Importance:Most individuals attempting smoking cessation relapse, even with evidence-based treatment. Mobile interventions offer a potential but largely untested strategy to sustain cessation. Objective:To test the effectiveness of mobile chat messaging for relapse prevention among individuals who recently quit smoking. Design, Setting, and Participants:This randomized clinical trial was conducted from March 14, 2023, to August 15, 2024, at 2 clinic-based smoking cessation services in Hong Kong. Participants were adults who smoked daily and had abstained for 3 to 30 days; they were randomly assigned to an intervention group or a control group. Interventions:All participants received usual smoking cessation treatment from the services. The intervention group additionally received 3 months of mobile relapse prevention intervention, including chat-based support delivered by a live counselor and access to a supportive chatbot via a messaging app. The control group received 8 text messages on generic smoking cessation advice over 3 months as a contact control. Main Outcomes and Measures:The primary outcome was biochemically validated tobacco abstinence at 6 months after randomization, defined by an exhaled carbon monoxide level of less than 5 ppm or a negative salivary cotinine test result. Secondary outcomes at 6 months included self-reported prolonged abstinence, 7-day point prevalence abstinence, and relapse (7 consecutive days of smoking) rate. Intention-to-treat analyses were conducted, assuming participants with missing outcomes relapsed. Results:Of 590 participants, 465 (78.8%) were male, and the mean (SD) age was 47.1 (11.2) years; 294 were randomized to the intervention group and 296 were randomized to the control group. The retention rate at 6-month follow-up was 98.0% (n = 578). Biochemically validated abstinence at 6 months was significantly higher in the intervention group than in the control group (45.9% [135 of 294] vs 35.5% [105 of 296]; relative risk [RR], 1.29; 95% CI, 1.06-1.58; P = .01). The intervention group also reported significantly higher prolonged abstinence (57.5% [169 of 294] vs 47.6% [141 of 296]; RR, 1.21; 95% CI, 1.03-1.41; P = .02), higher 7-day point prevalence abstinence (65.6% [193 of 294] vs 54.7% [162 of 296]; RR, 1.20; 95% CI, 1.05-1.37; P = .007), and lower relapse rate (33.0% [97 of 294] vs 44.9% [133 of 296]; RR, 0.73; 95% CI, 0.60-0.90; P = .003) at 6 months. Conclusions and Relevance:This randomized clinical trial found that mobile chat messaging for smoking relapse prevention increased validated abstinence by approximately 30%, offering a scalable approach to sustain abstinence among individuals who recently quit smoking. Trial Registration:ClinicalTrials.gov Identifier: NCT05370352.

BACKGROUND:Evidence on the associations of multiple minor ECG abnormalities (EA) with cardiovascular disease (CVD) and mortality in older populations is limited, particularly whether a weighted EA score better predicts CVD risk than a single EA severity. METHODS:We analysed 26 846 Chinese aged 50+ years from Guangzhou Biobank Cohort Study (GBCS), without CVD at baseline. Minor and major EAs were classified based on the Minnesota Code Manual. EA severity was defined as normal, one minor, two or more minor and major abnormalities. Cox regression with backward stepwise selection was conducted to develop EA score. Cox regression was used to examine the associations of EA (severity/score) with incident CVD events, all-cause mortality and CVD mortality. C-index and Net Reclassification Index (NRI) were used to assess the improvement in CVD risk prediction after adding EA (severity/score) to the GBCS model variables. RESULTS:During an average follow-up of 15.3 (SD=3.5) years, 6232 CVD events and 5960 deaths occurred. Compared with normal ECG, one minor (adjusted HR 1.12, 95% CI 1.05 to 1.19), two or more minor (1.20, 95% CI 1.11 to 1.29) and major abnormalities (1.46, 95% CI 1.31 to 1.63) were associated with a higher risk of incident CVD events. The EA score showed a strong dose-response relationship (0 point as reference): 1-29 points (1.12, 95% CI 1.05 to 1.19), 30-59 points (1.56, 95% CI 1.38 to 1.77), ≥60 points (3.16, 95% CI 2.56 to 3.91) (p value for trend <0.001). Similar findings were observed for all-cause and CVD mortality. Adding EA score improved the C-index for incident CVD events, but the improvement diminished over time (change in C-index: 0.011 (95% CI 0.002 to 0.022) at 3 years to 0.003 (95% CI 0.002 to 0.004) at 15 years). The NRI for 10-year risk was 0.016 (95% CI 0.007 to 0.024), indicating limited utility. CONCLUSIONS:Major EA and multiple minor EAs were associated with higher risks of CVD events and mortality, but the value in improving CVD risk prediction is limited.

OBJECTIVES:The relative contributions of life-course obesity to midlife and late-life cognitive function have not been reported. We examined the association of life-course body size with cognitive function and identified the relative contribution of body size at each life stage. DESIGN:This was a study based on data from the Guangzhou Biobank Cohort Study. SETTING:A community-based population in China. PARTICIPANTS:9,303 participants without a history of dementia or other serious mental disorders were included, with a mean age of 59.9 years (standard deviation = 6.0 years). MEASUREMENTS:Perceived childhood, adolescence, early adulthood, midlife, and current body size were assessed by Stunkard's Figure Rating Scale (labelled 1-9, from very thin to very fat), and analysed as categorical or continuous variables. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), and analysed as a continuous score. A Bayesian relevant life course exposure model was used to quantify the relative contributions of body size to cognitive function. RESULTS:After adjustment for confounders, each one-figure increase in body size was associated with lower MMSE scores. The βs (95% confidence intervals) were -1.121 (-1.200, -1.043), -1.077 (-1.161, -0.993), -0.795 (-0.871, -0.719), -0.450 (-0.520, -0.380), -0.253 (-0.318, -0.188) for childhood, adolescence, early adulthood, midlife and current status, respectively. The contributions of larger body size to poorer cognitive function varied across life stages, with childhood and adolescence accounting for 58.96% (95% credible interval (CrI) = 49.81%-68.07%) and 38.52% (95% CrI = 29.11%-47.82%) of the association, respectively. CONCLUSION:Body size in childhood and adolescence mainly explained the negative association between life-course body size and cognitive function in midlife and late-life. This finding highlights the importance of early-life obesity prevention for maintaining cognitive function.

To examine the associations of planetary health diet (PHD) with all-cause and cause specific mortality, alongside heart age based on the Guangzhou Biobank Cohort Study (GBCS) and conduct mediation analysis. Participants were recruited from the GBCS and were aged ≥ 50 years. Dietary information was collected using a validated Food Frequency Questionnaire. Participants were assigned PHD scores between 0 (no adherence to PHD) and 140 (complete adherence to PHD). Primary outcomes were all-cause, cardiovascular disease (CVD) and cancer mortality. Causes of death were identified through death registry. Secondary outcome, heart age, was calculated using sex-specific 10-year CVD risk prediction models previously developed and validated in the GBCS. Cox proportional hazards regression and linear regression were used to analyze the associations of PHD scores with mortality and heart age. Mediation analyses were conducted using the difference method implemented by the “mediate” SAS macro. Of 25,550 participants aged 50+ years, during 417,590 person-years of follow-up, higher PHD scores was linearly associated with lower all-cause and CVD but not cancer mortality (hazard ratio (HR) (95

INTRODUCTION:While ChatGPT has shown promise in health domains, its application in smoking cessation, particularly in non-English contexts, remains underexplored. This study assessed the consistency, specificity, and inclusion of behavior change techniques in ChatGPT-4's advice for smoking-related queries in Traditional Chinese across three phases. METHODS:ChatGPT-4 was accessed via Azure OpenAI Services (temperature: 0.7, Top P: 0.95). Phase I assessed consistency of 10 responses to identical smoking-related questions, measured using the Jaccard coefficient. Phase II evaluated response specificity using 12 smoking-related vignettes, tailored to age, readiness to quit, and nicotine dependence, through Jaccard distances and alignment to the 2008 U.S. Clinical Practice Guideline. In phase III, responses to 20 detailed smoking-related vignettes were analyzed for the inclusion of behavior change techniques and also analyzed qualitatively. Two independent coders performed analysis in each phase, and discrepancies were resolved by a third coder. RESULTS:Substantial agreement was observed between coders (Kappa = 0.63-1.00). ChatGPT-4 provided advice in Traditional Chinese with opening, bullet-point recommendations, and concluding. In phase I, the median Jaccard coefficient was 0.50, indicating moderate consistency. In phase II, specificity was higher for readiness to quit (0.58) and age (0.44) compared to nicotine dependence (0.40). Phase III identified 17 unique behavior change techniques, averaging 10 per response. Qualitative analysis found that ChatGPT-4's advice was somewhat tailored but lacked sufficient detail or contextual appropriateness. CONCLUSIONS:ChatGPT-4 demonstrated moderate consistency, specificity, and inclusion of evidence-based content in its Traditional Chinese cessation advice. Improvements are needed to increase adherence to cessation guidelines and enhance contextual relevance. IMPLICATIONS:This study is the first to evaluate ChatGPT's ability to deliver smoking cessation advice in Traditional Chinese, a non-dominant language for such large language model. It highlights the feasibility of using generative artificial intelligence for digital health interventions beyond English-speaking settings. The findings demonstrate ChatGPT's potential to support smoking cessation in Chinese-speaking populations and suggest broader applicability for culturally and linguistically underrepresented communities in global tobacco control efforts.

Abstract Background: Epidemiologic and other studies have identified environmental, occupational, and genetic risk factors for lymphoid and myeloid malignancies, but most studies have been conducted in Western populations. Investigations in populations with differing exposure patterns, distributions of disease subtypes, and genetic architecture are needed to fully understand hematopoietic tumor etiology. Methods: We conducted a large, multicenter, hospital-based case-control study of lymphoid and myeloid neoplasms in East Asia (AsiaLymph), including 5,671 lymphoid cases, 1,879 myeloid cases, and 3,858 controls. Participants completed a computer-assisted personal interview and provided biospecimens. Cases underwent central pathology review and were coded into the WHO Classification. Herein, we describe the study methods in detail and report association results for education, body mass index, and family history. Results: Greater BMI at age 20 but not at age 40 was associated with odds of total lymphoid neoplasm (per 5 kg/m2 increase: OR [95% CI]: 1.18 [1.09-1.27]), total myeloid neoplasm (OR [95% CI]: 1.17 [1.05-1.29]), and several subtypes. Greater educational attainment was associated with increased odds of total lymphoid neoplasm (for college vs. less than primary education: OR [95% CI]: 1.41 [1.21-1.65]) but not myeloid neoplasm (OR [95% CI]: 1.17 [0.95-1.45]; p-heterogeneity=0.02). There were also positive associations between family history of hematologic cancer in first degree relatives and odds of lymphoid neoplasm (OR [95% CI]: 1.53 [1.15-2.03]) and myeloid neoplasm (OR [95% CI]: 1.65 [1.11-2.44]) and specific subtypes. None of the evaluated risk factors were associated with NK/T-cell lymphoma, which supports a distinct etiology for this subtype. Conclusion: The AsiaLymph Study is one of the largest molecular epidemiology studies of both lymphoid and myeloid neoplasms with standardized World Health Organization classification of histopathologic subtypes and will serve as a valuable resource for etiologic investigations into risk factors for these malignancies. Citation Format: Qing Lan, Lauren M. Hurwitz, John K. Chan, Tai Hing Lam, Kexin Chen, Yok Lam Kwong, Xu Caigang, Brian CH Chiu, Raymond Liang, Ip Dennis, Wei Hu, Bryan Bassig, Mark Purdue, Jun Xu, Sarah Locke, Sophia S. Wang, James R. Cerhan, Sonja Berndt, Jonathan N. Hofmann, Jianxin Shi, Kai Yu, Shahinaz Gadalla, Lisa J. McReynolds, Rena Jones, Hongji Dai, Zhangyan Lyu, Lugui Qiu, Wei Liu, Huilai Zhang, Xianhuo Wang, Lindsay M. Morton, Stephen Chanock, Martha Linet, Melissa C. Friesen, Roel Vermeulen, Nathaniel Rothman. A multi-center hospital-based case-control study of lymphoid and myeloid neoplasms (AsiaLymph): Study design and initial findings for education, body mass index, and family history [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 5051.

BACKGROUND:The effects of lipid traits on colorectal cancer (CRC) risk and the extent to which obesity may modify these effects remain unclear. OBJECTIVE:To examine the associations between lipid traits and CRC risk using an observational study and Mendelian randomization (MR) analyses, and the role of weight status in the potential associations. METHODS:In the Guangzhou Biobank Cohort Study (GBCS), lipid profiles were measured during 2003-2008, and CRC events were identified through record linkage with the cancer registry. MR analyses assessed the causal effects of lipid traits on CRC using a genome-wide association study meta-analysis of 185,616 Europeans. RESULTS:Among 28,576 GBCS participants followed until 2020, 599 CRC events occurred. Participants in the highest quartile of apolipoprotein B (apoB) had a higher CRC risk (hazard ratio [HR] 1.43, 95% CI 1.02-2.01). This association remained in those with overweight/obesity (HR 2.21, 95% CI 1.28-3.83). MR analyses supported a detrimental effect of apoB on CRC (odds ratio 1.12 per 1 SD, 95% CI 1.02-1.22). MR analyses also showed positive associations for total cholesterol and the apoB/apolipoprotein A-I ratio, which were not significant in the observational study. CONCLUSION:Higher apoB levels were associated with an increased CRC risk in both observational and MR analyses, suggesting a potential role of apoB in CRC prevention, especially among participants with overweight/obesity. However, the limitations of single-time lipid measurements and the use of different ancestries across study designs indicate the need for further research to confirm the robustness and generalizability of the findings.

INTRODUCTION:Chewing gum has been used as a self-help strategy for managing smoking cravings, yet its effectiveness has not been evaluated. This pilot trial assessed the feasibility, acceptability, and preliminary effectiveness of delivering 1-week chewing gum for promoting quitting. METHODS:Adult daily smokers were recruited from smoking hotspots in Hong Kong in February 2025. All participants received very brief advice (VBA) and a selfhelp booklet at baseline. The intervention group additionally received 1 week of chewing gum (2 packs) and 2 weeks of instant messaging reminders to promote gum usage, whereas the control group received no placebo or sham intervention beyond VBA and the booklet. Follow-up was conducted at 2 weeks, 3 months, and 6 months post-enrolment. The primary outcome was biochemically validated tobacco abstinence at 6 months. Risk ratios (RRs) were used to estimate the intervention effect using intention-to-treat analysis in Poisson regression. RESULTS:The recruitment rate was 91%, and the retention rate was 86%, 78%, and 74% at 2 weeks, 3 months, and 6 months, respectively. Eighty participants were randomly assigned to the intervention (n=40) and control (n=40) groups using a 1:1 allocation ratio. The intervention group had a higher validated abstinence (10% vs 0%; risk difference, RD=0.53; 95% CI: 0.41-0.64) at 6 months than the control group. Among intervention group participants, 75% (30/40) used chewing gum, and 57% (17/30) rated it as helpful in relieving cravings. Those who used the chewing gum had higher rates of quit attempts (77% vs 40%, p=0.03) and smoking reduction (73% vs 40%, p=0.06) than those who did not. CONCLUSIONS:Delivering chewing gum was feasible and showed preliminary evidence of effectiveness in cessation outcomes. Full trials with an extended intervention period are warranted. CLINICAL TRIAL REGISTRATION:The study is registered on the official website of ClinicalTrials.gov. IDENTIFIER:CT06801860.

INTRODUCTION:Physical exercise has been used to assist smoking cessation, but supervised programmes are bounded by limited scalability and generalisability. Mobile instant messaging (MIM) offers a scalable platform for delivering exercise support with minimal supervision. We assessed the effectiveness of MIM-supported brief physical exercise intervention on smoking cessation. METHODS:In this two-arm, parallel, cluster randomised controlled trial, we recruited daily smokers aged 18 years or older from 70 community sites in Hong Kong from June to October 2022. Sites were randomised (1:1) to either the intervention group (n=492) or control group (n=539). Brief cessation advice, physical exercise instructions and MIM-based practice reminders were offered to the intervention group for 3 months. The primary outcome was biochemically validated 7-day point prevalence abstinence (PPA) at 6 months. RESULTS:Of the 1031 participants (80.9% male, mean age 44.2 years), 59.8% were followed up at 6 months. Biochemically validated abstinence rates at 6 months were non-significantly higher in the intervention than the control group (10.4% vs 9.1%; risk ratio (RR) 1.14, 95% CI 0.79 to 1.66, p=0.48). Self-reported 7-day PPA was 21.9% and 19.5%, respectively (RR 1.13, 95% CI 0.89 to 1.43, p=0.32). Weekly practice of handgrip and elastic band exercises in the intervention group declined significantly over 6 months (from 10.3 min to 2.5 min and from 9.4 min to 0.8 min; p<0.001). The proportion of participants with moderate to high physical activity levels was quite similar between groups at 6 months (41.1% vs 39.9%; RR 1.05, 95% CI 0.82 to 1.35, p=0.70). CONCLUSION:MIM-supported brief physical exercise intervention did not significantly increase smoking abstinence or physical activity compared with brief cessation advice alone. TRIAL REGISTRATION NUMBER:NCT05430451.

QuestionHow effective is mobile chat messaging for relapse prevention among individuals who recently quit smoking?FindingsIn this randomized clinical trial of 590 adults who were receiving evidence-based smoking cessation treatment and had abstained for 3 to 30 days, mobile chat messaging significantly increased 6-month biochemically validated tobacco abstinence compared with text messaging (45.9% vs 35.5%).MeaningThe findings support integrating mobile chat messaging for relapse prevention in existing smoking cessation treatment to improve long-term abstinence. ImportanceMost individuals attempting smoking cessation relapse, even with evidence-based treatment. Mobile interventions offer a potential but largely untested strategy to sustain cessation.ObjectiveTo test the effectiveness of mobile chat messaging for relapse prevention among individuals who recently quit smoking.Design, Setting, and ParticipantsThis randomized clinical trial was conducted from March 14, 2023, to August 15, 2024, at 2 clinic-based smoking cessation services in Hong Kong. Participants were adults who smoked daily and had abstained for 3 to 30 days; they were randomly assigned to an intervention group or a control group.InterventionsAll participants received usual smoking cessation treatment from the services. The intervention group additionally received 3 months of mobile relapse prevention intervention, including chat-based support delivered by a live counselor and access to a supportive chatbot via a messaging app. The control group received 8 text messages on generic smoking cessation advice over 3 months as a contact control.Main Outcomes and MeasuresThe primary outcome was biochemically validated tobacco abstinence at 6 months after randomization, defined by an exhaled carbon monoxide level of less than 5 ppm or a negative salivary cotinine test result. Secondary outcomes at 6 months included self-reported prolonged abstinence, 7-day point prevalence abstinence, and relapse (7 consecutive days of smoking) rate. Intention-to-treat analyses were conducted, assuming participants with missing outcomes relapsed.ResultsOf 590 participants, 465 (78.8%) were male, and the mean (SD) age was 47.1 (11.2) years; 294 were randomized to the intervention group and 296 were randomized to the control group. The retention rate at 6-month follow-up was 98.0% (n = 578). Biochemically validated abstinence at 6 months was significantly higher in the intervention group than in the control group (45.9% [135 of 294] vs 35.5% [105 of 296]; relative risk [RR], 1.29; 95% CI, 1.06-1.58; P = .01). The intervention group also reported significantly higher prolonged abstinence (57.5% [169 of 294] vs 47.6% [141 of 296]; RR, 1.21; 95% CI, 1.03-1.41; P = .02), higher 7-day point prevalence abstinence (65.6% [193 of 294] vs 54.7% [162 of 296]; RR, 1.20; 95% CI, 1.05-1.37; P = .007), and lower relapse rate (33.0% [97 of 294] vs 44.9% [133 of 296]; RR, 0.73; 95% CI, 0.60-0.90; P = .003) at 6 months.Conclusions and RelevanceThis randomized clinical trial found that mobile chat messaging for smoking relapse prevention increased validated abstinence by approximately 30%, offering a scalable approach to sustain abstinence among individuals who recently quit smoking.Trial RegistrationClinicalTrials.gov Identifier: NCT05370352 This randomized clinical trial examines the effectiveness of mobile chat messaging vs generic text messaging for relapse prevention among individuals who recently quit smoking and had abstained for 3 to 30 days.

Using different techniques to derive dietary patterns (DP) could evaluate real-world diet behaviours and provide DP recommendations. Therefore, we identified DP using hybrid methodologies and examined the associations of DP with all-cause and CVD mortality among older Chinese. Using data from the Guangzhou Biobank Cohort Study, dietary intake was assessed using a validated FFQ. DP were derived using hybrid methods including reduced rank regression (RRR) and partial least squares (PLS), focusing on nutrients commonly insufficient in Asian diets. Associations of the DP with mortality and CVD risk factors were examined using Cox regression and generalised linear models, respectively. Of 19 598 participants with an average follow-up of 15·8 years, 4966 deaths occurred. Two DP were derived based on the riboflavin-density, K:Na ratio and vitamin C-density. The DP derived from both RRR and PLS featured high intakes of green vegetables, yellow/orange fruits and whole grains and low intakes of refined grains and plant oils, with additional high intakes of fish identified by RRR and milk by PLS. These DP were associated with lower all-cause and CVD mortality risks. Compared with the lowest quartile, the highest quartiles showed lower risks of all-cause (hazard ratio (HR): 0·89–0·91, all P < 0·01) and CVD mortality (HR: 0·79–0·82, all P < 0·01). Moreover, both DP were associated with favourable cardiometabolic profiles, including lower systolic blood pressure, TAG and high-sensitivity C-reactive protein levels, and higher HDL-cholesterol levels. These findings suggest that nutrient-rich DP using hybrid methods may support the development of dietary recommendations to reduce mortality among older Chinese.

BACKGROUND:The Lancet Commission proposed an update in January 2025 on the definition of obesity which requires at least one anthropometric measurement in addition to body mass index (BMI) to confirm excess adiposity. Also, the presence of obesity-related organ dysfunction is used to differentiate between clinical and pre-clinical obesity. We evaluated how applying the Lancet Commission proposed definition of obesity, which required an additional anthropometric measurement to verify excess adiposity, would affect its prevalence, and its implications on the cardiovascular-kidney-metabolic health. METHODS AND FINDINGS:We used two representative Chinese community-based cohorts and compared five categories of participants with (i) clinical obesity, (ii) preclinical obesity, (iii) BMI ≥25 kg/m2 without confirmed excess adiposity, (iv) overweight and (v) normal/underweight in the cross-sectional cohort for cardiometabolic risk profiles and in the longitudinal cohort for long-term cardiovascular-kidney-metabolic outcomes. In the cross-sectional cohort, the prevalence of obesity was 44.5% in men and 26.7% in women defined by the Asian BMI cutoff of ≥25.0 kg/m2, and decreased to 33.8% and 24.1%, respectively, using the Lancet Commission definition (BMI ≥ 25.0 kg/m2 and elevated waist circumference). Applying the Lancet Commission definition would reclassify a portion of individuals who are initially classified as having obesity based on BMI criteria alone (BMI ≥ 25.0 kg/m2) but with normal waist circumference to be non-obese (category iii). The individuals falling into category iii had an adverse cardiometabolic health profile which was intermediate among the five categories regarding insulin resistance and visceral adiposity (falling in between categories ii and iv). In the longitudinal cohort with a median follow-up of over 20 years, people with clinical obesity had the poorest cardiovascular-kidney-metabolic outcomes including all-cause mortality, whereas those reclassified as non-obese had an intermediate risk of adverse cardiovascular-kidney-metabolic outcomes among the five categories. The main limitation of the study was that all participants were Chinese and findings might not apply to other ethnic groups. CONCLUSION:Adoption of the Lancet Commission definition would classify a small proportion of individuals with BMI of ≥25.0 kg/m2 as non-obese. People with clinical obesity identified by the revised criteria had the highest risks of cardiovascular-kidney-metabolic outcomes including all-cause mortality, whereas individuals reclassified as non-obese had intermediate risks of cardiovascular-kidney-metabolic outcomes between those in pre-clinical obesity and overweight categories.

Objectives: To explore the experiences of ex-smokers acting as peer supporters delivering chat-based instant messaging smoking cessation support in a post- randomized controlled trial qualitative study. Methods: We used purposive sampling to recruit 21 ex-smokers, who had previously provided chat-based instant messaging behavioral support to smokers in Hong Kong. Individual online semi-structured interviews were conducted. All interviews were audiotaped and transcribed verbatim. The transcripts were analyzed using inductive thematic analysis following Braun and Clarke's six-phase framework. Results: Five themes were identified: stepping into the supporter role as ex-smokers, contributions beyond facilitating smoking cessation, mutual benefits as ex-smoking peer supporters, challenges in providing support, and the potential of mobile health-based peer support. Participants identified experiential sharing as a key mechanism for engaging motivated smokers, although its impact was limited by low user responsiveness. They described extending their support beyond smoking cessation (e.g., stress relief and healthier lifestyles), and reported mutual benefits, such as enhanced happiness, a positive attitude, and prevention of smoking relapse. Nevertheless, participants' ability to effectively support smoking was challenged by limited interaction in the mHealth setting, difficulties offering timely responses, and uncertainty about how to handle complex personal situations. They suggested that future mobile health peer support can consider involving famous people as peer supporters, using personalized messaging, and adding incentives in the program to increase smokers' motivation. Conclusions: Ex-smoking peer support in mHealth settings appears feasible and mutually beneficial, but its effectiveness may be constrained by low engagement and unclear role expectations.

Air pollution accelerates biological aging via oxidative stress and inflammation, a process potentially mitigated by plant-based diets. However, the role of dietary or genetic modulators in this relationship remains understudied. Our study aimed to examine whether adherence to Sustainable Diets modifies the associations of PM2.5 and PM10 exposure with biological aging, and to assess potential effect modification by genetic susceptibility to longevity. Data from 9527 participants in the Guangzhou Biobank Cohort Study were used to examine the association of one-year average PM2.5 and PM10 exposure with biological aging, measured by phenotypic age, accelerated age, and relative telomere length (RTL). Sustainable diet adherence was assessed using Plant-Based Diet Index (PDI) and Planetary Health Diet (PHD) scores, with higher scores indicating greater adherence. The mean age of participants was 64.6 years (SD = 6.0). Higher exposure to PM2.5 (β = 0.039) and PM10 (β = 0.028) was associated with increased phenotypic age and higher odds of accelerated aging (OR = 1.008 for PM2.5, OR = 1.005 for PM10). These associations weakened with greater adherence to a sustainable diet (higher PDI/PHD scores). Stronger associations were found in those with lower polygenic risk scores for longevity. A suggestive association between higher PM exposure and shorter RTL was observed, particularly in participants ≥ 65 years and those with cardiovascular diseases. Sustainable dietary patterns rich in plant-based foods may attenuate the associations between air pollution and biological aging in older adults. These findings highlight the modifying role of dietary patterns as a potential strategy to mitigate the pollution-related aging burden.

BACKGROUND AND AIMS:Characterizing distinct quitting trajectories may inform tailored behavioral smoking cessation interventions. We identified the quitting trajectories and associated characteristics in Hong Kong Chinese smokers. METHODS:Data were from eight randomized controlled trials nested within the annual Smoking-free Community Campaign ('Quit-to-Win' Contest) from 2014 to 2021. The trials were two- or three-arm evaluating the effectiveness of behavioral smoking cessation interventions in 8300 adult daily smokers who were proactively recruited from communities across Hong Kong and followed-up at 1, 2, 3 and 6 months. Daily cigarette consumption was collected at baseline and follow-ups for identifying quitting trajectories by group-based trajectory modeling based on relative changes in cigarette consumption (vs. baseline) over four follow-up assessment points. Multinomial logistic regressions were used to yield relative risk ratios (RRRs) for the trajectories by baseline smoking-related characteristics, adjusting for sex, age, economic status and education attainment. RESULTS:Four quitting trajectories were identified, including quitters (4.6%), relapsers (6.8%), reducers (54.8%) and persistent smokers (33.8%). Compared with persistent smokers, smokers in the other 3 trajectories were associated with having previous quit attempts, higher intention to quit and perceived higher importance and confidence in quitting (all P < 0.05). Quitters [adjusted RRR (aRRR) = 0.59, 95% confidence interval (CI) = 0.62-1.00] and relapsers (aRRR = 0.75, 95% CI = 0.61-0.91) reported lower nicotine dependence vs. persistent smokers, whereas reducers showed higher nicotine dependence (aRRR = 1.39, 95% CI = 1.25-1.55) at baseline. Relapsers and reducers perceived higher difficulty of quitting (all P < 0.05). When compared with quitters, relapsers had higher intention to quit within 7 days (aRRR = 2.32, 95% CI = 1.64-3.28) and perceived higher importance (aRRR = 1.17, 95% CI = 1.09-1.25) and confidence (aRRR = 1.10, 95% CI = 1.04-1.17) in quitting, while reducers showed lower intention to quit within 7 days (aRRR = 0.59, 95% CI = 0.45-0.77) and perceived lower confidence in quitting (aRRR = 0.91, 95% CI = 0.86-0.95). Subgroup analysis of different interventions showed similar trajectory shapes and group probabilities. CONCLUSIONS:Chinese smokers who joined behavioral smoking cessation trials in Hong Kong appear to have four quitting trajectories, each with associated characteristics, which may help predict the potential quitting trajectories and inform future interventions.

BACKGROUND:Obesity is a risk factor for breast cancer (BC) after menopause, but the association of weight fluctuation during adulthood with BC risk remains unknown. METHODS:A total of 20,056 female participants aged 50 years or older from the Guangzhou Biobank Cohort Study (2003-2008) were followed up until 2020 through linkage with the cancer registry. At baseline, maximal weight change was defined as the difference between the highest and lowest weight since age 18. Cox proportional hazards regression was used, adjusting for potential confounders. RESULTS:During an average follow-up of 14.2 years, 326 BC cases were identified. A maximal weight gain of 5 kg or more since age 18 was associated with a higher BC risk, compared to a weight change of less than 5 kg (adjusted hazard ratio [adHR] 1.36, 95 % confidence interval [CI] 1.02-1.81; P = 0.03). Among participants who gained 5 kg or more, each additional kilogram was associated with a 2 % higher BC risk (adHR 1.02 per 1 kg, 95 % CI 1.00-1.04; P = 0.02). Similar patterns were found in women who reached the highest weight before the age of 50 (adHR 1.06 per 1 kg, 95 % CI 1.03-1.08; P < 0.001). Additionally, a 1-kg increase in weight was associated with a 10 % (95 % CI 1.05-1.16; P < 0.001) higher risk of BC in women who weighed more than peers at age 20. CONCLUSIONS:These findings suggest that preventing excessive weight gain in adulthood, particularly among women who reached their highest weight before 50 years of age and who were heavier than peers at age 20, may reduce BC risk. Weight management should be emphasized, both at the highest and earliest adult years, in mitigating BC risk.

BACKGROUND:Nasopharyngeal carcinoma is an aggressive malignancy originating from the nasopharyngeal mucosa and associated with genetic factors. Many nasopharyngeal carcinoma susceptibility loci have been identified by genome-wide association studies (GWASs), but their underlying functional insights are largely unexplained. RESULTS:A meta-GWAS including 5073 nasopharyngeal carcinoma patients and 5860 controls from nasopharyngeal carcinoma endemic areas identifies a total of 863 significant SNPs, including SNPs at a novel locus 3p24.1 (rs56365817; nearby genes: CMC1/EOMES). By integrating the GWAS signals with single-cell and bulk profiles, we find nasopharyngeal carcinoma susceptibility robustly associated with T cells in different methods and datasets. In nasopharyngeal carcinoma-associated cell type, we identify 234 putative susceptibility genes (81.62% of them novel), mainly enriched in immune-related biological processes. Five putative causal genes are prioritized. We perform in-depth bioinformatic analysis and functional experiments for EOMES, finding that the nasopharyngeal carcinoma-risk alleles of four functional SNPs upregulate EOMES expression by promoting the activity of regulatory elements in T cells, and EOMES participates in nasopharyngeal carcinoma tumorigenesis via regulation of CD8+ T cell exhaustion in the tumor microenvironment. CONCLUSIONS:This study uncovers novel nasopharyngeal carcinoma susceptibility genes and their functional cell types, which improves the understanding of nasopharyngeal carcinoma genetic etiology.

INTRODUCTION:Nicotine replacement therapy (NRT) sampling has been shown effective in increasing smoking abstinence by trials, but the real-world effectiveness in women is unknown. We examined the effectiveness of 1-week NRT sampling combined with counseling on smoking abstinence in Chinese women. AIMS AND METHODS:A prospective study was conducted on 545 Chinese women (mean age: 37.7 years) receiving nurse-delivered smoking cessation counseling from the Women Quit program in Hong Kong from 2006 to 2023. 1-week free NRT sampling was offered to all participants. Participants were categorized based on NRT usage at 1 month: non-users (n = 255), users of < 1 week (n = 112), and 1-week users (n = 178). The primary outcome was self-reported 7-day point prevalence of abstinence (PPA) at 6 months. RESULTS:Compared with non-users receiving counseling alone, 1-week users had higher 7-day PPA at 3- (aRR 1.66, 95% CI: 1.24 to 2.20) and 6-month (aRR 1.71, 95% CI: 1.29 to 2.25), higher 60-day (aRR 1.55, 95% CI: 1.03 to 2.33) and 150-day continuous abstinence (aRR 2.06, 95% CI: 1.33 to 3.20), and higher smoking reduction rates at 3- (aRR 1.66, 95% CI: 1.27 to 2.17) and 6-month (aRR 1.47, 95% CI: 1.07 to 2.02) follow-ups. Users of < 1 week had similar smoking abstinence and reduction rates compared with non-users (all p > .05). Higher 7-day PPA at 6 months of 1-week users was observed in lower versus higher education and income (both p for interaction < 0.05). CONCLUSIONS:The evidence presented suggests the real-world effectiveness of 1-week NRT sampling combined with counseling for increasing smoking abstinence and reduction rates in women. This implies that encouraging sampling of NRT will improve smoking cessation outcomes, particularly for women of low socioeconomic status. IMPLICATIONS:We found that using 1-week NRT sampling combined with counseling was associated with higher smoking abstinence and reduction rates compared with counseling alone in women receiving a quitline service. We also found that women with socioeconomic disadvantages and older age benefited more from the use of 1-week NRT sampling. These findings highlight the importance of offering and promoting the use of 1-week NRT sampling as part of smoking cessation programs for women, particularly those with lower socioeconomic status, potentially to narrow cessation disparities.