Tobacco Induced Diseases[JOURNAL]
Sun
200 papers
Association between maternal smoking during pregnancy and learning disabilities in children and adolescents: A propensity score matching analysis.
Li P, Lu T, Wang W … +1 more , Du L
Tob Induc Dis · 2025 · PMID 41445786 · Full text
INTRODUCTION: The evidence on the associations between maternal smoking during pregnancy and long-term neurodevelopmental outcomes in offspring, particularly learning disabilities, remains insufficient. This study aimed...
INTRODUCTION: The evidence on the associations between maternal smoking during pregnancy and long-term neurodevelopmental outcomes in offspring, particularly learning disabilities, remains insufficient. This study aimed to evaluate the association between maternal smoking during pregnancy and learning disabilities (LDs) in children and adolescents. METHODS: This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) cycles 1999-2004. Maternal smoking status during pregnancy was obtained from self-reported questionnaires and classified as smoking or non-smoking. The primary outcome, learning disabilities (LDs), was determined based on parental response to the question: 'Has a doctor or other health professional ever told you that your child has a learning disability?'. Multiple analytic techniques, including multivariable logistic regression, propensity score matching (PSM), doubly robust estimation, inverse probability weighting (IPW), standardized mortality ratio weighting (SMRW), and stratified analyses, were used to evaluate the robustness of our findings. RESULTS: There were 5835 participants in all, of whom 848 had mothers who smoked during pregnancy and 4987 had mothers who did not. The prevalence of LD was 18.9% (160/848) in the smoking group compared with 9.5% (474/4987) in the non-smoking group. After PSM, 1666 matched individuals were identified. The IPW model indicated that maternal smoking during pregnancy was significantly associated with LDs in offspring (AOR=1.94; 95% CI: 1.59-2.37). Consistent results were confirmed by multivariable logistic regression, doubly robust estimation, SMRW, and stratified analyses. CONCLUSIONS: Maternal smoking during pregnancy was positively associated with LDs among US children and adolescents. It is necessary to conduct further prospective studies to better understand this relationship.
The association between e-cigarette use among Chinese college students and lung function and physical activity: A cross-sectional study.
Wang D
Tob Induc Dis · 2025 · PMID 41424769 · Full text
INTRODUCTION: Electronic cigarettes have gained widespread popularity among young adults, yet their respiratory health impacts remain incompletely understood. This cross-sectional investigation aimed to examine associati...
INTRODUCTION: Electronic cigarettes have gained widespread popularity among young adults, yet their respiratory health impacts remain incompletely understood. This cross-sectional investigation aimed to examine associations between e-cigarette use and respiratory symptoms, pulmonary function, and physical activity among Chinese university students. METHODS: This cross-sectional study was conducted at a university in China from January to August 2024. The study recruited 122 participants aged 18-30 years from a university setting, comprising 60 regular e-cigarette users with ≥1-month consistent usage and 62 tobacco-naive controls. Comprehensive assessments included respiratory symptom evaluation using the Dyspnoea-12 questionnaire, pulmonary function testing via spirometry and impulse oscillometry, fractional exhaled nitric oxide measurement, and physical activity assessment through standardized questionnaires and objective monitoring. Statistical analyses employed independent samples t-tests, Mann-Whitney U tests, and multivariable linear regression models with significance set at p<0.05. RESULTS: The investigation revealed significantly elevated respiratory symptom burden among e-cigarette users compared to controls, with Dyspnoea-12 scores reaching 2.0 versus 0 points (mean difference=2.0; 95% CI: 0.5-3.5, p=0.008, Cohen's d=0.52). Analysis suggested a potential dose-response pattern with symptom escalation from 1.0 points in short-term users (1-3 months) to 3.5 points in long-term users (7-12 months, p=0.018). Impulse oscillometry detected subtle but significant increases in peripheral airway resistance (0.31 ± 0.07 vs 0.29 ± 0.06 kPa/L.s, p=0.045) and frequency-dependent resistance changes (p=0.028), among e-cigarette users compared to controls, indicating small airway dysfunction despite preserved conventional spirometric parameters. Physical activity levels remained comparable between groups across multiple assessment domains. Multivariable regression confirmed that e-cigarette use was independently associated with elevated respiratory symptoms (β=3.12; 95% CI: 1.01-5.23, p=0.004). CONCLUSIONS: These findings demonstrate that e-cigarette use among university students is associated with clinically meaningful respiratory symptom burden and early airway dysfunction, supporting the need for further longitudinal studies and the development of symptom-based surveillance systems in academic settings.
Association between duration or intensity of tobacco smoking and olfactory function: A cross-sectional study among smokers willing to quit smoking.
Wälchli C, Grünig V, Tal K … +9 more , Rodondi N, Berlin I, Humair JP, Frei A, Pohle S, Jakob J, Auer R, Poletti SC, Schoeni A
Tob Induc Dis · 2025 · PMID 41424768 · Full text
INTRODUCTION: A range of studies suggests that people who smoke tobacco have impaired olfactory function, but few have explored the association between smoking history, such as duration or intensity, and olfactory functi...
INTRODUCTION: A range of studies suggests that people who smoke tobacco have impaired olfactory function, but few have explored the association between smoking history, such as duration or intensity, and olfactory function. We aimed to determine the prevalence of olfactory dysfunction among adult smokers and to test the association between duration or intensity of smoking and olfactory function. METHODS: For this cross-sectional study we consecutively invited adult smokers, participating in a smoking cessation trial conducted in five Swiss study sites, to undergo olfactory function testing at baseline from September 2020 to June 2021. We tested olfactory function with the Burghart's Sniffin' Sticks 16-item identification test resulting in an olfactory identification score (OIS) of 0-16 points. We defined olfactory dysfunction as an OIS ≤11 points. We fitted multivariable regression models to test the association between the OIS or olfactory dysfunction and self-reported smoking parameters [cigarettes per day (CPD), years of smoking (YOS) and pack-years] adjusted for relevant confounders such as demographics, substance use and comorbidities. RESULTS: Of 388 eligible participants, 375 (96.7%) completed the olfactory testing. Mean age was 39.0 years (SD=13.2), and 44.8% identified as women. The participants smoked on average 15 (SD=7.1) cigarettes per day for a median duration of 18 years (IQR: 11-28). Mean OIS was 13.3 (SD=1.8) and 12.0% had olfactory dysfunction. Olfactory dysfunction was significantly associated with pack-years (OR=1.03; 95% CI: 1.00-1.05) but not with YOS or CPD. OIS was negatively associated with pack-years (coefficient= -11.11; 95% CI: -4.29 - -17.94). OIS was not significantly associated with YOS or CPD. CONCLUSIONS: Among smokers smoking ≥5 cigarettes per day participating in a smoking cessation trial, about one in ten had olfactory dysfunction. Higher number of pack-years were associated with a worse measure of olfactory function and with olfactory dysfunction. CLINICAL TRIAL REGISTRATION: This sub-study of the ESTxENDS trial is pre-registered on the official website of ClinicalTrials.gov. IDENTIFIER: NCT04617444.
The role of smoking in bladder cancer risk: Unveiling racial and ethnic disparities in US and global populations, a secondary dataset analysis.
Yang B, Yuan J, Song W … +3 more , Wang H, Wang H, Hou S
Tob Induc Dis · 2025 · PMID 41409446 · Full text
INTRODUCTION: Bladder cancer is a common malignancy of the urinary system, with smoking recognized as its most significant modifiable risk factor. Although substantial epidemiological evidence has established an associat...
INTRODUCTION: Bladder cancer is a common malignancy of the urinary system, with smoking recognized as its most significant modifiable risk factor. Although substantial epidemiological evidence has established an association between smoking and bladder cancer, there remains a gap in understanding the complex burden and risk patterns of bladder cancer across different populations. This study aims to investigate the potential relationship between smoking and bladder cancer risk among individuals aged ≥20 years by leveraging large-scale, multinational data. METHODS: This cross-sectional study utilized two databases: the Global Burden of Disease (GBD) 2021 and the National Health and Nutrition Examination Survey (NHANES) cross-sectional data cycles from 1999 to 2023. After excluding participants with missing data on smoking history, bladder cancer history, and other relevant variables, individuals aged ≥20 years were included. The GBD data provided macro-level estimates of bladder cancer mortality and disability-adjusted life years (DALYs) attributable to smoking both globally and within the United States. Individual-level data from NHANES were used to assess the association between smoking history and bladder cancer risk through multivariable logistic regression models, adjusting for multiple confounding factors. RESULTS: Smoking is a major risk factor for bladder cancer both globally and in the US, with the smoking-attributable burden of bladder cancer markedly higher in the US. In 2021, the age-standardized death rate (ASDR) in the US was 1.97 (95% uncertainty interval, UI: 1.57-2.47), significantly exceeding the global rate of 1.12 (95% UI: 0.94-1.35). Similarly, the US age-standardized disability-adjusted life year rate (ASDAR) was substantially higher than the global average, at 42.60 (95% UI: 34.89-51.57) versus 23.56 (95% UI: 19.87-28.13). From the NHANES study, a total of 66391 participants were included, among whom 187 had bladder cancer. The data demonstrated a significant positive association between smoking and bladder cancer risk; compared to never smokers, smokers had an adjusted odds ratio (AOR) of 2.00 (95% CI: 1.31-3.07), indicating a two-fold increased risk of bladder cancer. Further sensitivity analyses suggested that former smokers were associated with a 70% higher likelihood of risk, while current smokers showed a 265% higher likelihood. Additionally, subgroup analyses indicated differences in the observed risk across various racial groups. CONCLUSIONS: This study elucidates a significant positive association between smoking and bladder cancer risk among individuals aged ≥20 years, with notable racial/ethnic disparities observed. Our findings suggest the need for further investigation into strategies that may address these disparities. However, the cross-sectional design limits causal inference. Future longitudinal studies are warranted to investigate the carcinogenic effects of emerging tobacco products, particularly across different racial groups, to optimize prevention and control measures.
Cannabis products and trends in a cohort of young adults: The VapeScan longitudinal study.
McGraw KE, Oelsner EC, LoIacono NJ … +9 more , Gao S, Anderson W, Sangapalaarachchi D, Illievski V, Liu J, Martins S, Sanchez TR, Shimbo D, Navas-Acien A
Tob Induc Dis · 2025 · PMID 41409445 · Full text
INTRODUCTION: Cannabis is the third most used drug in the world with emerging legalization in the US and other countries. In a descriptive analysis, we report trends in cannabis use and types of products used in the Vape...
INTRODUCTION: Cannabis is the third most used drug in the world with emerging legalization in the US and other countries. In a descriptive analysis, we report trends in cannabis use and types of products used in the VapeScan longitudinal study, a cohort study of young adults designed to investigate subclinical health effects of e-cigarette use. METHODS: The VapeScan study recruited 372 adults aged 18-50 years in the New York City area in 2021-2024, independently of cannabis use. At Visit 1, we asked about cannabis use, and at Visit 2, we implemented a more detailed questionnaire to characterize longitudinal trends and methods of cannabis use. We performed descriptive analyses to compare and report cannabis and tobacco use among participants groups of: 1) no substance use, 2) exclusive cannabis use, 3) exclusive e-cigarette use, and 4) dual substance use (e-cigarette and cannabis use). RESULTS: Participants had a median age of 26 years (IQR: 21-33), were 50.5% male, 48.1% female, and 1.3% non-binary. At Visit 1, 125 (33.6%) participants reported dual substance use, 15 (4%) reported exclusive cannabis use, 129 (34.7%) reported e-cigarette but no cannabis use, and 103 (27.7%) reported no substance use. At Visit 2, 128 of 217 (58.9%) participants reported cannabis use; 63 (29.0%) vape cannabis, 61 (28.1%) smoke cannabis, 111 (51.2%) edible cannabis, 69 (31.8%) CBD, and 8 (3.7%) topical cannabis. Frequency and intensity varied by method of use. Self-reported trends of vaped or smoked cannabis use varied between visits, with 28 (20.9%) becoming new users at Visit 2, while quitting only happened in 5 (6.3%) of those who vaped or smoked cannabis at Visit 1 (p=0.007). CONCLUSIONS: Our findings support that cannabis use is diverse and complex and is growing in urban communities, requiring further investigation to better understand use patterns and potential exposure to cannabis-related contaminants and related health effects.
Cross-sectional comparison of sociodemographic and tobacco use characteristics of U.S. adults who regularly use leading electronic nicotine delivery system (ENDS) products.
Nyman AL, Henderson KC, Holland J … +4 more , Ashley D, Spears CA, Huang J, Weaver SR
Tob Induc Dis · 2025 · PMID 41394889 · Full text
INTRODUCTION: Before granting marketing authorization for electronic nicotine delivery systems (ENDS), the US Food and Drug Administration (FDA) must consider population risks and benefits associated with ENDS use. This...
INTRODUCTION: Before granting marketing authorization for electronic nicotine delivery systems (ENDS), the US Food and Drug Administration (FDA) must consider population risks and benefits associated with ENDS use. This study describes characteristics and usage patterns of individuals who use Juul or Vuse Alto to assess differences in product use. METHODS: A national, cross-sectional, online survey with US adults who use ENDS was conducted in 2022-2023 as the baseline component of a longitudinal study. Data from 503 people who regularly used either Juul (n=224) or Alto (n=279) were analyzed, including sociodemographic characteristics, cigarette smoking and quitting behaviors, ENDS use patterns, reasons for use, and risk perceptions. Chi-squared tests, ANOVA, and binary, ordinal, and multinomial logistic regression compared people who use each product. RESULTS: Those using Juul were less likely to have formerly smoked cigarettes than those using Alto (OR=0.50; 95% CI: 0.25-0.99), and those using Alto and currently smoking reported greater readiness to quit smoking cigarettes compared to those using Juul. People who used Juul and smoked cigarettes more often used Juul in places where they could not smoke compared with people using Alto. Those using Juul regularly were less likely to be over the age of 29 years (OR=0.47; 95% CI: 0.31-0.70) and more likely to come from racial/ethnic minoritized groups (34.1% vs 21.8%). People using Alto regularly consumed more e-liquid (6.6 mL vs 3.7 mL ) and those using Juul regularly used pods with higher nicotine content (OR=1.98; 95% CI: 1.25-3.14) than did those using Alto. CONCLUSIONS: We noted differences between people using Juul and Alto in sociodemographic characteristics and usage patterns of both cigarettes and ENDS. These data provide information about the potential impact of authorizing marketing of a new product on tobacco use behaviors.
Global burden of lip and oral cavity cancer across adults aged ≥45 years from 1990 to 2021 and projections to 2050.
Li M, Wang C, Wei Y … +4 more , Qin X, Huang W, Zhou B, Huang X
Tob Induc Dis · 2025 · PMID 41383222 · Full text
INTRODUCTION: As global population aging intensifies, the burden of lip and oral cavity cancer (LOCC) among middle-aged and older adults continues to worsen. This research systematically analyzed global LOCC burden trend...
INTRODUCTION: As global population aging intensifies, the burden of lip and oral cavity cancer (LOCC) among middle-aged and older adults continues to worsen. This research systematically analyzed global LOCC burden trends among adults aged ≥45 years, aiming to inform evidence-based policy and public health strategies. METHODS: Key metrics were obtained from the GBD 2021 database including age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR). Their correlations with the sociodemographic index (SDI) were explored. Joinpoint models assessed trends via annual percent change (APC) and average annual percent change (AAPC). Bayesian Age-Period-Cohort (BAPC) models projected future trends. RESULTS: From 1990 to 2021, globally, the ASPR (EAPC=0.77; 95% CI: 0.72-0.82) and ASIR (EAPC=0.35; 95% CI: 0.29-0.41) of LOCC among adults aged ≥45 rose significantly, while ASMR (EAPC= -0.15; 95% CI: -0.20 - -0.09) and ASDR (EAPC= -0.25; 95% CI: -0.31 - -0.20) rates declined. Regionally, all SDI quintiles experienced rising ASPR and ASIR, with middle SDI regions showing the fastest growth. Low-middle and low SDI areas saw increases in ASMR and ASDR. A notable correlation was identified between ASPR, ASIR and SDI. East Asia and Oceania had the most severe increases in ASPR/ASIR and ASMR/ASDR, respectively. Males bore a greater burden than females. Population growth and epidemiological shifts drove the rise in ASIR and ASPR, with alcohol and tobacco use as key mortality contributors. Projections estimate ASPR will reach 61.81 (95% UI: 37.31-86.30) and ASIR 17.09 (95% UI: 11.95-22.23) by 2050, with ASMR and ASDR expected to initially decline before rising again. CONCLUSIONS: The study highlights the need for early prevention, especially in high-risk regions and among male adults aged ≥45 years, and emphasizes the importance of considering multiple factors in public health interventions for effective disease management.
Global disparities in the regulation of electronic cigarettes.
Egbe CO, Nyatsanza S, Fagbule OF
Tob Induc Dis · 2025 · PMID 41378053 · Full text
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State of the evidence on economic impacts of smoke-free policies in the tourism sector: A narrative literature review.
Nian Q, Kennedy RD, Schotte K … +4 more , Gouda H, Xing E, Kataria S, Welding K
Tob Induc Dis · 2025 · PMID 41357962 · Full text
Article 8 of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) obligates Parties to enact policies that create 100% smoke-free environments in enclosed workplaces, public places and public...
Article 8 of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) obligates Parties to enact policies that create 100% smoke-free environments in enclosed workplaces, public places and public transport. This narrative literature review examines studies reporting economic impact of smoke-free policies on tourism industry sectors including hotels, casinos/gambling venues, and sporting venues. A literature search was conducted across academic and gray literature published between 1 January 2004 and 18 June 2024, using the Scopus, Embase, and JSTOR databases. Search terms included variations of 'smoke-free' and 'tourism', 'hospitality', 'casino', 'hotel', and other related terms. Studies were included if they reported direct or indirect economic impacts of smoke-free policies on the tourism sector. The screening process involved an initial review of titles and abstracts, followed by full-text assessment for eligibility. Database searching identified 692 articles, of which 37 met the inclusion criteria. Nearly all identified studies (95%) focused on economic impacts in high income countries. The majority (76%) reported neutral or positive economic impacts following the implementation of smoke-free policies. There is evidence that most hotels and other hospitality venues experienced stable or improved revenues, increased customer satisfaction, and enhanced employee health outcomes after going smoke-free. Some evidence indicates that certain casinos experienced short-term revenue declines. Comprehensive smoke-free policies were more consistently associated with economic benefits, while partial policies often produced mixed results, commonly attributed to enforcement challenges. This review supports the evidence that comprehensive smoke-free policies aligned with WHO FCTC Article 8 deliver both health and economic benefits without harming the tourism sector. Findings can help policymakers counter tobacco industry claims and build political support for stronger smoke-free policies, especially in tourism-dependent jurisdictions. The lack of studies from low- and middle-income countries highlights the need for further research in these contexts.
Trends in type 2 diabetes-related deaths and disability-adjusted life years among smoking middle-aged and elderly adults in China, 1990-2021.
He Y, Lai C, Xing B … +6 more , Xu H, He J, Mai W, Qin S, Wang J, Ye Y
Tob Induc Dis · 2025 · PMID 41357961 · Full text
INTRODUCTION: Type 2 diabetes mellitus (T2DM) poses a global health crisis. Smoking, a key risk factor for T2DM, significantly impacts middle-aged and elderly populations. In China, with the world's largest elderly popul...
INTRODUCTION: Type 2 diabetes mellitus (T2DM) poses a global health crisis. Smoking, a key risk factor for T2DM, significantly impacts middle-aged and elderly populations. In China, with the world's largest elderly population and a high prevalence of smoking, the burden of smoking-related T2DM remains underrecognized. METHODS: Using GBD 2021 data, we applied joinpoint regression, age-period-cohort analysis, and the ARIMA model for prediction. This is a secondary dataset analysis. The study population included Chinese adults aged ≥55 years. RESULTS: From 1990 to 2021, deaths and DALYs attributable to smoking-associated T2DM showed a substantial increase, with males experiencing a significant rise in both number of death and DALYs rates, while females exhibited a decrease in death rate though total number of deaths rose. Joinpoint analysis revealed fluctuating trends in mortality and DALYs. The age-period-cohort analysis highlighted the age group of 70-75 years as a high-risk period. Predictive analysis suggested a slight upward trend in mortality for the overall population and males, while the DALYs rate was expected to remain stable but increase among males and decrease among females. CONCLUSIONS: From 1990 to 2021, the impact of smoking on type 2 diabetes mellitus (T2DM) among middle-aged and elderly adults in China continued to rise, with notable gender differences. Strengthening tobacco control and diabetes management, particularly for males and high-risk age groups, is crucial for reducing this burden.
Changes in e-cigarette use and related behaviors following the 2022 e-cigarette tax increase in China: A prospective longitudinal observational study.
Yang T, Peng S, Cottrell RR
Tob Induc Dis · 2025 · PMID 41357960 · Full text
INTRODUCTION: Although the relationship between taxation and conventional cigarette use is well established, little is known about the association with electronic cigarette (e-cigarette) use and no study has accounted fo...
INTRODUCTION: Although the relationship between taxation and conventional cigarette use is well established, little is known about the association with electronic cigarette (e-cigarette) use and no study has accounted for the potential delayed effects of e-cigarette policies beyond the observation period. This study aimed to evaluate the impact of China's 2022 e-cigarette tax increase on e-cigarette use. METHODS: A prospective longitudinal observational design was utilized by collecting three-waves of online survey data in China. Participants were recruited through social media platforms. Baseline data were collected in October 2022, with follow-up survey conducted in March and August 2023. Participants were eligible if they were aged ≥18 years, reported using e-cigarettes in the past 30 days at baseline, and provided informed consent to be recontacted for follow-up. The Friedman test and the Cochran's Q test were used to assess differences across the waves. The Wilcoxon signed-rank test and the Tukey test were used to make pairwise comparisons between the groups. RESULTS: There were 116 participants recruited at baseline and 91 (78.5%) of them complete all three surveys. E-cigarette use (ECU) decreased by 33.0% (95% CI: 23.7-42.3) in wave 2 after the tax increase was implemented, and by an additional 35.2% (95% CI: 26.8-43.7) in wave 3. The overall quit rate was 68.2% (95% CI: 60.3-75.9). However, 74.2% (95% CI: 65.9-82.5) of e-cigarette users whose quit switched to conventional cigarettes, resulting in an absolute cessation prevalence of only 17.6% (95% CI: 7.8-25.4). While perceived risk for ECU (χ=0.41, p>0.05), perceived severity for ECU (χ=1.02, p>0.05), and behavioral beliefs (χ=2.28, p>0.05) did not change following the e-cigarette tax increase. Friends' attitudes (χ=8.74, p<0.05), coworkers' attitudes (χ=4.71, p<0.05), and exposure to e-cigarette advertising (Q=9.76, p<0.01) showed significant decreases. CONCLUSIONS: This study suggests a possible association between the China's 2022 e-cigarette tax increase and changes in e-cigarette use. However, its effectiveness was diminished due to the large number of e-cigarette users who switched to conventional cigarettes. China's 2022 e-cigarette tax increase also affected social norms regarding e-cigarette use and exposure to e-cigarette advertising. The findings may inform future policy considerations for a comprehensive strategy.
Impact of tobacco exposure on global deaths of digestive diseases: Findings from 1990-2021 and projected trends to 2042.
Qin S, Xing B, He Y … +1 more , Liu W
Tob Induc Dis · 2025 · PMID 41340859 · Full text
INTRODUCTION: Tobacco exposure is a leading modifiable risk factor for preventable deaths, harming the digestive system, and leading to a large number of deaths. METHODS: A secondary assessment of Global Burden of Diseas...
INTRODUCTION: Tobacco exposure is a leading modifiable risk factor for preventable deaths, harming the digestive system, and leading to a large number of deaths. METHODS: A secondary assessment of Global Burden of Disease (GBD) datasets was conducted. From 1990 to 2021, data on deaths from tobacco exposure on digestive diseases, including various genders and age groups, from the 2021 GBD Study were utilized. Trends across 204 countries/territories, 21 GBD, and 5 sociodemographic index (SDI) regions were analyzed. Additionally, a detailed analysis was conducted. Pearson correlation analysis, frontier analysis, age-period-cohort (APC) model, and the Bayesian APC (BAPC) model was utilized. RESULTS: From 1990 to 2021, the global number of deaths from tobacco-attributable digestive diseases decreased from 52789 (95% uncertainty interval (UI): 36999-68307) to 34061 (95% UI: 23821-46548). The age-standardized rate also decreased, from 1.34 (95% UI: 0.93-1.73) to 0.40 (95% UI: 0.28-0.55). Overall, SDI was negatively associated with disease burden, and the Quality of Care Index for digestive diseases increased with SDI. Results from the APC analysis showed that the mortality rate increased with age; more recently born cohorts had lower mortality rates at the same age; and the mortality rate across all age groups decreased over time. Predictions indicated that the death burden of tobacco-attributable digestive diseases will continue to decline for both males and females from 2022 to 2042. CONCLUSIONS: Global tobacco-attributable digestive diseases mortality may have decreased due to tobacco control and medical advances. The disease burden in older adults, males, and regions with middle to high SDI deserves special attention. Countries with a relatively high disease burden should learn from those with a lower burden among nations at the same SDI level regarding tobacco control and healthcare management.
Gulf region smoking mortality trends and forecasts: A 30-year systematic evaluation of tobacco-attributable deaths.
Al-Regaiey KA, Al-Hussain F, Abualait T … +4 more , Iqbal M, Ali EM, Maqsood K, Bashir S
Tob Induc Dis · 2025 · PMID 41322251 · Full text
INTRODUCTION: Tobacco use remains a major preventable cause of morbidity and mortality worldwide. Despite economic development and growing health system capacity, countries in the Gulf Cooperation Council (GCC) region fa...
INTRODUCTION: Tobacco use remains a major preventable cause of morbidity and mortality worldwide. Despite economic development and growing health system capacity, countries in the Gulf Cooperation Council (GCC) region face rising tobacco use and a shifting burden of smoking-attributed diseases. This study systematically analyzes age-specific and age-standardized smoking-related mortality trends across six Gulf countries Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates over a 30-year period. METHODS: We extracted and analyzed smoking-attributed mortality data from the Global Burden of Disease 2021 dataset (1990-2019), including death rates per 100000 population for age groups 15-49, 50-69, and ≥70 years, and the age-standardized percentage of deaths due to smoking. We conducted descriptive trend analysis, heatmap visualization, correlation assessment, and linear projections to 2030. RESULTS: Bahrain and Kuwait exhibited the highest smoking-attributed mortality rates with 14.3% of all deaths in 2019, particularly among those aged ≥70 years, with death rates exceeding 1300 per 100000. In contrast, Saudi Arabia and Oman maintained relatively lower and stable rates. Strong correlations were observed between mid-life and elderly smoking mortality (r about 0.97), while slightly lower in the ≥70 years group (r about 0.85). Projections indicate a highest burden increase in Bahrain (about 13.5%) and slight increases in Qatar and UAE (about 9%, each) by 2030 without policy intensification. CONCLUSIONS: Despite regional advances in tobacco control, the burden of smoking-related mortality remains high in parts of the Gulf, especially among older adults. Immediate, targeted interventions particularly for middle-aged smokers are necessary to prevent further escalation. These findings support prioritizing tobacco cessation and surveillance as part of GCC public health strategies.
Smoking among Malaysian adults aged ≥15 years: A secondary dataset analysis of Global Adult Tobacco Survey-Malaysia 2023 (GATS-M 2023).
Lim KH, Cheong YL, Lim JH … +9 more , Ghazali SM, Cheong KC, Teh CH, Heng PP, Marine AA, Cheah YK, Saidin NS, Hashim MHM, Lim HL
Tob Induc Dis · 2025 · PMID 41322250 · Full text
INTRODUCTION: The ongoing assessment of smoking rates and their related factors is a crucial component of anti-smoking initiatives and is essential for evaluating the success of anti-smoking strategies and policies. This...
INTRODUCTION: The ongoing assessment of smoking rates and their related factors is a crucial component of anti-smoking initiatives and is essential for evaluating the success of anti-smoking strategies and policies. This research aimed to ascertain the prevalence of smoking and to identify the sociodemographic factors linked to smoking among adults in Malaysia aged ≥15 years. METHODS: We analyzed the secondary data of GATS-M 2023, which employed a cross-sectional design with a representative sample of 4269 adults in Malaysia aged ≥15 years, selected through a stratified, two-stage proportionate-to-size sampling technique. The research team collected the GATS-M data through face-to-face interviews conducted by trained research assistants, using a standardized, validated questionnaire. A multivariable logistic regression analysis was performed to identify sociodemographic factors associated with smoking among Malaysians. RESULTS: The overall smoking prevalence was found to be 19.0% (95% CI: 17.1-21.1), with males exhibiting a significantly higher prevalence than females (35.7%; 95% CI: 32.0-39.5 vs 1.5%; 95% CI: 0.8-3.1). The highest rates of smoking were noted among individuals of other ethnic backgrounds (39.1%), those aged 25-44 years (24.9%), and individuals who completed primary school but less than secondary school 95% CI: 2.60-5.91 (23.6%). Multivariable analysis revealed that Males from Malay (AOR=3.92; 95% CI: 2.60-5.91), Indian (AOR=3.17; 95% CI: 1.50-3.74), Other Bumiputra (AOR=3.14; 95% CI: 1.83-0.33), and other ethnic groups (AOR=4.77; 95% CI: 2.36-9.65) (Chinese ethnic as reference), and individuals with primary (AOR=2.98; 95% CI: 1.81-4.90) and secondary education level, showed a higher risk of being current smokers (AOR=1.81; 95% CI: 1.17-2.80, tertiary education level as reference) whilst no similar trends were found among female adults. CONCLUSIONS: The smoking prevalence among Malaysian adults aged ≥15 years showed a slight decrease. There is a need for more anti-smoking policies or interventions, particularly aimed at males, Malays, younger adults, and those with lower levels of education, to further reduce the smoking prevalence in Malaysia.
Content analysis of media coverage on smoke-free policy implementation in ten low- and middle-income countries.
Xing E, Kim S, Cohen JE … +1 more , Tseng TY
Tob Induc Dis · 2025 · PMID 41312371 · Full text
INTRODUCTION: Low- and middle-income countries (LMICs) face a disproportionate exposure and disease burden from secondhand smoke (SHS). Creating completely smoke-free indoor public places is effective in protecting peopl...
INTRODUCTION: Low- and middle-income countries (LMICs) face a disproportionate exposure and disease burden from secondhand smoke (SHS). Creating completely smoke-free indoor public places is effective in protecting people from SHS. This study examines how online news outlets in LMICs discuss existing smoke-free policies and their implementation. METHODS: In September 2023, we used Tobacco Watcher (www.tobaccowatcher.org), a tobacco news surveillance platform, to identify articles using the built-in topic 'Air' (i.e. smoke-free policy) and search terms 'implementation' or 'compliance' in 10 LMICs from 2022 to 2023. Two trained coders independently assessed all articles for their relevance (either substantially discussing in multiple paragraphs or holding a clear position on smoke-free policy implementation). A content analysis was conducted, with the coders independently coding each article for argument position, content, evaluation of current implementation efforts, and argument presenters until reaching 80% agreement or higher. Discrepancies in coding were resolved through discussion. RESULTS: Among 634 articles retrieved, 345 met the inclusion criteria. Most of these articles (81%, n=276) supported implementation of existing smoke-free policies; 31% (n=107) considered current smoke-free policy implementation efforts unsuccessful, citing lack of enforcement, signage, and other violations, while 20% (n=70) considered implementation to be successful; 21% (n=74) suggested a need for stronger smoke-free policies, including the elimination of designated smoking areas. Common argument presenters included government agencies (84%, n=291), civil society organizations (e.g. civil society: 40%, n=139), WHO (19%, n=67), and researchers or experts (18%, n=62). CONCLUSIONS: Discourse around smoke-free policy implementation in online news media of LMICs was generally supportive, praising complete bans and active implementation. However, coverage highlights that enforcement remained a challenge and pointed to a need for stronger policies. News media can be utilized as avenues for raising awareness surrounding tobacco control challenges, building support for policy, and countering tobacco industry narratives.
Evaluating early implementation of the innovative Canadian policy of cigarette stick warnings among adults in Canada who smoke: An assessment using repeat cross-sectional surveys and daily diaries.
Hackworth EE, Sun Y, Petillo S … +9 more , Xiong L, Vidaña-Pérez D, Yang CH, Kim M, Moodie C, Ferguson S, Hammond D, Niederdeppe J, Thrasher JF
Tob Induc Dis · 2025 · PMID 41312370 · Full text
INTRODUCTION: In 2024, Canada became the first country to implement warning messages on cigarette sticks. Warnings were required on king-size cigarettes in April 2024 at the manufacturer level and July 2024 at the retail...
INTRODUCTION: In 2024, Canada became the first country to implement warning messages on cigarette sticks. Warnings were required on king-size cigarettes in April 2024 at the manufacturer level and July 2024 at the retail level. The purpose of this study was to evaluate responses to cigarette stick warnings among adults who smoke in Canada using a standard survey and a daily diary study. METHODS: We used two separate online survey (i.e. questionnaire) methods with Canadian adults who smoke daily and use king-size cigarettes, with data collected in February, May, and August 2024. The first method was a standard cohort survey (observations=1724; participants=999), with one survey each data collection period. Participants were followed up in subsequent waves. Participants reported noticing health information on cigarette sticks 'any' vs 'none', and ≥ 'almost all' vs 'fewer cigarettes' in last month. The second method was a daily diary study (observations=10572; participants=527), with brief surveys every evening for two weeks during each data collection period. Participants reported noticing health information on cigarette sticks ('any' vs 'none' in last 24 hours). Samples for the two studies were distinct. In both studies, we also assessed feelings about the look of cigarette sticks (1=very bad to 5=very good), forgoing cigarettes normally smoked (no vs yes), and quit motivation (continuous). Generalized estimating equations regressed outcomes on survey period, adjusting for sociodemographic and smoking-related covariates. RESULTS: Noticing stick warnings increased in both surveys [standard 'any': May=58%, August=73%, OR=2.29 (95% CI: 1.81-2.91); standard ≥ 'almost all': May=27%, August=44%, OR=2.56 (95% CI: 1.99-3.30); daily diary: February=6%, May=10%, OR=1.77 (95% CI: 1.29-2.44), August=16%, OR=2.92 (95% CI: 1.73-4.93), all p<0.001]. Over time, negative feelings toward sticks [February=4.10, August=3.91, mean diff= -0.19 (95% CI: -0.32 - -0.05), p=0.006], forgoing cigarettes [February=56%, August=63%, OR=1.44 (95% CI: 1.12-1.86), p=0.004] and quit motivation [February=4.74, August=5.03, mean diff=0.30 (95% CI: 0.06-0.53), p=0.014] increased in the standard surveys, but not the daily diary study. CONCLUSIONS: Canadian adults who smoke king-size cigarettes increasingly noticed cigarette stick warnings over the early implementation period. The standard survey also found increases in cessation-related responses to stick warnings. Future research should assess long-term impacts of this policy and validate standard and daily diary survey methods for evaluating labeling policies.
Social media use and child cigarette smoking and e-cigarette use: A cohort study 2015-2023.
Laverty AA, Parnham JC, McKee M … +2 more , Filippidis FT, Hopkinson NS
Tob Induc Dis · 2025 · PMID 41292559 · Full text
INTRODUCTION: There are growing concerns that advertising and promotion on social media are driving youth use of tobacco and e-cigarettes. The UK provides an instructive example as it has high levels of e-cigarette use,...
INTRODUCTION: There are growing concerns that advertising and promotion on social media are driving youth use of tobacco and e-cigarettes. The UK provides an instructive example as it has high levels of e-cigarette use, high levels of social media use and a restrictive tobacco control environment. Existing evidence in the UK, however, has not focused on children, and has not been updated to reflect changes in patterns of social media use and in the use of these products. The aim of this study is to assess the associations of social media use with smoking and vaping. METHODS: Using data from the United Kingdom Household Longitudinal Study on adolescents aged 10-17 years between 2015-2023, we employed generalized estimating equation (GEE) models to estimate the relationships between time spent on social media and likelihood of smoking tobacco and using e-cigarettes. Models were controlled for possible confounders including sociodemographics and whether children lived in a home with e-cigarette use or tobacco smoking. We included data from 9359 participants with 25704 observations. RESULTS: Current cigarette smoking was reported by 4.9% of the sample and current e-cigarette use by 3.1%. Our adjusted models found strong relationships between time spent on social media and both smoking and vaping (p for trend <0.001). For example, use of social media for ≥7 hours/day was linked to greater odds of tobacco (adjusted odds ratio, AOR=5.13; 95% CI: 3.32-7.95) and e-cigarette use (AOR=4.26; CI: 2.25-8.08). CONCLUSIONS: This study finds associations between time spent on social media and both smoking and vaping among children. Enforcing regulations on content and restricting the duration of social media use may be warranted to protect children's health.
Integrating ChatGPT for smoking cessation counseling practice in pharmacy education: A single group quasi-experimental study.
Chinwong D, Penthinapong T, Chinwong S
Tob Induc Dis · 2025 · PMID 41281586 · Full text
INTRODUCTION: Practicing smoking cessation counseling with real patients is often limited in pharmacy education. To address this gap, artificial intelligence (AI) was employed to simulate patient interactions for role-pl...
INTRODUCTION: Practicing smoking cessation counseling with real patients is often limited in pharmacy education. To address this gap, artificial intelligence (AI) was employed to simulate patient interactions for role-playing, providing a flexible and pressure-free learning experience. This study aimed to evaluate the use of an AI-simulated patient (ChatGPT) for smoking cessation counseling in pharmacy education by assessing students' satisfaction, perceived learning impact, benefits, and difficulties encountered. METHODS: A quasi-experimental one-group post-test design was conducted with fourth-year pharmacy students enrolled in the smoking-cessation skills course at the Faculty of Pharmacy, Chiang Mai University, during the first semester of 2024 academic year. All students registered and attending the course were eligible and invited to participate. Case scenarios based on the 5As framework were developed and implemented in ChatGPT to simulate real-time counseling. After completing the AI session, students completed a self-administered questionnaire. RESULTS: Among 145 fourth-year pharmacy students, 66% reported satisfaction with the AI activity, and 84.4% indicated improved understanding of smoking cessation. Reported benefits included enhanced self-assessment and adaptability in the learning process, while common challenges involved technical limitations and limited understanding of how AI functions. CONCLUSIONS: Overall, students expressed satisfaction with the AI-based activity, reported improved learning, and identified both benefits and areas for improvement. These findings support the integration of AI tools like ChatGPT as a student-centered, scalable approach in smoking cessation education, aligned with SDG 4: Quality Education.
Causal association between cigarette smoking and the prevalence of preserved ratio impaired spirometry (PRISm), and the progression risk factors of PRISm: A study based on Mendelian randomization and meta-analysis.
Zhang X, Chen T, Zhang G … +2 more , Du X, Xu R
Tob Induc Dis · 2025 · PMID 41281585 · Full text
INTRODUCTION: Preserved ratio impaired spirometry (PRISm) is a new and variable phenotype of spirometry impairment that was first defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 2023. The...
INTRODUCTION: Preserved ratio impaired spirometry (PRISm) is a new and variable phenotype of spirometry impairment that was first defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 2023. The identification of high-risk factors for the progression from PRISm to COPD remains insufficient at present. METHODS: Mendelian randomization (MR) analysis was conducted using genome-wide association study (GWAS) summary statistics. Genetic instruments for smoking behavior were derived from the GWAS & Sequencing Consortium of Alcohol and Nicotine use (GSCAN) (n=607291), while PRISm case-control data were sourced from the UK Biobank (n=296282). The inverse-variance weighted (IVW) method served as the primary analytical approach, supplemented by heterogeneity assessment, pleiotropy evaluation, and sensitivity analyses. For the meta-analysis, PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from inception to 31 December 2024, to identify relevant studies that followed up on the changes in spirometry among individuals with PRISm or studies that reported the possible factors related to the changes in spirometry among individuals with PRISm. The risk of bias and the quality of the included studies were assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: The MR analysis identified 85 SNPs as genetic instruments, revealing a modest causal link between cigarette smoking and PRISm prevalence (IVW: OR=1.01-1.02, p=0.048). The meta-analysis of 14 studies (n=7336 PRISm cases) shows 20.8% (95% CI: 15.6-25.9) progress to COPD at follow-up, with no significant difference by follow-up duration (<5 vs ≥5 years). Persistent PRISm occurs in 41.5% (95% CI: 35.8-47.2), more frequently in long-term follow-up subgroups. Baseline 'chest distress/dyspnea' (OR=3.81; 95% CI: 1.47-9.84) and 'current smoking' (OR=2.18; 95% CI: 1.14-4.15) significantly predict progression, while respiratory symptoms, FEV/FVC ratio, TLC%, and FVC% show no association. CONCLUSIONS: Our findings suggest a modest causal link between cigarette smoking and PRISm prevalence. The progression of PRISm to COPD within 5 years is approximately 20.8%. Among individuals with PRISm at the first visit, 'chest distress or dyspnea' and 'current smoking' are potential clinical risk factors for the progression of PRISm to COPD.
Secondary cross-sectional analysis of smoking and drinking factors among older Korean men: A 13-year national survey.
Lee J, Kim Y, Cho WK
Tob Induc Dis · 2025 · PMID 41281584 · Full text
INTRODUCTION: Given the shared risk profiles and interdependence of smoking and drinking behaviors, this study aimed to examine factors associated with smoking and alcohol consumption among older adult Korean men. METHOD...
INTRODUCTION: Given the shared risk profiles and interdependence of smoking and drinking behaviors, this study aimed to examine factors associated with smoking and alcohol consumption among older adult Korean men. METHODS: This was a secondary cross-sectional analysis of data pooled from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted between 2007 and 2019, encompassing 7259 men aged ≥65 years. The participants were divided into the non-smoking/non-drinking, smoking/non-drinking, non-smoking/drinking, and smoking/drinking groups, and the sociodemographic and various health-related data collected via questionnaires and blood tests were used for multinomial logistic regression. RESULTS: When examining factors associated with each group using the non-smoking/non-drinking group as the reference group, several associated factors were identified. For example, not participating in regular exercise (AOR=1.31; 95% CI: 1.06-1.61; p=0.011), perceived health status as poor/very poor (AOR=1.56; 95% CI: 1.21-2.00; p<0.001), and skipping breakfast (AOR=1.90; 95% CI: 1.22-2.98; p=0.005) were some of the factors positively associated with the smoking/non-drinking group. Conversely BMI ≥25 (AOR=1.44; 95% CI: 1.12-1.83; p=0.004), elevated triglyceride levels (AOR=1.03; 95% CI: 1.03-1.05; p<0.001), and more daily fat intake (AOR=1.20; 95% CI: 1.03-1.40; p=0.019) were positively associated with the non-smoking/drinking group. Higher triglyceride levels (AOR=1.03; 95% CI: 1.01-1.05; p<0.001), depressive mood (AOR=2.10; 95% CI: 1.20-3.67; p=0.009), and more daily fat intake (AOR=1. 27; 95% CI: 1.07-1.51; p=0.007) were positively associated with the smoking/drinking group. CONCLUSIONS: Metabolic changes, such as higher triglyceride levels, were more common in the drinking groups, whereas negative emotions were more prevalent among smokers. These findings may highlight the need for targeted interventions to promote healthier lifestyles among older adults; however, further research is necessary to revalidate our study findings.
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