INTRODUCTION:Systemic inflammation has been implicated in cancer development, but prospective evidence regarding its association with lung cancer risk remains limited. This study evaluated the associations of systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) with lung cancer risk according to smoking status, alcohol drinking status, and their combined exposure patterns in Korean men. METHODS:This secondary dataset analysis utilized data from the Korean Cancer Prevention Study-II (KCPS-II), a nationwide prospective cohort. Among 20167 men, 236 incident lung cancer cases were identified during a median follow-up of approximately 14 years. Adjusted hazard ratios (AHRs) for lung cancer per 1 standard deviation (SD) increase in SII and NLR were estimated using multivariable Cox proportional hazards models adjusted for demographic, lifestyle, liver function, and endogenous antioxidant biomarkers. Analyses were performed in the overall population and stratified by smoking and alcohol status, including concurrent current smokers and drinkers. RESULTS:Higher SII and NLR were associated with increased lung cancer risk in Korean men, with consistent associations observed among current smokers, current drinkers, and individuals with concurrent current smoking and drinking. In combined exposure analyses, substantially elevated risks were observed among current smokers with high inflammatory marker levels (SII: AHR=3.58; 95% CI: 2.51-5.09; NLR: AHR=3.78; 95% CI: 2.65-5.39). SII showed the strongest association among individuals smoking ≥30 cigarettes/day (AHR=1.39; 95% CI: 1.21-1.60). CONCLUSIONS:Systemic inflammatory markers, particularly SII, were associated with lung cancer risk in Korean men, with stronger associations observed among current smokers. These findings suggest that systemic inflammatory status may help identify individuals at elevated risk of smoking-related lung cancer.
INTRODUCTION:Questionnaire-based assessment of secondhand smoke (SHS) exposure may not fully capture children's internal nicotine burden. We assessed concordance between parent-reported SHS exposure and urinary cotinine classifications and examined correlates of discordance by developmental stage and survey cycle. METHODS:This secondary analysis included children aged 3-11years with urine specimens and parent-completed questionnaire data from two independent cross-sectional samples in the Korean National Environmental Health Survey (KoNEHS 2016-2017 and 2019-2020; N=2619). Pooled analyses were unweighted; cycle-specific weighting was examined in sensitivity analyses. Concordance between parent-reported SHS exposure (≥1 time/week) and urinary cotinine-based classifications at three prespecified thresholds [at or above the limit of detection (LOD), ≥3 ng/mL, and ≥5 ng/mL] was evaluated using sensitivity, specificity, Cohen's κ, and McNemar's test. Correlates of questionnaire-negative/biomarker-positive discordance were examined using multivariable logistic regression. RESULTS:Concordance was negligible across thresholds and age groups (κ range: -0.02-0.01; McNemar p<0.001 for most strata). Sensitivity ranged from 7.1% to 16.1%, and at least 83.9% of biomarker-positive children were questionnaire-negative. Parent-reported SHS exposure was lower in Cycle 4 among children aged 3-5 and 6-8 years, whereas urinary cotinine concentrations were higher across all age groups. Among children aged 3-5 and 6-8 years without parent-reported SHS exposure, cotinine concentrations were higher in those with at least one current parental smoker than in those with no current parental smoker. At ≥LOD, questionnaire-negative/biomarker-positive discordance was associated with younger age (3-5 vs 9-11 years: adjusted odds ratio, AOR=1.64; 95% CI: 1.20-2.24) and with Cycle 4 (vs Cycle 3: AOR=2.09; 95% CI: 1.59-2.75). CONCLUSIONS:Parent-reported SHS exposure and urinary cotinine classifications showed marked discordance. These measures captured related but non-interchangeable information; urinary cotinine may complement questionnaires when characterizing children's internal nicotine burden.
INTRODUCTION:Neuroblastoma suppressor of tumorigenicity 1 (NBL1) is an established tumor suppressor and prognostic biomarker in neuroblastoma (NB). Although tobacco exposure is a well-known carcinogenic factor, its potential effect on NBL1 expression remains unclear. This two-sample Mendelian randomization (MR) study aimed to explore potential links between diverse smoking exposures, circulating NBL1 levels and NB risk. METHODS:This study performed a two-sample MR analysis to investigate the causal effects of maternal smoking around birth (66 single-nucleotide polymorphisms, SNPs), household smoking exposure (17 SNPs), and smoking initiation (37 SNPs) on circulating NBL1 levels using large-scale GWAS summary statistics. Causal estimates were obtained using IVW, weighted median, and MR-Egger methods, with sensitivity, reverse MR, and validation analyses conducted to assess robustness and directionality. RESULTS:No evidence of a causal association was observed between maternal smoking around birth or household smoking exposure and NBL1 levels. In contrast, genetically predicted smoking initiation was associated with lower NBL1 expression (IVW: OR=0.70; 95% CI: 0.50-0.99, p=0.04). The weighted median method failed to reach statistical significance (OR=0.642; 95% CI: 0.40-1.04, p=0.07), whereas MR-Egger regression yielded a non-significant estimate (OR=0.39; 95% CI: 0.06-2.56, p=0.34). Sensitivity analyses indicated no substantial pleiotropy or influential outliers. Reverse MR analysis provided no evidence that NBL1 influences smoking behavior. Additional validation analyses showed no causal association between smoking initiation and NB risk. CONCLUSIONS:Prenatal and household smoking exposures do not appear to affect NBL1 expression. Genetically predicted smoking initiation was associated with reduced NBL1 expression, but not with neuroblastoma risk.
INTRODUCTION:Low-back pain (LBP) is the leading cause of disability worldwide. Although smoking is a well-established, modifiable risk factor that accelerates intervertebral disc degeneration, comprehensive spatiotemporal analyses of its attributable burden remain scarce. This study assessed the global burden of smoking-attributable LBP from 1990 to 2021, elucidating the underlying temporal dynamics and socioeconomic inequalities. METHODS:Data were extracted from the Global Burden of Disease (GBD) study 2021. We evaluated absolute disability-adjusted life years (DALYs), age-standardized DALYs rate (ASDR), and estimated annual percentage change (EAPC) across 204 countries and territories. To disentangle temporal trends, age-period-cohort and joinpoint regression models were applied. The spatial-temporal relationship between the burden and the sociodemographic index (SDI) was also examined. RESULTS:Globally, the absolute number of DALYs for smoking-attributable LBP increased by 29.6% to 8.67 million in 2021, primarily driven by population growth and aging. Conversely, the global ASDR decreased significantly by 35.8% to 99.95. Males bore a substantially higher burden than females, with biological risk peaking at 60-69 years (inverted U-shape). The ASDR trajectory exhibited a distinct inverted U-shaped relationship with SDI; while high-income nations experienced rapid declines (e.g. Denmark, EAPC= -2.29), the burden surged in specific developing regions (e.g. Afghanistan, EAPC=2.37). Joinpoint analysis revealed an accelerated global decline from 2016 to 2021 (annual percent change, APC= -1.70). Age-period-cohort modeling confirmed continuous monotonic reductions in both period and cohort relative risks, highlighting a profound 'generational dividend'. CONCLUSIONS:Despite continuous improvements in age-standardized rates driven by recent global tobacco control policies and younger birth cohorts, the absolute burden of smoking-attributable LBP continues to grow. Progress is alarmingly unequal, heavily favoring high-income countries while intensifying in developing nations. Global health strategies must prioritize equitable implementation of tobacco control in lower income regions and integrate cessation programs into occupational health initiatives and strengthening of targeted tobacco control policies, particularly in low- and middle-income regions.
INTRODUCTION:Smokeless tobacco use is a major preventable risk factor for lip and oral cavity cancer, with a particularly heavy burden in South and Southeast Asia. We aimed to quantify, across countries, whether the socioeconomic gradient of any tobacco use is more pro-poor than that of smoked tobacco alone, thereby indirectly assessing the additional inequality attributable to smokeless tobacco. METHODS:In this secondary analysis of publicly available Demographic and Health Surveys (DHS) data (66 countries, survey years 1999-2024), supplemented by the WHO Global Health Observatory and World Bank indicators, we computed concentration indices (CIXs), the slope index of inequality (SII), and Wagstaff-normalized CIXs for smoking and any tobacco use across wealth, education level, and residence dimensions. Eligible observations were country-survey estimates stratified by wealth quintile, education level, or urban/rural residence, with complete data across all subgroups; national-total, age-, and region-only estimates were excluded. The core hypothesis was tested indirectly, via paired comparison of any-tobacco versus smoked-only CIXs (81 paired observations), because DHS smokeless indicators are available only as national aggregates. Wagstaff decomposition quantified the relative contributions of socioeconomic determinants. RESULTS:The mean wealth-related CIX for smoking was -0.045 (SD=0.184), with 66% of estimates negative. The mean CIX for any tobacco use (-0.094) was significantly lower than for smoking alone (-0.060; paired ΔCIX= -0.033, 95% CI: -0.060 - -0.007, p=0.017), with 62% of pairs showing a more pro-poor gradient for any tobacco use. Education level and residence together accounted for >80% of explainable inequality in the decomposition analysis. CONCLUSIONS:The socioeconomic gradient of any tobacco use is significantly more pro-poor than that of smoking alone, suggesting that smokeless tobacco amplifies tobacco-related health inequality. These ecological findings suggest that tobacco-control monitoring may benefit from integrating smokeless tobacco into inequality surveillance; individual-level studies are needed before specific populations are targeted.
INTRODUCTION:Globally, tobacco use is a key public health issue. Exploring the impact of developing AI technologies on tobacco use and intervention will help promote the digital transformation of public health research. This study aims to map the trends, networks, and core themes of research at the intersection of artificial intelligence and tobacco use through visual analytics. METHODS:In this study, a bibliometric analysis was conducted on 335 articles on AI and tobacco use in the Web of Science core collection from 1997 to 2026. The search cutoff date was 8 April 2026. Descriptive and visual analysis were conducted on the publication trend, cooperation network, keyword co-occurrence, clustering, and burst of this literature. RESULTS:The speed of publication of literature in this field has increased significantly since 2018. In the cooperation network, national cooperation is dominated by the United States. Universities, rather than transnational institutions, significantly promote cooperation. The authors' cooperation network is more dispersed. The characteristics of interdisciplinary cooperation are obvious. The research hotspots focus on several aspects. These include machine learning prediction of smoking, dialogue AI and robot interventions, and NLP and social media monitoring. Other topics encompass the analysis of smoking-cessation behavior among youth groups, combined with AI, deep learning, and behavioral analysis; and the evaluation of tobacco characteristics, tobacco products, media, and health. Keyword hotspots and bursts reveal that the field has recently paid special attention to the intervention of cutting-edge technologies in smoking and smoking cessation behavior. CONCLUSIONS:Through data mining and visualization technology, this study reveals the overall evolution, interaction mode, and key fields of AI and tobacco use knowledge. The results provide an important framework for further research.
INTRODUCTION:Secondhand smoke (SHS) exposure is recognized as an important contributor to multiple adverse health outcomes, including hyperuricemia. However, the association between SHS exposure and hyperuricemia remains inconclusive. This study aimed to examine the relationship between SHS exposure and hyperuricemia using serum cotinine concentration as an objective biomarker. METHODS:Data were obtained from the National Health and Nutrition Examination Survey (NHANES) collected between 1999 and 2020. A cross-sectional analysis was performed among 18610 adults who self-reported never smoking (never smokers). Participants were categorized into four groups based on serum cotinine concentrations: non-exposure (<0.05 ng/mL), low-exposure (0.05-0.99 ng/mL), moderate-exposure (1-10 ng/mL), and heavy-exposure (>10 ng/mL). Associations between SHS exposure and hyperuricemia were evaluated using multivariable logistic regression analysis models and smooth curve fitting. RESULTS:After adjusting for potential confounders, the adjusted odds ratios (AOR) for hyperuricemia in the low-, moderate-, and heavy-exposure groups, compared with the non-exposure group, were 1.34 (95% CI: 1.18-1.53), 1.48 (95% CI: 1.08-2.02), and 1.97 (95% CI: 1.27-3.05), respectively. A non-linear positive saturation association was observed between log2-transformed serum cotinine concentrations and the prevalence of hyperuricemia. The inflection point was identified at approximately -3.37 ng/mL, with an AOR of 1.15 (95% CI: 1.08-1.22). Subgroup analysis revealed consistent associations across all demographic and clinical stratifications. CONCLUSIONS:Among never smokers, SHS exposure was significantly associated with an increased risk of hyperuricemia. A threshold effect was identified at a serum cotinine concentration of -3.37 ng/mL. These findings provide a direction for further study on the relationship between SHS exposure and hyperuricemia.
INTRODUCTION:Type 2 diabetes (T2D) is a major global health burden with rising prevalence and significant morbidity and mortality. Smoking has been recognized as an independent risk factor for T2D, but the exact underlying mechanisms are not yet fully understood. METHODS:We conducted a two-sample Mendelian randomization (MR) study to investigate the effects of smoking behaviors and smoking-related DNA methylation on type 2 diabetes (T2D) risk. This secondary analysis was based on publicly available summary statistics. Smoking traits were obtained from a large meta-GWAS of over 1.2 million individuals of European ancestry. DNA methylation data were derived from the CHARGE Consortium EWAS (n=15907) and mQTLs from the GoDMC (n=27750). T2D outcome data were obtained from a European GWAS including 74124 cases and 824006 controls. Replication was performed in FinnGen (17268 cases, 184778 controls) and BioBank Japan (40250 cases, 170615 controls). Stringently selected genetic instruments were applied, and causal effects were estimated primarily using two-sample MR with inverse-variance weighted analysis, complemented by MR-Egger and weighted median approaches, and further validated by colocalization analysis. RESULTS:In our genomic analysis, we presented convincing evidence supporting the association between genetically predicted smoking initiation and an increased susceptibility to T2D. In epigenetic analysis, we identified methylation at 21 smoking-related CpG sites associated with T2D risk. Subsequently, 14 of these CpG sites were validated using the FinnGen dataset, and 12 of them were validated using the BBJ dataset. Furthermore, we observed strong colocalization evidence for four CpG sites, including cg23756272 (BCL2), cg03864215 (KCNJ11), cg09861057 (TDRD10) and cg10672416 (C12orf65), and T2D risk. CONCLUSIONS:This research provides novel findings of the impact of smoking on T2D susceptibility, highlighting the role of epigenetic DNA methylation.
INTRODUCTION:Geographical research on tobacco control has focused predominantly on tobacco retail environments, whereas spatial accessibility studies using methods such as Enhanced Two-Step Floating Catchment Area (E2SFCA) have examined primary care but rarely smoking cessation services. This study aimed to evaluate the geographical accessibility of smoking cessation clinics and hospitals across Japan's secondary medical areas (SMAs) in a cross-sectional ecological spatial analysis using large-scale spatial data. METHODS:Accessibility scores (AS) were calculated at 422804 grids nationwide using E2SFCA. Demand was defined as the smoking rate-adjusted population, and supply comprised approximately 19000 facilities registered under Japan's insurance-covered smoking cessation program. A regional typology was developed using Ward's hierarchical cluster analysis. The distribution of standardized claim ratios (SCRs) from nationwide claims data (2018-2022) was examined descriptively across clusters. RESULTS:Of the 335 SMAs, 319 were analyzed after excluding 16 areas with missing SCR data. The median AS varied substantially across areas (range: 286-5626). Three clusters emerged: Cluster 1, 'Low accessibility-High disparity' (24.1%); Cluster 2, 'Moderate accessibility-Low disparity' (62.4%); and Cluster 3, 'High accessibility-Low disparity' (13.5%). Clusters 2 and 3 showed similar Gini coefficients, differing primarily in AS levels. Cluster 3 showed descriptively higher SCR values (median: 117) compared with Clusters 1 and 2 (median: 93-95). CONCLUSIONS:This study demonstrates substantial geographical disparities in the accessibility of smoking cessation services in Japan. Regions with higher accessibility tended to exhibit lower intra-regional disparities. For the implementation of the WHO FCTC Article 14, ensuring an equitable geographical distribution of services may be as important as expanding the overall number of facilities.
INTRODUCTION:While initiation of adolescent cigarette smoking has declined in the last two decades, changes to smoking progression have not been examined. METHODS:Survey data were from five cohorts of youth in Southern California (grade 12 in 1995, 1998, 2001, 2004, or 2014; n=2346). Among those who had smoked a cigarette by grade 10 (n=418), we modeled self-reported past-month, past-year, and lifetime number of cigarettes smoked in grade 12 as a function of grade 10 number of cigarettes and cohort (1995, 1998, 2001, 2004 vs 2014). RESULTS:Smoking progression declined markedly over time. Among youth who had smoked by grade 10, the 1995 cohort smoked on average 23 times as many lifetime cigarettes by grade 12 as the 2014 cohort (adjusted rate ratio, ARR=22.9; 95% CI: 9.40-55.6). Similar findings were observed for the past year (ARR=30.1; 95% CI: 6.75-134) and the past month (ARR=12.1; 95% CI: 2.19-67.0) number of cigarettes smoked. Over time, females smoked less, but the pattern of decreasing progression in lifetime cigarettes smoked was more pronounced for females than males (lifetime, p for interaction <0.0001). CONCLUSIONS:The rate of progression among those initiating cigarette smoking in early high school decreased markedly over the two-decade period starting in 1995, suggesting that social or environmental factors may play a substantial role in the escalation of smoking through adolescence.
INTRODUCTION:Tobacco use among healthcare workers is important not only in terms of individual health risks but also regarding the effectiveness of tobacco control services. The aim of this study was to determine the prevalence of tobacco use among healthcare personnel working in public primary, secondary, and tertiary care facilities in Trabzon Province and to assess factors associated with tobacco use. METHODS:This cross-sectional study was conducted between July 2025 and February 2026 among healthcare workers aged ≥18 years who were actively employed in public healthcare institutions in Trabzon Province and agreed to participate. Data were collected from 1381 participants through face-to-face interviews. Use of any tobacco product within the past 30 days was considered the primary dependent variable. Nicotine dependence was assessed using the Fagerström test for nicotine dependence (FTND). Logistic regression analysis was performed to identify factors associated with tobacco use and nicotine dependence. RESULTS:The prevalence of current tobacco product use was 25.2% (95% CI: 23.0-27.4). Specifically, 20.9% used only traditional tobacco, 1.5% used only novel nicotine and tobacco products, and 2.8% were dual users. Approximately half of the users exhibited moderate-to-high nicotine dependence. Multivariable analysis showed current use was strongly associated with having a tobacco user in the close environment (AOR=10.40; 95% CI: 5.20-20.81). Male sex (AOR=1.84; 95% CI: 1.33-2.56), shift/on-call work (AOR=1.51; 95% CI: 1.12-2.04), exposure to pro-tobacco social media content (AOR=1.73; 95% CI: 1.31-2.27), and higher stress scores (AOR=1.31; 95% CI: 1.22-1.42) were also associated with current use. Among users, male sex increased the odds of moderate-to-high nicotine dependence (AOR=2.04; 95% CI: 1.23-3.38), whereas living with family was associated with lower odds (AOR=0.47; 95% CI: 0.24-0.92). CONCLUSIONS:Tobacco use among healthcare workers remains a significant public health issue. These findings reveal associations between tobacco use and individual, occupational, and psychosocial factors, highlighting the need for longitudinal studies and tailored tobacco control strategies in this population.
INTRODUCTION:As a common clinical symptom, diarrhea imposes considerable burdens on patients' lives and healthcare. Smoking and secondhand smoke (SHS) exposure, as modifiable risk factors, currently exhibit an uncertain relationship with diarrhea, lacking relative studies to clarify the relationship. The study aims to clarify the relationship between different tobacco exposure situations and diarrhea. METHODS:This is a secondary analysis of 2005-2010 NHANES data, following a cross-sectional analytical design. Tobacco exposure in the population was divided into four groups (smokers, ex-smokers, never smokers exposed to SHS, and never smokers not exposed to SHS) based on smoking status and household SHS exposure. Diarrhea was ascertained using the Bristol Stool Form Scale (BSFS). Logistic regression analyses evaluated associations between tobacco exposure and diarrhea, with stratification analysis conducted to validate the robustness of findings. Additionally, we examined the potential mediating role of serum nicotine in this relationship. RESULTS:Compared to never smokers not exposed to SHS, smokers demonstrated a significantly elevated likelihood of diarrhea (AOR=1.56; 95% CI: 1.25-1.93). However, this association was not observed among ex-smokers or never smokers exposed to SHS. Among smokers, those who reported smoking immediately after waking showed an increased likelihood of reporting diarrhea (AOR=1.69; 95% CI: 1.17-2.45). Each additional year of smoking duration was associated with a 2% increase in the likelihood of diarrhea (AOR=1.02; 95% CI: 1.00-1.03) while daily cigarette consumption showed no significant association. Serum cotinine was not a mediator in the relationship between tobacco exposure and diarrhea. CONCLUSIONS:Active tobacco exposure is associated with an elevated likelihood of diarrhea, whereas no association was found for either passive smoking or former smoking. Both smoking duration and smoking immediately upon waking exhibit positive associations with heightened diarrhea likelihood, suggesting potential intestinal health benefits from smoking cessation at an earlier stage. Serum cotinine did not mediate this relationship.
INTRODUCTION:Workplaces are important settings for smoke-free protection and cessation support, but enterprise ownership may shape quit attempts. This cross-sectional data analysis examined whether employees of state-owned enterprises experience greater smoking cessation difficulty than employees of private enterprises. METHODS:We analyzed cross-sectional self-reported data from an anonymous online questionnaire administered in October 2025. The questionnaire link was distributed through employee WeChat groups in six enterprises in Zhejiang Province, China (three state-owned and three private). Eligible participants were full-time employees aged ≥18 years who had worked in the enterprise for at least six months. The analytic sample comprised 989 employees. Outcomes were workplace cessation culture, indoor workplace secondhand smoke exposure in the past 30 days, quit intention within six months, and past-year quit attempt among current smokers. Ownership-group differences were assessed descriptively and using multivariable linear regression and logistic generalized estimating equations. RESULTS:The sample included 483 state-owned and 506 private enterprise employees. Current smoking was more common in state-owned enterprises (34.8% vs 27.5%, p=0.046). State-owned enterprise employees reported lower cessation culture (3.33 vs 3.64, p<0.001), less cessation support (2.5 vs 3.6, p<0.001), stronger pro-smoking norms (2.90 vs 2.49, p<0.001), and more indoor workplace secondhand smoke exposure (42.0% vs 25.5%, p<0.001). Among current smokers, quit intention (36.9% vs 52.5%, p=0.009) and past-year quit attempts (29.8% vs 57.6%, p<0.001) were less common in state-owned enterprises. After adjustment, private enterprise employment was associated with higher odds of quit intention (adjusted odds ratio, AOR=1.51; 95% CI: 1.05-2.19) and past-year quit attempt (AOR=2.82; 95% CI: 1.65-4.84). CONCLUSIONS:State-owned enterprise employees experienced greater cessation difficulty than private enterprise employees. Higher secondhand smoke exposure, stronger pro-smoking norms, weaker cessation support, and lower leadership commitment may contribute to this ownership-related difference.
INTRODUCTION:Vape use in Australian young adults (18-24 years) is the highest of all age groups. With long-term health behaviors established during young adulthood, vaping addiction is concerning, as is establishing appropriate cessation supports for this group. Our qualitative study explored the perspectives and experiences of vaping-related addiction and cessation among Australian young adults. METHODS:This study was a qualitative study using data from the Generation Vape research study. Twenty semi-structured focus groups were conducted online in February 2023. The Framework Method was used to thematically analyze for key themes and sub-themes. RESULTS:Participants (n=114) were, on average, 21 years old, approximately half were female (51.8%), and most had vaped (78.9%). Our analysis identified three themes: 1) factors facilitating regular vaping; 2) perceptions of vaping addiction; and 3) vaping cessation behaviors. Themes appeared to influence each other and highlighted the nuanced ways young adults understand addiction and reflect on their use. While young adults agreed that vapes were addictive, addiction itself was categorized as habitual (i.e. embedded in daily routine) or compulsive (i.e. an uncontrollable urge) - with varying levels of acceptability. Young adults experiencing addiction to vaping highlighted that this was an unintended outcome, describing cessation challenges of nicotine withdrawal and social temptation. Those not considering cessation felt in control of their use and would avoid addiction, viewing vaping as a transient life-phase. CONCLUSIONS:Our findings are timely considering the recent policy changes in Australia. Vaping attitudes and potential misconceptions need to be challenged in young adults who may underestimate addiction. Given that vaping is a socially embedded practice among young adults, support tailored specifically to this group is needed to effectively promote cessation.
INTRODUCTION:Nicotine replacement therapies (NRTs) are established evidence-based interventions for smoking cessation. In Saudi Arabia, where tobacco use remains a significant public health concern, understanding public awareness, perceptions, and motivations related to NRT use is essential for designing effective cessation strategies. This study aimed to assess awareness, perceptions, motivation to quit smoking, and self-reported nicotine dependence related to NRT use among adults in Saudi Arabia. METHODS:Between February and May 2025, a cross-sectional online survey was distributed via social media platforms to adults aged ≥18 years across Saudi Arabia. The survey comprised four domains: demographics, NRT awareness/perception, the Questionnaire on Motivation to Quit (Q-MAT; 4 scored items, range 0-20), and the Nicotine Dependence Syndrome Scale (NDSS; 16 items, 5-point Likert scale). The Q-MAT and NDSS were administered only to current smokers. Internal consistency was assessed using Cronbach's alpha. Chi-squared tests examined associations between demographic variables and NRT awareness. Binary logistic regression identified predictors of NRT awareness. Independent samples t-tests compared NDSS scores by motivation level. RESULTS:Among 425 eligible participants, 72.5% were male, and the largest proportion were aged 25-34 years (43.3%). Overall, 89.1% of the participants were aware of NRTs. However, 49.3% were unsure about the most effective NRT type, and 37.3% were uncertain about its side effects. The Q-MAT (Cronbach's α=0.729) yielded a mean motivation score of 12.3 ± 5.8 (out of 20), with 44.4% classified as highly motivated. The NDSS (α=0.876) revealed moderate-to-high dependence (overall mean 2.94 ± 0.78), with the Drive subscale scoring highest (3.25 ± 1.09). Logistic regression showed male gender was a significant predictor of NRT awareness (OR=1.98; 95% CI: 1.01-3.89; p=0.048). Two-thirds of participants (66.0%) supported NRT integration into academic curricula. CONCLUSIONS:While general NRT awareness was high among our sample of Saudi adults, significant knowledge gaps persist regarding its effectiveness and safety. High motivation to quit combined with moderate-to-high nicotine dependence underscores the importance of this area for future investigation. Longitudinal and interventional studies are needed to determine whether targeted education, improved access to cessation support, and integration of smoking cessation content into healthcare training programs can effectively address these gaps.
INTRODUCTION:Health professional students are potential tobacco users and future advocates for tobacco control. Evidence from the Caucasus on factors associated with tobacco use and policy support remains limited. This study examined tobacco use and support for tobacco-control policies among medical and public health students in Georgia. METHODS:A cross-sectional survey was conducted from June to December 2022 among students at Tbilisi State Medical University using a self-administered online questionnaire; all data were self-reported. Of 1078 randomly invited students, 667 completed the survey. Any past 30-day use of cigarettes, electronic cigarettes, heated tobacco products, cigars, bidis, or hookah was assessed, together with tobacco-related media exposure, peer and household tobacco use, and support for five tobacco-control policies. Multivariable logistic and linear regression examined factors associated with current use and policy support, adjusting for sociodemographic characteristics, media and retail exposures, and social exposures. RESULTS:Overall, 18.6% of students reported past 30-day tobacco or nicotine product use, and mean policy support was 5.45 on a 7-point scale. In adjusted analyses, the number of friends who used tobacco was the factor most strongly associated with current use (adjusted odds ratio, AOR=2.49; 95% CI: 1.81-3.43). Anti-tobacco media exposure was modestly associated with higher odds of use (AOR=1.07; 95% CI: 1.02-1.11), whereas pro-tobacco exposure was inversely associated (AOR=0.92; 95% CI: 0.87-0.97). Current use (adjusted regression coefficient, B= -0.65; 95% CI: -0.94 - -0.35) and male sex (B= -0.41; 95% CI: -0.64 - -0.18) were independently associated with lower policy support. CONCLUSIONS:Peer tobacco use was the factor most strongly associated with current tobacco or nicotine product use among medical and public health students in Georgia. Although policy support was generally high, current users expressed weaker support. Additional longitudinal and multi-institutional studies are needed to provide sufficient evidence to inform tobacco-use prevention and the promotion of tobacco-control engagement during health professional training.
INTRODUCTION:Smoking and sleep problems are both major public health concerns, but the causal nature of their association remains unclear due to confounding and reverse causality. To address this, observational and Mendelian randomization approaches were combined to investigate the causal relationships between smoking status, cotinine levels, and sleep deprivation and sleep disorder. METHODS:Data from NHANES (2005-2020) were analyzed using weighted logistic regression, subgroup, and threshold analyses to assess associations between smoking status, cotinine levels, and sleep deprivation and sleep disorder. Mendelian randomization was then performed using genetic instruments for smoking phenotypes to evaluate causal relationships. RESULTS:In NHANES (n=22380), current smokers showed significantly higher risk of sleep disorder (OR=1.68; 95% CI: 1.49-1.90) and sleep deprivation (OR=1.52; 95% CI: 1.36-1.70) compared to never smokers. Serum cotinine was positively associated with both outcomes in a nonlinear manner, with threshold effects observed. In Mendelian randomization, genetic predisposition to current smoking was causally associated with increased risk of sleep deprivation (OR=1.253; 95% CI: 1.015-1.548), while never smoking showed protective causal effects on both outcomes. However, no causal associations were found between cotinine and sleep outcomes. CONCLUSIONS:Observational analyses revealed associations between smoking status, serum cotinine levels, and both insufficient sleep and sleep disorders. However, while Mendelian randomization provided evidence supporting a causal relationship between smoking status and sleep outcomes, it did not establish a causal link between serum cotinine and either insufficient sleep or sleep disorders.
