Tobacco Induced Diseases[JOURNAL]
Sun
200 papers
Health impacts of e-cigarette and traditional tobacco use in Shanghai male railway workers: A population-based retrospective cohort study.
Xiao L, Weah NM, Chen Y … +5 more , Weedor JG, Wang W, Jiang L, Cong X, Chen Y
Tob Induc Dis · 2025 · PMID 41111565 · Full text
INTRODUCTION: The health implications of electronic cigarette (e-cigarette) use remain uncertain despite their increasing global prevalence. This study evaluates the health hazards of e-cigarettes on railway workers by c...
INTRODUCTION: The health implications of electronic cigarette (e-cigarette) use remain uncertain despite their increasing global prevalence. This study evaluates the health hazards of e-cigarettes on railway workers by comparing the differences in clinical and biochemical health indicators resulting from exposure to different smoking methods. METHODS: Using a retrospective cohort design, this study analyzed 7719 routine physical examinations and clinical health records from male railway workers in Shanghai (March 2022). Participants were stratified into four smoking subgroups: non-users, e-cigarette users, cigarette smokers, and dual users (concurrent e-cigarette and cigarette use). A multinomial logistic regression analysis evaluated the potential health impacts associated with each type of cigarette use, while a linear regression analyzed the impact of accumulated smoking years on these health indicators. RESULTS: E-cigarette use was associated with increased odds of elevated systolic blood pressure (AOR=1.12; 95% CI: 1.01-1.24; AOR=1.18; 95% CI: 1.06-1.31) and heart rate (AOR=1.18; 95% CI: 1.06-1.33) per 10-unit increase, as well as reduced urine pH (AOR=0.64; 95% CI: 0.52-0.80; AOR=0.70; 95% CI: 0.56-0.88) compared to non-users and cigarette smokers. Compared to cigarette use, e-cigarette use was associated with higher hemoglobin levels (AOR=1.22; 95% CI: 1.05-1.42) and increased aspartate aminotransferase levels for every 10-unit increment (AOR=1.23; 95% CI: 1.01-1.51). Furthermore, relative to non-users, e-cigarette users showed higher levels of white blood cells and carcinoembryonic antigen, with the largest effect sizes observed among e-cigarette users compared to other subgroups. In addition, the number of accumulated smoking years significantly impacted clinical and biochemical health indicators in both cigarette and e-cigarette users. CONCLUSIONS: E-cigarette use was associated with adverse alterations in several clinical and biochemical health indicators, some of which were comparable to or more pronounced than those observed in cigarette smokers. Public health policies are necessary to regulate their use, particularly in occupational settings.
Efficacy of a preoperative smoking cessation intervention in orthopedic and general and urological surgery patients: A study protocol for a randomized clinical trial.
Gavilan E, Fernández E, Minguell J … +15 more , Trilla E, Sánchez JM, Espín-Basany E, Zuriguel E, Álvarez C, Montllor I, Ferré M, Aneas S, Gayubas A, Botana C, Colmenero M, Pérez G, Rodríguez N, Gili N, Martínez C
Tob Induc Dis · 2025 · PMID 41111564 · Full text
UNLABELLED: Tobacco use is a major risk factor for any surgical intervention. Offering patients help with giving up smoking before surgery increases cessation rates and lowers the risk of complications. The aim of this c...
UNLABELLED: Tobacco use is a major risk factor for any surgical intervention. Offering patients help with giving up smoking before surgery increases cessation rates and lowers the risk of complications. The aim of this clinical trial is to evaluate the efficacy of an intensive presurgical intervention for promoting smoking cessation in smokers undergoing either orthopedic surgery with implants or general/urological surgery. We will conduct a stratified randomized clinical trial [intervention group (IG) and control group (CG), 1:1 allocation] at the Vall d'Hebron University Hospital, Barcelona, Spain. The IG will receive intensive help to quit smoking (psychoeducational and behavioral support, nicotine replacement therapy with follow-up, and an information leaflet). The CG will receive brief advice and the same information leaflet in a single session. Sample size was calculated to include four equal groups (IG and CG in both types of surgery) with an estimated difference of 15 points in abstinence between IG and CG; assuming a loss to follow-up of 10%, a total of 232 subjects will be needed (58 per group). The primary dependent variables are self-reported and verified abstinence from tobacco consumption (expired CO) and surgical complications. We will conduct descriptive and bivariate statistical analysis for independent data. Logistic regression will be performed to assess the efficacy of the intervention. The relative risk of surgical complications will be calculated using Cox regression models. Patient recruitment began in May 2023. This trial will be the first to evaluate an intervention of this nature in Spain. If its efficacy is demonstrated, the results will support the design of a protocol for a smoking cessation program aimed at smokers who are scheduled for surgery. CLINICAL TRIAL REGISTRATION: The study is registered on the official website of ClinicalTrials.gov. IDENTIFIER: ID NCT05961813.
Decision to use e-cigarettes and associated factors among students of a university in Northern Thailand.
Wanaratwichit C, Mekrungrongwong S, Rakprasit J
Tob Induc Dis · 2025 · PMID 41111563 · Full text
INTRODUCTION: The use of electronic cigarettes (e-cigarettes) is spreading among adolescents, especially at higher education institutions, and it may have effects on health and learning. The objectives of this cross-sect...
INTRODUCTION: The use of electronic cigarettes (e-cigarettes) is spreading among adolescents, especially at higher education institutions, and it may have effects on health and learning. The objectives of this cross-sectional study were to examine the decision to use e-cigarettes and identify the associated factors among students of a university in northern Thailand. METHODS: Data were collected by using a developed questionnaire via an online system with 430 undergraduate students from a university in northern Thailand. Samples were selected by stratified random sampling. Data were analyzed using frequencies and percentages, means and standard deviations, and logistic regression at a confidence level of 0.05. RESULTS: In a sample group, the decision to use e-cigarettes was found to be 18.6%. Factors significantly associated with the decision to use e-cigarettes included receiving information about the dangers of e-cigarettes from loved ones (AOR=2.84; 95% CI: 1.20-6.71), having friends who use e-cigarettes (AOR=8.53; 95% CI: 3.41-21.37), attitudes toward e-cigarettes (AOR=3.10; 95% CI: 1.61-5.95), perceived risk of e-cigarette use (AOR=2.51; 95% CI: 1.22-5.13), and perceived benefit of avoiding e-cigarette use (AOR=2.38; 95% CI: 1.23-4.57). CONCLUSIONS: The factors associated with the decision to use e-cigarettes were found to be directly related to the students themselves, as well as their friends, acquaintances, and partners. Therefore, universities should have a policy to prevent the use of e-cigarettes by focusing on the individual level with all students. Further, activities should be organized in groups, especially among friends and partners, with a focus on changing attitudes, providing accurate information, and increasing the perceptions of e-cigarette risks as well as the benefits of avoiding e-cigarette use.
Expansion of low-price cigarette market and its implications for cigarette tax revenue: Evidence from Bangladesh.
Hossain MN, Huque R, Abdullah SM … +1 more , Nargis N
Tob Induc Dis · 2025 · PMID 41111562 · Full text
INTRODUCTION: In Bangladesh, a significantly lower minimum retail price and preferential ad valorem tax rate for low-price cigarettes incentivized manufacturers to avoid tax by expanding the low-price cigarettes market....
INTRODUCTION: In Bangladesh, a significantly lower minimum retail price and preferential ad valorem tax rate for low-price cigarettes incentivized manufacturers to avoid tax by expanding the low-price cigarettes market. The effect of this industry response on government tax revenue has not been quantified yet. This study aims to fill this gap. METHODS: Using cigarette sales data (2019-2020) of British American Tobacco (BAT) Bangladesh in the WHO Tobacco Tax Simulation Model, we estimated the gap of actual from potential revenue by simulating four counterfactual scenarios involving government tax interventions and cigarette manufacturers' decision to expand low-price cigarette sales. We analyzed optimal government policy response vis-à-vis manufacturers' actions in a game theoretic framework based on a payoff matrix of tax revenue and industry revenue. RESULTS: The revenue gap due to expansion of low-price cigarette sales (scenario 1) was BDT 22.1 billion (US$ 0.26 billion; US$ 1≈ BDT85 in Year 2020), equivalent to around 10% of the collected revenue in 2019-2020. Due to lower minimum price of low-price cigarettes (scenario 2), the revenue gap was BDT 14.7 billion (US$ 0.17 billion). The revenue gap was BDT 30.5 billion (US$ 0.36 billion) for the lower minimum price and lower excise tax rate of low-price cigarettes (scenario 3). The revenue gap due to lower minimum price, lower excise tax rate of low-price cigarettes and low-price cigarette sales expansion (scenario 4) was BDT 49.4 billion (US$ 0.58 billion). CONCLUSIONS: In Bangladesh, revising the tiered excise tax structure by raising prices in the low-tier and unifying tax rates across tiers can curb tax avoidance, boost government revenue, and promote public health.
Correlation between smoking and delirium in patients with sepsis: A retrospective analysis utilizing the MIMIC database.
Wang R, Liu R, Xu Z … +1 more , Wang H
Tob Induc Dis · 2025 · PMID 41111561 · Full text
INTRODUCTION: This study aimed to examine the relationship between smoking and delirium in patients with sepsis and identify potential mediating mechanisms, utilizing data from the Medical Information Mart for Intensive...
INTRODUCTION: This study aimed to examine the relationship between smoking and delirium in patients with sepsis and identify potential mediating mechanisms, utilizing data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. METHODS: A retrospective cohort analysis was conducted involving 10855 adult patients with sepsis. Multivariable logistic regression, propensity score matching (PSM), and inverse probability treatment weighting (IPTW) were applied to assess associations while controlling for confounders such as demographics, comorbidities, vital signs, and laboratory parameters. Causal mediation analysis (CMA) was employed to explore the mediating role of partial pressure of carbon dioxide (PaCO2). Subgroup and sensitivity analyses were performed to assess result robustness. RESULTS: The incidence of delirium was significantly higher among smokers compared to non-smokers (34.8% vs 25.7%). Adjusted models identified smoking as an independent risk factor (OR=1.44; 95% CI: 1.28-1.61). These findings were validated through PSM (OR=1.35; 95% CI: 1.20-1.53) and IPTW (OR: 1.25, 95% CI: 1.18-1.32). Subgroup analyses affirmed associations across most strata. CMA indicated that 7.876% (95% CI: 4.433-13) of the effect of smoking on delirium was mediated by elevated PaCO2, with direct and indirect effects quantified at 0.0625 (95% CI: 0.0428-0.0800) and 0.0050 (95% CI: 0.0027-0.0081), respectively. Sensitivity analyses among ICU survivors yielded consistent results (OR=1.52; 95% CI: 1.34-1.72). CONCLUSIONS: Smoking is independently linked to an increased risk of delirium in patients with sepsis, with hypercapnia partially mediating this relationship. These findings emphasize the importance of smoking cessation and targeted respiratory management in preventing delirium.
Analysis of secondhand smoke exposure and harm awareness among non-smoking individuals aged 15-44 years in Jilin Province: A cross-sectional study.
Li W, Jiang J, Li R … +4 more , Zhang L, Jia B, Zhang Q, Qian X
Tob Induc Dis · 2025 · PMID 41080624 · Full text
INTRODUCTION: In recent years, alongside the Healthy China Initiative, extensive nationwide efforts have been undertaken to enhance the health literacy of the population. Health knowledge dissemination has emerged as a k...
INTRODUCTION: In recent years, alongside the Healthy China Initiative, extensive nationwide efforts have been undertaken to enhance the health literacy of the population. Health knowledge dissemination has emerged as a key approach within these efforts. This study focused on non-smokers aged 15-44 years in Jilin Province, China. It analyzed their patterns of secondhand smoke (SHS) exposure and their level of awareness regarding its risks. METHODS: The study selected non-smoking permanent residents aged 15-44 years from the 2020 Jilin Province Adult Tobacco Survey database as its subjects. Following the requirements of the China Adult Tobacco Survey Protocol, the project employed a multistage stratified cluster random sampling method. This involved: selecting 10 surveillance sites from all of the province's districts or counties; choosing 3 sub-districts/townships within each surveillance site; selecting 2 neighborhood or village committees within each sub-district or township; and randomly sampling 120 households from each neighborhood or village committee. This resulted in a total sample of 7200 households province-wide. One resident aged ≥15 years was randomly selected from each household for a face-to-face in-home interview. The present analysis utilized eligible questionnaires from individuals within the target age group 15-44 years. RESULTS: The prevalence of secondhand smoke (SHS) exposure among surveyed non-smoking residents in Jilin Province was 59.16% (95% CI: 52.87-65.17). Awareness rates of specific SHS health risks were as follows: 76.16% (95% CI: 59.77-87.30) knew SHS causes lung cancer in adults; 61.95% (95% CI: 52.26-70.77) knew SHS causes lung diseases in children; and 49.21% (95% CI: 34.99- 63.56) knew SHS causes heart disease in adults. However, only 42.26% (95% CI: 32.60-52.56) were aware that SHS causes all three conditions (heart disease in adults, lung diseases in children, and lung cancer in adults). SHS exposure rates varied significantly by location: restaurants had the highest exposure rate (50.85%) , homes (37.72%), and public transport (5.01%). CONCLUSIONS: SHS exposure prevalence among residents aged 15-44 years in Jilin Province remained high, while comprehensive awareness of its associated health risks was relatively low. A discrepancy existed between possessing knowledge about SHS harms and translating that knowledge into protective behaviors or reduced exposure. Intervention efforts should focus on priority venues, intensify the dissemination of core knowledge on tobacco hazards, implement targeted health promotion activities for key populations, and foster supportive smoke-free environments.
Investigating current and temporal variation in municipal youth smoking rates in the Netherlands: A multivariable regression analysis.
Jooren SJA, Bommelé J, Wijnen B … +4 more , den Hollander W, Baars J, Jansen MWJ, Willemsen MC
Tob Induc Dis · 2025 · PMID 41080623 · Full text
INTRODUCTION: Variations in smoking prevalence rates exist across different regions. While most research tends to study demographic, cultural or social determinants of smoking, few studies have looked into whether munici...
INTRODUCTION: Variations in smoking prevalence rates exist across different regions. While most research tends to study demographic, cultural or social determinants of smoking, few studies have looked into whether municipal-level variables are associated with smoking rates, especially among the younger population. We examined which municipal-level factors explain differences in youth smoking rates in the Netherlands. METHODS: We conducted linear regression analyses to examine municipal-level smoking behavior among the population aged 12-16 years. Main outcomes were the proportion of youth within municipalities that had ever smoked or weekly smoked in 2021, and trend differences in ever smoking and weekly smoking between 2015 and 2021. Independent variables were population density, level of urban density, proportion of people with a migration background, proportion of elderly residents, and proportion of adults with a low level of education. We examined municipalities' involvement in the Smoke-free Generation campaign, their tobacco control policies, the number of smoke-free outdoor areas implemented, and their self-assessed tobacco control scores. RESULTS: Dutch municipalities show great variation in smoking prevalence (2021: ever smoking 3.0-21.8% and weekly smoking 1.4-11.1%). Smoking has decreased in almost all municipalities in recent years; 108 of the 113 municipalities had a decrease in ever smoking, while 89 of the 100 municipalities showed a decrease in weekly smoking prevalence. Municipalities with a higher proportion of individuals with a migration background had lower ever (β= -0.08, p=0.021) and weekly (β= -0.06, p=0.013) youth smoking prevalence rates in 2021. CONCLUSIONS: Considering that municipality-specific variables were not associated with levels of youth smoking prevalence, the question remains why some municipalities have much higher smoking rates than others, after having been exposed to the same national level tobacco control policy measures.
Assessing quit interest and the correlates and preferred ways of quitting snus in Norway: A cross-sectional study.
Sæbø G, Lund I
Tob Induc Dis · 2025 · PMID 41080622 · Full text
INTRODUCTION: Snus is currently the most used tobacco product in Norway. This study aims to identify the overall cessation interest among Norwegian snus users, the preferred quitting aids, and correlates of cessation int...
INTRODUCTION: Snus is currently the most used tobacco product in Norway. This study aims to identify the overall cessation interest among Norwegian snus users, the preferred quitting aids, and correlates of cessation interest. METHODS: Survey data were collected by the Norwegian Directorate of Health through a nationwide web panel, with respondents completing an online questionnaire. Three time points (two in 2018, one in 2019) were pooled, resulting in n=820 snus users. Descriptive statistics and adjusted multinomial logistic regression were applied to identify the extent of snus cessation behavior and factors associated with overall cessation interest. RESULTS: In all, 58.5% had attempted to quit snus, while 52.7% expressed current plans to quit. Of all snus users, 26.6% had never tried to quit and did not intend to quit in the future; 35.7% had either previously tried to quit but held no current quit plans, or they had never attempted to quit but were willing to try in the future. The remaining 37.7% had both tried to quit and intended to try again. Frequently preferred quitting aids were: quit on my own, mobile app, and nicotine-free snus. Higher interest in quitting was associated with younger age (AOR=0.94, p<0.001), living in western (AOR=2.27, p=0.019) or northern (AOR=2.60, p=0.022) Norway, perceiving snus use as hazardous to health (AOR=2.37, p<0.001), using snus daily (AOR=2.83, p<0.001), and non-smoking (AOR=0.53, p=0.033). Cessation behavior was not statistically associated with education level or income, after controlling for covariates. CONCLUSIONS: The majority of snus users are interested in quitting, especially those who are young and worry about their own health. We found no evidence of a social gradient in cessation interest.
Role of OAF and smoking initiation in COPD risk: Insights from Mendelian randomization.
You F, Xu K, Chen G … +3 more , Chen S, Yuan Q, Sun B
Tob Induc Dis · 2025 · PMID 41080621 · Full text
INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is a complex condition influenced by both genetic and environmental factors. This study aims to identify potential biomarkers and explore the associations betwee...
INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is a complex condition influenced by both genetic and environmental factors. This study aims to identify potential biomarkers and explore the associations between specific maker genes, smoking initiation, and COPD. METHODS: We used Mendelian randomization (MR) with inverse variance weighting (IVW) to identify significant associations (p<0.05). Genetic instruments for smoking initiation (Genome-Wide Association Study [GWAS]: ieu-b-4877) and Out at First (OAF) (cis-expression Quantitative Trait Locus [eQTL] GWAS) were selected based on single nucleotide polymorphisms (SNPs) with p<5×10. COPD GWAS data served as the outcome. Two-sample MR analysis estimated causal effects of smoking initiation/OAF on COPD. Mediation analysis explored the role of 731 immune cell phenotypes in these associations. RESULTS: We identified OAF as a key genetic marker associated with COPD risk, with the eQTL analysis yielding an odds ratio (OR) of 1.09 (95% CI: 1.02-1.17, p=0.01). The IVW analysis for smoking initiation-COPD indicated an OR of 1.89 (95% CI: 1.69-2.11, p<0.001). Mediation analysis revealed that the immune cell phenotype CD14- CD16- absolute count (AC) (GCST90001581) accounted for 30.16% and 4.27% of the mediation in the OAF-COPD and smoking initiation-COPD associations, respectively. CONCLUSIONS: The MR results suggest that OAF may be a genetic risk factor for COPD, with immune cell phenotypes, particularly CD14-CD16-AC, potentially playing a mediating role in COPD development. Smoking initiation is also positively correlated with COPD, playing an important role in its pathogenesis.
China's cigarette health warning labels: Undermined by branding.
Nian Q, Smith KC, Welding K … +5 more , Brown JL, Wang Z, Zheng P, Ren C, Cohen JE
Tob Induc Dis · 2025 · PMID 41080620 · Full text
INTRODUCTION: In China, health warning labels (HWLs) on cigarette packs are text-only with two messages in rotation. We examined China's HWLs as they appear on packs, focusing on elements of design and branding that may...
INTRODUCTION: In China, health warning labels (HWLs) on cigarette packs are text-only with two messages in rotation. We examined China's HWLs as they appear on packs, focusing on elements of design and branding that may undermine their effectiveness. METHODS: We used a systematic protocol to purchase 488 unique cigarette packs in 2023 from five major Chinese cities. The study sample consisted of the 471 packs that displayed the current HWLs mandated by China. A detailed codebook was developed to assess design elements in the HWL area (color/pattern schemes, text to background contrast, branding, etc.) and pack characteristics (brand family). Two trained coders who were native Chinese speakers independently double-coded the packs. We examined the prevalence of identified design elements and compared differences across brand families. RESULTS: Colors/patterns that appeared on the pack overlapped with the HWL area on almost all packs (90%). About one-quarter (27%) of packs featured branding directly below the HWLs; significant differences were observed across brand families (p<0.05). On 11% of packs, the HWL text lacked contrast against its background. Other concerning design elements included the use of multiple colors in HWL text and background, and split HWLs. CONCLUSIONS: The prevalence of appealing branding and design elements that overlap the HWL on cigarette packs, potentially diminishes the effectiveness of HWLs and makes the Chinese HWLs less prominent compared to best practices. To enhance the effectiveness of HWLs and align with FCTC Article 11, China could implement stricter HWL regulations prohibiting branding within HWLs.
Trends in global research on tobacco use among sexual and gender minorities: A bibliometric analysis, 1984-2024.
Qiu L, Shirui Z, Luo M
Tob Induc Dis · 2025 · PMID 41070238 · Full text
INTRODUCTION: Globally, sexual and gender minorities (SGM) exhibit significantly higher tobacco use rates than their cisgender heterosexual counterparts, a persistent health disparity that has garnered increasing attenti...
INTRODUCTION: Globally, sexual and gender minorities (SGM) exhibit significantly higher tobacco use rates than their cisgender heterosexual counterparts, a persistent health disparity that has garnered increasing attention in public health research. METHODS: We conducted a bibliometric analysis of 704 SGM tobacco use-related publications from the Web of Science Core Collection. First, we examined publication trends, key contributors, and collaborative networks. Second, we performed co-citation network analysis to identify disciplinary characteristics and research hotspots. Finally, we applied keyword burst detection and clustering techniques to assess emerging trends and frontier areas. RESULTS: From 1984 to 2024, research on SGM tobacco use demonstrated consistent growth. The US accounted for the majority of publications (82.52%), with institutions such as the University of California System serving as key hubs for research collaboration. Research hotspots clustered around five key themes: 1) the effects of novel tobacco products, 2) subgroup differences in tobacco use, 3) tobacco-related health disparities, 4) smoking cessation research, and 5) social and psychological mechanisms. CONCLUSIONS: Using data mining and visualization techniques, this study constructed a comprehensive knowledge map of research on SGM tobacco use. Our findings elucidate evolving patterns and emerging trends while offering valuable perspectives to guide future investigations.
Effectiveness of online tobacco control education: A cross-sectional study among healthcare professionals.
Chen Y, Chen S, Xu J … +10 more , Xu L, Wang Z, Liu S, Cai Y, Wang Z, Zhao X, Yu X, Yang X, Zhang N, Chan KS
Tob Induc Dis · 2025 · PMID 41070237 · Full text
INTRODUCTION: Online education platforms offer promising solutions for tobacco control capacity building. This study evaluated an online tobacco control course's effectiveness on healthcare professionals' knowledge, atti...
INTRODUCTION: Online education platforms offer promising solutions for tobacco control capacity building. This study evaluated an online tobacco control course's effectiveness on healthcare professionals' knowledge, attitudes, and behavioral intentions. METHODS: A cross-sectional survey was conducted among healthcare workers and medical students (n=719) in a Chinese city, January 2023. Participants were categorized as course participants (n=387) or non-participants (n=332). The validated survey instrument (Cronbach's α=0.963) assessed tobacco-related knowledge, attitudes, and behavioral intentions using 5-point Likert scales. Statistical analyses included t-tests, effect size, and multivariable regression. RESULTS: Course participants demonstrated significantly higher knowledge scores across multiple domains compared to non-participants. Regarding specific tobacco harms, participants showed greater awareness that smoking causes stroke (4.21 ± 0.90 vs 3.86 ± 1.04, p<0.001, Cohen's d=0.37), heart disease (4.27 ± 0.85 vs 3.93 ± 1.03, p<0.001, d=0.36), and erectile dysfunction (4.05 ± 0.97 vs 3.72 ± 1.12, p<0.001, d=0.32). For secondhand smoke, participants better recognized risks of adult cardiovascular disease (4.26 ± 0.81 vs 4.04 ± 0.90, p=0.001, d=0.26) and pediatric respiratory illness (4.37 ± 0.73 vs 4.15 ± 0.83, p<0.001, d=0.28). Participants also showed more positive attitudes toward tobacco control policies and greater behavioral intentions for tobacco control advocacy. In multivariable analysis adjusting for demographics and smoking status, course participation remained significantly associated with higher knowledge scores (β=0.28; 95% CI: 0.18-0.38, p<0.001), more positive attitudes (β=0.22; 95% CI: 0.12-0.32, p<0.001), and stronger behavioral intentions (β=0.31; 95% CI: 0.19-0.43, p<0.001). CONCLUSIONS: The online tobacco control course significantly improved participants' knowledge of tobacco harms and strengthened their support for tobacco control measures. These findings suggest that digital health education platforms may be valuable tools for tobacco control capacity building, though further longitudinal studies are needed to establish causal relationships and assess long-term effectiveness.
Assessing the impact of tobacco smoke exposure on earlyonset osteoarthritis: A cross-sectional analysis of secondary data from the National Health and Nutrition Examination Survey (NHANES), 1999-2020.
Li Y, Wan X, Long W
Tob Induc Dis · 2025 · PMID 41036087 · Full text
INTRODUCTION: There is evidence that exposure to tobacco smoke is associated to a number of chronic diseases, but the evidence for an association with osteoarthritis (OA) is sparse and inconclusive. The aim of this study...
INTRODUCTION: There is evidence that exposure to tobacco smoke is associated to a number of chronic diseases, but the evidence for an association with osteoarthritis (OA) is sparse and inconclusive. The aim of this study was to investigate whether exposure to tobacco smoke for an adult is associated with developing OA at a young age, and to assess dose-response patterns. METHODS: We conducted a pooled, cross-sectional analysis of secondary data from the National Health and Nutrition Examination Survey (NHANES) 1999-2020 among US adults aged 20-54 years (n=26145). Tobacco smoke exposure was quantified by serum cotinine. Multivariable logistic regression, restricted cubic splines, and threshold analyses were used to estimate the dose-response relationship between cotinine and self-reported physician-diagnosed early-onset OA. RESULTS: Overall, 1086 participants (4.2%) reported early-onset OA. After full adjusted odds ratio (AOR), serum cotinine ≥3 ng/mL was associated with a 52% increase in odds of early-onset OA (AOR=1.52; 95% CI: 1.30-1.79), compared with <0.05 ng/mL. A non-linear, positively saturated relationship was observed between the cotinine levels after the natural logarithm (LN) transformation and early-onset OA, with an inflection point at approximately 2.90 ng/mL (AOR=1.38; 95 % CI: 1.17-1.63, p=0.00). Subgroup analyses confirmed the robustness of this association across demographic and clinical strata. CONCLUSIONS: This study, based on a nationally representative sample from the United States, suggests that high levels of tobacco smoke exposure significantly increase the likelihood of early-onset OA, highlighting the need for further research into factors associated with early-onset OA.
Prevalence of e-cigarette users in the Medina region of Saudi Arabia.
Aloufi N, Alhamawi RM, Alalwani SN … +4 more , Alrefaei WK, Aljohani HA, Ali MM, Alahmadi FH
Tob Induc Dis · 2025 · PMID 41031094 · Full text
INTRODUCTION: Electronic cigarettes are battery-operated devices that allow users to 'vape' flavored solutions including nicotine. The prevalence of users of e-cigarettes with different flavors, is not known in the Medin...
INTRODUCTION: Electronic cigarettes are battery-operated devices that allow users to 'vape' flavored solutions including nicotine. The prevalence of users of e-cigarettes with different flavors, is not known in the Medina region in Saudi Arabia. Thus, the study aimed to assess the prevalence and characteristics of e-cigarette smokers in Medina region. Additionally, this study aimed to determine the popular flavors and the most common reasons for smoking e-cigarettes among young adults. METHODS: This cross-sectional study was conducted between 1 February and 19 March 2024 using an online questionnaire via convenience sampling. The total number of participants was 388, including males and females aged ≥18 years. RESULTS: The study findings showed that 78.2 % of the e-cigarette smokers were young adults, while 58.4 % of the participants aged 18-29 years preferred fruit flavors. Additionally, the majority of young adults used e-cigarettes for reducing stress and enjoyment, corresponding to 40.6 % and 31.7 % of participants, respectively. CONCLUSIONS: Our study is useful for identifying the preferences towards e-cigarette usage within a population and monitoring emerging trends, particularly among young adults. Researching regional preferences for e-cigarette flavors might help to direct future studies into the health effects of various flavorings.
Association between home smoking and e-cigarette use restrictions and concurrent use behaviors among dual users of cigarettes and e-cigarettes.
Do VV, Huang J, Pechacek TF … +4 more , Spears CA, Ashley DL, Berg CJ, Weaver SR
Tob Induc Dis · 2025 · PMID 41019464 · Full text
INTRODUCTION: Limited data exist on how home smoking and e-cigarette use restrictions influence patterns of cigarette and e-cigarette use among individuals who use both products. This study examined the association betwe...
INTRODUCTION: Limited data exist on how home smoking and e-cigarette use restrictions influence patterns of cigarette and e-cigarette use among individuals who use both products. This study examined the association between home restrictions and the use of cigarettes and e-cigarettes among dual users of these two products. METHODS: We conducted a secondary analysis of data from the Adult Consumers of Tobacco Study (ACTS), an online, nationwide survey administered during 2020-2021. A sub-sample of 250 dual users of cigarettes and e-cigarettes was included in this analysis. Outcome variables were concurrent use behaviors, categorized as predominant smokers (daily smoking, e-cigarette use some days), equivalent users (either daily or some days use of both products), and predominant e-cigarette users (daily e-cigarette use, smoking some days), as well as e-cigarette use frequency (daily vs some days). Primary explanatory variables were home smoking and e-cigarette use restrictions (both categorized as complete, partial, or no restrictions). Multivariable logistic regression was used to examine associations between restrictions and concurrent use behaviors. RESULTS: Nearly half (46.8%) of dual users reported having complete smoking restrictions in their homes, complete e-cigarette use restrictions (12.8%), and complete restrictions on both (11.2%). Dual users reported having complete home smoking restrictions (vs no restrictions) were more than two times more likely to be predominant e-cigarette users versus equivalent users or predominant smokers (AOR=2.60; 95% CI: 1.30-5.30), after controlling for home e-cigarette use restrictions and other covariates. Neither partial smoking restrictions nor partial e-cigarette use restrictions were associated with concurrent use behaviors. CONCLUSIONS: Small proportions of dual users reported having complete smoking and e-cigarette use restrictions adopted in their homes, suggesting a need for promoting the adoption of such restrictions. Moreover, how and why home smoking and e-cigarette use restrictions differentially impact use behaviors warrant additional investigation.
Do China's e-cigarette control policies work? A decade-long analysis of public discourse using an AI-integrated mixed-methods approach.
Li Z, Wang X, Yao X … +1 more , Chen Y
Tob Induc Dis · 2025 · PMID 41019463 · Full text
INTRODUCTION: China, the world's largest tobacco market, has raised concerns due to e-cigarettes' health risks and rising youth usage. Despite a decade of regulatory policies, their effectiveness remains uncertain. This...
INTRODUCTION: China, the world's largest tobacco market, has raised concerns due to e-cigarettes' health risks and rising youth usage. Despite a decade of regulatory policies, their effectiveness remains uncertain. This study examines trends in e-cigarette discourse on Weibo (2016-2025), analyzing discussion volume shifts and the impact of various topics on public engagement. METHODS: This study employs a hybrid computational approach integrating topic modeling, LLM-assisted annotation, and quantitative analysis to examine the evolution of e-cigarette discussions on Weibo (2015-2025) and topic dissemination effects (n=129769). LDA modeling identify 10 topics, followed by DeepSeek-V3-assisted classification. Linear regression in SPSS analyzed relationships between topic categories and social media engagement metrics (reposts/comments/likes) at 95% confidence intervals. RESULTS: Findings reveal 2020 as a key year of change: pro-vaping posts declined while anti-vaping content increased. Despite reduced volume, pro-vaping material maintained significant digital influence. Pre-policy, marketing content (p<0.01), health effects (p<0.01) and regulation (p<0.01) drove engagement. Post-policy, marketing lost engagement impact, while 'user experience' posts gained traction, significantly correlating with all interactions (all p<0.05). This indicates regulations were less effective against user-generated content, with pro-vaping messaging shifting towards peer-driven channels. Crucially, influencers consistently triggered strong engagement throughout the period (p<0.01) despite lower post volume, remaining key discourse drivers. CONCLUSIONS: Although China is strengthening its control over e-cigarettes, the results of our study indicate that this control remains limited. We advocate for more robust regulation of social media content, particularly concerning the management of celebrities and influencers, as well as the sharing of e-cigarette use experiences. However, the current regulatory framework enforced by the State Tobacco Monopoly Administration has proven inadequate for widespread and effective governance. We suggest that regulatory authority be shared with public health agencies in order to better integrate e-cigarette regulation with broader public health objectives.
A protection motivation theory-based scale for e-cigarette use assessment among Chinese college students: Development and validation.
Chen Y, Wang Z, Xu J … +4 more , Chen X, Cai Y, Chen S, Chan KS
Tob Induc Dis · 2025 · PMID 41019462 · Full text
INTRODUCTION: Electronic cigarettes (e-cigarettes) have gained increasing popularity among young adults worldwide, particularly among college students who represent a key target population for e-cigarette marketing. Unde...
INTRODUCTION: Electronic cigarettes (e-cigarettes) have gained increasing popularity among young adults worldwide, particularly among college students who represent a key target population for e-cigarette marketing. Understanding cognitive factors that influence e-cigarette use susceptibility is critical for developing effective prevention strategies. This study aimed to develop and validate a scale based on the Protection Motivation Theory (PMT) to assess cognitive factors related to e-cigarette use susceptibility among Chinese college students for prevention purposes. METHODS: A cross-sectional survey design was employed and data were collected among 303 students aged 18-24 years from universities in China during February 2023. A 21-item PMT scale was adapted from a previous study on Chinese youth tobacco use. Construct validity was assessed using confirmatory factor analysis (CFA). Internal consistency reliability was evaluated using Cronbach's α. Structural equation modeling was used to examine associations between PMT constructs and e-cigarette use susceptibility. Statistical significance was set at p<0.05, and all tests were 2-tailed. Power calculations indicated adequate sample size for the planned analyses. Concurrent validity was examined by correlating PMT constructs with e-cigarette use susceptibility. RESULTS: After removing one item, the final 20-item scale demonstrated good model fit in the CFA (GFI=0.917, CFI=0.933, RMSEA=0.055). Internal reliability was acceptable to good (Cronbach's α=0.52-0.83). The overall Cronbach's α coefficient was 0.831. All PMT constructs were significantly correlated with e-cigarette use susceptibility in the expected directions (p<0.05). CONCLUSIONS: The PMT-based scale is a valid and reliable measure to investigate e-cigarette use related cognitions among Chinese college students, and can be used as a tool to guide prevention efforts. The study supports the utility of applying PMT to e-cigarette research in different socio-cultural contexts.
The hidden threat of tobacco use among Chinese adolescents.
Lin J, Ma C
Tob Induc Dis · 2025 · PMID 41019461 · Full text
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Association between long-term smoking cessation and COVID-19 outcomes: Findings from a nationwide crosssectional online survey in China.
Zhou X, Aihemaiti A, Cheng A … +10 more , Liu Z, Su Z, Xie Y, Huang Z, Zhao L, Xia X, Liu Y, Song Q, Xiao D, Wang C
Tob Induc Dis · 2025 · PMID 41019460 · Full text
INTRODUCTION: Smoking has been identified as a potential risk factor for adverse COVID-19 outcomes. This study aimed to investigate the association between long-term smoking cessation and COVID-19 outcomes. METHODS: In t...
INTRODUCTION: Smoking has been identified as a potential risk factor for adverse COVID-19 outcomes. This study aimed to investigate the association between long-term smoking cessation and COVID-19 outcomes. METHODS: In this nationwide, cross-sectional online survey conducted in China (January-February 2023), 22709 adults with COVID-19, confirmed by nucleic acid amplification test (NAAT) or SARS-CoV-2 antigen testing, were included. Smoking status was self-reported and classified as never smokers, long-term ex-smokers (≥10 years), ex-smokers (<10 years), and current smokers. COVID-19 outcomes, including pneumonia, hospitalization, and severe COVID-19, were compared across these groups. Logistic regression models were used to adjust for potential confounders. Sensitivity analyses included all self-reported cases irrespective of test confirmation. RESULTS: Among 22709 COVID-19-positive participants, current smokers and ex-smokers <10 years exhibited significantly higher proportion of pneumonia, hospitalization, and severe COVID-19 than never smokers. Current smokers (AOR=3.18; 95% CI: 2.90-3.48) and ex-smokers quit <10 years (AOR=3.48; 95% CI: 2.96-4.09) had increased odds of pneumonia, whereas long-term ex-smokers showed no elevated risk (AOR=1.12; 95% CI: 0.45-2.41). These associations were consistent in sensitivity analyses. Other factors significantly associated with pneumonia included sex, education level, residence, obesity, income, and chronic conditions. CONCLUSIONS: Long-term smoking cessation was not associated with an elevated risk of COVID-19-related pneumonia compared to never smokers, whereas ex-smokers (<10 years) and current smokers remained high-risk groups. These findings support the potential benefits of sustained cessation, although further longitudinal studies are needed to confirm and extend these findings.
Determinants of successful smoking cessation in outpatient settings: A comparative analysis of varenicline and free program interventions.
He Y, Chen J, Zhao L … +1 more , Qu S
Tob Induc Dis · 2025 · PMID 41000452 · Full text
INTRODUCTION: Smoking cessation is a significant challenge, and various factors influence the success rates. Understanding the factors affecting cessation outcomes can guide more effective intervention strategies. This s...
INTRODUCTION: Smoking cessation is a significant challenge, and various factors influence the success rates. Understanding the factors affecting cessation outcomes can guide more effective intervention strategies. This study compares the efficacy of a general outpatient cessation program versus a free cessation program, with subgroup analyses based on medication type (bupropion vs varenicline), aiming to identify factors associated with successful smoking cessation in outpatient settings. METHODS: We analyzed data from 356 patients visiting our smoking cessation clinic between January 2018 and June 2022, with random allocation into two groups via computerized random number table upon enrollment: Group A (general outpatient intervention, n=188) and Group B (free cessation program, n=168). Both groups were further subdivided based on the use of bupropion (A1, B1) or varenicline (A2, B2). Factors such as demographic data, nicotine dependence, smoking cessation confidence, exhaled carbon monoxide, and smoking cessation success (7-day point prevalence abstinence rate [PPAR] and 3-month continuous quitting rate [CQR]) were analyzed. To ensure comprehensive results, we performed an intention-to-treat (ITT) analysis, including participants who dropped out or did not complete the study as failures in the smoking cessation outcome. RESULTS: There were no significant differences between groups A and B in demographics, smoking behavior, or medication, except for occupation and duration of cigarette smoking. Group B had lower nicotine dependence but comparable smoking cessation outcomes to Group A. Factors associated with successful cessation included being older, married, employed full-time, smoking ≤20 cigarettes/day, and using varenicline. The CQR of Group A2 was 9.36% higher than that of Group A1. The PPAR and CQR of Group B2 were 16.66% and 17.93% higher than those of Group B1, respectively. However, there were no significant differences in PPAR and CQR between Group A2 and Group B2. CONCLUSIONS: Varenicline use, specific sociodemographic characteristics (aged >50 years, married, full-time employment), and less severe smoking behavior (≤20 cigarettes/day, ≤25 years duration, ≤600 pack-year) are key determinants of successful smoking cessation in outpatient settings. Varenicline use was associated with significantly higher cessation rates compared to bupropion within both intervention models. The free program incorporating varenicline (B2) demonstrated particularly high success rates.
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