-89 years. Projections indicate that from 2022 to 2050, absolute numbers of deaths, YLDs, YLLs, and DALYs attributable to smoking-related AF/AFL will continue to rise, particularly among males, despite stable or slightly declining age-standardized rates. CONCLUSIONS: Although age-standardized smoking-attributable AF/AFL rates in G20 countries have remained largely stable, absolute burdens are expected to increase substantially due to population growth and ageing. Pronounced sex- and country-level heterogeneity highlights the need for sustained and targeted tobacco control and cardiovascular prevention strategies.
Dual use of novel tobacco products and socioeconomic paradox in smoking cessation: An age-period-cohort analysis of KNHANES data 2007-2022.
Le Tu H, Mai XD, Oh JK
Tob Induc Dis · 2026 · PMID 41867631 · Full text
INTRODUCTION: Despite significant declines in smoking prevalence, South Korea faces stagnation linked to new tobacco product (NTP) adoption. This study examines sociodemographic and temporal drivers of smoking cessation...
INTRODUCTION: Despite significant declines in smoking prevalence, South Korea faces stagnation linked to new tobacco product (NTP) adoption. This study examines sociodemographic and temporal drivers of smoking cessation intentions, with an emphasis on dual use of conventional cigarettes and NTPs. METHODS: We analyzed pooled secondary and nationally representative data from the Korea National Health and Nutrition Examination Survey 2007-2022 (n=37142) using an age period-cohort model via the Intrinsic Estimator. The analytic sample included adults aged ≥20 years who reported current smoking of conventional cigarettes or dual use with NTPs. Outcomes were intentions to quit within 1 and 6 months, adjusting for dual use status, sociodemographics, household factors, and applying survey weights. RESULTS: Dual users accounted for 6.4% of smokers, were more often college graduates (51.5% vs 37.0%, p<0.001) yet less likely to plan quitting. After adjusting for other covariates, cessation intentions peaked at the age of 35 years (adjusted prevalence odds ratio POR=1.111; 95% CI: 1.105-1.116) then declined by 23.1% by the age of 70 years. Following 2016 policy changes, intentions decreased overall (POR decreased from 1.012 to 0.994), while dual users showed an opposite period trend (POR increased from 0.966 to 1.022). Birth cohorts from 1947-1950 had higher intentions (POR=1.058; 95% CI: 1.051-1.064), contrasting with decreases in post-1955 cohorts (POR=0.969; 95% CI: 0.943-0.994). CONCLUSIONS: These findings demonstrate that socioeconomic and temporal factors are associated with quit intentions among Korean smokers. Future longitudinal and cross-country studies are needed to confirm these associations and to examine product-specific patterns and contextual influences, providing a broader understanding of how cessation intentions evolve in changing tobacco markets.
Estimated pulse wave velocity, waist-to-height ratio, and risk of cardiometabolic multimorbidity: A secondary dataset analysis of the China Health and Retirement Longitudinal Study (CHARLS).
Fei Z, Bian L, Lu S … +1 more , Wu C
Tob Induc Dis · 2026 · PMID 41867630 · Full text
INTRODUCTION: Obesity, smoking, and atherosclerosis increase the risk of developing various cardiometabolic diseases. The estimated pulse wave velocity (ePWV) is a new indicator of arterial stiffness. However, the relati...
INTRODUCTION: Obesity, smoking, and atherosclerosis increase the risk of developing various cardiometabolic diseases. The estimated pulse wave velocity (ePWV) is a new indicator of arterial stiffness. However, the relationship between ePWV, waist-to-height ratio (WHtR), smoking, and cardiometabolic multimorbidity (CMM) remains unclear. METHODS: The study is a secondary dataset analysis of CHARLS, which included 8414 participants from the China Health and Retirement Longitudinal Study conducted between 2011 and 2018. The ePWV was calculated using the mean blood pressure and age. Cox proportional hazards models were used to explore the relationship between ePWV, WHtR, and CMM in both smoking and non-smoking populations. Additionally, we also employed restricted cubic spline (RCS) analysis and mediation analysis to investigate the relationship between ePWV, WHtR, and CMM. A p<0.05 was considered statistically significant. RESULTS: During the 7-year follow-up period, 1545 participants (18.36%) developed new-onset CMM. The RCS model exhibited a U-shaped relationship between WHtR and CMM incidence, with a positive correlation when WHtR exceeded 0.5. Cox regression analysis revealed that ePWV and WHtR were independent predictors of CMM in both smoking and non-smoking populations. Additionally, ePWV significantly mediated the association between WHtR and CMM risk. CONCLUSIONS: Our findings indicate that ePWV and WHtR are associated with increased CMM risk. Early detection of ePWV and WHtR, combined with smoking cessation, may help identify high-risk individuals and provide a basis for future preventive research.
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