Tobacco Induced Diseases[JOURNAL]
Sun
200 papers
Smoking-attributable ischemic heart disease burden in China from 1990 to 2021 and projections to 2036: A retrospective analysis and forecasting study.
Xu D, Yang Z, Yao W … +1 more , Wang X
Tob Induc Dis · 2026 · PMID 41867629 · Full text
INTRODUCTION: Ischemic heart disease (IHD) remains a leading global health challenge, with smoking identified as a key modifiable risk factor. China, with its high smoking prevalence and aging population, faces a growing...
INTRODUCTION: Ischemic heart disease (IHD) remains a leading global health challenge, with smoking identified as a key modifiable risk factor. China, with its high smoking prevalence and aging population, faces a growing burden of smoking-related IHD. This study evaluates the disease burden of smoking-related IHD in China from 1990 to 2021 and projects future trends to inform targeted interventions. METHODS: Using data from the Global Burden of Disease (GBD) 2021 (1990-2021) and the cross-sectional baseline survey of the China Health and Retirement Longitudinal Study (CHARLS, Wave 1, 2011-2012), we analyzed trends in mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Joinpoint regression identified temporal trends, and an autoregressive integrated moving average (ARIMA) model forecast disease burden up to 2036. The CHARLS analysis included participants aged ≥45 years with complete smoking and health records. Multivariable logistic regression assessed the association between smoking status and heart disease likelihood in CHARLS participants. RESULTS: CHARLS data revealed that former smokers had an 84% higher likelihood of heart disease than never smokers (adjusted odds ratio, AOR=1.84; 95% CI: 1.50-2.25). GBD analysis showed that China's age-standardized mortality rate (ASMR) for smoking-related IHD surpassed global and US levels after 2005, with males bearing a significantly higher burden than females. Joinpoint regression identified key turning points, with male ASMR rising until 2010 before declining slightly, while female indicators consistently improved. ARIMA projections suggest male ASMR will remain high (39.01; 95% UI: 22.69-55.33) by 2036, indicating persistent challenges. CONCLUSIONS: The burden of smoking-related IHD in China exceeds the global average and reveals significant gender disparities, with a worsening burden for males and improvement for females. There is a critical need for more effective smoking control measures aimed at the male population to tackle this major public health issue.
Exercise-induced abnormal recovery of heart rate and ventricular repolarization parameters among smokers without known cardiovascular disease: A cross-sectional study.
Cosgun A, Oren H
Tob Induc Dis · 2026 · PMID 41867628 · Full text
INTRODUCTION: Smoking is a major preventable risk factor for cardiovascular disease and is strongly associated with sudden cardiac death (SCD). This study investigated the relationship between the heart rate recovery ind...
INTRODUCTION: Smoking is a major preventable risk factor for cardiovascular disease and is strongly associated with sudden cardiac death (SCD). This study investigated the relationship between the heart rate recovery index (HRR-I), T peak-end recovery index (Tp-eR-I), and QT interval recovery index (QTR-I) in smokers compared with non-smokers. METHODS: This cross-sectional study, conducted in Bilkent City Hospital, Ankara, Turkey, between May 2017 and June 2025, included 150 healthy smokers (120 males, 30 females) and 123 healthy non-smokers (97 males, 26 females). Smoking data are self-reported. All participants underwent symptom-limited treadmill exercise testing using the Bruce protocol. Heart rate (HR), QT, and Tp-e intervals were measured at baseline, peak exercise, and during recovery periods. HRR-I was calculated as the difference between peak HR and HR at the 1st, 2nd, and 3rd minutes of recovery. Tp-eR-I and QTR-I were calculated as the differences between baseline values and those obtained during peak, 1st, 2nd and 3rd minutes recovery times. RESULTS: Smokers exhibited significantly lower HRR-I values at the 1st [18.6 ± 7.1 vs 24.2 ± 6.9, p<0.001; 17.9 (95% CI: 12.9-22.9)], 2nd [27.4 ± 7.3 vs 33.1 ± 7.1, p<0.001; 10.7 (95% CI 7.3-14.1)], and 3rd minutes [33.8 ± 7.9 vs 39.5 ± 8.3, p<0.001; 13.4 (95% CI: 9.6-17.2)] of recovery compared with non-smokers. Tp-eR-I and QTR-I values were significantly higher in smokers [Tp-eR-I: 7.8 ± 2.6 vs 5.2 ± 2.1, p<0.001; 18 (95% CI: 12-24)] [QTR-I: 24.5 ± 6.3 vs 18.9 ± 5.8, p<0.001; 12 (95% CI: 6-18)]. Smoking intensity was positively associated with Tp-eR-I (r=0.41, p<0.001) and QTR-I (r=0.36, p<0.001), and negatively associated with HRR-I (r= -0.39, p<0.001). CONCLUSIONS: Cigarette smoking impairs autonomic regulation as reflected by reduced HRR-I and abnormal ventricular repolarization recovery, shown by increased Tp-eR-I and QTR-I. These findings suggest that smoking disrupts sympathetic-parasympathetic balance and myocardial repolarization, potentially explaining the higher incidence of arrhythmias and sudden cardiac death among smokers.
Association of smoking with serum uric acid levels, hyperuricemia, and gout based on the 7th to 9th Korea National Health and Nutrition Examination Survey: A secondary dataset analysis based on a cross-sectional study.
Kim S
Tob Induc Dis · 2026 · PMID 41867627 · Full text
INTRODUCTION: Previous studies have reported conflicting results on the relationship of smoking with gout and hyperuricemia. This study aimed to investigate the associations of smoking with serum uric acid levels, hyperu...
INTRODUCTION: Previous studies have reported conflicting results on the relationship of smoking with gout and hyperuricemia. This study aimed to investigate the associations of smoking with serum uric acid levels, hyperuricemia, and gout. METHODS: This study was a pooled analysis of secondary data from the 7th to 9th Korea National Health and Nutrition Examination Survey (2016-2022). We analyzed 29516 participants (12626 for gout analysis) aged ≥19 years. Smoking status (exposure) and doctor-diagnosed gout (primary outcome) were assessed through self-reported questionnaires, while serum uric acid levels (secondary outcome) were measured from blood samples. Multiple linear and logistic regression analyses were performed to assess the associations, adjusting for potential confounders. RESULTS: In females, current smokers had significantly higher serum uric acid levels than never smokers (adjusted mean difference=0.16 mg/dL; 95% CI: 0.08-0.24; p<0.001). Current smoking in females was also significantly associated with increased odds of both hyperuricemia (adjusted odds ratio, AOR=1.49; 95% CI: 1.11-2.00; p=0.008) and self-reported doctor-diagnosed gout (AOR=22.07; 95% CI: 6.66-73.09; p<0.001) compared with never smoking. In contrast, no significant associations were observed in males; the adjusted mean difference in serum uric acid levels between current and never smokers was -0.01 mg/dL (95% CI: -0.08-0.05; p=0.668), and the AOR for gout was 1.00 (95% CI: 0.62-1.59; p=0.984). CONCLUSIONS: The results suggest that smoking is associated with elevated serum uric acid levels and an increased prevalence of hyperuricemia and gout in women but not in men.
A cross-sectional study on the associations of overweight and smoking with current asthma symptoms in US adults, NHANES 2015-2018.
Zhou W, Qiao J, Zhu H
Tob Induc Dis · 2026 · PMID 41836218 · Full text
INTRODUCTION: Asthma drives significant healthcare use, including frequent emergency department (ED) visits in the US. Modifiable factors like overweight/obesity and smoking exacerbate the disease through inflammation an...
INTRODUCTION: Asthma drives significant healthcare use, including frequent emergency department (ED) visits in the US. Modifiable factors like overweight/obesity and smoking exacerbate the disease through inflammation and reduced treatment efficacy. Their combined link to the burden of current symptoms in adults requires further study. This study used nationally representative data to investigate the independent and synergistic associations of overweight and smoking history with current asthma symptoms among United States adults, specifically examining potential gender differences. METHODS: This cross-sectional study conducted a pooled analysis of secondary data from 1655 participants in the 2015-2016 and 2017-2018 cycles of the National Health and Nutrition Examination Survey (NHANES). The outcome was current asthma symptoms, defined by a positive response to the question 'Do you still have asthma?', among those ever diagnosed. Exposures were overweight (body mass index, BMI ≥25 kg/m) and ever smoking (≥100 cigarettes in lifetime). Multivariable logistic regression models adjusted for age and gender were used to assess associations. RESULTS: Among 1655 participants (mean age 46.5 years), 999 (60.4%) reported current asthma symptoms. In the fully adjusted model, both overweight (adjusted odds ratio, AOR=1.42; 95% CI: 1.12-1.79) and smoking history (AOR=1.27; 95% CI: 1.03-1.57) were independently associated with higher odds of current asthma symptoms. Notable gender differences were observed: these associations were significant and strong in women (overweight, AOR=1.89; smoking, AOR=1.41) but absent in men. No significant interaction between overweight and smoking was detected (interaction p=0.580). CONCLUSIONS: Overweight and smoking are independent, modifiable predictors associated with current asthma symptoms in US adults, with a disproportionately strong effect observed in women. These findings identify a symptomatic profile that is associated with the likelihood of exacerbations. This profile may help inform clinical attention and future research aimed at reducing asthma morbidity and potential ED visits.
Tobacco control policies that influence Filipino adults who smoke: Results from a discrete choice experiment.
Czaplicki L, Crespi E, Zaman R … +5 more , Islam F, Cohen JE, Mayor AMFG, Dayagbil FT, Welding K
Tob Induc Dis · 2026 · PMID 41822391 · Full text
INTRODUCTION: In the Philippines, approximately 13 million adults smoke. Policies to raise cigarette taxes, increase health warning label (HWL) size, and restrict menthol could reduce smoking. METHODS: We conducted an on...
INTRODUCTION: In the Philippines, approximately 13 million adults smoke. Policies to raise cigarette taxes, increase health warning label (HWL) size, and restrict menthol could reduce smoking. METHODS: We conducted an online discrete choice experiment (DCE) in November 2023 to assess hypothetical policy responses among 886 Filipino adults who smoke across three regions of the Philippines (Luzon, Visayas, Mindanao). The DCE included ten choice sets of three cigarette packs. Packs varied on excise tax [60 (ref.), 70, 80, 90 pesos (PHP)], packaging [domestic packs: 50% HWL branded (ref.), 50% HWL plain, 85% HWL branded, 85% HWL plain; foreign pack, no HWL], and flavor [tobacco (ref.), menthol]. Participants were randomly assigned to see one choice set using a programmed 1:1 randomization ratio and asked to select which pack: 1) they would choose, 2) would make them most consider quitting, and 3) would be less harmful. RESULTS: Participants had lower odds of choosing packs with a 70 (adjusted odds ratio, AOR=0.58; 95% CI: 0.45-0.74), 80 (AOR=0.33; 95% CI: 0.25-0.43), or 90 (AOR=0.24; 95% CI: 0.18-0.33) PHP excise tax, and higher odds (AOR=4.02; 95% CI: 2.86-5.66) of choosing the foreign branded pack with no HWL. For quitting, participants had higher odds of selecting packs with an 80 (AOR=1.53; 95% CI: 1.18-1.99) or 90 (AOR=1.94; 95% CI: 1.50-2.51) PHP tax and 3.40 (95% CI: 2.58-4.46) and 3.30 (95% CI: 2.42-4.49) higher odds of selecting a branded or plain pack with 85% HWL coverage, respectively. Participants had lower odds of thinking packs with a 70 (AOR=0.69; 95% CI: 0.52-0.92), 80 (AOR=0.73; 95% CI: 0.56-0.96), or 90 (AOR=0.67; 95% CI: 0.50-0.89) PHP excise tax were less harmful and higher odds (AOR=5.21; 95% CI: 3.70-7.32) of thinking the foreign pack was less harmful. CONCLUSIONS: Results suggest raising the excise tax to at least 80 PHP and implementing 85% HWLs may encourage smoking cessation in the Philippines. Our findings can be used by policymakers and advocates in the Philippines to implement strong tobacco control policies to protect public health.
Global, regional and national burden of neurodegenerative diseases attributable to smoking: A descriptive study based on the Global Burden of Disease Study 2021.
Yang Z, Jing Z, Song Q … +2 more , Ding X, Lu X
Tob Induc Dis · 2026 · PMID 41816118 · Full text
INTRODUCTION: Neurodegenerative diseases impose a significant healthcare burden worldwide. Within the context of smoking, the risk of dementia and multiple sclerosis significantly increases. However, the global epidemiol...
INTRODUCTION: Neurodegenerative diseases impose a significant healthcare burden worldwide. Within the context of smoking, the risk of dementia and multiple sclerosis significantly increases. However, the global epidemiological characteristics of smoking-induced neurodegenerative diseases remain unclear. METHODS: This study, based on data from the GBD 2021 database, quantified the burden of smoking-attributable neurodegenerative diseases globally, across 5 SDI regions, 21 regions, and 204 countries and territories. The analysis was stratified by age and sex and covered the period from 1990 to 2021, utilizing a descriptive study design. The analysis incorporates transnational inequality assessment, decomposition techniques, and frontier analysis. Projections of the neurodegenerative diseases attributable to smoking burden for 2035 are also presented. RESULTS: From a global perspective, smoking-attributable deaths and disability-adjusted life years from both dementia and multiple sclerosis have risen. Males consistently outnumber females across all age groups. Significant health inequalities persist, with Lebanon and Denmark exhibiting the highest disease burden for dementia and multiple sclerosis, respectively. Demographic factors emerge as key drivers of this burden. CONCLUSIONS: This study underscores the persistent global health challenges posed by smoking-attributable dementia and multiple sclerosis. These findings underscore the compelling need for targeted health policies and interventions. Furthermore, future epidemiological investigations focused on high-burden regions are warranted.
Propensity score modeling of adolescent e-cigarette use and cognitive performance: One-year follow-up study.
Dai HD, Puga TB, Zhang J … +1 more , Benowitz NL
Tob Induc Dis · 2026 · PMID 41799272 · Full text
INTRODUCTION: Adolescent e-cigarette use remains an important public health challenge, and evidence on its neurocognitive effects at an early age is limited. This study examined associations between exclusive e-cigarette...
INTRODUCTION: Adolescent e-cigarette use remains an important public health challenge, and evidence on its neurocognitive effects at an early age is limited. This study examined associations between exclusive e-cigarette use and cognitive performance in adolescents. METHODS: This study is a propensity score modeling cohort study. This study performed a secondary data analysis on data collected from 21 US sites in the Adolescent Brain Cognitive Development (ABCD) Study between 1 October 2016 and 31 October 2018, with one year of follow-up data. Adolescents reported substance use at ages 12-13 years and completed National Institute of Health (NIH) Toolbox Cognition Batteries one year later, which consists of the following scores: Picture Vocabulary, Flanker Inhibitory Control and Attention, List Sorting Working Memory, Dimensional Change Card Sort, Pattern Comparison Processing Speed, Picture Sequence Memory, and Oral Reading Recognition. Propensity score models incorporating 12 confounders assessed associations between baseline exclusive e-cigarette use (vs no tobacco use) and follow-up cognitive performance at one year. RESULTS: The cohort included 4574 participants (55.7% White, 25.3% Hispanic, 8.9% Black). Propensity score matching substantially improved covariate balance between e-cigarette users and non-users. Adolescents who exclusively used e-cigarettes in the past six months at baseline (n=35) had lower scores in Oral Reading Recognition (b[Standard Error (SE)]= -4.5 [1.3]; 95% CI: -7.3 - -1.7; p=0.003) and similar associations were observed in multivariable regression models adjusting for demographic, socioeconomic, and behavioral covariates. CONCLUSIONS: Exclusive e-cigarette use among early adolescents was associated with poorer performance in specific cognitive domains. These preliminary findings raise concerns about potential neurocognitive implications of e-cigarette use and warrant confirmation in larger, longitudinal studies with longer follow-up.
Prevalence and associated factors for COPD and pre-COPD in Guizhou Province, China: A cross-sectional study.
Shao S, Hu S, Zhang C … +4 more , Rao SS, Yuan G, Tang X, Ye X
Tob Induc Dis · 2026 · PMID 41799271 · Full text
INTRODUCTION: In China, the incidence of chronic obstructive pulmonary disease (COPD) is escalating swiftly, encompassing almost 100 million patients documented in 2018. Nevertheless, a considerable proportion of individ...
INTRODUCTION: In China, the incidence of chronic obstructive pulmonary disease (COPD) is escalating swiftly, encompassing almost 100 million patients documented in 2018. Nevertheless, a considerable proportion of individuals persist in a Pre-COPD condition and have not been given a COPD diagnosis. Currently, the prevalence of COPD and Pre-COPD, linked to various associated factors in Guizhou Province, China, is still uncertain. METHODS: Adults aged ≥20 years were enrolled in a 2012 cross-sectional survey of Guizhou Province via multistage random sampling. All participants underwent post-bronchodilator pulmonary function tests (PFTs). The 2012 Global Initiative for COPD was used for diagnosis. RESULTS: The participants were 6400, recruited in Guizhou Province, of whom 5395 provided reliable post-bronchodilator results and were included in the final analysis. Among individuals aged ≥20 years, the overall prevalence of COPD was 9.60%, and of Pre-COPD was 8.92%. The important factors associated with COPD and Pre-COPD included smoking, household smoke pollution, and low level of education. This survey revealed that 31.96% of participants had a history of smoking, and 3.30% had successfully quit smoking. Indoor smoke exposure from biomass burning contributed to 3.24% of the total biomass. Additionally, a lower level of education was identified as a significant associated factor for COPD and Pre-COPD. CONCLUSIONS: In Guizhou, COPD and Pre-COPD prevalence are greater than those in the general Chinese population. The primary associated factors for COPD and Pre-COPD include smoking (especially mother smoking during pregnancy), exposure to kitchen cooking fumes, and low level education.
Value of blended teaching in graduate tobacco medicine training: A prospective intervention study.
Wang H, Zhang J, Xu X … +1 more , Zhou J
Tob Induc Dis · 2026 · PMID 41799270 · Full text
INTRODUCTION: Tobacco use remains a critical global public health challenge, particularly in developing countries. As future healthcare providers, medical students and physicians play important roles in smoking cessation...
INTRODUCTION: Tobacco use remains a critical global public health challenge, particularly in developing countries. As future healthcare providers, medical students and physicians play important roles in smoking cessation interventions. This study evaluates how systematic tobacco medicine training impacts medical graduate students' smoking cessation knowledge and attitudes. METHODS: This prospective intervention study was conducted at Chongqing Medical University, China, from 2022 to 2024. A total of 540 graduate students were enrolled and randomly assigned (1:1) to an untrained group (n=270) or a trained group (n=270). The untrained group received no training, while the trained group underwent a 6-week blended tobacco medicine training, comprising 12 online and six offline courses. Post-intervention, an online questionnaire and test were used to assess attitudes and knowledge. Data were analyzed using independent t-tests, Mann-Whitney U tests, chi-squared tests, or Fisher's exact tests for group comparisons; multivariable linear regression models were employed to adjust for baseline characteristics and evaluate the intervention's impact. RESULTS: The trained group achieved significantly higher cognitive scores regarding smoking cessation compared to the untrained group (mean difference=1.03; 95% CI: 0.73-1.33, p<0.001). Multivariable regression analysis indicated that training was positively associated with cognitive scores (B=0.92; 95% CI: 0.64-1.20, p<0.001), whereas current smoking status, longer smoking duration, and male gender were negatively associated. Regarding knowledge, the trained group demonstrated higher accuracy rates in most items (p<0.001). CONCLUSIONS: Systematic blended tobacco medicine training effectively improves medical graduate students' knowledge and attitudes toward smoking cessation. Integrating such training into medical education is essential for preparing future professionals to support tobacco control.
Evaluation of the relationship between insulin resistance and nicotine dependence: A cross-sectional study.
Saruhan S, Kocabaş M, Tekbil GT … +1 more , Sezgin Y
Tob Induc Dis · 2026 · PMID 41767115 · Full text
INTRODUCTION: The mechanisms underlying the association between insulin resistance and nicotine dependence remain incompletely understood. This study aimed to examine the association between insulin resistance, assessed...
INTRODUCTION: The mechanisms underlying the association between insulin resistance and nicotine dependence remain incompletely understood. This study aimed to examine the association between insulin resistance, assessed by the triglyceride-glucose (TyG) index, and nicotine dependence, measured by the Fagerström test for nicotine dependence (FTND), among adult exclusive combustible cigarette smokers. METHODS: This cross-sectional study was conducted between February and June 2025 in a tertiary care setting and included 169 adult exclusive combustible cigarette smokers aged 18-80 years. Individuals with diabetes mellitus or those receiving lipid-lowering therapy were excluded. Nicotine dependence was assessed using the Fagerström test for nicotine dependence (FTND), and insulin resistance was estimated using the triglyceride-glucose (TyG) index. Correlation analyses and multivariable linear regression were performed to examine factors associated with the TyG index. RESULTS: The mean age of the participants was 40.23 ± 12.95 years, and 55.6% were male. The mean TyG index was 8.51 ± 0.56, and the mean FTND score was 4.86 ± 2.32. The TyG index showed positive correlations with FTND score (r=0.280; p<0.001), age (r=0.261; p=0.001), and pack-years (r=0.218; p=0.004), and was significantly higher in males than in females (p<0.001). In multivariable linear regression analysis, older age, male sex, and higher FTND scores were independently associated with higher TyG index values. CONCLUSIONS: The findings suggest a potential association between nicotine dependence and insulin resistance among adult exclusive combustible cigarette smokers. Prospective studies are needed to clarify the direction and clinical significance of this association.
Association of smoking behavior and time to first cigarette with all-cause and cause-specific mortality: A cohort analysis from the NHANES 2001-2018.
Bao N, Wu J, Li Z … +4 more , Qi F, Tao G, Li C, Xiao H
Tob Induc Dis · 2026 · PMID 41767114 · Full text
INTRODUCTION: Smoking is a major risk factor for death, but the impact of behavioral patterns such as time to first cigarette (TTFC) on this risk has been little studied in the US population. To address this, we investig...
INTRODUCTION: Smoking is a major risk factor for death, but the impact of behavioral patterns such as time to first cigarette (TTFC) on this risk has been little studied in the US population. To address this, we investigated the association between smoking status and TTFC with all-cause, cardiovascular disease, and cancer mortality based on a national sample. METHODS: We conducted a pooled secondary data analysis of the National Health and Nutrition Examination Survey data from the United States, covering nine continuous cycles between 2001 and 2018. The initial pooled sample comprised 91355 participants. After applying a series of exclusion criteria, the final analytical cohort consisted of 39084 adult subjects. TTFC was investigated by means of a touch-screen questionnaire. Outcomes included all-cause mortality, cardiovascular disease mortality, and malignancy-related mortality. Mortality information was obtained from the National Death Index (NDI) using death certificates (https://www.cdc.gov/nchs/linked-data/mortality-files/?CDC_AAref_Val=https://www.cdc.gov/nchs/data-linkage/mortality-public.htm). RESULTS: After full adjustment, former smokers had a significantly elevated risk of mortality compared to never smokers. A U-shaped association was observed between TTFC and both all-cause and CVD mortality. For all-cause mortality, the risk was highest in smokers with TTFC <30 min (hazard ratio, HR=4.47; 95% CI: 2.23-8.98, p<0.001). Similarly, for CVD mortality, the highest risk was also found in the TTFC <30 min group (HR=5.53; 95% CI: 2.32-13.14, p<0.001). In contrast, TTFC showed an inverse relationship with cancer mortality, with the risk being highest for TTFC <30 min (HR=3.23; 95% CI: 1.25-8.31, p=0.020) and decreasing with a later TTFC. CONCLUSIONS: Former and current smokers showed elevated all-cause, CVD, and cancer mortality risks versus never smokers. TTFC exhibited a U-shaped association with all-cause and CVD mortality, but not with cancer mortality. ABBREVIATIONS: TTFC: time to first cigarette, NHANES: National Health and Nutrition Examination Survey, NDI: National Death Index, NCHS: National Center for Health Statistics, CDC: Centers for Disease Control and Prevention, HEI-2020: Healthy Eating Index, GED: General Educational Development, PIR: poverty-to-income ratio, BMI: body mass index, CVD: cardiovascular disease, TC: total cholesterol, ALT: alanine aminotransferase, AST: aspartate aminotransferase, HbA1C: glycated hemoglobin, WTDR1D: dietary one-day sample weight.
Cognitive confusion: A cross-sectional study on the cognitive differences between traditional tobacco and e-cigarettes among college students in Zhejiang Province, China.
Sun Y, Yi Y, Huang G … +4 more , Jiang S, Chen R, Wang D, Zhao F
Tob Induc Dis · 2026 · PMID 41767113 · Full text
INTRODUCTION: This study aimed to explore the differences in knowledge and cognitive perceptions of traditional tobacco and e-cigarettes among college students in Zhejiang Province, China, and to provide evidence-based i...
INTRODUCTION: This study aimed to explore the differences in knowledge and cognitive perceptions of traditional tobacco and e-cigarettes among college students in Zhejiang Province, China, and to provide evidence-based insights for future prevention and control strategies. METHODS: A cross-sectional survey was conducted in September 2020 among students from nine undergraduate institutions in Zhejiang Province, selected through a combination of typical and convenience sampling. An anonymous online questionnaire was used to collect data on tobacco-related knowledge, usage behavior, and cognitive perceptions. Statistical analyses included chi-squared tests, rank-sum tests, logistic regression, McNemar's tests, and Cohen's kappa (κ) to assess differences and consistency in knowledge regarding traditional tobacco and e-cigarettes. RESULTS: A total of 728 valid responses were obtained. Among the respondents, 9.20% were current smokers and 6.73% were current e-cigarette users, of whom 1.37 % used e-cigarettes exclusively. Only 42.72% of respondents showed high knowledge of e-cigarettes, significantly lower than the 80.36% for traditional tobacco (χ=128.410, p<0.001). Consistency in knowledge and risk perception between the two product types was also poor (κ<0.6). Among college students, 75.19% learned about e-cigarettes through the internet, and only 20.37% of those who had never used e-cigarettes correctly identified e-cigarette packaging. CONCLUSIONS: College students demonstrated significantly lower awareness of e-cigarettes compared to traditional tobacco, with notable cognitive inconsistency regarding health risks. The prevalence of misinformation, especially from online sources, underscores the urgent need for targeted education and control measures to address cognitive confusion and improve awareness of e-cigarette risks.
Global burden of tobacco-induced atrial fibrillation/flutter: Trends from 1990 to 2021 and projections to 2045 based on the Global Burden of Disease study.
Chen L, Zhang Z, Wang L … +6 more , Pan R, Yang J, Lin W, Zeng J, Yu C, Chen L
Tob Induc Dis · 2026 · PMID 41767112 · Full text
INTRODUCTION: Tobacco use is a key modifiable risk factor for atrial fibrillation/flutter (AF/AFL). We assessed global, regional, and national burdens attributable to smoking from 1990 to 2021 and projected future trends...
INTRODUCTION: Tobacco use is a key modifiable risk factor for atrial fibrillation/flutter (AF/AFL). We assessed global, regional, and national burdens attributable to smoking from 1990 to 2021 and projected future trends. METHODS: Data on deaths and DALYs were extracted from the GBD 2021 study. Main statistical analyses included the calculation of ASMR and ASDR. Trends were quantified using the estimated annual percentage change (EAPC). An age-period-cohort (APC) model was employed to decompose the effects of age, period, and birth cohort. Furthermore, a Bayesian age-period-cohort (BAPC) model was utilized to project the disease burden through 2045. RESULTS: In 2021, AF/AFL related to tobacco caused around 396000 cases, more than 10000 deaths, and 400000 disability-adjusted life years (DALYs). Compared with 1990, absolute cases and DALYs increased, while ASDR and ASR DALY declined (20%). High SDI regions improved most; low SDI regions lagged. Men and older adults bore disproportionate burdens. By 2045, deaths are projected to reach 14500 and 4200, respectively. Despite rising absolute DALYs, ASMR and ASDR are expected to decline in both sexes. CONCLUSIONS: Although standardized rates declined, the absolute burden of tobacco-related AF/AFL continues to rise, highlighting the urgent need for stronger tobacco control and targeted interventions in vulnerable populations.
Cessation outcomes and healthcare provider advice to quit among tobacco users: A cross-sectional analysis of the 2018-2019 Tobacco Control Policy (TCP) India survey.
Kodali PB, Pednekar MS, Gupta PC … +4 more , Quah ACK, Fong GΤ, Bialous SA, Vijayaraghavan M
Tob Induc Dis · 2026 · PMID 41716892 · Full text
INTRODUCTION: Tobacco cessation is crucial to reducing morbidity and mortality in India. Through a secondary analysis of the Tobacco Control Policy (TCP) India Wave 3 (2018-2019) survey data, we examined cessation outcom...
INTRODUCTION: Tobacco cessation is crucial to reducing morbidity and mortality in India. Through a secondary analysis of the Tobacco Control Policy (TCP) India Wave 3 (2018-2019) survey data, we examined cessation outcomes, including successful quitting, quit attempts, use of cessation services, and healthcare provider (HCP) advice to quit, among combustible, smokeless, and mixed (combustible and smokeless tobacco) users. METHODS: We conducted a cross-sectional analysis of the TCP India Wave 3 (2018-2019) survey data. The survey captured self-reported data on tobacco use and cessation using structured questionnaires. Participants included combustible tobacco (cigarette/bidi) users (n=977), smokeless tobacco users (n=5806), and mixed users (i.e. combustible and smokeless tobacco users, n=1157). Weighted prevalence estimates were calculated, and multivariable analysis evaluated factors associated with cessation outcomes. RESULTS: Successful quitting among lifetime tobacco users ranged from 6.3% to 12.4%. Among current users, past quit attempts ranged from 4.8% to 20.9%, and cessation services use in the latest quit attempt ranged from 5.8% to 9.3%. More combustible tobacco users (67.5%) reported receiving HCP advice to quit than smokeless tobacco users (40.5%). Combustible tobacco users aged ≥55 years (adjusted odds ratio, AOR=3.82; 95% CI: 2.06-7.07) reported higher odds of quitting compared to individuals aged 15-39 years. Smokeless tobacco users who reported that their 'partner thinks a lot that they should quit tobacco use' (AOR=2.21; 95% CI: 1.85-2.64) and who received HCP advice to quit (AOR=2.07; 95% CI: 1.65-2.59) had higher odds of attempting to quit than their respective counterparts. Mixed users who perceived tobacco 'caused a lot of damage to their health' had higher odds of receiving HCP advice to quit (AOR=2.47; 95% CI:1.16-5.29) compared to those reporting 'not at all'. CONCLUSIONS: Cessation outcomes and HCP advice to quit are suboptimal across tobacco users. Longitudinal studies are needed to understand the role of anti-tobacco advertising campaigns and spousal support on cessation outcomes.
Global, regional, and national burden of smoking-attributable digestive cancers in adults aged ≥60 years, 1990-2021, with projections to 2036: A secondary dataset analysis of Global Burden of Disease (GBD) 2021.
Wang X, Huang L
Tob Induc Dis · 2026 · PMID 41716891 · Full text
INTRODUCTION: Smoking is a key driver of esophageal, stomach, liver, pancreatic, and colorectal cancers, and its impact is stronger in adults aged ≥60 years due to cumulative exposure and population aging. A comprehensiv...
INTRODUCTION: Smoking is a key driver of esophageal, stomach, liver, pancreatic, and colorectal cancers, and its impact is stronger in adults aged ≥60 years due to cumulative exposure and population aging. A comprehensive analysis of temporal trends and sociodemographic drivers for major digestive cancers in this population is lacking. This study quantified smoking-attributable deaths and disability-adjusted life years (DALYs) from digestive cancers in adults aged ≥60 years globally from 1990 to 2021. It also projected future burdens to 2036 to inform age-focused tobacco control and cancer prevention. METHODS: This study is a secondary dataset analysis of data from GBD 2021. We analyzed smoking-attributable deaths and DALYs for esophageal, stomach, liver, pancreatic, and colorectal cancers among adults aged ≥60 years across 204 countries and territories (1990-2021). We decomposed temporal changes into contributions from population growth, aging, and changes in age-specific rates. Associations with the sociodemographic index (SDI) were assessed, and future burdens (2022-2036) were projected using a Bayesian age-period-cohort model. RESULTS: From 1990 to 2021, global smoking-attributable deaths increased by 27.5% (398426 to 508147) and DALYs by 14.6% (8.9 to 10.2 million). Decomposition attributed the increase primarily to population growth (41-43%), partially offset by declining age-specific rates (-30% to -35%). Regional disparities were stark: high-SDI regions stabilized burdens through epidemiological improvements, while low-SDI regions saw population-driven escalations. SDI was positively correlated with burden at the country level (ρ=0.20-0.48; p<0.001), peaking at mid-high SDI. CONCLUSIONS: Despite falling age-specific rates, the absolute burden of smoking-attributable digestive cancers in older adults is rising in parallel with demographic growth. Projections to 2036 suggest that, if current demographic trends continue, absolute deaths and DALYs are expected to continue increasing as populations age and grow.
The global burden of aortic aneurysm attributable to smoking from 1990 to 2021: Current trends and projections for 2036.
Jin X, Xu D, Lian X … +4 more , Geng X, Yue Z, Yao W, Wang X
Tob Induc Dis · 2026 · PMID 41716890 · Full text
INTRODUCTION: Smoking is a major risk factor for aortic aneurysm (AA). This cross-sectional study used Global Burden of Disease (GBD) data to examine trends in smoking-related AA and project future trends. METHODS: We co...
INTRODUCTION: Smoking is a major risk factor for aortic aneurysm (AA). This cross-sectional study used Global Burden of Disease (GBD) data to examine trends in smoking-related AA and project future trends. METHODS: We conducted a secondary analysis on the GBD 2021 dataset. Data on mortality, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) associated with AA attributable to smoking from GBD. The estimated annual percentage change (EAPC) was employed to assess burden trends from 1990 to 2021. The autoregressive integrated sliding average (ARIMA) model was utilized to project disease trends from 2022 to 2036. Decomposition analysis and frontier analysis were employed to comprehensively examine the data. RESULTS: Globally in 2021, there were 47538 deaths (95% UI: 39480-56008) from smoking-attributable AA, with an ASMR of 0.56 per 100000 (95% UI: 0.46-0.66) and 1157488 DALYs (95% UI: 989966-1325831). The ASMR showed a decreasing trend from 1990 to 2021 (EAPC= -2.17; 95% CI: -2.30 - -2.04). However, there were significant differences between regions, with the burden of deaths in high sociodemographic index (SDI) areas accounting for 40.3% of the global total, while ASMR in low-middle SDI areas rose (EAPC=0.99; 95% CI: 0.94-1.03). The point estimates for ASMR and ASDR were consistently greater in males compared to females throughout the study period. Projections indicate a continued global decline in ASMR and ASDR over the next 15 years, but the burden would gradually rise in Central Asia, East Asia, and South Asia. CONCLUSIONS: Smoking remains a significant preventable risk factor for AA, with substantial sex and regional disparities. Targeted public health strategies are urgently needed to address rising burdens in specific regions and reduce health inequalities.
The declining but persistent burden of lower respiratory infections from secondhand smoke in children aged under 14 years: Global trends 1990-2021 and forecasts to 2035, based on a secondary dataset analysis of Global Burden of Disease (GBD) 2021.
Yang F, Zhu Y, Hu C … +11 more , Dong X, Liu C, Li Y, Pan Z, Yang Y, Jin X, He Q, Wang Q, Sun L, Li Q, Shen J
Tob Induc Dis · 2026 · PMID 41710485 · Full text
INTRODUCTION: Although global smoke-free policies have significantly reduced smoking rates, exposure to secondhand smoke (SHS) in homes and public places remains common. SHS continues to be a significant risk factor for...
INTRODUCTION: Although global smoke-free policies have significantly reduced smoking rates, exposure to secondhand smoke (SHS) in homes and public places remains common. SHS continues to be a significant risk factor for lower respiratory infections (LRIs) in children. However, there is still a lack of systematic assessment of the spatiotemporal trends and future disease burden of LRIs attributable to SHS in children aged under 14 years. METHODS: This study is a secondary analysis of the Global Burden of Disease (GBD) 2021 data. We used joinpoint regression to analyze trends and calculate the average annual percentage change (AAPC) in the burden of LRIs attributable to SHS among children aged under 14 years, globally from 1990 to 2021. Age-standardized rates (ASRs) of mortality and DALYs were quantified at the global, regional, and national levels. Finally, a Bayesian age-period-cohort (BAPC) model was applied to forecast trends up to 2035, providing a basis for formulating targeted intervention strategies. RESULTS: In 2021, the number of deaths and disability-adjusted life years (DALYs) among children aged under 14 years worldwide due to LRIs caused by SHS decreased significantly. The ASR declined to 2.25 (95% UI: 0.73-3.86) for mortality and 199.84 (95% UI: 64.82-342.97) for DALYs per 100000 population. The forecast results indicated that by 2035, both the mortality and the DALY rates would continue to decline. CONCLUSIONS: Although the global burden had declined significantly and was expected to continue decreasing through 2035, SHS remained a significant contributor to LRIs in children.
Framing effects on smoking cessation intentions: A quasi-experimental study of gain- versus loss-framed text messages among male smokers in China.
Jin J, Jiang Y, Guo W … +1 more , Jiang S
Tob Induc Dis · 2026 · PMID 41710484 · Full text
INTRODUCTION: China has over 300 million smokers, yet overall willingness to quit remains low. Moreover, more than 90% of Chinese smokers who attempt to quit have no professional support, underscoring the need for effect...
INTRODUCTION: China has over 300 million smokers, yet overall willingness to quit remains low. Moreover, more than 90% of Chinese smokers who attempt to quit have no professional support, underscoring the need for effective self-directed cessation interventions. METHODS: We conducted a pretest-posttest quasi-experimental study in Hangzhou, China (March-June 2023). A total of 1082 eligible adult male smokers were allocated to receive gain-framed (n=546) or loss-framed (n=536) cessation messages after baseline assessments. Quit intention was measured with a 5-point Likert scale immediately before and after exposure to the allocated message. The primary outcome was an increase in quit intention post-exposure. Logistic regression was used to compare framing effects between groups, adjusting for occupation, annual household income, baseline quit intention, self-exempt beliefs, self-efficacy, and nicotine dependence (FTND). Subgroup analyses explored effect modification by these psychological factors. RESULTS: All participants received the allocated intervention and 1081 were included in the final analysis. Increased quit intention was observed in 34.6% of the gain-framed group versus 30.7% of the loss-framed group (adjusted odds ratio, AOR=0.73; 95% CI: 0.55-0.98; p=0.038). Subgroup analyses showed consistent benefits of gain-framed messages, with stronger associations among participants with low self-exempt beliefs (AOR=0.66; 95% CI: 0.45-0.96; p=0.031) and low self-efficacy (AOR=0.48; 95% CI: 0.28-0.83; p=0.008). CONCLUSIONS: Gain-framed messages were associated with higher quit intentions than loss-framed messages among Chinese male smokers. Tailoring message framing to smokers' psychological profiles may yield more favorable responses. Given the quasi-experimental design, further studies are needed to obtain sufficient evidence for culturally sensitive tobacco control strategies in China.
Herbal smoking products: A neglected frontier in global tobacco control.
Rewatkar K, Kokane N, Khatri S
Tob Induc Dis · 2026 · PMID 41696539 · Full text
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Smoking habits and factors that influence them among school students from rural areas of Romania.
Tudor TE, de Vries H, Lotrean LM
Tob Induc Dis · 2026 · PMID 41696538 · Full text
INTRODUCTION: The aim of the study was to evaluate smoking habits and the factors influencing them among school students in rural areas of Romania. METHODS: The study sample included 748 school students aged 13-14 years...
INTRODUCTION: The aim of the study was to evaluate smoking habits and the factors influencing them among school students in rural areas of Romania. METHODS: The study sample included 748 school students aged 13-14 years from twenty-four schools from rural areas situated in two counties of Romania. The cross-sectional study was conducted in 2019 among participating students using confidential questionnaires to assess smoking-related behaviors and the factors that influence them. RESULTS: Our findings revealed that 15.9 % of the sample were current smokers (no statistically significant differences were noticed between boys and girls). Smoking prevalence was higher among students without household goods such as a phone or a computer, compared to those who owned them (28.4% vs 13.8%, p<0.001, and 25.2% vs 14%, p<0.01, respectively). Students with lower school results also had higher smoking rates than those with better results (21.1% vs 8.1%, p<0.001). Adolescents who consumed alcohol monthly had higher smoking prevalence compared to those who did not (41.2% vs 13.4%, p<0.001). Engaging in fights monthly (34.6% vs 15%, p<0.001), vandalism (44.1% vs 14.3%, p<0.001), and stealing monthly (50% vs 15.2%, p<0.01) were also linked to higher smoking prevalence compared to not having these behaviors. Spending most spare time in bars/discos was associated with higher smoking prevalence (60% vs 14.9%, p<0.001). Practicing sports was correlated with lower smoking prevalence than not practicing sports (12.7% vs 16.4%, p<0.05). Smokers were more likely to perceive the benefits of smoking, whereas non-smokers were significantly more convinced about several disadvantages of smoking. Additionally, the study found an increased perceived behavior and pressure to smoke from parents, siblings, friends, best friends, and peers in the same school year among smokers. Smokers had lower self-efficacy to refrain from smoking in different situations. Intention to smoke in the next year was higher among smokers. CONCLUSIONS: The results have implications for the development of health promotion activities for smoking prevention among Romanian adolescents from rural areas.
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